Background: The Calcium Score (CS) is a pre clinical index of atherosclerosis and the prediction of cardiovascular risk is more accurate if CS is included. Current guidelines recommend the use of CS scoring for cardiovascular risk with intermediate-risk patients but there is not established the role of CS in patient with low risk factors.Objective: To define the prognostic significance of CS in smokers (SMO) or not smokers (NSMO)without symptoms. Diabetic patients were excluded in the first analysis.Methods: we’ve studied, in primary prevention, 32 not diabetic patients, 16 females and 16 males, range 60 ± 15 years old, with a metabolic syndrome based on the Third Adult Treatment Panel ATP III criteria of the National Cholesterol Education Program. Patients underwent to a heart coronary CT angiography (HCCT), a not invasive procedure. We have classified the patients into two groups: SMO (a pack of cigarettes for 10 years minimum) and NSMO (In NSMO category are included adults patients that have never smoked or have smoked not more than 100 cigarettes during their entire life). The SMO displayed have higher CS (94 (3;301.5) vs 0 (0;10.2); p<0.001), in comparison with NSMO. Accordingly, the associations between CS and cigarette smoking was still maintained after adjustment for age (rs 0.317; p<0.05). Finally, multiple regression analysis showed that smoke was the variable that best predicted the CST variance (R2 0.131; ®-standardised coefficient 0.362; p<0.05) . Results: CS gravity and extension have been elevated in smokers and the statistical correlation has been highly significant. CS is related to age, epicardial fat and smoke. Stepwise analysis demonstrated that smoke parameter is independent to age and epicardial fat. Conclusions: CS score offers a direct measurement of subclinical coronary pathology. Our study demonstrates that smokers have an elevated CS and the CS, in our opinion, is absolutely useful for the screening of coronary disease in asymptomatic smokers.

Background: We aimed to investigate the post-procedure effect of pulsatile and non-pulsatile flow utilized in cardiopulmonary bypass on brain ischemia among patients undergoing coronary artery bypass grafting (CABG) surgery. Methods: A total of 80 patients undergoing elective CABG between April 2012 and January 2013 were separated into two groups. While pulsatile flow was implemented during cardiopulmonary bypass in 40 patients, non-pulsatile flow was used in the remaining 40 cases. Formation of new ischemic lesions in the brain was evaluated by Diffusion-weighted magnetic resonance imaging (DW-MRI), performed prior to and after the operation. Results: No statistically significant differences were found between the two groups in terms of demographic values and concomitant diseases. New focal lesions were detected in 7 of 40 patients subjected to pulsatile flow (17.5%) and in 4 of 40 cases subjected to non-pulsatile flow (10%). Although the number of new lesions detected on brain diffusion MRI in the non-pulsatile flow patient group was lower in terms of the number of patients and the number of lesions, no statistically significant differences were determined between the two groups. Conclusions: Magnetic resonance imaging evidence of brain injury were similar after pulsatil-pump and nonpulsatil-pump coronary artery bypass grafting surgery.

Noonan syndrome is a genetic disorder characterised by skeletal malformations and cardiac defects. In view of its autosomal inheritance it can run in families. Males are usually infertile, but reports of paternal transmission exist. In this case series we report three members of a single family involving two generations (father and 2 sons), with phenotypic characteristics of Noonan syndrome associated with severe dysplastic pulmonary valvular stenosis. We attempted balloon pulmonary valvuloplasty of all three cases in a single day. The procedure was successful with acceptable decrease in gradient across the pulmonary valve in all patients except for one case.

If tricuspid regurgitation (primary and secondary) is left untreated, it will be associated with significant complications and death, even if left ventricular dysfunctions are corrected, TR does not decrease in many cases. Since many studies have not been conducted in this area, we decided to evaluate the results of tricuspid repair. In this retrospective study conducted since 2006 to 2011, 448 patients undergoing tricuspid surgery with different methods with or without surgery were studied. Statistical analysis was performed by Friedman, Fisher exact and Pearson chi-square methods. In the Mod and Severe RV dysfunction section, the mean age of the patients was 52 years, 289 were female (64%), 343 (76%) had rheumatic pathology, 79 (17%) had myxomatous pathology, 12 (2%) had endocarditis pathology, and 14 had an unknown pathology. Before surgery, Mod and Severe dysfunction was seen in 226 patients (40%) and after surgery (follow up), it was seen in 85 patients (19%). Before surgery, Mod and Severe TR was seen in 356 patients (79%) and after surgery, it was seen in 91 patients (20%). The mean of PAP before surgery was 54 mmHg and after surgery, it was 37 mmHg, which was significant in all cases (P<0.05). Out of 282 people with Mod to Sever TR before the surgery by bicuspidization method, 37 people reached follow up and out of 156 people operated by devega method, 22 people reached follow up and out of 65 people operated by ring method, 9 people reached follow up. Based on the results obtained in this study, all the methods used for tricuspid repair are useful, but the results of ring use and bicuspidization were better than devega method and had less residual TR after surgery. Therefore, it is recommended to use the Ring method in cases of TR with or without involvement of other valves, since it showed better results and bicuspidization method and devega method are not recommended.

COVID-19 was declared by the World Health Organization as a “Public Health Emergency of International Concern” [1]. These patients may develop shock due to sepsis or cardiac injury; however, hemodynamic characteristics have not been described. We analyzed the hemodynamic profile of 2 ventilated patients (critical cases), 2 non-ventilated patients with severe pneumonia (severe cases) and 1 patient with pneumonia (moderate cases) admitted to the ICU of the Tropical Medicine Institute “Pedro Kouri”, Havana, Cuba. SARS-CoV-2 infection was confirmed in all cases by reverse-transcriptase-polymerase-chain-reaction at hospital admission. Non-invasive hemodynamic measures (within the first 24 h of ICU admission) were used in order to minimize viral transmission to health-care provider. Arterial and central venous samples were simultaneously collected for testing. Fick method was used to calculate the Cardiac Output (CO) as CO=VO2/Ca-CVO2, where VO2 is the oxygen consumption (using the Bergstra's formula) and Ca-CVO2 is the arterial-to-central venous oxygen content difference. We observed a hyperdynamic profile, characterized by high CO and low systemic vascular resistance, in critical and severe cases; conversely, moderate cases have a normal hemodynamic pattern (Table 1). Of note, hyperdynamic changes were markedly higher for critical cases compared to those for severe cases, suggesting that a poor clinical course is associated with a more severe imbalance in hemodynamic parameters. Despite these finding, impairment in the mean arterial pressure was not observed in severe cases and low-dose norepinephrine was required in critical cases, indicating that tissue perfusion was guaranteed by the increased CO (Table 1). Serum concentrations of inflammation-related biochemical markers were higher in patients with critical disease than those in patients with severe or moderate disease (Table 1), suggesting a close relationship between inflammation and hemodynamic imbalance. Angiotensin II effects are increased in COVID-19 patients because of a reduced activity in the angiotensin-converting enzyme 2, but inflammation-induced vasodilatation may overcome the Angiotensin II - associated vasoconstriction. In fact, Angiotensin II may be an inductor of inflammation and oxidative damage in early phases [2]. All patients had a central venous oxygen saturation >70% and central venous-to-arterial carbon dioxide difference (Pcv-aCO2) <6.0 mmHg, indicating an adequate tissue oxygen supply and CO2 wash-out, respectively; however, biological markers of anaerobic metabolism such as hyperlactatemia and Pcv-aCO2/Ca-cvO2 ratio >1.8 were observed in critical patients (Table 1). These founds suggest microcirculatory or mitochondrial disturbances [3]. In summary, this report highlights that in early phase of COVID-19-assocaited critical illness, patients show a hyperdynamic profile with microcirculatory/mitochondrial disturbances. These abnormalities may contribute to mortality.

Covid-19 caused a pandemic in the world in 2020 and also caused the collapse of many medical systems. In order to keep the virus out of the hospital, it is very important to design a good "traffic control" and policy. Through the control of the entrance, our hospital initially screened people with fever or upper respiratory symptoms or foreign travel history, and shunted to the emergency epidemic diagnosis area. When the patient entered the epidemic diagnosis area, the dedicated medical staff that completed the protective equipment, after preliminary consultation X-ray examination is carried out in the outdoor X-ray irradiation area to assess whether there are Acquisition conditions of the inspection, and then go to the outdoor negative pressure inspection and inspection station to complete the inspection and inspection operations. After distributing the medicine from the special medicine receiving window, all treatments will not enter the hospital area and be handled in a one-stop service. The patient will not move back and forth in the area to reduce cross-infection. When the doctor assesses the need for hospitalization, it will be directly admitted to the negative pressure isolation ward through a certain planned movement line to reduce exposure in the hospital and ensure the safety of inpatients and medical staff. The outdoor moving line design can be used for general chest X-ray examination, basic blood drawing and collection of COVID-19 related specimens. If the patient needs to be temporarily placed in the hospital, there are also planned outdoor compartments to accommodate the patient. When need use the toilet, it can use the outdoor mobile toilet (Figure 1). The design of this is mainly for risk management and diversion shunt. High-risk cases are treated through a specially designed one-stop service visit to effectively control the virus outside the hospital area and prevent patients from entering the hospital and other patients cross infection.

Abstract: Introduction: Lower urinary tract symptoms (LUTS) is a common condition, with Benign prostatic hyperplasia (BPH) being a frequent condition in men over 50 years of age. The natural history of BPH is characterized by an age-dependent increase in histological changes and an increase in prostate size. Cystoscopy is often used in the diagnosis and treatment. This study aims to assess the relative use of cystoscopy in patients with LUTS. Methods: The study design is a descriptive, prospective study design. The targeted group were male patients above the age of 50 years who presented with lower urinary tract infection in Yastabshiron, and Ibn Sina hospitals between the periods of (August 2015-January 2016). Primary data collected from sampling units using a questionnaire containing questions of the variables of interest. The data was analyzed by using Statistical Package for Social Science (SPSS) and chi square for analysis with alpha level of significance 95%. All appropriate permission and consents were taken.Results: BPH was diagnosed in 90% of cases. 60% of patients had complications. The most common complications was Orchitis/Epididymitis and found to be in 26% in study participants, followed by hematuria in 18%, dysuria in 12% and stricture in 4%. The mean reduction in IPSS score for those receiving medical treatment was 4.8, while in the cystoscopy group it was 3.8. Independent sample t test analysis shows that there is a statistical difference between the cystoscopy and medical treatment groups (p=0.016). Conclusion: A trial of medical treatment was found to be significantly better at treating the symptoms of patients with LUTS as compared to cystoscopy. Since cystoscopy is associated with a high rate of complications, a trial of medical treatment should be the first line treatment.

COVID-19 or SARS-COV-2 is a serious viral illness that has spread all over the world, this disease belongs to the group of coronaviruses. Like other coronaviruses it was transmitted to humans by animals, which is said to be an outbreak from a fish market in Wuhan (China) in December 2019. World Health Organization (WHO) has reported that COVID-19 is a pandemic on March 11, 2020 [2]. For the management of spreading of this disease, some countries forced a complete lockdown. Social distancing, hand hygiene, and isolation were considered largely effective for COVID-19 control [2]. Many medications have been reported for the treatment of Covid-19 disease. One of these medications is hydroxychloroquine/chloroquine which has gained a lot of popularity during the pandemic. This study aims to review the effect of HCQ and CQ on cardiovascular patients with COVID-19 and estimate the potential adverse effects.

Introduction: The cerebellar mutism syndrome is a neurological condition which has been seen in children and only rarely described in adults after surgery of the posterior fossa. It usually appears as a consequence of posterior fossa surgery in children with cerebellar or fourth ventricle tumors. Objectives: It is a case report of an adolescent girl from Bangladesh presenting with postoperative cerebellar mutism. Case: The 15-year-old young, student initially presented with headache of raised intracranial pressure due to obstruction. She developed mutism on the second postoperative day following Surgery for astrocytoma of fourth ventricle. By the second and third post- operative day, her responses to query had almost stopped, but to persistent queries she gave a single word response and it was restricted to either ‘yes’ or ‘no’. She remained silent and kept her eyes closed most of the time and cried for any attempts to wake her. She had mood instability with sudden unprovoked laughter followed by cry. She ate what she was fed and did not have any difficulty swallowing. Conclusion: To the authors’ best knowledge, this is first case report of the cerebellar mutism in Bangladesh which would help the clinicians to deal with syndrome

Background: Maternal nutritional status is important for health and quality of life in women and growing fetus. Maternal weight gain in pregnancy can offer a good means of assessing the wellbeing of the pregnant mother and her baby. Inadequate prenatal weight gain is a significant risk factor for intrauterine growth restriction, preterm delivery and low birth weight in infants. Obesity and excessive weight gain on the other hand can lead to adverse maternal and fetal outcomes. Interestingly, to get a good fetomaternal perinatal outcome mode of delivery decision is also changed with BMI. Objective: The aim of the study was to evaluate the effect of maternal BMI on the mode of delivery. Methods: This cross-sectional study was carried out department of obstetrics and gynaecology at Bangabandhu Sheikh Mujib Medical University. A total 100 population of purposive sampling was the methods of choice to select the sample from the hospital admitted patients during the period from August 2016 to December 2017. Results: The mean age of 100 mothers were 28.4 (± 6.2) years. The maximum mothers attended from 3rd trimester were overweight (55.36%) whereas 44.64% from the same trimester were normal BMI mothers. Maximum mothers (27%) were from 25-29 years age group and the minimum mothers (4%) were from >= 40 years. Forty Seven Percent mothers came as primigravida. Primigravid women and multigravida with LSCS and without LSCS showed different mode of deliveries. The more the gravida with history of caesarean section the more frequency of present occasion of CS (p=0.006). The higher BMI showed more frequency of caesarean section than NVD or assisted delivery (p=<0.00001) Multiparous women showed more BMI than the p nulliparous. (p=0.005). Multiparity, maternal age and pre-existing medical conditions revealed more complicated labor. Conclusion: The more BMI of mother showed more frequency of caesarean section, assisted delivery than the normal vaginal delivery.

Acute Respiratory Distress Syndrome (ARDS) is a major medical emergency requesting acute therapeutic intervention. Here we report that Nitric Oxide (NO) gas attenuates ARDS in mice. Using a novel portable NO generator we found that NO at 20 ppm attenuates endotoxin (LPS) induced neutrophil recruitment lung alveolar epithelial damage reduced inflammatory cytokines, neutrophil. Therefore, the data suggest that the use of a portable NO generator may be considered as an interesting therapeutic possibility for patients with severe ARDS.

Since the first reports of a novel Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), emerged from the province of Wuhan, China in December 2019 [1], it has brought the entire worldwide to a standstill and impacted every single individual on the planet. In this age of globalization, as expected, the eyes of the world have been vehemently focused on the medical fraternity in hopes of a so far elusive cure. In spite of hundreds of clinical trials, anecdotal reports and off-label attempts, no therapy has proven to be effective in improving outcomes nor provide effective prophylaxis. Intense social, political and media scrutiny, along with the sheer scale of the pandemic, have presented a unique challenge to the medical and scientific fraternity to be able to develop effective remedies in an extremely limited amount of time, and at times, with limited resources as well. Unfortunately, the discovery and licensing of a nascent molecule as an effective drug involves a prolonged gestational period, creating an unacceptable lag between therapeutic need and availability. Drug repurposing, a novel approach which involves identification of new indications for pre-existing drugs, is an economic and time saving endeavor [2], allowing a drug to directly enter phase III or IV clinical trials, thereby saving billions of dollars in production cost [3]. Much like the Middle East Respiratory Syndrome virus (MERS), the SARS-CoV-2 spreads through the respiratory route; however, unlike the former which utilizes Dipeptidyl Peptidase 4 (DPP4), it utilizes Angiotensin Converting Enzyme 2 (ACE 2) as a receptor to enter cells [4,5]. Fusion, is followed by endocytosis of the virion, which is facilitated by an acidic environment, wherein comes in to play diprotic bases such as hydroxychloroquine and chloroquine [6]. Activation of the main RNA Dependent RNA Polymerase (RDRP) enzyme requires proteolysis by a viral protease. Inhibition of the latter by anti-retroviral agents such as lopinavir, ritonavir and darunavir hold therapeutic promise [6]. Agents targeting RDRP such as remdesivir, favipiravir and arbidol have demonstrated some degree of in vitro and in vivo activity against SARS-CoV-2.

Introduction: Most epidemiological data concerning low back pain (LBP) are related to developed and industrialized countries but little information about LBP in the general population in developing and low-income countries. Back pain affects 60-80% of people at some time in their lives. Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare case of serious underlying pathology. Aim of the study: The aim of the study is to evaluate the different causes of low back pain, occupational and risk factors, association with age and sex of the patient and their life styles. Materials and Methods: The present study is a retrospective study of 300 patients of low back pain between the age group of 31-70 years of both sexes who were admitted and treated at Dept. of Forensic Medicine, Kushtia Medical College Hospital, Kushtia, Bangladesh from January 2020 to December 2020. The information was collected from the patients regarding their occupation, education, obesity, smoking, tuberculosis, diabetes, alcohol consumption, osteoporosis, Osteoarthritis and history of trauma. The provisional diagnosis of cases was done and confirmed radiologically. A proforma was prepared and the patient’s age, sex, duration of symptoms, place of living and the cause for low back pain was noted. A neurological examination of the lower limbs was performed. Results: The author tabulated 300 patients of low back pain into four categories according to age and noted the number of cases in each group. The highest number of cases (124) is observed in the age group of 31-40 years (41%) and the lowest number of cases (45) is observed in the age group of 51-60 years (15%). All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus, smoking, alcohol and medication history), subjected to a rigorous clinical examination and a battery of investigations. In 300 cases of LBP studied, the most common cause for back pain was disc prolapse (44%). The next common causes were lumbar spondylosis, spondylolisthesis and lumbar spinal stenosis (17%, 10% & 10% respectively).The study found association between low back pain and various factors. Prevention is the best strategy for avoiding low back pain but is realistically hard to practice because the problem of low back pain has many environmental and intrinsic risk factors. Conclusion: Low back pain affects a large proportion of the population and is difficult to diagnose. Physicians must accept the diagnostic ambiguity that often accompanies the condition. Identification of etiological and risk factors, cause for back pain and type of occupation and instituting preventive measures, as well as rehabilitation of patients can lead to a meaningful reduction in the incidence of debilitating back pain.

Background: Legionella pneumophila is a common cause of Community Acquired Pneumonia (CAP) which is often associated with a severe clinical course and a mortality rate of 5% to 25% among immunocompetent patients. Complications of Legionella infection include acute renal and respiratory failures, disseminated intravascular coagulation and septic shock which often require intensive level of medical care. Reported cases of myocardial dysfunction and acute systolic heart failure from legionella disease are rare. This case describes an atypical presentation of legionella pneumonia in a previously healthy patient complicated by multi-organ failure. Case Presentation: A 63 year old female with medical history of hypertension was admitted to the intensive care unit for acute onset of altered mental status, decreased oral intake, subjective fevers, dizziness and diarrhea. Physical exam was remarkable for temperature of 101.2 F, pulse rate 112 beats/minute, respiratory rate 22 cycles/minute and blood pressure 88/60 mmHg. Laboratory studies showed leukocytosis, markedly elevated serum Creatinine Kinase (CPK), and creatinine and lactic acid levels. Troponin was elevated; however no evidence of cardiac ischemia on electrocardiogram. Chest X-ray revealed right mid-lung opacities consistent with pneumonia. A Transthoracic Echo (TTE) showed reduced ejection fraction of 35% and urine legionella antigen test was positive for Legionella pneumophilia group 1 antigen. She was admitted to the medical Intensive Care Unit (ICU) and initiated on Intravenous (IV) fluids and empiric antibiotics for CAP (IV Ceftriaxone 2 g daily and Azithromycin 500 mg daily) and by day 5 of hospitalization, her fever had completely resolved and neurological status returned to normal. Her serum CPK and creatinine levels significantly improved and troponin levels normalized. She was discharged home to follow up with infectious disease and cardiology team outpatient. A repeat TTE six weeks later showed normal ejection fraction of 60% to 65% and a normal cardiac stress test.

Aim: To assess obstetric patients treated in anesthesiology intensive care unit. Methods: We retrospectively screened 269 patients. In all patients, gestational age, mode of delivery, parity, referring clinic, previous medical disease, diagnosis at admission, APACHE II Score and GCS score were recorded. Clinical course in intensive care unit and cause of death in non-survivors were recorded. Results: The percentage of obstetric patients treated in intensive care unit was 9.4% with a mortality rate of 3.7%. Preeclampsia, eclampsia and HELLP syndrome were leading causes for intensive care unit admission. Conclusion: Most common cause of death was postpartum bleeding and its complication.

Post-partum Thrombotic Thrombocytopenic Purpura (TTP) is a life-threatening occurrence. A lady with such illness was successfully cured with anti-CD-20 monoclonal antibodies and mycophenolate [1]. This lady had been infertile for seven years, and underwent six attempts of in vitro fertilization without success. Several authors, and ourselves, found that a common cause of couple infertility is the infection by Helicobacter pylori, which can be cured at low price if recognized [2-4]. Moreover, in vitro fertilization reportedly failed in cases of ladies suffering of unrecognized infection by H. pylori [5], possibly by molecular mimicry between sperm and bacterial antigens [3,5,6]. Not only so, but this woman had been known to suffer of Idiopathic Thrombocytopenic Purpura (ITP). This illness had been found closely linked to H. pylori infection and to be reversible by eradication of the bacterium [7-9]. In conclusion we wish to stress the opportunity to test for presence of H.pylori in the long list of tests usually performed in infertile couple, and prior to pregnancy.

Hepatic tuberculosis is a rare form of extra-pulmonary tuberculosis The aim: to describe the clinical, morphological and evolutionary aspects of hepatic tuberculosis. Methods: The medical data of all cases of hepatic tuberculosis admitted to our department. Results: Among the 240 cases of abdominal tuberculosis, 6 patients had a hepatic location with a prevalence of 2.5%. They were 2 men and 4 women, with an average age of 38 years. The clinical and imaging manifestations were various. The diagnosis of tuberculosis was confirmed by the pathological study of the liver biopsies (4cases) or by the association of clinical, biologic and morphological arguments (2cases). The clinical and biological course was favorable in all patients under anti-tuberculosis protocol. Conclusion: Hepatic tuberculosis, although rare, should be considered in endemic countries. Its diagnosis is difficult to establish, because it simulates many pathologies.

Introduction: Infertility is a public health problem associated with medical, emotional, social, and financial consequences. Recent study on infertility suggests that in India, approxi- mately 15 to 20% of married couples in the reproductive age group suffer from infertility and its incidence is on the rise. Artificial reproductive techniques (ARTs) including IVF/ICSI and ET have been a major development in the treatment of infertility. Objective: To compare reproductive outcomes of day 2 and day 3 embryo transfer (ET). Materials and methods: In this retrospective records study, all couples who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and ET cycles at International Fertility Center, Delhi, India over a period of 1 year were studied. Data were collected and analyzed by chi-square test and unpaired t-test by Statistical Package for the Social Sciences, version 19. Results: There was no statistically significant difference between the clinical and demographic parameters of group day 3 and day 2 ET. In our study, clinical pregnancy rate was 45% in day 3 ET and 36.5% in day 2 ET group [odds ratio (OR) 1.43, p-value 0.49]. The ongoing pregnancy rate was 39.2% in day 3 ET and 26.9% in day 2 ET group (OR 1.75, p-value 0.26). We observed that the miscarriage rate was 5.9% in day 3 ET and was 5.8% in day 2 ET group (p-value 0.69, OR 1.02). We observed one case each of multiple pregnancies, ectopic pregnancy, and fetal anomaly (anencephaly) in day 2 ET group, while in day 3 ET group, no such case was detected. Conclusion: There are chances that day 3 ET has better clinical and ongoing pregnancy rates than day 2 ET, but the difference is not statistically significant. Study showed similar miscarriage rates in both groups and very low incidence of complications like multiple pregnancy, ectopic pregnancy, and fetal anomaly. So, it is safe to schedule and transfer embryos either on day 2 or on day 3 for planning and programming cycles in coordination with patient and IVF team and for adjusting weekends (nonworking days).

Introduction: Pleomorphic adenoma is a benign neoplasm that develops at the expense of the salivary gland. It evolves without symptoms; the reason why late consultations are often observed. The size of its volume can have an important functional implication. Observation: A 22 years old patient was referred by a dental surgeon for a palatal swelling evolving for two years. Intraoral examination presented an ovoid palatal mass not crossing the median line. It was covered with normal mucosal. The swelling on palpation was non tender and with a firm consistency. The scanner presented a well limited homogenous lesion located at the palate. Excision was done under general anaesthesia. Palatal silicone plate was used to protect the operated wounds. Post operation evolution was simple. Discussion: Pleomorphic adenoma is one of the most frequents benign salivary glands tumours. It is relatively rare intraorally, but when it occurs it is mostly located at the palate. It is recommended to use a palatal plate after surgery to facilitate healing and promote oral functions like phonation, as well as feeding. However, most often we are faced with unforeseen events that do not permit us to follow the usual pattern. Conclusion: Oral surgeon must be able to adapt to any situation in order to provide quality services regardless of the context.

Numerous medications are now approved to treat and relieve symptoms related to Alzheimer's Disease (A.D.). Most of these drugs regulate the neurotransmitters, thereby modulating the transmission of messages between neurons. However, these drugs are helpful in the reduction of A.D. symptoms associated with particular behavioral problems but are unable to change the underlying pathophysiological process accounting for the disease. In addition, their effectiveness is limited for a small group of people and thus may be helpful for a limited period. Therefore, the scientists are investigating the possible strategies for the symptomatic treatment and finding out the ways to hold back or prevent the disease. Drug development and assessment for newer and better drugs as well as treatment methodologies are caring out by the scientists in ongoing clinical trials. This study has been carried out to accumulate the different treatment strategies, including drug therapies intended for various targets such as loss of specific neurotransmitters & synapses, cerebrovascular function, neurofibrillary tangles & beta-amyloid plaques, as well as other nondrug approaches

Coronary artery disease (CAD) is leading due to disability and death of the working population, and successful its treatment is largely determined by maintaining adequate coronary blood flow, including through interventions, percutaneous interventions. This article describes the efficacy of the adding herbal hepatoprotector - Hepofresh 2 tablets 3 times a day on the framework of the standard therapy on some indicators of the functional state of the liver of patients with coronary heart disease with stable angina of III-IV FC, subjected to percutaneous intervention (PCI). And the results show that Hepofresh contributes to better tolerance of treatment, increases its effectiveness and prevent the development of side effects and various liver disorders in patients CAD after PCI.

Background: We aimed to investigate the post-procedure effect of pulsatile and non-pulsatile flow utilized in cardiopulmonary bypass on brain ischemia among patients undergoing coronary artery bypass grafting (CABG) surgery. Methods: A total of 80 patients undergoing elective CABG between April 2012 and January 2013 were separated into two groups. While pulsatile flow was implemented during cardiopulmonary bypass in 40 patients, non-pulsatile flow was used in the remaining 40 cases. Formation of new ischemic lesions in the brain was evaluated by Diffusion-weighted magnetic resonance imaging (DW-MRI), performed prior to and after the operation. Results: No statistically significant differences were found between the two groups in terms of demographic values and concomitant diseases. New focal lesions were detected in 7 of 40 patients subjected to pulsatile flow (17.5%) and in 4 of 40 cases subjected to non-pulsatile flow (10%). Although the number of new lesions detected on brain diffusion MRI in the non-pulsatile flow patient group was lower in terms of the number of patients and the number of lesions, no statistically significant differences were determined between the two groups. Conclusions: Magnetic resonance imaging evidence of brain injury were similar after pulsatil-pump and nonpulsatil-pump coronary artery bypass grafting surgery.

Introduction: The aim of our study was to compare the effectiveness of both TA and EACA in reducing post surgical bleeding in on-pump CABG surgeries with regards to the amount of blood loss at 4 hrs and 24 hrs asthe primary outcome. Materials and Methods: After the completion of surgery patients were shifted to ICUand were assessed for blood loss at 4 hrs and 24 hrs after shifting. Indication for transfusion of PRBC was a haemoglobin level of <8gm/dl. FFP was trasfused if post operative drain was > 250ml/hr in first hour. Platelet trasfusion was indicated if platelets counts were <50000/mm3. Results: The requirement of PRBC in group TA was for 4patients, where as in EACA group 5patients required PRBC (P>0.05). One patient in each group required FFP transfusion (P>0.05).Both the groups did not require any platelet transfusion & the transfusion rate was non-significant between the groups. Both the groups had no re exploration due to excessivebleeding. Conclusion: Based on the results of our study it can be concluded that both TA & EACA effectively inhibits fibrinolysis during on pump CABG surgery and thus results in decreased post operative bleeding. When compared between the two, TA was slightly better with respect to post operative bleeding at 24hrs

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

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

Introduction: We done the Comparative Assessment of Motor Nerve Conduction Velocity among Non-Diabetic, Diabetic Non-Smoker and Sub Groups of Diabetic Smoker the diagnosis of diabetic peripheral europathy is mainly based on its characteristic symptoms, but mostly these symptoms develop at any stage of neuropathic impairment or they may not develop at all. Materials and Methods: Smoking index is used to find the exposure of smoking on body quantitatively and is calculated by multiplying the average number of cigarettes smoked per day in last seven days with the duration of smoking in years

ackground: While COVID-19 per se does not seem to represent a significant threat to the paediatric population, the pandemic has caused indirect detrimental consequences in the management of children in paediatric intensive care units (PICUs). This study analyses the impact of the pandemic on PICU admission patterns in a tertiary care centre. Methods: We performed a retrospective observational study of all admissions to PICU during COVID-19 pandemic i.e. from April 2020-September 2021, and compared the data with corresponding pre-covid times.

Background: Fine needle aspiration cytology is a simple, quick and inexpensive method that is used to sample palpable lymph nodes. Objective: To study the role of FNAC in the evaluation of lymphadenopathies. To categorize various lymph node lesions into neoplastic and non-neoplastic lesions. To study the various cytomorphological patterns in correlation with histopathology of various lymph node lesions. To evaluate the sensitivity and specificity of FNAC using histopathology as gold standard. Material and Methods: All patients referred to the Department of Pathology, Dr VRK Womens Medical College and Research centre. RR District, Telangana. for FNAC of palpable lymph node were included in our study. FNAC was done and the standard method for the procedure adopted. All the slides were reviewed and their diagnosis was made. FNAC diagnosis was compared with histopathology in cases which underwent surgical excision and thus it's diagnostic accuracy determined. This was two years prospective study from Jan-2015 to Dec-2016. Results: A total of 150 patients were included in our study, reported to various clinical departments with history of swelling. Lymph node biopsy was done in 55 cases. Statistical analysis was done in 55 cases, where FNAC diagnosis was correlated well with histopathological diagnosis. Maximum number of cases were in the age group of 21-40 years. Our study showed female preponderance of cases. Cervical group of nodes were most commonly involved. Benign lymphadenopathies were diagnosed in 72.67% of cases. Maximum number of cases being granulomatous lymphadenitis (50.46%). Metastatic deposit was diagnosed in 23.33% of cases. Most common subtype being adenocarcinoma (54.3%). Lymphoma were diagnosed in 06 cases (4%). The overall correlation between FNAC and histopathology was 98% (54 out of 55). Conclusion: FNAC is an accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathies

Introduction: Eclampsia has been recognized as a clinical entity since the time of Hippocrates; and has been a nightmare to healthcare providers ever since. It is defined as the occurrence of generalised convulsions associated with preeclampsia during pregnancy, labour or within 7 days of delivery and not caused by epilepsy or other convulsive disorders. The incidence of eclampsia has often been viewed as an index of civilization in a country. There is low utilization of both antenatal and intrapartum care services and the patients may present to the hospital only as a last resort. Materials And Methods: This is a Prospective Study was carried out at the Department of Obstetrics and Gynecology at Tertiary Care Teaching Hospital over a period 2 years. All patients presenting with eclampsia during the said period were recruited into the study. All patients presenting with eclampsia during the said period were recruited into the study. Eclamptics are usually admitted directly into the labour ward. Patients who were diagnosed with other causes of convulsions in pregnancy like cerebral malaria and epilepsy were excluded from the study. A total of 821 pregnant mothers with eclampsia admitted in the inpatient department of the tertiary care teaching hospital were recruited for the study, irrespective of their previous antenatal check up history. Results: Majority (66%) of the patients had between 2 to 5 episodes of convulsion. The MINIMUM number was 1 episode of convulsion , seen in 13 % of the patients. The MAXIMUM number of convulsions was 40. Of the 66 patients who had had more than 10 no. of convulsions , 30 had not received any treatment prior to referral, while there were no patients who had had more than 10 no. of convulsions after receiving the Loading Dose of MgSO4. For patients having less than 5 no. of convulsions , the number of patients having received only the IM Dose of MgSO4 was 1.5 times those having received the Loading Dose.(228/154 =1.48) In 29% of the patients, Hypertension was controlled by delivery alone. Those who failed to achieve a control of BP by Delivery alone were administered Calcigard (Nifedipine). Conclusion: Eclampsia was noted to be commoner among the young primigravida patients. The importance of this finding is that this group of patients deserve extra surveillance during antenatal care in terms of monitoring their blood pressure and screening their urine for proteinuria to detect pre-eclampsia. It is hoped that such interventions will have positive impact on maternal and child care. However, all this will go in vain unless health care providers at the grassroot levels are sensitised regarding the early diagnosis of Pre eclampsia and prompt and appropriate initiation of treatment

Background: Malnutrition is an important and major public health problem in a developing nation like India. Keeping this in mind, a study was conducted to determine the proportion of under-five children with malnutrition among hospitalised under-five-year children and to examine co-morbid diseases and epidemiological factors associated with malnutrition. Methods: This was a hospital-based cross-sectional study conducted in the paediatric ward of a tertiary care hospital in Koraput, Odisha. All children under the age of five years suffering from malnutrition were admitted in the hospital over a period of 1 month were included in the study. Results: The total number of children under the age of five diagnosed with malnutrition was 72 (40.4%). Moderate and severe/very severe malnutrition were statistically significantly higher in the girl child. The proportions of moderate and severe/very severe malnutrition were higher in low-birth-weight babies, i.e., children who were incompletely immunised due to age. Incorrect infant feeding practice was observed in 41 (56.9%) children. Some of the co-morbid conditions that contributed to the morbidity of the malnourished child were acute diarrhoea, acute respiratory infections, anaemia, and septicemia. Conclusion: A large proportion of the hospitalised children were malnourished. Girls suffered from moderate to severe malnutrition compared to male children, which was the only statistically significant association. This may be due to the negligence of a girl child

Introduction: Heart failure (HF) is a clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and or function, develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales) that lead to frequent hospitalizations, a poor quality of life, and a shortened life expectancy. UA is the final product of purine metabolism and hypoxic states cause an elevation of the serum UA level. Cell death, tissue hypoxia, and impaired metabolism in HF increase XO activity, leading to an overproduction of UA. Aim: To study correlation of uric acid levels with ejection fraction in heart failure patients (both acute & chronic). Materials and Methods: This is an observational study conducted at tertiary care Teaching Hospital over a period of 1 year. All patients who are admitted with symptoms and signs of Heart Failure in the wards like Intensive Care Unit, Acute Medical Care, Intensive Cardiac Care unit, Medical Wards, Cardiac Wards both paid and general rooms were recruited in the study. The sample size was 100 patients after evaluation by clinical and 2D echocardiography findings. Patients with signs and symptoms of Heart Failure and by satisfying inclusion and exclusion criteria were recruited. Results: A total of 100 patients with heart failure and ejection fraction less than 50 who presented to the department of general medicine. 26 male patients had ACS as the precipitating cause of heart failure compared to 29 female patients. In the present study the range of uric acid was observed between 7.1 – 10 mg/dl, the mean uric acid levels were observed to be 8.6 ± 0.67. In the present study, the range of Ejection fraction was observed between 28 – 48%, the mean ejection fraction was observed to be 34.8 ± 6.65. In the present study, it was observed that there was a significant and inverse correlation observed between uric acid levels and ejection fraction r = -0.808 p<0.001. Conclusions: The analysis of correlation conclusively proves that when serum uric acid is more than 7 mg / dl, then either RWMA or Global hypokinesia positive OR LVEF < 50 % in heart failure patients. The analysis also proves that serum uric acid levels are more in the severe functional disability patients (NYH III AND IV). This implies that Uric acid levels can be used as a marker for cardiac

Introduction: Type 2 Diabetes mellitus (Type 2DM) is chronic, lifelong progressive metabolic disease characterized by hyperglycaemia due to absolute or relative insulinopaenia. Monotherapy with Metformin, a biguanide agent acts primarily as an insulin sensitizer. Its primary clinical site of action is in the liver, improving hepatic insulin sensitivity and as a result, decreasing hepatic gluconeogenesis. Sitagliptin is an oral, highly selective dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of patients with Type 2 Diabetes Mellitus. Sitagliptin inhibits the enzymatic degradation and inactivation of glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic peptide (GIP) by DPP-4 the major incretins involved in glucose homeostasis, thereby increasing insulin release and lowering glucagon secretion in a glucosedependent manner. Material and Methods: This is an Open label, Randomized, Parallel group, Comparative and Prospective clinical study. Study was conducted in Type 2DM patients attending the outpatient department of Medicine in tertiary care center. Inclusion criteria: Patients of either sex having age group between 30 -60 years, Patients willing to participate and willing to give written informed consent prior to any study-related procedures and to comply with the requirements of the study protocol. Patients having newly diagnosed Type II DM with prandial blood glucose levels >180 mg% and <250 mg%. HbAlc in the range of 6.5 to 8.5 % at screening and BMI >27 kg/m2 Results: The mean fasting blood glucose level in Group I at baseline was 150.81±11.61 mg/dl, in Group II was 151.92±10.44 mg/dl and in Group III was 150.53±11.64. The mean fasting blood glucose level in Group I after 3 months was 99.73±9.91 mg/dl, in Group II was 92.72±9.82 mg/dl and in Group III was 85.72±9.82 mg/dl. These was statistically highly significant difference in mean Fasting Blood Glucose level at baseline versus after 3 months in Group I, Group II and Group III (p<0.0001). The mean of HbA1c level was 9.61±1.91% at baseline and 8.99±1.82% after 3rd month. In Group II the mean of HbA1c level was 9.61±1.83% at baseline, 8.65±1.73% after 3rd month. In Group III the mean of HbA1c level was 9.64±1.81% at baseline and 8.44±1.73% after 3rd month. Conclusion: Sitagliptin with Metformin causes efficient glycaemic control with less significant adverse reaction but the gylcaemic control of patients taking Sitagliptin with Metformin was slightly better as compared to patients taking alone. Thus, concluding Sitagliptin with Metformin to be more efficacious than alone

Introduction: Since the first detection on 8th March 2020 in Bangladesh, the number of cases is rising alarmingly. The paediatric population is also getting infected in Bangladesh. So far there is very few studies of COVID in children in this country. Aim of the study: The aim of this study was to explore the demographic profile, clinical presentation, laboratory findings and outcomes of COVID-19 children patients. Methods: This is a retrospective hospital-based study; 149 Children were enrolled and analyzed in this study. The study was conducted from June 2020 to June 2021 at the Department of Pediatrics in Dhaka Shishu Hospital, Dhaka, Bangladesh. Result: Among 149 patients were included in the study over a period of 13months. Mean age was 59.96 ± 43.24 months, 48% were male and 52% were female. Out of 149 cases 7(4.6%) cases were associated with co-morbidities like congenital heart disease& bronchial asthma was 2(1.34%) followed by hereditary hemolytic anaemia, adenoid and ROP was 1(0.67%) (Table-4). Out of all 149 patients 125(83.89%) patients were improved and discharged, 12(8.05%) patients transferred to other hospitals and 5(3.36%) childs died in this study. Conclusion: During the pandemic of COVID19 Children were also affected due to household contact. Children present with flu like illness with or without other system involvement should be investigated for COVID19, as because early diagnosis will help to restrict the spread of the virus and will help to get a better outcome

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

Objective: The purpose was to study the ocular manifestations pattern and complications of vernal keratoconjunctivitis (VKC) and efficacy of corticosteroid, cyclosporine, alcaftadine. Material and methods: A Prospective study was done taking 227 patients from 15th Oct 2021 to 15th Mar 2022 in Department of Ophthalmology SLN Medical College and Hospital. Vernal Keratoconjunctivitis (VKC) was diagnosed basing on clinical presentation and scoring of signs and symptoms

Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children. Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), After obtaining approval from the Institutional Ethical Committee and informed consent from the parents, all children (aged one month to 14 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included.

Background- Patients on chemotherapy frequently presented with signs and symptoms of autonomic dysfunction. Cardiac autonomic dysfunction (CAD) is a significant cause of morbidity, mortality and affects the quality of life with progressive advancing disease and is associated with short survival of cancer patients. Therefore a thorough assessment of cardiovascular autonomic functions is crucial to monitor the disease prognosis and chemotherapy side effects on these patients. The present study was done to evaluate baseline Heart Rate Variability (HRV) and Ewings battery of Cardiac autonomic reactivity tests in cancer patients on chemotherapy to evaluate CAD

Introduction: Day care procedures has now becoming a popular modality of treatment throughout the world. Day care procedures means that patient gets admitted, undergoes interventional procedure and gets discharged from the hospital on the same day of the procedure.[1] Anaesthetic agents available now-a-days play an important role in achieving specific criteria for ambulatory anaesthesia. Anaesthestic agents like, propofol and sevoflurane favors the anaesthesiologist to perform successful day case surgeries.Propofol has become the drug of choice for induction of anesthesia in the day care procedures due to its favorable recovery profile and low incidence of side effects.[2] Newer inhaled anaesthetics like desflurane and sevoflurane with low blood gas partition coefficient facilitates rapid induction of anaesthesia and rapid recovery and less adverse effect at the end of anaesthesia, leading to their use in day care surgery

Background: The most frequent injuries are lower limb fractures because road traffic accidents, which are the main cause of trauma, are occurring more frequently worldwide. Recent developments and the creation of newer fixation techniques have produced promising results in the treatment of complex lower limb fractures thanks to a better understanding of fracture healing. In our study, we treat lower limb fractures with a novel plate fixation method known as biological plate fixation-bridge plating. The two major fracture fragments are fixed by using the plate as an internal fixator. Without affecting the intricate fracture zone, length, alignment, and rotation are restored. In this case, as opposed to the traditional plating method, the fracture is healed by callus formation

Introduction: Long since the dispute regarding the time duration of umbilical cord clamping after birth in a neonate, there have been several recommendations for the same. The delayed cord clamping improves the cerebral blood volume in term and preterm neonates and it also decreases the risk of anemia in neonates, apart from multiple other maternal and neonatal benefits. Objectives: The purpose of this prospective study is to determine the effect of differential duration of cord clamping (at30seconds, 1min and 2min) on cerebral blood flow (middle cerebral artery flow dynamics) in normal term neonates. Methods: 390 deliveries, which fulfilled inclusion and exclusion criteria, in tertiary care centre were attended and the cord was clamped using aseptic precautions at 30 seconds, 1 minute and at 2 minutes exactly using random number table and the data were entered into master chart and then analysed using IBM SPSS statistical software. Results: The results showed no significant difference in cerebral blood flow hemodynamics, with different duration of cord clamping. Conclusion: Our hypothesis was that longer duration of cord clamping would lead to greater middle cerebral artery (MCA) blood flow velocity, but there was no significant change in hemodynamic parameters in middle cerebral artery blood flow with increasing duration of cord clamping. This implies that the known maternal and neonatal benefits of delayed cord clamping beyond 30 seconds were independent of cerebral circulation and hemodynamic parameters

Introduction: Coronavirus disease 2019 (COVID 19) infection has rapidly spread across the world, currently affecting more than 39 million people, leading to major societal, economical and health care system distruptions. Aim of the study: The study aimed to identify and explore the concerns of the long-term mishap of respiratory diseases regarding the impact of the COVID-19 pandemic and how these concerns were affecting them. Methods: A retrospective observational study was performed on consecutive patients admitted to the Shaheed Monsur Ali Medical College, Dhaka, Bangladesh. This study was carried out from January 2020 to December 2020 with 62 patients.

Background: Patients with diabetes mellitus (DM), have poor long term glycaemic control, even when fasting glucose concentrations are normal.3,4, Glycosylated haemoglobin (HbA1c) is a useful index of glucose intolerance and hyperglycaemia. HbA1c is an established marker of long-term glycaemic control. HbA1c can be assessed in the non-fasted state and has higher reproducibility than fasting glucose. Aim of the Study: To study the blood levels of HbA1C in patients of Acute Coronary Syndrome at the time of admission and to find out the correlation with the angiographic pattern.

Background: The area near opening of pulmonary veins into the left atrium act as triggering focus of the electrical activity in atrial fibrillation. Selective radiofrequency ablations of these foci are being performed to treat patients with drug resistant atrial fibrillation. So the accurate knowledge about variations of pulmonary veins and their drainage pattern is very important for diagnostic and therapeutic intervention in atrial fibrillation. Materials and Method: Fifty formalin fixed adult cadaveric hearts were included in the present cross sectional observational study. The heart were examined for the variations in the number of pulmonary veins (and pulmonary ostia) opens into left atrium through pulmonary ostium and their drainage pattern.

Introduction: Skin and soft tissue infection contribute to a substantial proportion of infective disease pool in OPD attendees, in both urban and rural set up across the globe and staphylococcus aureus is one of the common causative agent of cutaneous bacterial infections involving skin & soft tissue. MRSA can cause severe problems , if not detected early, resulting in complications like septicaemia, pneumonia, sepsis and death. Community acquired MRSA(CA-MRSA) infections are common among skin & soft tissue infections (SSTIs), making their management quite difficult. One simple method to reach the diagnosis is the culture and sensitivity pattern. As sensitivity and distribution pattern vary according to different geographical area as observed in other bacterial infections, it has become imperative to know the extent of MRSA distribution and it’s sensitivity pattern in a particular community

Introduction: Thyroid disease is more common in women than in men, because most thyroid diseases are autoimmune in nature and increased susceptibility to autoimmune diseases, perhaps secondary to the female endocrine environment is likely contributing factor. Thyroid physiology plays a major role in pregnancy and thyroid disorders constitute one of the most common endocrine disorders in pregnancy. Pregnancy is associated with significant and reversible changes in thyroid function and failure to adapt to these changes result in thyroid dysfunction. Material and Methods: This is a Prospective study done among 1000 pregnant women. Antenatal women attending the outpatient department of tertiary care centre from August 2021 October 2022. Detailed history was taken, regarding the symptoms of thyroid disorders, menstrual history, obstetric history, past medical history, family history and personal history

Background and Aims: One of the most common illnesses with high morbidity and death is urinary tract infections (UTIs). Even though a broad variety of medicines are available for the care of UTI, uropathogens have developed resistance, leading to a major treatment failure. In order to assess the rate of pathogen isolation as well as the pattern of antibiotic susceptibility of microorganisms causing UTI, the current investigation was conducted. Materials and Methods: 350 urine samples from individuals who had a UTI that was clinically suspected were processed between January and March 2019. The susceptibility of various antibiotics and UTI isolates were studied using the Kirby-Bauer disc diffusion method. Results: In this study, among the 350 samples, 195 (55.7%) samples showed microbial growth. Out of 195 isolates, 33 were Candida spp., and 162 were bacteria. E. coli (46.29%) was the predominant isolate, followed by E. faecalis (23.45%) as well as Klebsiella spp. (19.75%). E. coli was most susceptible to nitrofurantoin (96.29%), and Candida spp was most susceptible to Fluconazole (90.90%). Conclusion: The study outcome showed that E. coli is the major uropathogen responsible for UTI, and Nitrofurantoin is the superior antibiotic with a high susceptibly rate

Background: Distal Peripheral Neuropathy (DPNP) is a frequent micro-vascular complication of long-term diabetes and one of the main causes of morbidity and disability due to ulceration and amputation. Our aim is Correlation Study of Peripheral Neuropathy in Impaired Glucose Tolerance and newly diagnosed Type-2 Diabetes Mellitus Methods: A prospective Cohort study was taken among 160 patients. From patients with diagnosis of Impaired Glucose Tolerance& Newly diagnosed case of Type -2 Diabetes Mellitus (DM) attending the OPD and IPD in Department of Medicine at our Medical Hospital. During study period from 1st of Feburary 2021 to 31st August 2022. Results: In the current study, the mean NDS for newly diagnosed diabetic participants was.43, whereas it was.30 for IGT subjects, and it was determined to be non-significant. In the current study, it was determined to be highly significant that the mean Sensory Nerve Conduction Velocity in newly diagnosed diabetes participants was 56.44± 9.85 and in IGT subjects it was 50.35± 10.94. Out of the total 160 study respondents, 32 subjects were having any kind of sensory abnormality in their body. out of these 32 subjects, 23 belongs to new diabetic group while nearly only 9 subjects belong to IGT group. This association was found to be significant with a p value 0.006 Conclusions: The mean Sensory Nerve Conduction Velocity in new diabetic subjects were 56.44± 9.85 and in IGT subjects were 50.35 ± 10.94which was found to be highly significant with a p value<0.001.However, The mean Sensory Nerve Action potential in new diabetic subjects were 7.64± 3.13 and in IGT subjects were 7.52 ± 3.24which was found to be non-significant with a p value 0.79.Patients with DM and pre diabetes are at elevated risk for PN, and PN patients are at increased risk for dm and pre diabetes

Introduction: Although communicable diseases are more common in developing countries, recently an upsurge in non-communicable diseases has been noticed. Among these non communicable diseases neurological and musculoskeletal disorders constitute a significant proportion affecting morbidity, mortality, disability and quality of life. The annual incidence of musculoskeletal disorders accounts for 31% of all occupational diseases estimated in the world in 1994. This means that the musculoskeletal disorders are the most frequent occupational disease affecting workers throughout the world. Aim: to identify the epidemiological factors that contribute in developing neurological and musculoskeletal disorders. Method: This was a hospital based cross sectional study conducted at Geetanjali College of Physiotherapy located in Geetanjali Medicity with institute of Geetanjali Hospital and College, Udaipur. Consisted cases of ND & MSD attending GCP and the referral calls for ND & MSD from GMCH to GCP. Results: In the index study male subjects constituted (60.7%) while the rest (39.3%) were female. There was a significant association of studied patients of neurological and Musculoskeletal disorder reporting to physiotherapy hospitals with gender p=0.011. There was a significant association of studied patients with BMI. Conclusion: Out of 300 studied patients 60.7% were male and 39.3% were female. The male to female ratio was 1.4 : 0.92. Most of our patients belonged to age group 50-59 years

Background: Interval duration measurements (IDMs) were compared between standard 12-lead electrocardiograms (ECGs) and 12 lead mobile ECG recorded with Spadnan ECG based ECG device, a single channel, hand-held mobile device designed for use by patients at home. Objective: Objective of this prospective, cross-sectional, within patient diagnostic validation study was to compare the interval durations between standard 12 lead ECG and 12 lead mobile ECG recorded with Spadnan ECG based single channel ECG device. Materials and Methods: This single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from January 2019 to August 2022. All patients (n=2308) visiting the electrocardiogram (ECG) room at the Department of Cardiology of the SMIH, Dehradun during the study period were enrolled in the study by taking their written consent and explaining the purpose of the study. Results: Smartphone-operated 12 lead ECGs showed good diagnostic accuracy for QT, PR, QRS, QTc and Heart rate measurement in comparison to the standard 12 lead ECG machine. The PR interval, QRS duration and Heart rate were under the clinical agreement levels. Whereas, the QT and QTc showed the variability of more than 20 ms. hence, the detection of the Arrhythmias associated with shorten PR intervals, prolonged PR intervals can be detected by the Smartphone ECG with accuracy, the conduction blockages like LBBB involving the QRS duration can be precisely be detected by the smartphone ECG. Conclusion: Our research evidence proved the equivalency of device in measuring the morphological parameters like PR intervals and QRS duration. Our study observed variation in detection of the QT and QTc intervals at above 25 ms, which might make it difficult to be used in diagnosis but for general purpose where no medical facility is available, our device can be used for primary care. Hence, the Smartphone ECGs can be used in the primary care and for general use

Background: Ambulatory assessment of the heart rate–corrected QT interval (QTc) within arrhythmia patients can be of diagnostic value where these patients are on QTc-prolonging medication. Repeating sequential 12-lead electrocardiograms (ECGs) to monitor the QTc is cumbersome, but Spandan Smartphone ECG devices can potentially solve this problem. Objective: Objective of this prospective and retrospective, cross-sectional, within patient diagnostic validation study was to validate the measurement of QTc interval in Spandan 12 lead ECG and to assess the accuracy of the 12 lead Spandan Smartphone ECG device in measuring the QTc intervals in the general cardiology outpatient population with normal ECG and arrhythmias. Materials and Methods: This single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from August 2022 to October 2022. All patients (n=1168) visiting the electrocardiogram (ECG) room at the Department of Cardiology of the SMIH, Dehradun during the study period were enrolled in the study by taking their written consent and explaining the purpose of the study. Results: Mean (SD) age was 54.36±4.9 years. The male gender (n=783,67.03%) shows the maximum frequency than female gender. Primary Coronary Intervention was noted in 426 (36.4%) of the study population. All the four parameters showed positive Pearson correlation between 12 Lead Standard ECG and Spandan Smartphone ECG. The maximum mean difference between 12 Lead Standard ECG and Spandan Smartphone ECG was noted for QTc parameter in overall participants. Conclusion: 12-lead Spandan Smartphone ECG allows for QTc assessment with good accuracy and can be used safely in ambulatory QTc monitoring. This may improve patient satisfaction and reduce healthcare costs

Introduction: Yoga is an art in all its aspects, from the most practical to the highest. It is a spiritual art, in the sense that it transforms the seer and brings him into contact with his inner soul. It is a fine art, since it is aesthetic, expressive, visual art, since the body is made to form geometrical designs, lines architectural shapes and the like which are beautiful to behold. It is essentially a useful art for the doer and is presented as a performing art for viewer. Objective: To assess the effect of 45 minute yogic kriya (Surya Namaskar and Kapalbhati) for for 30 days on various physiological and biochemical parameters. Materials and Methods: This is a prospective and observational study conducted in the Department of Physiology and Biochemistry at Tertiary Care Teaching Hospital over a period of 6 months. All subjects volunteering for participation in the study had given their written informed consent. The study protocol was approved by our college ethical committee. Only healthy volunteers with daily regular lifestyle and are not involved in any sport regularly, were chosen to be part of the study between the age group 17-21 were taken into study. Subjects having any pathological condition and those who are on any pharmacological treatment from 3 months prior to the study were excluded from the study. Results: In the present study it was found that the pulse rate was decreased significantly (p<0.05) at 30 days in Group I and II. RR decreased significantly at 30 days in group I, and II with p<0.05. This significant decrease continued at 30 days with group I and II. In our study it was found that significant decrease in SBP at 30 days. At 30 days two groups had highly significant decrease in SBP (p<0.05). In addition, it was also found that significant decrease in DBP at 30 days. At 30 days two groups had highly significant decrease in DBP (p<0.05). After yoga, at 30 days, the reduction in the Serum Total cholesterol, serum triglycerides levels were found in two groups in the present study. The decrease was significant (p<0.05) in Group I and II (p<0.01). In addition, after 30 days of yogic practices significant (p<0.05) increase in the HDL level was found in Group I and II. Conclusion: It was concluded that in hypertensive subjects whether newly diagnosed subjects were restoration of the altered parameters towards normal

Background: Miscarriage is considered the most common adverse outcome in early pregnancy. Thyroid autoantibodies have a role in these regions and have been linked to substantial changes in the path of pregnancy that affect the mother, foetus, & newborn. Aim: To estimate the prevalence of TPO antibodies in recurrent pregnancy losses, first trimester abortions and preterm deliveries. Material & Methods: Study Design: Descriptive Cross sectional study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Baharampur, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Pregnant women who had preterm deliveries, miscarriages attending outpatient as well as admitted in the antenatal & postnatal ward in the department of Obstetrics & Gynecology Sample size: Study consisted a total of 100 subjects. Study tools and Data collection procedure: The study group was comprised of all the pregnant women who had preterm deliveries and miscarriages regardless of the gestational age, that were fulfilling inclusion & exclusion criteria. Written informed consent was taken from all the patients participating in the study. They were subjected to a detailed history & thorough general & clinical examination, lab investigations, thyroid profile, thyroid peroxidase antibody testing (Normal range: TPO AB <9 IU/ML), ultra-sonic examination & other clinical work up was done. The study showed that the contribution of thyroid peroxidase antibody testing & its sensitivity determining risk of preterm deliveries and recurrent pregnancy loss. Results: The association between TPOAB and T3 category, among the high TPOAB (+ve) cases (n=11), 8 (72.7%) cases had normal level of T3, and, 3 (27.3%) cases had low level of T3. Whereas in the normal TPOAB (-ve) group (n=89), 5 (5.6%) cases had high level of T3, 84 (94.4%) cases had normal level of T3. The association between TPOAB and T3 category was shown statistically significant (P<0.0001). Conclusion: We concluded that, there was a statistically significant association of TPOAb with T3, T4, and, TSH (P<0.05) and it leads to developing hypothyroidism during pregnancy. The presence of TPO-Ab in pregnant women significantly increases the risk of preterm delivery. The screening of TSH and TPOAb was essential during pregnancy to avoid complications related pregnancy

Power point assisted spotter Examination (PASE): A digital tool in assessment of gross anatomy spotters Background: Power pointbased spotter assessment is a tool wherein the spotter questions were prepared using digital images of specimens in a power point format. Digital spotter assessment can be customized according to institutional resource and need without having to go through recreation of specimen or infrastructure. The objective of the study is to compare the Power point based spotter assessment with the traditional method of spotter examination. Methodology: Fifty, first year MBBS students Participated in this study. The students were randomly divided into two batches of 25 students each. Each batch of students were assessed by the two method of examination in sequential cross over manner. A survey was also administered asking faulty & students’ perception on the two different methods of assessment. Result: In the present study 83 % of faculty felt that the Power Point spotter assessment was easy to administrate, wide variety of questions can be implemented and less time consuming. 100% of the faculty agreed that this method can be included with the traditional method but cannot replace it. 42 % of students preferred the traditional format, 38% of students preferred the digital method of assessment and 20 % of students were comfortable with both the method of assessment. Conclusion: Digital spotter assessment method can be implemented in places where continuous availability of human cadaver is not possible. Medical educators can explore the concept and feasibility of integration of digital technology in evaluation of medical students

Introduction: Cadaveric dissection remains the most powerful tool to teach and learn anatomy in clinical and surgical specialities. It helps to visualize the structures and their relations in a three dimensional view. This knowledge collected will bring about innovations and strengthen the anatomical basis for clinical and surgical module. Objective: To modify steps of dissection in region of axilla that allows exposure of other contents of axilla more clearly. Material and method: dissection technique was performed on the embalmed cadaver given to first year MBBS students. Result: The students were able to visualize the relations and identify the structures in the axilla better. Conclusion: The application of modified technique helped the students to learn anatomy with more clear understanding and also provides an opportunity to innovate clinical or surgical modules

Background: Dengue is known to cause multi-organ dysfunction including cardiac involvement, In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis not reported as a common complication we present a case series of dengue fever with cardiac involvement observed during a period of month August to December 2021 at PBM & Associated Group of Hospital, Bikaner Rajasthan. Case presentation: We have been reported 9 cases of dengue complicated with cardiac involvement admitted to Wards and ICU at PBM & Associated Group of Hospital. Age group ranging from 15 to 65 years. In our case series out of 9 cases comparising 2 females and 7 males. The group had 5 cases of Dengue hemorrhagic fever with dengue shock syndrome, 2 cases had Dengue hemorrhagic fever, 2 cases had dengue shock syndrome. There is co-infection of dengue with malaria in 2 cases. All cases had acute dengue hepatitis. Blood transfusion and other empirical therapeutic methods used apart from meticulous fluid management to suit issue of each patient. Bed side USG, digital chest x-ray PA view & 2D ECHO scanning help in early detection of critical phase of dengue. Out of 9 cases with complicated dengue 7 patients recovered and 2 patients expired. Data were collected during hospital admission, stay and follow up visits. Methods: A prospective observational study was conducted on patients with age group more than 15 years and having confirmed dengue fever. Patient on medication affecting heart Rate, Rhythms, pre-existing heart disease and electrolytes abnormalities excluded. A base line ECG, Troponin I NT Pro BNP were done for all patients. The biomarkers were measured using Enzyme linked immune fluorescent assay and recommended cut off were used. Patients with increased biomarkers gone for 2D ECHO (As per criteria of European society of cardiology 2019). Conclusion: Myocarditis and cardiac involvement in dengue may be overlooked due to Nonspecific clinical finding and co-existing multi organ dysfunction. Atypical presentation of this case series may be due to micro-geographical variation and unusual out break of dengue. Co-infection of malaria should be considered in managing patients especially in endemic area

Background: Breastfeeding is an ancient social custom, an unparalleled and most determinant way of giving ideal and safest food for the optimum development of vulnerable infants which fulfills all nutritional needs. WHO proposes exclusive breastfeeding during the 1st six months and introduction of safe complimentary feeds from 6 months onwards with continuation of breastfeeding till 2years of life. This study intends to give a better understanding of not only breastfeeding behaviors, but also of practices regarding formula feeding in 'upper middle class' population. Aims and Objective: To assess the knowledge, and practices of breastfeeding mothers with Children less than 2 years

Background and Aims: The success of labour analgesia is significantly influenced by the patient's position during the insertion of the epidural catheter. In this study, we contrasted how simple it was to implant the epidural catheter in the crossed-legged sitting position (CLP) against the traditional sitting position (TSP) (CLSP). The main goal was to compare how many of the groups' initial epidural placement attempts were successful. The patient's comfort, the simplicity of landmark palpation, and the quantity of needle-to-bone contacts were secondary goals

Background: The platelet count declines and petechiae appear in widespread distribution with spontaneous ecchymoses. Bleeding occurs at mucosal surfaces from the gastrointestinal tract and at venipuncture sites. Objective: to study Correlation between the laboratory features – thrombocytopenia, elevated hepatic enzymes, hyponatremia, high hematocrit and severity of dengue infection. Methods: It is an observational study conducted at a multispeciality teaching Hospital. The study population (cohort) was selected from the hospital inpatients who are admitted in paediatric intensive care unit as well as paediatric ward

Introduction: Meningitis is a clinical syndrome characterized by inflammation of the meninges; it is one of the most common infectious diseases of the central nervous system (CNS). Infection with the human immunodeficiency virus (HIV) is emerging as a major risk factor for meningitis in adults. Meningitis causes significant morbidity and mortality globally. Long term sequelae of bacterial meningitis in adults include hearing and visual loss, seizures, and cognitive impairment

Background and objectives: In situ hybridization (IHC) markers p63, SMA, and ki67 in the spectrum of ductal proliferative breast lesions: a study employing excision biopsy and mastectomy patients. The goal of this study is to evaluate myoepithelial markers for their potential in spotting breast cancer in its earliest stages. Methods: The research used representative paraffin sections from 30 breast mass tissue samples submitted to the Department of Pathology, Osmania Medical College, Hyderabad, Telangana, India, between April 2018 to March 2019. P63, SMA, and Ki 67 antibodies were used to immunostain 40 breast masses categorised as ductal proliferative lesions, ductal carcinoma in situ, or invasive ductal carcinoma by the Department of Pathology. Results: p63 non myoepithelial had 22 in negative frequency and 8 in positive frequency. While for SMA nonmyoepithelial negative frequency was 4 and positive frequency was 16. Over and over, it was shown that stromal cells, and myofibroblasts in particular, did not react to the stimuli. There was a ring of p63-immunoreactive cells encircling lobular and ductal cancer in situ, however it was disjointed compared to the normal structures. Conclusion: Ki67, myoepithelial P63, and stromal myoepithelial antigen (SMA) were shown to be reliable markers for discriminating normal epithelium from hyperplasia, MIN, and invasive carcinoma in this study.

Background: Lack of micronutrients like zinc and copper has been linked to a poor prognosis and high mortality in HIV infection. The purpose of this study was to look at the availability and deficit of a few trace elements in HIV-positive subjects undergoing HAART. Methods: A cross-sectional study was done on 150 persons who had been chosen at random and were receiving HAART at the clinic and had received a confirming diagnosis of HIV. Subjects signed written informed permission forms before receiving questionnaires. Following sample collection, the concentration of blood levels of zinc and copper was assessed using the spectrometric method, and the CD4+T-cell count was assessed using a flow cytometer. Simple percentages were used to calculate prevalence. The association between zinc, copper, CD4 and viral load deficiencies was investigated using the Mann Whitney U nonparametric test and the Chi-square test of independence. Results: The frequency of copper and zinc insufficiency was 59% and 16.7%, respectively, among the participants. A significant difference in median CD4 count and viral load was seen across zinc levels, with a p-value of 0.05, although CD4 count and viral load did not change by copper level among patients. Furthermore, p-value 0.05 indicated a link between subjects' zinc levels and immunological suppression. Conclusions: This study demonstrated that the CD4+T-cell count levels rather than the nutritional status do not complement HAART therapy. While the focus of HAART therapy is strengthening the immune system, patients may still be lacking in some micronutrients while having an increased CD4+T-cell count.

Introduction: In December 2019 , COVID 19 had put unprecedented load over healthcare-systems across the world. The key to good surveillance and prognosis for COVID 19 cases lies in early diagnosis and appropriate management

Introduction: With the availability of better health care services and decrease in mortality rates the elderly population has increased significantly over the last couple of decades.1 Psychiatric illness in the elderly is compounded by mental morbidities due to ageing of the brain, problems associated with physical health, socio-economic factors such as breakdown of the family support systems, and decrease in economic independence. The presence of comorbidities and the attendant polypharmacy makes management of these diseases a complex issue

Introduction: Coronal plane fractures of femoral condyle, commonly known as HOFFA fracture, first described by Busch in 1869, latter by Hoffa in 1904. Coronal plane fractures of femoral condyle are rarer than saggital plane fractures. Unilateral bicondylar coronal plane fractures are even rarer than unicondylar coronal plane fractures

Pain is defined as "an unpleasant sensory and emotional experience associated with existing or potential tissue damage or described in terms of such damage" by the updated taxonomy committee of the International Association for the Study of Pain (IASP).

Background: Back pain is regarded as one of the unrewarding problems that were dealt with in orthopedics. Of the various forms of low back pain, only those syndromes associated with neurologic compression of the cauda equina or nerve roots have a reasonably well-understood clinical presentation.

Objectives: The present study aims to study Micro lumbar Discectomy's functional outcome using a magnifying loop for lumbar intervertebral disc prolapse.

Materials and methods: Patients admitted in department of ortgopaedics in katuri medical college with a clinical diagnosis of lumbar disc herniation at either L4-L5, or L5-S1 levels and undergone lumbar microdiscectomy following the inclusion criteria specified in our protocol. Explained all the patients about the procedure, the necessity for follow up, and written consent was taken.

Results:48% of patients are between 41 to 50 years. 64% of the participants are males. The average pre-operative ODI (Oswerty disability index) score was 54.56. The ODI score at the most recent follow-up (3m) was 9.36. The result was excellent in all cases improving from severe disability to minimal disability. Mean ODI at each follow-up visit was compared with pre- operative using Paired T-test, and p-values were calculated. P-value was found to be significant with each comparison.(41-60%)Severe disability was present pre-operatively about 54.56 (21-40%)Moderate disability was present at 1st month about 24.24 and (0-20%)Minimum disability was present at 3rd month about 9.36.

Conclusion: Micro lumbar discectomy with loupe magnification is an excellent cheap procedure, which can be done on an daycare basis. The operated patients had less post-operative pain due to the minimal soft tissue exposure, minimal handling of paraspinal muscles on one side only, less or no damage to the lamina, and no damage to facet joints. All the patients required less dose of postoperative analgesics. Post-operative mobilization is very earlier compared to standard laminectomy and discectomy. All the patients had less postoperative morbidity avoiding complications. Functional outcomes are better compared to standard procedures

Objective: To evaluate the interaction between Thyroid hormones and Glucose homeostasis in post menopausal Diabetic and Non-Diabetic women. Materials and Methods: The study was conducted in the Department of General Medicine, Sapthagiri Institute of Medical Sciences & Research Center, Bangalore. 40 Post menopausal Non-diabetic women attending OPD, Department of Medicine. Anthropometric & Physiological parameters were taken. Complete blood picture count, Fasting blood glucose(FBS),Glycosylated haemoglobin(HbA1C), Oestradiol, progesterone, Follicle stimulating hormone(FSH), Luteinizing hormone(LH) levels were analyzed

Objectives: The aim of this study was to assess the fracture union with percutaneous autologous bone marrow injection in delayed union and non-union of long bone fractures.

Methods: Patients who were admitted in department of orthopaedics in Katuri medical college and hospital, Chinnakondrupadu, Guntur, with delayed union and non-union of long bone fractures, were included in this prospective study. Study span is about 2 years and sample size of 34 patients. Preoperatively patients were examined clinically and radiologically. Post operatively patients were followed up through serial post operative x-rays.

Results: This study included 34 patients, out of which one case was lost in follow up. 24 out of 33 cases good bone union was achieved (72.7%). Radiographically the healing   was seen on an average of 14 weeks.

Conclusion: Percutaneous bone marrow injection is a minimally invasive procedure. It is a simple, quick, safe procedure providing cellular reactivation of osteogenesis with no related complications that may occur with bone grafting

Background: Psychosocial disturbance can have its effect on all organ systems of our body including cardiovascular system and at the same time prolonged cardiovascular diseases may also lead to worsening of mental health in people. Objective: Present study is carried out to find the effect of certain common psychiatric diseases and social stresses along with the effect of different levels of social support on the incidence and prevalence of cardiovascular diseases. Material and Method: The present cross-sectional analytical study was conducted in cardiac ward and on new and follow up cases in outpatient unit, Andhra Medical College, Visakhapatnam. 100 participants male and female of all age groups were taken as cases along with 100 participants as control after obtaining written informed consent by purposive sampling.

Data was analyzed using SPSS 21.0. The statistical tests used were student’s t-test and chi square test.

DSM-5 criteria, M.I.N.I, Perceived social stress scale, Oslo’s social support system and Modified Kuppuswamy criteria were used to carry out study. Results: Out of the total population under study, 15% of all the CVD cases were found to have psychiatric illness prior to cardiovascular disease where as 21% of CVD patients developed psychiatric illness after having diagnosed for cardiovascular disease. Among these cases 82% were having low social support. Gender predilection for psychiatric diseases in CVD patients was found to be more in females (12%) compared to males (9%) with (p-value = 0.042) and chi square value of 4.13. Conclusion: This research indicates that psychiatric illnesses and low social support can act as an independent risk factor for CVD while CVD patients are susceptible to develop psychiatric illnesses over the course of disease. We recommend multi centre detailed study with higher sample size in this area to generalize the results and use them for the benefit of society

Aim:  To determine the bacteriological profile and antibiogram of burn wound patients in teritiary care hospital.

Materials And Methods : A cross sectional descriptive study conducted  from January 2022- June 2022 and collected  50 specimens ( swabs ) from burn wound patients admitted in Burns ward  and processed in Microbiology Department ,Andhra Medical college, Visakhapatnam.  Drug susceptibility tests were performed using Kirby Bauer method   according to CLSI guidelines.

Results: Out of 50 samples , 42 samples  shown bacterial growth in which 34 bacterial isolates were GNB and 8 were GPC. Out 0f 42 , most frequently isolated was Pseudomonas aeurginosa ( 24 )(57.14% )of which 8 were ESBL producing , followed by Staph aureus ( 7) (16.66%), Klebsiella species (4)(9.52%), Acinetobacter species (4)(9.52% ) ,Escherischia coli (2)( 4.76%) ,Proteus species (1)(2.38% ). GNB were mostly sensitive to Piperacillin- Tazobactam, Fluoroquinolones, Macrolides and were  resistant to Beta lactams. GPC were sensitive to Vancomycin , Linezolid and were resistant to Cefoxitin .

Conclusion: Due to increased morbidity and mortality associated with burn wound infections, early detection and intervention are a prerequisite for better clinical outcomes of burn patients

Introduction: Nephrotic syndrome, characterized by presence of heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia, is a common renal disorder in pediatric population and is most common in Asian child.

Aims & Objectives: To know the bacterial etiologies and their antibiogram in urinary samples of Pediatricnephrotic syndrome.

Materials And Methods:   This was a Cross sectional, Descriptive study conducted for a period of 6 months i.e., January 2022 – June 2022 in pediatric patients admitted in PICU’s of KING GEORGE HOSPITAL, VISAKHAPATNAM.  Urine samples are collected and transported to Department of Microbiology, ANDHRA MEDICAL COLLEGE, VISAKHAPATNAM.

Results: Out of 70 urine samples studied, 21(30%) have urinary tract infection, 13(62%) were asymptomatic and 8(38%) are symptomatic.  Majority of UTI caused by E.coli 8(38%) followed by klebsiella 6(29%), Proteus 4(19%), Staphylococcus aureus 2(10%), Acinetobacter 1(4%).

Gram negative bacilli were sensitive to Amikacin, Cefixime, Piperacillin plus Tazobactum, Nirofurantoin, Meropenem.

Gram positive cocci were sensitive to Amoxicillin, Vancomycin, Linezolid.

Conclusion: Children with nephrotic syndrome are frequently predisposed to UTI and in most cases, it is asymptomatic.  It is necessary to examine the patient and prevent the risk of complications by initiating appropriate antibiotic therapy

Introduction: Ventilator associated pneumonia is defined as pneumonia occurring more than 48hours after the initiation of endotracheal intubation and the most common nosocomial infection in intensive care unit.VAP is second most common health care associated pneumonia in spite of wide range of preventive measures. Aim: To isolate the bacterial pathogens and their antibiogram of organisms causing VAP. Materials and Methods: Cross sectional descriptive study conducted for a period of 6 months i.e January 2022 - June 2022 in patients admitted in ICUs of King George hospital on ventilator for more than 48 hours. Endotracheal aspirates are collected and transported to department of Microbiology, AMC, Visakhapatnam. Results: From 50 endotracheal samples studied ,15(30%) were culture positive. Among them the most predominant organism is Pseudomonas aeruginosa 5(33.3%) followed by Methicillin resistant Staphylococcus aureus 4 (26.6%), Klebsiella species 3 (20%) and Acinetobacter species 3(20%).Gram negative bacilli were sensitive to Piperacillin – Tazobactam, fluoroquinolones, macrolides, Polymyxin whereas resistant to beta lactams.Gram positive cocci were 100% resistant to Cefoxitin, Oxacillin and sensitive to Linezolid and Vancomycin. Conclusion: Knowledge of incidence of VAP, their causative microbial flora along with their susceptibility pattern help in selection of appropriate antibiotics for therapeutic use and better outcome

This study is a Prospective cross sectional observational study. The study was conducted from December 1st, 2020, to June 1st, 2022 in which 100 patients who had presented to the Surgery OPD and Emergency Department of Katuri medical college &hospital, Chinakondrupadu, Guntur with history suggestive of urolithiasis were enrolled for the purpose of studying the incidence of urolithiasis at different levels of the urinary tract and to assess different modalities of treatment and compare outcome of those results with that of the world literature. Our Study had found that the incidence of urolithiasis at our center was 3.74%. The age group of people between 21-30 years were the most commonly affected. However, the mean age for developing urolithiasis was 40.4 years. Males appear to be predisposed to the formation of calculi with M: F ratio being 1.77:1. Pain was the most common symptom which was seen in 91 % of the patients followed by nausea/vomiting seen in 58% followed by burning micturition (43.84%), fever (16.44%) and haematuria (15.08 %) of the study group. Right kidneys were affected more commonly than the left. Diabetes mellitus   was   the   most   commonly   associated   comorbidity   followed   by hypertension. Renal pelvis was the most commonly affected site (35%) followed by lower 1/3rd, urinary bladder (17%) upper ureter (14%) and lower ureter (11%) respectively. E. coli was the most commonly isolated organism in the urine cultures followed by Klebsiella. Serum calcium was normal in 96% of the study group while serum uric acid was raised in 25% of the subjects. Plain X ray KUB and ultrasound were the initial imaging modalities used. IVP was preferred over CT in diagnosis as CT was costlier and could not be afforded by the poor. Patients consuming mixed diet seemed to be more predisposed to the formation of urolithiasis. Open Pyelolithotomy was the operative modality for renal pelvic calculi, Open Ureterolithotomy for upper and mid ureters and URS for lower ureter. Open Cystolithotomy was used for bladder calculi. Stone free rates for Open Pyelolithotomy was 91.4%, 96% for Open Ureterolithotomy, 91.3% for URS and 100% for Open Cystolithotomy. The average size of stone extracted in Open Pyelolithotomy was 2.78 cm, 1.34 cm for Open Ureterolithotomy, 3.92 cm for Open Cystolithotomy and 1.1 cm for URS. Mean duration of hospital stay was 7.42 days for Open Pyelolithotomy, 6.16 days for Open Ureterolithotomy, 5.35 days for Open Cystolithotomy and 1.34 days for URS. Thus we can conclude that, the incidence of urolithiasis was 3.74% in our study. The patients underwent open procedure for removal of stones at our cente.r However, as seen in our study, open procedures have good success rates and also have less post- operative complications. It can thus be concluded that it does not hamper patient care. This is in accordance with the other studies over open urological procedures

Background: Prematurity is a burden on any country for being the leading cause of infant mortality in the world. APGAR score, being a component of the degree of birth asphyxia,  is an important tool to assess the quality of  care used for observing neonatal outcome in the delivery room itself. Vitamin D has important role in decreasing the mortality and morbidity in the neonatal period as it helps in prevention of sepsis and respiratory complications .

Aim of the study: To determine the relationship between serum vitamin D level and APGAR score in premature infants.

Patients and methods: This cohort study was done in Sri Guru Ram Das Hospital, Vallah, Sri Amritsar from April 2021 to July 2022on 82 preterm (< 37 weeks ) neonates admitted to the NICU. Patients were divided into 3 groups based on their serum vitamin D levels : deficient , insufficient and sufficient. APGAR score of these preterm neonates at 1 minute and 5 minute was recorded. Later these were analyzed and relationship between serum vitamin D level and APGAR score at 1 minute and 5 minutes was noted.

Results: The lowest APGAR score at 1 minute (between 0-3 ) belonged to the neonates in the deficient group whereas majority of neonates in the insufficient group and in sufficient group had good APGAR scores (>6) at 1 minute. At 5 minutes, all neonates in the insufficient and sufficient group improved their APGAR scores to >6 and in the deficient group, 23.1 % neonates still had low score (4 to 6 ). Therefore, the relationship between APGAR score and serum vitamin D levels in the neonates was statistically significant with p value of 0.006 for APGAR at 1 minute and p value of <0.001 for APGAR at 5 minutes.

Conclusion: In this study, lower vitamin D levels were associated with lowerAPGAR score at 1 minute and 5 minutes

Tibial plateau fractures are one of the most common intraarticular fractures. Open reduction and internal fixation procedures is the common technique used to treat it however, it jeopardises the soft tissue. So, the use of a minimally invasive approach to fix plates has been recommended. As a result, the so-called internal fixators were created. So, the present study was conducted with an aim to study the functional outcome of tibial plateau fractures with locking compression plates by using modified Hohl and luck evaluation. A prospective observational study was conducted among 30 patients with fractures of tibial plateau (Schatzker classification Type I,II,III). 73.3% cases had excellent and 16.6% had good outcomes in the study. 6% had stiffness of knee, 3.3% had instability, 3.3% had infection and 3.3% had implant failure. We conclude that better preoperative surgical planning and correct application of principles of LCP (Locking Compression Plate) and MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) technique will yield excellent biological fixation for tibial plateau fractures

Background: One of the most typical illnesses seen in clinical practise is urinary tract infection (UTI). 50% to 60% of adult women may encounter a urinary tract infection at some point in their lives, making it one of the most prevalent bacterial illnesses in women. Due to their anatomical characteristics, such as a narrow urethra, as well as other variables like pregnancy, the use of diaphragms, and sexual activity, women are more likely to acquire UTI. Objectives: 1. To isolate and identify the uropathogens from the urine samples. 2. To detect the antimicrobial resistance of uropathogens to fluoroquinolones. Material & Methods: Study Design: Descriptive Cross-sectional study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Berhampore, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Urine culture sensitivity reports were analyzed of patients who were suspected to be having urinary tract infection. Sample size: Study consisted a total of 300 subjects. Sampling Technique: Simple Random technique. Results: The resistant pattern of E.coli and Klebsiella to the 4 fluroquinolones, highest resistance is seen to ciprofloxacin followed by norfloxacin. In this study the most sensitive drug was Amikacin, followed by Pippericillin/Tazobactum and imipenem. In this study the drug with maximum resistance was cotrimoxazole. Amoxycillin and quinolones followed the list. Conclusion: We need to take a number of steps to address the significant worldwide opposition issue we are facing. These include (i) using fewer antibiotics to lessen the pressure for resistance to develop. (ii) increasing our understanding of the mechanisms by which bacteria acquire resistance and how they reduce the ensuing fitness costs.

Background: Preterm birth is defined as a delivery occurring at less than 37 weeks of gestation. It is divided into three categories: extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate to late preterm (32 to <37 weeks). Similarly, preterm birth can be classified based on birth weight. Neonates weighing less than 2500 g at birth are considered low birth weight (LBW), <1500 g are considered very low birth weight (VLBW), and <1000 g are considered extremely low birth weight (ELBW). Preterm birth can also occur spontaneously or as a result of a provider's intervention (induced). Aim: The purpose of this study was to compare the neonatal outcomes of spontaneous and induced/indicated preterm births that occurred less than 37 weeks of gestation. Material & Methods: Study Design: Prospective Hospital based Comparative study. Study area: Department of Pediatrics & Department of Obstetrics, Government General Hospital, Vijayawada. Study Period: 1 year.  Study population: Singleton live preterm births <37 wk of gestational age born during the study period. Ethical consideration: Institutional Ethical committee permission was taken prior to the commencement of the study. Study tools and Data collection procedure: The collected data includes A) Maternal characteristics: (i) age, (ii) parity, (iii) mode of delivery, (iv) Type of diabetes, (v) mode of control. B) Neonatal characteristics: (i) sex, (ii) gestational age, (iii) birth weight C) Physical examination was performed D) Laboratory investigations done: blood sugar, calcium and bilirubin levels, X-ray chest and abdomen, sepsis screen. Results: The mean birth weight of Spontaneous Preterm was lower than Indicated Preterm (2.036±0.3716 kg and 2.497±0.5878 kg). There was a statistically significant difference in infant birth weight between Spontaneous Preterm and Indicated Preterm. With statistical significance, the birth weight of late preterm infants was higher than that of early preterm infants. Conclusion: From our study it can be concluded that, Preterm births account for 5% of all deliveries during the study period. There were 200 (66.66%) spontaneous preterm births and 100 (33.34%) indicated preterm births among them. The mean birthweight of Spontaneous Preterm was lower than Indicated Preterm with statistically significant difference (p< 0.0001).

Introduction: Type-2 diabetes mellitus are reported to have a 2 to 3-fold increase in the incidence of cholesterol gallstones. Gallstone disease in patients with diabetes mellitus is largely due to dyslipidemia, leading to the alteration in the composition of bile. Impairment of gallbladder motility and contraction, as a result of hyperglycemia and diabetic autonomic neuropathy. Hence the study is undertaken to determine prevalence of gall-bladder disorders in diabetic patients with autonomic neuropathy and association of different parmaetrs with Cases and without autonomic neuropathy. Material & Methods: This was a hospital based case-control study carried out during the period of October 2010 to October 2012. Institutional ethics committee approved the study.The study comprised of known or newly diagnosed 101 patients of type-2 diabetes mellitus and 101 age and sex matched controls. Observation & Results: Out of 101 cases studied 67(66.33%) had autonomic neuropathy and out of 101 controls 9(8.91%) had autonomic neuropathy. Thus prevalence of autonomic neuropathy was significantly more in cases than controls.  Out of 67 cases with autonomic neuropathy 32 (47.76%) had gallbladder disorders and out of 34 cases without autonomic neuropathy 4(11.76%) had gallbladder disorders. Thus prevalence of gallbladder disorders in cases with autonomic neuropathy was significantly more than in cases without autonomic neuropathy. Conclusion: Present study concluded that Gallbladder disorders are significantly associated with metabolic syndrome in type-2 diabetics.Type-2 diabetics with autonomic neuropathy have larger gall bladders with poor contraction in response to fatty meals, thus predisposing these patients to various forms of gall bladder disease

Diabetes is a public health problem; prevalence of diabetes is progressively on the rise. International diabetes federation estimates a doubling prevalence of diabetes mellitus by 2035 from that of 541 million in 2022. Objectives: To find out the prevalence of peripheral neuropathy among known type 2 diabetics and to correlate peripheral neuropathy with select socio – demographic variables. Materials and Methods: A Descriptive cross -sectional community-based study was done among Known type 2 diabetes mellitus individuals of age group 30 years and above. The study was carried out for a period of 10 months after getting approval from the institutional ethical committee. Peripheral neuropathy was classified using the Toronto clinical scoring system of peripheral neuropathy. Data collected was entered in Microsoft 2010 excel spread sheet, compiled and analyzed using IBM SPSS Version 22 statistical package. Results: The prevalence of peripheral neuropathy was found to be 12.6% among the study subjects. Frequency of Peripheral neuropathy was increasing as the duration of diabetes increases. A significant association was found between duration of diabetes and peripheral neuropathy. A significant association was found between increased RBS value and peripheral neuropathy. Conclusion: Maintaining a proper blood-glucose control is the key to primary prevention of diabetes related complications. Regular monitoring of blood-glucose level must be done for the management of Diabetic peripheral neuropathy.

The second covid wave caused unprecedented havoc, morbidity and mortality all over India. This retrospective study delves into the disastrous impact of Covid 19 second wave in the pregnant population at our tertiary care center. This retrospective study was done to bring insight into demographical factors, associated comorbidities, mode of delivery, role of inflammatory markers, treatment administered, complications in pregnant women who were severely affected by COVID -19. Material and Methods: This retrospective observational study collected data from 1 April 2021 to 30 June 2021. A total of 40 pregnant COVID-19 patients admitted during the second wave of COVID-19 infections were included in the study. All demographic characteristics like age, parity, type of conception, BMI, associated comorbidities, symptoms and their duration, type of oxygen support, the inflammatory markers (IL6, serum ferritin, N/L ratio, LDH), mode of recovery and outcomes were analyzed. Statistics: Data was collected, summarized, tabulated using Microsoft Excel and expressed as percentage. Results: Of the 40 COVID- 19 cases, 10 pregnant women succumbed to COVID- 19. Age above 30 years and higher BMI was associated with all mortalities. Fever and Breathlessness was a common symptom in all. All women who succumbed had falling SPO2 levels and all were on higher oxygen support. CRP, D- dimers and IL-6 levels are markedly increased in all the fatalities who were infected by COVID-19. Conclusion: The second COVID-19 wave affected the pregnant population the most. The outcomes of women who were on higher oxygen support was worser. Serum Ferritin and IL-6 was raised in all patients with worse prognosis

Introduction: One of the most common lower-extremity impediments in people suffering with diabetes-mellitus is foot ulceration. There is an increased risk of amputation and increased mortality rate in patients with foot ulcer. The neutrophil-to-lymphocyte-ratio (NLR) has lately been shown to forecast chemotherapy response in cancer patients, associated with peripheral arterial disease, systemic endothelial dysfunction and cardiovascular diseases. NLR is an useful measure in predicting overall mortality and disease-specific mortality.

Objectives: To evaluate the role of Neutrophil- Lymphocyte Ratio NLR in prognosis of Diabetic-Foot-Ulcer (DFU)

Methodology: The outcomes of diabetic foot ulcers in 100 patients admitted to surgical wards were assessed. Demographic, patient-specific, and wound specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing and chronic ulcer. The data was entered in Microsoft excel and analyzed using SPSS version 16.

Results: The mean (SD) age was 57.1(11.29) years. 58% of subjects were females and 42% were males. The mean (SD) duration of Hypertension was 10.3(3.50) years and that of Diabetes Mellitus was 9.49(3.03) years. 53% had history of trauma, 48(48%) of subjects had pain, 51(51%) had gangrene of foot. The mean (SD) CBP, Neutrophils, Lymphocytes and Neutrophil-Lymphocyte Ratio was 20.24(2.89) per thousand, 94.73(3.21) %, 14.97(3.23) % and 6.65(1.52) respectively. 58% had healing ulcers and 42 had non healing ulcers. 44% of study subjects were having NLR <6 which is normal and 56% had NLR>6 which is abnormal. Among 58 subjects with healing ulcers, 44(75.9%) had NLR<6 and among 42of non-healing ulcers, 42(100%) had NLR >6. This was statistically significant (p value <0.001). The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was 75% and negative predictive value was 100%. The mean (SD) NLR in healing group was 5.15(0.65) and in non-healing group was 8.205(0.84) and this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with poor prognosis.

Conclusion: NLR is a good prognostic variable in predicting the outcome of Diabetic foot ulcer. The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was75% and negative predictive value was 100%.

Background: It is difficult to ascertain reliably the overall incidence and prevalence of the various cutaneous infections in different parts of the world because studies of one region of the country may not be a true representation of the overall disease pattern of that country; furthermore, incidence and prevalence figures may only will be representative of the population sampling, which may have associated risk factors for infection. Most of the studies done in this field are dealt with adults or with a specific clinical form of dermatophytosis. Only few surveys were performed in pediatric age group. Aim: To study clinical presentation of superficial dermatophytic infection in paediatric patients in tertiary health care centre. Methods: It is an observational type of study.  The present study was conducted in Department of Dermatology, Rajshree Medical & Research Institute, Bareilly, from 1st march 2021 to 28th February 2022. Results: Majority of the study population belonged to 11-15 years (48.7%) followed by 15-18 years (24.1%), 0-5 years (16.6%) and 5-10 years (10.6%). The mean age of the study population was 9.16±4.241 (0-18) years. There were 47.7% males and 52.3% females. Itching was present among most of the patients that is 226 patients had this complaint (95.3%). The most commonly affected sites was Groin (47.2%) followed by Trunk (29.9%), buttocks (29.1%), upper limbs (24.0%), Face (6.7%), Scalp (4.6%), lower limbs (4.6%) and Nails (0.4%). The predominant lesion type was Plaque (43.5%) followed by Others like  Pustules, erosions, excoriation, crusting (29.5%), Plaque with papules (16.5%), Plaque, Others (4.6%), Papules, Others (4.6%) and Macule being the least lesion type (1.3%). The most common lesion feature found in most of the study group was discoloration (94.1%). The most common diagnosis was T. corporis (29.1%) followed by T. corporis+ T. cruris (28.3%), T. cruris (22.4%). Limitations: The study was an observational study done at the first visit of the patient in OPD with no follow-up. This was major limitation of the study, since the further change of course of presentation was not noted. Also the patients undergoing any other treatment with dermatophytosis were not studied. Conclusion: Total 237 patients of superficial dermatophytosis were included in the study, out of which mean age was 9.16 ± 4.241 with female predominance (52.3%). Maximum patients were from middle school (48.9%) corresponding to age and belonged to middle class (70.5%) socioeconomic status. Common presenting complaints were itching (95.3%), affected site was groin (47.2%) and annular plaque was predominant type of lesion. The most common made in our study was T. Cruris (47.2%). More studies should be carried out in future on large scale so that this study can be corroborated to evidence. Along with that, alternation in dosage for pediatric age group should be studied

Background: Portal hypertension is a major consequence of cirrhosis and is responsible for its most severe complications, including ascites, bleeding from gastro-oesophageal varices and encephalopathy. Measuring HVPG is very ideal to diagnosis and to grade severity. But the drawback of this procedure is its invasiveness leading to complications. So, a simple, routinely available, cost effective method for severity assessment of portal hypertension would be attractive. Methodology: It was a cross sectional study which included patients diagnosed as Chronic liver disease attending to the OPD as well as in-patients. Results: This study included a total of 100 subjects who had esophageal varices secondary to liver cirrhosis with portal hypertension. Majority of the patients were in the age group of 36 to 45 years (31%) with mean age of study subjects being 47.43 with male preponderance (87%). A statistically significant association was found for splenic size and esophageal variceal grading. 57% of the patients had splenomegaly between 13-15cm size of which 22 % had grade 3 esophageal varices followed grade 1 varices who constituted 17%. 20% of the patients had spleen size >15cm. Conclusion: Ultrasonographic measurement of spleen size > 13 cm can be considered as non-invasive predictor of presence of esophageal varices and grading in patients with Cirrhosis with portal hypertension along with other measurements like portal vein diameter and platelet count

Background: Caesarean section is the most common done obstetric emergency and the outcome of surgery differs depending on various factors. Maternal and fetal outcome depends on proper follow up during antenatal period. Aims: To study the maternal and fetal outcome of emergency caesarean delivery between unbooked rural referrals and booked cases. Materials and methods: This is a Comparative cross sectional study was conducted in the Department of Obstetrics and Gynaecology in Gestational age > 37 weeks, Unbooked cases handled outside and referred, who underwent caesarean delivery on emergency, Booked cases admitted in our hospital and underwent emergency caesarean delivery and Singleton pregnancy. Results: This study included 980 antenatal patients who underwent emergency caesarean section, among them 420 were booked cases and 560 were unbooked cases. The incidence of emergency caesarean section was more in unbooked group compared to booked group.  This comparison of age, Teenage pregnancy, parity, socioeconomic status had  statistical significance with p value < 0.05. The major indication of emergency caesarean section in booked cases was previous caesarean section (29.26%), where as it was fetal distress (22.6%) in unbooked group. Septicaemia in unbooked group (4.6%) was more than booked group(1%).66 cases (11.8%) of unbooked group and only 21 cases (4.9%) of booked group had wound infection. Postpartum haemorrhage, Perinatal mortality, NICU admission rate statistically significant among the two groups. Maternal intrinsic factors such as nutrition socioeconomic status and lack of antenatal care have been suggested as the causative factors in the unbooked patients. Conclusion: Poor utilization of antenatal care is associated with adverse feto-maternal outcome. Most maternal deaths are preventable if complications are diagnosed early and managed effectively in time .Early admission and management of critical obstetric patients decreases maternal morbidity and mortality

Introduction: Fetal movement tracking may be used to identify worsening in the fetus condition. It is described as any kick, flutter, swish, or roll perceived by the pregnant women and is considered evidence of the musculoskeletal and central nervous systems' integrity. Decreased fetal movement has been linked to poor pregnancy outcomes such as intrauterine growth restriction, fetal death and preterm deliveries. Clinical data on the association between decreased fetal movements and perinatal outcome is insufficient. Methodology: Ethical clearance was obtained from SRIMANTA SANKARDEVA UNIVERSITY of HEALTH SCIENCE for study of decreased fetal movements in Gauhati medical college and hospital. A doppler study was conducted using 3 dimensional ultrasound machines in ANOPD, departmental indoor USG room, and 2 dimensional ultrasound machine in observation room in the Department of Obstetrics & Gynaecology, Gauhati Medical College& Hospital. Patients were placed in supine position with left lateral tilt and umbilical artery Wave forms were recorded in the mid position from the free floating loops. Indices noted were S(systolic)/D(diastolic) ratio, resistance index (RI), plasticity index (PI), and reversal of blood flow in diastole. CTG monitoring was done in Departmental Observation Room using a CTG machine (labelled as FETAL MONITOR, SN-EATB8L1732, manufacturer-BPL, model no. FM 9854). Each selected patient was monitored for a period of 20minutes with a paper speed of 3cm/minutes during antepartum or intrapartum status. Noted following information were: base line FHR, beat to beat variability, FHR accelerations, presence of deceleration, and reactive. Results: A prospective observational study was conducted in Gauhati Medical College & Hospital, Guwahati, Assam during a time period of one year. 150 antenatal women at term gestation with decreased fetal movements without any other high risk conditions were monitored for fetal wellbeing by CTG and Doppler. Four groups were categorised into four groups: Group I-CTG reactive and Umbilical Artery Doppler normal, Group IIA, Group IIB, and Group III. The findings of each group were compared with different modes of delivery and different parameters of perinatal outcomes. Conclusion: Maternal perception of fetal movements is the most widely used technique to evaluate fetal wellbeing. Low-risk pregnancies with decreased fetal movements should be monitored for close antenatal fetal monitoring, appropriate and prompt interventions. Non-reactive CTG alone or with combination of abnormal Doppler results are better predictors of poor perinatal outcome and can indicate if neonatal resuscitation is required. These two tools can be used together for fetal monitoring and appropriate intervention at the correct time to improve the perinatal outcomes

Objective: Several new or repositioned drugs have been tried in covid19, but none have been shown to be efficacious. This observational study was carried out because previous data showing effect of remdesivir in treatment of moderate to severe covid19 patients were controversial. Method: A retrospective analysis was carried out of moderate to severe covid19 patients with SpO2 level<94% admitted in hospital after approval of the ethics committee. Patients were divided in 2 groups according to treatment received, standard treatment (Group A) or standard treatment + remdesivir (group B). Purpose of the study was to determine the difference in term of final outcome (death or recovered), change in SpO2 level, average hospitalization duration and change in laboratory values between both group. Results: There were total 1193 covid19 patients (group A: 1044 patients; group B: 149 patients). No significant difference observed in final outcome [death in group A(43.29%), group B(42.28%), P=0.88]. Adding remdesivir to standard treatment significantly reduced hospitalization duration in those recovered (P=0.0025) and improved SpO2 level significantly between day 1-5(P=0.0002), 1-10(P<0.0001) and 1-14(P=0.0001). Conclusions: We concluded that adding remdesivir in the standard treatment of the patients did not improve the final outcome (prevention of death) of the disease

Background: HIV is predominantly lymphotropic to CD4 (T-helper) lymphocytes Other cells bearing CD4 receptors are also infected (e.g, macrophages, B cells, Langerhans cells, NK cells  etc.). Objective: To  find  out  the  various  patterns and presentations of  dermatological  conditions occurring  in  HIV Patients and their association with CD4count. Methods: In this study we included 100  patients above age of 15 years who were infected with HIV Virus. Results: The most prevalent infection was candidiasisseen in 25 patients it was a definite maker for HIV disease progression and was seen in early as well as late stages of HIV infection. Dermatophytosis was the second most common fungal infection seen in 11patients. Among viral infections, herpes simplex virus(HSV) wasthemost common infection found in 12patients, Herpes zoster was seen in 8 patients. The most common non – infectious dermatosis seen in our study was seborrhoeic dermatitis in 12patients. Conclusions: Dermatological manifestations occur throughout the course of HIV infection some of the manifestations can be considered as the predictors of advanced immunosuppression.

Background: Low blood platelet counts are a defining characteristic of the illness known as thrombocytopenia. It is the most typical haematological aberration observed in people with chronic liver disease.1 It has been documented in 64%–84% of individuals with various aetiologies of liver cirrhosis or fibrosis.2 Thrombocytopenia has been regarded as one of the key signs of advanced liver disorders as a result. OBJECTIVES: 1. Identifying the correlation of platelet count, spleen size, and their ratio with the presence of esophageal varices in patients with liver cirrhosis without any previous evidence of GI bleeding. 2. Assessing the ability of these parameters as non-invasive tools to predict the presence of esophageal varices. MATERIAL & METHODS:  Study Design: Prospective Observational study. Study area: Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatient. Study Period: January 2019 to December 2020. Study population: Liver cirrhotic Patients attending Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatients. Sample size: Study consisted a total of 50 subjects. Sampling Technique: Simple random technique. Study tools and Data collection procedure: In this prospective observational study of 50 patients, newly diagnosed patients with liver cirrhosis without a history of gastrointestinal bleeding were included. Relevant clinical parameters were assessed, which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of spleen long axis diameter. Platelet count/ spleen diameter ratio were calculated for all patients. Results: Patients were grouped according to Child-Pugh Classification of Cirrhosis. Majority of study group patients belonged to Child-Pugh class C (66.00%) followed with class B (30.00%). Majority of patients belonged to the category of ratio between 501-1000 (48.00%) followed with<500 (24.00%), 1001-2000 (20.00%) and >2000 (8.00%). CONCLUSION: we conclude that the incidence of thrombocytopenia and lower PC/SD ratio can be used to establish higher grades of varices. It can be used to identify the subset of patients requiring endoscopy for prophylactic management of esophageal varices. It may further reduce the burden on the endoscopy units, avoid unnecessary screening endoscopies and management costs for bleeding varices.

Introduction: Prostate cancer is a disease of men. An early observation reports that more than 65% of all prostate cancers are diagnosed in men over the age of 65. Current advances in molecular techniques have provided new tools facilitating the discovery of new biomarkers for prostate cancer. High levels of leptin have been significantly correlated with testosterone and Prostate specific antigen values in subjects with Prostate Cancer compared with subjects in the control group. Adiponectin is the most abundant circulating adipokine and accounts for 0.05% of the total plasma proteins. As a consequence of these observations, and its inhibitory role on the growth of breast and endometrial Cancer cells ,it can be labelled as an Anti-Cancer Adipokine. Interleukin (IL)-6 is a pro-inflammatory cytokine that is expressed in prostate tumors and in the stromal tumor micro-environment. It is known to regulate proliferation, apoptosis, angiogenesis, and differentiation. Material and Methods: This Observational study was conducted among 120 Males, aged above 50 years, out of which 60 were prostate cancer patients and 60 were Healthy controls, who attended the O.P at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre. Men were excluded at baseline, if they had a history of myocardial infarction, stroke, transient ischemic attack, unstable angina, cancer or current renal or liver disease, peptic ulcer, gout, or use of platelet-active agents, vitamin A, or β-carotene supplements. Serum samples of men with prostate cancer based on high prostate specific antigen (PSA),biopsy and/or abnormal DRE  and those of healthy controls were collected after an overnight fast and analysed on the same day. Serum PSA and IL-6 levels were estimated using ELISA. Plasma adiponectin and leptin concentrations were measured by competitive RIA.  Results: In our study, 60 Males were Cases of Prostate Cancer and 60 were Healthy Control group. The age of the patients was almost similar in both Cases of Prostate Cancer (66.23±7.25) and Control group (61.01 ± 7.81). The PSA (ng/ml) level was significantly (<0.001) higher in PCa patients (7.12±0.80) as compared to control group (0.93±0.84). Similarly, the Interleukin-6 level was significantly (<0.001) higher in PCa patients (9.71±0.75) as compared to control group (5.9±0.61). In our study, Leptin (ng/mL) level of Prostate cancer group was 13.31±0.84 which was higher when compared to control group where it was 7.52±0.74. Adiponectin (µg/mL) Levels of Prostate cancer group were 11.72±2.34 which was lower compared to control group where it was 16.25 ±2.73. Conclusion These data further support a relationship between elevated IL-6 and prostate cancer disease prognosis. IL-6 correlates with rising PSA levels and extent of disease, and thus can be used in conjunction with other disease indicators. The multifaceted role of adiponectin in regulating several hallmark pathways that drive cancer growth suppression has been proposed in various studies. Adiponectin is an adipose tissue-derived polypeptide hormone, that in addition, to its anti-diabetic and anti-atherogenic effects also exerts anti-angiogenic properties and therefore it can be used as a target for anti Cancer therapy. On the other hand, leptin would affect PCa growth by means of factors related with obesity such as testosterone and could influence cell differentiation and Prostate Cancer progession.

Background: No single modality of treatment for breast cancer can be the mainstay of therapy. One of them is breast conservation treatment (BCT) comprises BCS and whole breast radiotherapy. BCT is not popular among the surgeons in India (11-23% vs. > 60-70% in west). The advantages of BCS over MRM include, better body image, sexual functioning and better psychological adjustment. In view of this, the present study was undertaken to highlight the importance of BCT and comparison of post-operative events with MRM. Aim And Objective: To evaluate the possibility of BCT in cases of LABC after neo-adjuvant chemotherapy. To compare BCT with MRM in terms of quality of life and postoperative complications. Patients And Methods: The study was carried out in the PG department of General Surgery and Oncosurgery Wing of M.K.C.G. Medical College & Hospital from August 2018 to June 2021 (including 12 months of follow up period).Total no of cases included in this study are 20. We have selected stage I & II and few cases of stage III A for our study. Results: In our study, as the study period is only 2 years and follow-up period was only 12 month, so overall survival is 100% for both BCT & MRM. Recurrence rate for BCT is 15% and for MRM is 5%. Out of Several studies maximum show that overall survival rate for both BCT and MRM group are almost same and comparable. Recurrence rate in case of BCT is high as compared to MRM except in study of Fisher et al and Blichert-Toft et al where recurrence rate in MRM is high. Conclusion: It is a challenge for a surgeon to do BCS in early breast cancer case, as till now both the patients and the surgeons are in favour of MRM for reasons of safety and due to fear of recurrences. We felt that both the surgeons in the periphery and the women folks need to be made aware about the huge benefits of BCT in comparison to MRM. While selecting the patients, proper criteria must be adhered to. Radiation is a must after BCT but failing, for which the incidence of local recurrences goes up

Background: "Hypertrophic scars" are excessive scars in which the dense fibrous tissue does not extend beyond the borders of the original wound or incision. They tend to be wider than necessary for normal wound healing to occur. Histologically, hypertrophic scars have more organized collagen fibers than keloids, and scant mucoid matrix. Hypertrophic lesions are characterized by randomly distributed tissue bundles consisting of uni-axially oriented extracellular matrix and cells. Materials and methods: This is a prospective and single centre study conducted in the Department of Plastic Surgery, Tertiary Care Teaching Hospital from November 2021 to October 2022. Males and females in the age group between 18 and 60 years were included in this study. The split thickness skin graft was harvested from a normal thigh where no skin graft had been harvested earlier. Indications for skin grafting were both elective and emergency. Result: Better Aesthetic and symptomatic outcome in Triamcinolone injected skin graft donar areas. Conclusion: Injection of Triamcinolone into skin graft donar areas will reduce hypertrophic scarring significantly

Background:  Ventilator Associated Pneumonia (VAP) is one of the common nosocomial infections associated with high morbidity due to multidrug resistant pathogens. Rapid spread of resistance to broad spectrum beta-lactams in pathogenic strains causes antibiotics ineffectiveness and increased severity of illness. The CTX-M is the most dominant Extended Spectrum β Lactamase (ESBL) among Enterobacteriaceae in many regions of the world. The aim of the study was to identify the occurrence of ESBL. Materials and methods: This prospective study was conducted in the Department of Microbiology, Shadan Institute of Medical Sciences Teaching Hospital and Research Center. A total of 300 consecutive urine samples were screened from patients with symptomatic UTI. Clean-catch midstream urine samples were collected in sterile disposable container and processed within one hour. Semi quantitative loop measuring 2.2 mm diameter with a holding capacity of 0.005 ml was employed to culture urine on CLED agar and MacConkey’s agar. The inoculated plates were incubated over night at 37oC. Isolates in significant number (colony count ≥ 105 CFU/ml) was identified by standard procedures. Results: In our study high susceptibility of meropenem (74.3%) and imipenem (100%) was seen and least was  Ciprofloxacin 41.4%. Double disc synergy test and Inhibitory potentiated disc diffusion Test screening test for ESBL production, 70 (43.7%) isolates were resistant to at least one of the three representative cephalosporin drugs. The highest resistance was observed with cefpodoxime (n=57; 40.1%) followed by ceftazidime (n=52; 37.9%) and cefotaxime (n=39; 28.4%). Out of the three cephalosporins tested in the study, ceftazidime was found to be the better antibiotic drug for the identification of ESBL production by both Double disc synergy test and Inhibitory potentiated disc diffusion Test. Conclusion: This study showed that the ESBL‑positive isolates were more resistant to some first‑line antibiotics, and this highlights the necessity to control and monitor the prescribed antibiotics used for empirical treatment for UTI patients.

Lower urinary tract infections are accountable for a huge number of presentations in general practice and were treated with regular antibiotic prescriptions. But, they cause a significant financial burden while seeking treatment services. In our prospective study, that took place over 18 months at Katuri Medical College and Hospital, was done to determine the etiology and treatment modalities of lower urinary tract symptoms. Our Objectives were- 1. To assess various etiological factors causing lower urinary tract symptoms among patients attending the outpatient department at Katuri Medical College and Hospital. 2. To investigate the etiological factor causing lower urinary tract symptoms among the patients. 3. To evaluate various treatment options available for management of lower urinary tract symptoms. Results: A total of 87 patients who were screened and a sample size of 30 cases had been selected with objective evidence of LUTS on whom an surgical intervention is needed. It was found that the highest incidence of LUTS in males was in 7th decade, and then sixth and eight decade, meanwhile, the lowest incidence was seen in ninth decade. In this present study, major proportion i.e., 73.33% (22cases) were men and the remaining 2 6.67% (8 cases) are females. Patients presented with the following complaints. 1. Frequency and nocturia were found in highest number of cases i.e., 28 (76.67%). 2. Weak Stream was in the least number of patients i.e.,11 (36.67%). 3. Intermittency and Urgency were found to be suffered by 60% and the later was observed to be present in 70% of the study subjects. The most common cause was BPH which was observed in 53.33% followed by bladder stones (23.33%), carcinoma prostate (10%), Urethral stricture (10%) and bladder carcinoma (3.37%). Out of 30 cases of LUTS, 14 underwent TURP, 5 cases underwent cystolithotripsy, 1 underwent radical cystectomy and ileal conduit, 1 underwent VIU, 2 underwent urethroplasty, 5 underwent open prostatectomy, 2 underwent cystolithotomy.

BACKGROUND: Motor vehicle accidents are one of the major causes of facial injuries. Midface is the common site to get involved. Midface fractures are frequently involved with head injury or associated with other facial fractures or in isolation.Mid face fracture patterns were first published by a French surgeon Rene Lefort in 1901.At present midfacefractures rarely fit into Lefort classification patterns.The changes in the lifestyle led to increased use of advanced motor vehicles which increased the road traffic accidents.The fractures are deviated from the Lefort patterns due to changes in the velocity,forces direction of impact on the skull. To emphasize the need for more comprehensive classificationto include variations in midface fractures patterns such as unilateral fractures, asymetricalLefort fractures,associated fractures etc., OBJECTIVE:A prospectiveobservational  cross sectional  study to assess various patterns of maxilla fractures in relation to age,sex and mode of injury. MATERIALS AND METHODS:Study includes patients presented to Plastic Surgery department in King George Hospital,Andhra Medical College from  June 2014  to May 2021.Patients were examined clinically and reviewed  with 3D CT facial bones .Injuries were classified using Lefort system and those fractures deviated from Leforts are noted. RESULTS: Evaluation of midfacial fractures done among facial bone fractures.Total number of patients in the study are 685 with 9.5 :1 male to female ratio.The peak incidence is in the age group of 21-30 years.The most common cause beingroad traffic accidents.Mid face fractures which are deviated fromlefort fractures aridentifie and evaluated.Different patterns in midface are observed with the help of radiological imaging.Among midface fractures majority doesnot fit into classical Leforts .Only 8.5%  constitutesLeforts patterns.

Background:  In India smoking and tobacco dipping are major health problems and one of the largest preventable causes of disease and premature death. Nicotine has been reported to improve attention, learning, reaction time (RT), problem solving, and stimulus evaluation and discrimination. Previous research has established that cholinergic systems are important for cognitive functioning and nicotine is a potent cholinergic stimulant that affects many central nervous system (CNS) pathways, including the auditory pathway. It is a measure of function of sensory­ motor association and performance of an individual. It involves stimulus processing, decision making, and response programming. Material and Methods: This is a Prospective, observational, comparative study was conducted in the Departments of Physiology at Index Medical College. Audio-visual reaction time – Measurement of reaction time is a simple test which is measured by ‘audiovisual reaction time apparatus’ (Anand agency, Pune). Reaction time is a commonly used parameter for measuring implicit learning. In measurement of reaction time subject was asked to respond by pressing the button as soon as he had received the stimulus in the form of sound or light. The apparatus provides both auditory (low and high pitched sounds) and visual (red and green) stimuli. The arrangement consists of a source of stimulus, response key and the time recording device. The response is given by the subject by pressing a key with his index finger. Results: In the present study, in age groups ART values were significantly different (Graph-1) in all three groups, ART and VRT values increase in control, smokers and dipping tobacco users as age advances. As regards ART values, age group 31-40 years differs significantly from age group 11-20 years and 21-30 years (p<0.05), similarly age group 41-50 years differs significantly from age groups 11-20 years, 21-30 years and 31-40 years. As regards, VRT values age groups differ from each other but age group 41-50 years differ significantly from age group 11-20 years and age group 21-30 years.  Conclusion: Significant difference was also observed after smoking and after 12 hours of abstinence in study group subjects. This indicated increased reaction time required for integration process in CNS and delayed conduction in reflex arc after abstinence. Thus, the evidence presented in this article supports that temporary abstinence from nicotine has adverse effect on reaction time which may force them to smoke again. Health education and nicotine replacement therapy may help them to achieve the ultimate goal of complete cessation from smoking.

Background:  Patients with the chronic obstructive pulmonary disorder (COPD) are at risk of developing postoperative respiratory failure. That is the reason they may require artificial respiration for longer periods than others. However, being on mechanical ventilation for a long time leads to lung damage and infections. Objective: The present study was undertaken to observe the relation between the severity of COPD in patients of spinal surgery and the prevalence of respiratory failure. Materials and Methods: 40 patients with COPD who had undergone spinal surgery were part of the study. The data was collected from the medical records department including the demographics, spirometry results, blood gas analysis, comorbidities, postoperative and other variables. The important outcome is a respiratory failure within one week after the surgery. Results: Data was presented in table 1 and table 2. Table 1 presents the demographic and clinical parameters of the participants. Table 2 presents the risk factors for respiratory failure of the participants. A longer duration of anesthesia was required for the mild COPD patients. Comorbidities were present in all levels of COPD patients. Table 2 presents the risk factors for respiratory failure of the participants. Length of stay was longer in patients with severe COPD. Extubating time, and endotracheal intubation after surgery were more in the severe COPD patients. Pulmonary infection is present in all groups of patients. Conclusion: There is no significant relationship between the severities of COPD with postoperative respiratory failure. However, there is a strong need to conduct a prospective study with more defined parameters to understand better these relations. So that better and more effective treatment strategies can be developed

Background:  Asthma attack is the most common respiratory symptom observed and is of great concern. Throughout the world asthma cases are increasing during pregnancy. The major issue is that the control levels of asthma is changing during pregnancy so the management is a little difficult during pregnancy. Objective: The present study was undertaken to observe the prevalence of asthma and respiratory symptoms during pregnancy. Materials and methods: 40 pregnant women attending OPD in the hospital were part of the study after obtaining the written informed consent. Confidentiality of the data was maintained. Willing pregnant women were included in the study. Pregnant women with any other complications severe were excluded from the study. Respiratory symptoms were examined during the general physical examination by an expert physician. Results: The age group of the participants ranges from 22-30 years. 25% of individuals have asthma. 37.5% of individuals have wheeze without cold, 15% of individuals have nasal allergies. 27.5% have shortness of breath. 5% of individuals have a history of smoking. 15% of individuals are currently under the medication for asthma. Conclusion: The present study results explained that wheezing without cold and shortness of breath are the most common respiratory symptoms during pregnancy. Further detailed studies with a higher sample size are recommended to understand better the respiratory symptoms during pregnancy

Introduction: Even before the culture reports are obtained, hematological alterations in sepsis can help in the early diagnosis of sepsis. One of the most common issues with neonatal sepsis is thrombocytopenia, which is also one of the most reliable independent risk factors for sepsis-related mortality. The purpose of the current study was to figure out the incidence of thrombocytopenia in newborn sepsis and to assess if it might be used as a screening test for the condition. Materials and methods: The Neonatal Intensive Care Unit at a tertiary care hospital hosted this hospital-based prospective observational cross sectional study from July 2022 to December 2022. In total, 220 neonates who were hospitalized to the NICU with suspected sepsis before turning 28 days old were included in the study. Results:  A total of 220 newborns with clinical sepsis were admitted during the research period. There included 73 (33.18%) female neonates and 147 (66.82%) male neonates. In 56 (25.4%) patients, the blood culture proved positive. The most prevalent Gram positive and Gram negative organisms were Kleibsella species 13 (23.21%) and coagulase negative Staphylococci (CONS) 23 (41.07%). 101 births (45.91%) by caesarean section and 119 (54.09%) by normal vaginal delivery were recorded. 43 neonates (19.55%) had low birth weights, while 177 had normal birth weights (>2.5 kg). SGA made up 33 (15%), AGA made up 183 (83.18%), while LGA made up 4 (1.82%). Preterm births made up 42 (19.09%), term births made up 168 (76.36%), while postterm births made up 10 (4.55%) cases. CRP was positive in 123 instances (55.91%) and negative in 97 cases (44.09%). Among the total cases, 89 (40. 45%) had thrombocytopenia, in which mild was 53 (24.09%), moderate was 28 (12.73%), severe was 8 (3.64%). Thrombocytopenia was significantly associated with Blood culture positivity, LSCS, SGA and CRP positivity. (P<0.05) Conclusion: Thrombocytopenia acts as an early predictor of neonatal sepsis and also the outcome of the neonates. Platelet counts and clinical correlation can be used in conjunction to detect early sepsis and administer prompt, effective care

Introduction: Chronic kidney disease (CKD) is characterized by a progressive loss of renal function that often leads to end-stage renal disease (ESRD), high risk for cardiovascular disease, and high mortality. Diabetes mellitus is a growing epidemic and is the most common cause of chronic kidney disease (CKD) and kidney failure. Diabetic nephropathy affects approximately 20–40 % of individuals who have diabetes, making it one of the most common complications related to diabetes. Screening for diabetic nephropathy along with early intervention is fundamental to delaying its progression in conjunction with providing proper glycemic control. The kidneys play a vital role in the excretion of waste products and toxins such as urea, creatinine and uric acid, regulation of extracellular fluid volume, serum osmolality and electrolyte concentrations, as well as the production of hormones like erythropoietin and 1,25 dihydroxy vitamin D and renin. Material and Methods: This is a prospective and observational study was conducted in the Department of Biochemistry at Tertiary care Teaching Hospital over a period of 1 year. Either Gender aged between 18 and 70 years. The study participants were signed written informed consent before the start of data collection. The study participants were selected based on a convenient sampling technique and total of 120 study participants were included.  Subjects suffered from an acute infection and critically sick individuals were excluded from the study.  Results: There was a significant difference  between case when compared to  Control in Male and female.  There was a significant difference in case group in FBS, HbA1c, Urea and S. Creatinine when  compared to control group and no significant difference between both groups in SBP and DBP. Conclusion: The present study it can be inferred that serum urea and creatinine levels were significantly higher in CKD subjects then control subjects. Increased amount of urea and creatinine levels were seen only in CKD subjects and no difference was seen in controls. Thus, it can be recommend that urea and creatinine values can be used for screening of renal status in CKD subjects

Background: Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. Methods: This is a prospective, descriptive and observational study conducted at Department of Microbiology, Ayaan institute of medical sciences over a period of 1 year included 410 patients. Patients of either sex of any age who have been admitted inward and on antibiotic therapy were included. Outdoor patients were excluded in our study. Conducted from various clinical Departments such as Medicine wards, Surgical wards, Paediatric wards and Orthopaedics wards. All data was be documented and reviewed periodically. Any deviations from the agreed criteria were communicated, discussed, and documented. Results: On the basis of gender, frequency of Male patients were recorded little bit higher (62.6%) than female (37.4%). So, the hospital attendance rate of this study was male predominant. Majority of subjects belonged to 21-40 years (32.1%) followed by 1-20 years (29.5%) of age range. When it is categorized according to ward, in Medicine ward was recorded 34.8%, and for Orthopaedics it was 20.0%, while 30.9% for surgery and 14.1% paediatrics wards. For this study, subjects were categorised in eighteen groups on the basis of their diagnosis. Out of which, majority of the population (20.50%) were found with diagnosis of carcinoma followed by orthopaedic diseases (19.90%), while least number of patients (0.9%) were diagnosed with ophthalmological as well as thyroid diseases. Beta lactam and Cephalosporin were found the most frequent used first antibiotic even after surgery. Even for the each wards, Beta lactam and Cephalosporin were recorded highly significant and most desirable choices among all the antibiotics. Conclusions: Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits

Background: The most frequent cause of morbidity among newborns is respiratory issues. That is the most frequent reason for admission to a NICU. In order to manage newborn distress and improve clinical outcomes, early detection of the aetiology of respiratory distress is crucial [3]. A combination of symptoms called respiratory distress results from illness processes that impair gas exchange. Objectives: To identify the etiological factors of respiratory distress in the early neonatal period and its immediate outcome. MATERIAL & METHODS: Study Design: Prospective Hospital based descriptive study. Study area: SNCU, Department of Pediatrics, Siddhartha Medical College, Vijayawada. Study Period: January 2020- December 2020. Study population: Full-term neonates with respiratory distress GA (≥37 weeks). Sample size: study consisted 207 study subjects. Sampling method: Simple random technique. Study tools and Data collection procedure: Full-term (gestational age 37 weeks and above) neonates (only inborn) admitted in SNCU Ward of Government Siddartha Medical College & Hospital, with respiratory distress, were consecutively recruited into this descriptive study after getting informed consent from the parents. The early neonatal period (full-term neonates admitted to the NICU with respiratory distress that started within 7 days of birth) was the focus of the study. Instances that were unfollowed were not included in the analysis. Results: Out of the 89 TTN cases, 47 were born early term & 42 were late-term, out of 33 birth asphyxia cases, 19 were born early term and 14 were born late-term, out of 19 CHD cases, 5 were born at early term and 14 were late-term, out of 22 sepsis cases 9 were early term and 13 were late-term, out of 7 surgical cases, 5 were born at early term and 2 were born late-term. 1 case of RDS was born late-term. Out of 2 cases due to other causes, 1 was early term and 1 was late-term. Thus TTN, surgical causes, and Birth asphyxia were common in the early term. CHD, MAS, and Sepsis were common in late term. CONCLUSION: From our study it can be concluded that the most prevalent reason for neonatal admission to the NICU was respiratory distress. TTN was the commonest cause of RD in term neonates, followed by Meconium aspiration, Perinatal asphyxia, Sepsis and pneumonia, and Congenital Heart Disease. Males are more likely than females to experience respiratory distress. Pneumonia are the most common causes of mortality

Introduction: Seizures are one of the most common medical problems affecting children, and epilepsy is the most common chronic neurological condition in children. Materials and Methods: This was a hospital based retrospective study carried out in the data retrieved from the records maintained in the Department of Pediatrics, Tertiary Care Teaching Hospital over a period of 1 year. Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course. Results: The male–female ratio was 0.8. Mean age was 5.4. The most common causes of seizures were acute symptomatic. Most frequent coexistent diagnosis was infectious diseases, and 53.3% had recurrent seizures. Medications were administered to 51.1% of the patients before admission. Seizures were focal in 21 (46.7%), generalized in 11 (24.4%) and 13 (28.9%) had status epilepticus. Intravenous midazolam was first-line therapy in 48.9%. Acute symptomatic seizures were usually new-onset, and duration was shorter. Epileptic seizures tended to be recurrent and were likely to progress to status epilepticus. However, type of seizures did not change severity of the disease. Also, laboratory test results, medications administered before admission, requirement and duration of ventilation, mortality and length of stay were not significant between epileptic/acute symptomatic patients. Conclusion: Seizures in critically ill children, which may evolve into status epilepticus, is an important condition that requires attention regardless of cause. Intensified educational programs for PICU physicians and international guidelines are necessary for a more efficient approach to children with seizures

Introduction Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms such as cough, wheeze, and shortness of breath and chest tightness. It can be difficult to coordinate breathing using an inhaler, especially for children and during emergency situations. The assessment of asthma control has become pivotal in the management of asthma. However, several surveys in developed nations have shown that the majority of patients with asthma do not enjoy adequate asthma control. This is not because asthma control is unrealistic and not achievable; the multicentre, multinational study of asthma management, the Gaining Optimal Asthma control (GOAL) study, has shown that well-controlled asthma is achievable in the majority of patients.  Materials and Methods: This is a descriptive and cross-sectional study to assess the levels of asthma control among adult patients attending Tertiary Care Teaching Center. The study used those (physician-diagnosed asthma patients) participants who volunteered. There is a causality department where patients presenting with acute asthma attack are managed. Complicated cases of asthma including status asthmaticus are managed in the high dependency unit. Results: Prevalence of bronchial asthma in adolescents was 13.1% (n = 110) of which 10.2% had episodes in the past 1 year. Prevalence was higher among males (6.23%) compared to females (3.94%). About 79.1% of total asthmatics were newly diagnosed cases. Prevalence was significantly higher among those having pets at home (P < 0.001), belonging to higher socioeconomic status (P = 0.021), using smoke producing fuel at home (firewood/cow dung/kerosene; P = 0.021), and with history of smoking among family members (P = 0.027). Among current asthmatics, 71.8% reported cold/rhinitis (51.3% in March–May duration), 59.1% nocturnal dry cough, 48.2% sleep disturbances, and 42.7% speech disturbances in the past 1 year. Discussion: In our study we found, there is significant increase in weight, BSA, BMI, where as significant decrease in DBP of diabetic group compared to Non-Diabetics & there is significant increase in FBS, HbA1C levels of Diabetic group significant decrease in LH levels of Diabetics compared to Non-Diabetics. However T3 levels of Diabetic and Non-Diabetic group were almost same, where as T4, Oestradiol and progesterone levels of diabetic group non-significantly increased and FSH and TSH levels non-significantly decreased in Diabetics. There is frequent co-existence of thyroid dysfunction and diabetes mellitus among post menopausal diabetic women. Conclusion: We estimated the global prevalence of ACO based on population-based studies and found that 2.0% of the general population is affected. However, the prevalence of ACO depends on its diagnostic criteria. Therefore, there is a vital need to better define the ACO diagnostic criteria, management and treatment. It is worth noting that the limitations of the present study include lack of studies in some region of the world and small number of studies included in the subgroup analyses

Background: Preeclampsia is a multi-system disorder of pregnancy that manifests after 20 weeks of pregnancy in previously normotensive women. It is characterised by new-onset hypertension (systolic and diastolic blood pressure of 140 and 90 mm Hg, respectively, on two occasions, at least 6 hours apart) and proteinuria (protein excretion of 300 mg in a 24 hr urine collection, or a dipstick of ≥ 2+). AIM: To evaluate the utility of placental laterality and uterine artery doppler in the prediction of preeclampsia. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Radio diagnosis, Anil Neerukonda Hospital.  Study Period: 1st January 2020 to June 2021. Study population: All Antenatal cases referred to the department of Radio-Diagnosis for clinically suspected Pre-eclampsia.  Sample size: study consisted of 86 subjects.  Sampling method: Simple random technique. EQUIPMENT: The study will be performed using Philips AFFINITY 50G ultrasound machine using a 3-7C curvilinear probe. SCANNING TECHNIQUE: A written informed consent was taken before performing the scan. The scan was performed with patient in supine position and moderately distended bladder. Data Collection: Basic demographic details, clinical data obtained from study subjects were recorded in a pre-designed proforma. Location of the placenta and uterine artery doppler velocimetry was performed by using convex probe. During the first and second trimesters of pregnancy, ultrasound was used to identify uterine arteries on each side of the uterocervical junction. In third trimester it was seen at the crossover of external iliac vessels. Sample box was 2mm. Insonation angle was less than 60 degrees. Angle dependent Doppler indices are obtained during each examination. Results: In our study 63 (74%) subjects had central placenta and 23(26%) subjects had laterally located placenta. Fourteen of the 86 patients developed preeclampsia; eight (57%) had unilaterally located placentas while only six had centrally located placentas. According to our study, 8 (34%) out of 23 women bearing lateral placentas alone developed preeclampsia whereas 6 (85%) out of 7 women bearing lateral placentas with Doppler abnormalities developed preeclampsia. Conclusion: A lateral placenta puts a pregnant woman at significant risk of developing preeclampsia. In lateral placentas co-occurring with uterine artery Doppler abnormalities, preeclampsia risk significantly increases as compared to those of lateral placentas alone

Background: COVID 19 positive pregnantwomen form a very vulnerable group.  It adversely affects their physical and psychological health. These women are likely to develop new health problems or aggravation of existing problems during pregnancy and in the post-partum period. Materials and Methods: This was a prospective observational study of 100 consecutive Covid positive pregnant women who were admitted in the isolation wards of Government Medical College, Thrissur and delivered during the study period from 1st may 2021. These women were followed up till 6 months postpartum. Data was collected from recordsand bypersonal interview or telephonic call using astructuredquestionnaire. Demographic profile, Covid symptoms and their severity, obstetric details, breast feeding practices, neonatal outcomes and post Covid symptoms were studied. The association between breastfeeding, hygiene practices and neonatal positivity was also looked into/. Results: 51% of Covid positive pregnant women were asymptomatic. Nine women had severe Covid pneumonia with 2 of them requiring ventilatory support. There were no cases of vertical transmission or transmission through breastfeeding among the newborns studied. There was a strong association between strict adherence to hygienic practices and neonatal positivity. 24% of women had persistent symptoms at 6 months postpartum. Post exertion malaise was most commonly observed. Conclusion: Women with COVID-19 infection during pregnancy may continue to have health problems and hence need a close follow up

Introduction: Blood is essential part of life saving treatment options in medical sciences. Various blood group systems have been identified till now but different human populations express to have different frequencies of blood types. The prevalence of blood groups differs distinctly in different parts and groups of populations around the globe.The information about distribution of blood groups in an area is of great value for better inventory management. Aim and Objective:To determinethe prevalence of ABO-Rh(D) blood types in apparently healthy population in Kota (Hadoti region). Material and Method: This blood centre based cross sectional study was carried out during the period of one year, i.e., from 1st January, 2021 to 31st December, 2021.During that period,5,657 blood donors donated whole blood at our blood centre and among the outdoor camps. ABO and Rh (D) typing was done by saline agglutination method done manually using commercially prepared antisera (for forward/cell grouping) and in house prepared reagent cells (for reverse/serum grouping).Descriptive analysisof sex and blood groups was done by using Microsoft Office Excel 2007. Results: Male donors 97.83% were more than female donors2.17%with M:F ratio being 45:1. 4.68% were detected to be having Rh (D) negative blood group while 95.32% were Rh (D) positive. Distribution of ABO-Rh(D) blood typesamong was found to be B+(36.70%)>O+(30.63%)>A+(19.32%)>AB+ (8.66%) > B- (1.75%) >O- (1.61%) > A-(0.92%) > AB-(0.41%). Conclusion: Present study concludes B+ being the most common blood group and Rh (D) negativity being 4.68% in the Hadoti region of Rajasthan. We recommend multicentricstudies with larger sample size to be conducted and comparative analysis to be done to more precisely understand the distribution pattern of blood groups in this region

Background: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behaviorBackground: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behavior

The Nottingham prognostic index (NPI) is a tool that takes into account the histological features of the tumor, which helps in the prediction of outcomes and supports clinical decision making while managing breast cancer patients. Hormonal receptors particularly estrogen, progesterone and HER2NEU receptors are present in the tumor tissue, considered as an important advancement in the evaluation of breast cancer. Objective: To calculate Nottingham Prognostic Index in newly diagnosed patients of breast carcinoma and to compare prognostic efficacy of molecular markers ER, PR, HER2NEU expression with Nottingham prognostic index. Material and Methods: A total 125 diagnosed cases of breast cancer were enrolled. Nottingham Prognostic Index was calculated from the histopathology report and molecular markers. Prognostic efficacy of molecular markers was compared with Nottingham prognostic index. Results:  After statistical analysis, ER expression was positive in 66 (53%) patients, PR expression in 55 (44%) patients and HER-2-neu expression was positive in 22 (18%) cases. Mean Nottingham Prognostic Index was found to be 4.99±1.23 SD. Molecular Markers were found to have an excellent prognosis in majority of group and Nottingham Prognostic Index show majority group has moderate prognosis value. No significant difference was observed between the Nottingham Prognostic Index and molecular markers receptors cases (p>0.05). Conclusion: The Nottingham Prognostic index is a better tool for prognosis determination than Immunohistochemistry markers in diagnosed cases of carcinoma breast

Background: The most significant cause of infant fatalities in the neighborhood is neonatal sepsis. Objective: To identify the typical bacterial infections linked to neonatal sepsis, as well as their pattern of antibiotic sensitivity. Materials and Methods: A total of 100 newborns admitted to the neonatology unit during the study period had their physical examinations and clinical characteristics. All infants were observed using conventional methods and the Kirby-Bauer disc diffusion method. Samples were also tested for standard antibiotic sensitivity.  Results: The present study showed that out of 100 clinically suspected neonatal sepsis cases. 44% newborn sepsis patients with clinical suspicion and positive screening test results were confirmed by culture. The majority pathogen in the culture-positive cases was discovered to be Gram Negative 66% (n= 29); among them 62.06% (n=18) belonged to EONS and 37.93% (n=11) belonged to LONS. Klebsiella pneumoniae 46.15 % (n=12) was the most common isolate followed by Escherichia coli  23.06 %(n=6) whereas 34 % (n=15) were Gram Positive isolates. Out of 15 Gram-Positive isolates, 53.33% (n=8) were of EONS and 46.7 % (n=7) were of LONS. Staphylococcus aureus 19.23% (n=5) was the most common isolate followed by CoNS 7.69 %(n=2) and Enterococcus faecalis 3.85% (n=1).  Conclusion: The timely diagnosis and prompt use of antibiotics according to standard policy is warranted to save newborns from septicemia. Knowing the bacterial infections that are widespread in NICUs and their antimicrobial susceptibility pattern can assist the doctor choose the right drugs for treating cases of suspected newborn sepsis in light of the developing bacterial resistance to commonly used antibiotics

Background: Major cause of death/Adult fungal meningitis in HIV/AIDS patients is Cryptococcus neoformans. Fungal meningitis precedes serum/plasma cryptococcal antigen (CrAg) by several weeks. Cryptococcal Antigen (CrAg) screening and presumptive treatment can prevent fungal meningitis in HIV/AIDS patients significantly. Method: The descriptive cross-sectional study included 100 ART Naive patients ( 65  males &35   females) from both ART clinic and Medicine Indoor. Serum/CSF cryptococcal positivity detected by Latex agglutination test (Pastorex TM Cryptoplus, BIO-RAD,France) and  Lateral flow assay by IMMY Kit(US FDA approved).  CD4 Counts were measured using flow cytometer (Becton-Dickinson FACS count flow cytometer) Result: Prevalence of CrAg positivity in our study is 7 %(7/100), out of which 4%(4/100) had features of meningitis. Comparison of Antigenemia with Demographic features like Age, Inpatients; Symptomatic groups were having statistically significant association (p value0.0≤5).  Low CD4 count (<50) is associated with more seropositivity 33.3 %(5/100). Clinical features like Headache,Vomiting,Fever were having statistically significant association  with cryptococcal Antigenemia. Conclusion: Prevalence of cryptococcal Antigenemia  is higher in ART Naive  HIV patients with lower CD4 count which needs urgent attention for screening and substitution of Antifungal treatment to reduce morbidity / mortality from cryptococcal meningitis

Background: The ability of sonography to depict the subtle changes in the myometrium and endometrium makes it the diagnostic modality of choice for evaluation of many uterine disorders. The transvaginal sonography (TVS) has a pivotal role for assessment of gynecological patients and the vaginosonographic examination allows visualization of phasic variation of endometrial thickness, endometrial infiltration in endometrial cancer. Aims and Objectives: Validation of ultrasonographic measurement of endometrial thickness (ET), histopathological study and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause. Materials and Methods: The current study was a prospective observational study carried out in the department of Obstetrics and Gynecology, MKCG Medical College; Berhampur; Odisha from November-2017 to October-2019 over 120 cases. Cases were selected according to following inclusion and exclusion criteria after informed consent. After selection cases were subjected for detailed history taking with special attention to oral contraceptive use, use of HRT, antihypertensive medications, history of diabetes followed by thorough clinical examinations and baseline investigations including hemogram, FBS, urine routine and microscopic, chest X-ray and Pap smear. Then all the cases were subjected for ultrasound examination for ET followed by endometrial biopsy. Results: Majority of 52 cases (43.33%) had menarche at age of 13-15 yrs, of them 44 cases (84.61%) had ET ≥ 4 mm, 41 cases (34.16%) had menarche at age of 16-18 yrs, of them 30 cases (73.17%) had ET ≥ 4 mm. Most of cases i.e. 41 cases (34.16%) were of P4, of them 38 cases (92.7%) had ET ≥ 4 mm followed by 36 cases (30%) were of P5, of them 22 cases (61.11%) had ET ≥ 4 mm, 17 cases (14.16%) were of P3, of them 15 cases (88.2%) had ET≥ 4 mm, 8 cases (6.66%) were of P2, of them 6 cases (75%) had ET≥4mm,4cases(3.33%)wereofP1, ofthem3cases(75%)hadET≥4mmand2cases (1.66%) were of P0, of them one case had ET ≥ 4 mm. Among the cases, 26 cases (21.66%) who give history of OCP use, of them 16 cases (61.53%) had ET ≥ 4 mm whereas 94 cases (78.33%) who had never used OCP, of them 78 cases (82.9%) had ET ≥ 4 mm . Among the 108 cases (90%) who never taken HRT, 84 cases (77.77%) had ET ≥ 4 mm whereas among the 12 cases (10%) who had taken HRT, 10 cases (83.33%) had ET ≥ 4 mm(p value is 0.94). Conclusion: Transvaginal ultrasound is a measurement tool, justify subsequent study of the relationship between endometrial thickness and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause in cases of postmenopausal bleeding.

Background:  Hypertension in pregnancy is a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or both. Both systolic and diastolic blood pressure raises are important in the identification of Pregnancy induced hypertension. Pregnancy induced hypertension (PIH) is hypertension that occurs after 20 weeks of gestation in women with previously normal blood pressure. The broad classification of pregnancy-induced hypertension during pregnancy is gestational hypertension (GE), pre-eclampsia and eclampsia. Serum uric acid and creatinine levels are a part of work up for the pregnant women with hypertension. The elevated levels of these parameters were due to decreased urinary clearance secondary to reduced Glomerular filtration Rate (GFR) and increased reabsorption. Materials and methods: The present study was carried out in the Department of Biochemistry, Dr VRK Womens Medical College, Teaching hospital and Research center. Total 70 patients of pregnancy were selected out of which 30 patients were of normal pregnancy and 40 patients were of pregnancy induced hypertension. Serum uric acid levels were estimated before delivery and after delivery in cases of pregnancy. Pregnant women with recurrent abortions, bad obstetric history, twins, preexisting medical disorders – such as diabetes mellitus, essential hypertension, renal disorders, cardiovascular, thyroid disorders, and liver disease – were excluded from the study. Results:  In our study, we observed a significantly elevated serum uric acid PIH (9.51 ± 1.33 mg/dl) and Normal pregnant women (5.29 ±0.8 mg/dl). Blood Urea was 5.29 ±0.8 mg/dl among Normal pregnant women and 9.51 ±1.33 mg/dl among PIH. Moreover, Serum Creatinine level was1.25±0.53 mg/dl among PIH and 0.97±0.23 mg/dl among Normal pregnant women. Conclusion: On the basis of study findings we, concluded that the increased levels of serum uric acid, serum creatinine and serum urea are better diagnostic and predictive marker for PIH and immediate medical attention required for PIH. With the help of these parameters most cases are detected early in the pregnancy before they can progress to eclampsia

Congenital birth abnormalities are a major factor in infants' poor health, which affects their likelihood of surviving. Even though these visual anomalies are rare, they have a substantial influence on people's quality of life.This study aimed to describe the clinical profile of congenital ocular anomalies with different epidemiological parameters in a tertiary health center in western Orissa. The study examined 3674 patients in the age group from 0 to 14 years who were admitted to the V.S.S. Medical College, Burla, Odisha and included 151 eyes from 99 cases of various types of congenital anomalies. A detailed history and other necessarydata were collected by trained ophthalmologists and descriptive analyses were carried out. The incidence of congenital ocular anomalies was 2.69%. Nasolacrimal duct anomalies (47 eyes) were the most common congenital ocular anomaly (31.1%); followed by congenital cataract (41 cases; 27.3%) and colobomy eye (18 cases; 11.9%). There was a slight male preponderance that accounted for 56.57% of all cases.The majority ofpatients were younger than 5 years (68%) and theincidence of congenital ocular anomalies was highest in the 0-5 year age group (68.69%). Single ocular involvement was observed in 47 cases (47.47%) while bilateral involvement was observed in 52 cases (52.53%). Consanguinity was identified in 13.13% of cases, with an increased risk of bilateral involvement (84.6% of cases). The most common symptom was ametropia (38.4%), followed by tearing (32.3%) and a white pupillary reflex (14.1%). A total of 60 eyes (39.7%) required surgery. Congenital ocular anomalies are a common cause of ocular morbidity, accounting for 2.7% of all cases in the pediatric age group. Early diagnosis, referral, and appropriate intervention would help prevent most permanent sequelae in congenital ocular abnormalities

Objectives: Sigma metrics is a emerging tool in internal quality assurance and it helps in determining accuracy and precision. It is not new to quality assurancebut its applicability in hematology laboratory is still in its developing stages. The study aimed to theutility of sigma metrics as an additional toolin the Haematology laboratory against the current quality tools of Internal Quality assurance. Methods: In the present study, IQC data was analysed from January 2022 to November 2022. Control material included second-party controls. Sigma was calculated for five key haematological parameters run in HORIBA PENTRA ES60. Sigma metrics were calculated using the formula Sigma = (TEa – Bias) / CV(coefficient of variation) .TEa(Total allowable error) was taken from CLIA(Clinical Laboratory Improvement Amendments) haematology guidelines. Bias was calculated using the formula Bias = [(ourlaboratorymean–target mean)/targetmean] ×100. Results: Average sigma metrics achieved for parameters were, RBC: 3.95, HB: 7.06, HCT 3.67, PLT: 5.42, and WBC: 7.1. The laboratory has achieved marginal to world-class performance in all analytes. Conclusion: Labs must use six sigma to design their IQC protocols, for individual parameters. This would help to achieve better quality in the haematology laboratory.

The purpose of the current study is to evaluate the impact of low dose isotretinoin therapy on the changes of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol in acne vulgaris patients. Methodology: Fifty patients with moderate to severe acne who were attending the dermatology department and were between the ages of 15 and 45 were treated with 20 mg of isotretinoin every day for four months. Blood samples were taken on day 0, the second week, the first, second, third, and fourth months. Results: The measured baseline cholesterol levels in the continuous therapy group were 116.86 ± 23.55, and they grew above the baseline levels at each subsequent interval of 4 weeks, 8 weeks, 12 weeks, 16 weeks, and at the end of the treatment. The P-value is significant when compared to the baseline. At all time points, compared to baseline and above the normal limit, there was a statistically significant increase in cholesterol, triglycerides, and LDL. There was also a statistically significant decline in HDL levels. Conclusion: Increase in cholesterol, triglycerides, and LDL over the usual range was brought on by low dosage continuous isotretinoin therapy. HDL values fluctuate with grade 1 (increase and decrease). Mild, well-tolerated side effects did not need therapy discontinuation. So it's crucial to raise awareness of the implications. We tell our expert that using low dose isotretinoin for moderate to severe acne can be done with little worry, although close monitoring is crucial

Introduction: Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. Materials and methods: This is a prospective study was conducted in the Department of Radiology at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre Hyderabad, among 70 cases of acute pancreatitis. All the cases of acute pancreatitis referred under department of radiology in a tertiary healthcare institute, and fulfil the set inclusion criteria, who consented to participate in the study were included in the present study. It was carried out among 46 indoor cases of acute pancreatitis referred under department of radiology for further diagnostic evaluation, in a tertiary healthcare teaching institute in Maharashtra during study period. Ethical Approval was taken from the college ethics committee. Result: In our study, a total 70 patients were studied using CT scan, who was suspected to have acute pancreatitis. Among them, 50 (71.5%) were males and 20 (28.5) were females. Necrosis of the pancreatic gland parenchyma was seen in 17 (24.3%) patients. 12 patients (17.1%) showed <30% necrosis. 8 patients (11.4%) showed 30-50% necrosis, and 10 patients (14.3%) showed more than 50% necrosis. Conclusion: In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It could also predict the need for interventional procedures

Face, limb, and oral abnormalities are hallmarks of Papillon-Léage-Psaume Syndrome. It is inherited in a prenatally lethal manner that is X linked dominant (XLD). We reported a case of 13-year-old male who was prima facie diagnosed with aforementioned syndrome .Early diagnosis from an odontogenic perspective can lessen the physical and dental abnormalities that may develop as a result of this condition, so it deserves the attention of paediatric dentists

Allergic diseases are developed through complex interaction between exposure to environmental substances and genetic susceptibility. The prevalence of allergic diseases has increased during last decade globally. The present cross sectional study was designed to evaluate the skin prick test reactivity in children with allergic diseases. A total of 400 children between age group 1-12 years were recruited. The Skin prick tests (SPT) using 14 standardized allergen extracts were conducted in the volar surface of forearm. Majority children had asthma (52.5%), followed by atopic dermatitis (22.75%) and allergic rhinitis (15.75%). Food habits triggering allergic conditions in 76% children, environmental factors in 4.75% children, pets in 8.25% and indoor conditions in 11% children. Skin prick test was positive to egg (13.5%), milk (22%), wheat (9.75%), apple (4.5%), cereals (6.5%), cat (18%), dog (6%), blatella (9.5%), aspergillus fumigatus (9.5%), fungi (12.75%), Dermatophytes farina (24.75%), Dermatophytes pteromyssinus (23.75%), Blomia tropicalis (9.5%) and Bermuda grass (13.75%). Determination of allergen sensitization patterns in children with atopic disease is crucial for selecting proper preventive and therapeutic strategies which helps to improve quality of life of in children

Background: Hypertension is a chronic illness associated with high morbidity and mortality. Once hypertension is diagnosed, starting antihypertensive therapy on a long-term basis along with regular follow up is important. Drug utilization research also provides insight into the efficiency of drug use, i.e. whether a certain drug therapy provides value for money and the results of such research can be used to help to set priorities for the rational allocation of health care budgets. The main objective of the study is to assess the utilization pattern of antihypertensive in a tertiary care hospital. Materials and methods: This prospective, cross‑sectional observational study was conducted in the Department of Pharmacology, Dr. VRK Women's Medical College, Aziznagar, Moinabad. Before initiation of the study, the approval of the Institutional Ethics Committee was obtained. A predesigned pretested schedule was employed to collect the data. The schedule contained information pertaining to basic demographic variables, comorbid conditions, and a format to assess the antihypertensive drugs prescribed. Patients coming to the medicine outpatient department were screened over a 4‑month period. Among all the prescriptions that were screened, prescriptions that had antihypertensive medication as a component were noted along with the hospital number. Results: A Total of 90 patients with history of hypertension were included. In the present study majority of patients i.e., 55.6% (50/90) were among 51-60 years, followed by 24.4% (22/90) patients among 41-50 years, 11.1% (10/90) were 61-70 years.5.6% among 30-40 years, 2.2% were among 71-80 years, least were more than 81 years i.e., 1.1%. The patients were categorized depending on the stages of the hypertension- 10 /90 (11.1%) patients belonged to prehypertension stage, 60/90 patients (66.7%) belonged to stage 1 hypertension and 20/90 (22.2%) patients belonged to stage 2 hypertension. Conclusion: In this study usage of anti-hypertensive drugs were prescribed rationally in tertiary care hospital. The study emphasizes that need for effective continuing medical education and also preventive measures in hypertensive individuals

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

Background: -Brain abscess is defined as a focal infection within the brain parenchyma which starts as a localised area of cerebritis which is subsequently converted into a collection of pus within a well vascularised capsule.Intracranial abscesses are life-threatening infection that pose a diagnostic challenge not only to the neurosurgeon but also to the microbiologists. Detailed studies documenting the spectrum of infecting agents involved in brain abscesses are limited from India. Case report: -A 17-year-oldboy presented to Trauma and emergency Department AIIMS Raipur in a drowsy state with complaints of severe headache and right sided ear discharge for 15 days,fever on and off and weakness over all limbs for 1 day.Patient had a history of chronic suppurative otitis media (CSOM) of right ear discharge without any evidence of recent trauma or neurological procedure.Contrast enhanced CT brain showed cerebellar abscess with compressed fourth ventricle. Patient underwent emergency craniotomy, drainage of abscess and extra ventricular drain. Pus sample on gram stain showed gram positive cocci in chains and pairs and few gram-negative bacilli.Aerobic bacterial culture revealed pinpoint beta-haemolyticcolonies along with few translucentnonhaemolytic colonies which failed to grow in MacConkey agar.The two isolates were identified asStreptococcus constellates and.Spingobacterium multivorumby VITEK II system.Antibiotic susceptibility pattern was performed by Kirby Bauer Disk diffusion and VITEK II system compact automated ID/ AST system.Initial empirical antibiotics were replaced withIV vancomycin as both the organisms were found sensitive to it. Patient responded with improved Glasgow comma Score and gradual resolution of abscess size which was evident on successive postoperative CECT Scan findings. Conclusion: Streptococcus constellatus and Spingobacterium multivorumboth are ubiquitous.Haematogenous spread from ear could have resulted in brain abscess.Appropriate sampling and use of automated instruments may increase isolation of new and unusualpathogensand result in early and appropriate management of brain abscess

Introduction: Cataract affects nearly 9–12 million Indians annually after the age of 50 years. and, this exceeds glaucoma, macular degeneration, and diabetic retinopathy numbers combined. Cataract surgery is the most frequently performed surgery in India, with a success rate of nearly 98% and excellent visual rehabilitation. More than a million intraocular lenses (IOL) are implanted every year. Aims: A Comparative analysis of Recent Generation intraocular lens power calculation formulae to achieve emmetropia following Cataract surgery by phacoemulsification. Materials and methods: The present study was a prospective comparative study. This Study was conducted from October 2022 – February 2023 at Department of Ophthalmology, Venkateshwara Institute of Medical Sciences, Amroha (U.P). 120 patients were included in this study. Result: In our study for small eyes (< 20mm) Haigis group, the mean residual spherical refractive error was 0.68 ± 0.26 and in Holladay group, the mean residual refractive error was 0.83 ± 0.14 which was statistically significant (p=0.0008). In our study for normal eyes of Axial Length 20 to 24mm of in Haigis group the mean residual spherical refraction of the patients was -0.36 ± 0.80 and in Holladay group, the mean residual spherical refraction of the patients was 0.31 ± .63 which was statistically significant (p<0.0001).  In our study for long eyes > 24mm of Axial length, In Haigis group the mean residual refractive error of large eye was -0.50 ± 0.00 and in Holladay group the mean residual error in large eye was 0.12 ± 0.64 which was not statistically significant (p=0.1189). Conclusion: we concluded that, prospective analysis of results showed that Comparing all four IOL formula we had found that in SMALL eyes, NORMAL eyes as well as in LARGE eyes The HOLLADAY IOL formula is having better result followed by HAIGIS

Introduction: The current feasibility study is to be analysed for the possibility of establishing a podiatry unit in PMR hospital Hyderabad. This study focuses on the better performance  in means to facilitate the service to the diabetic foot patients. This study is performed with the way of framing close ended questionnaires stating the goal of the study.  Aims: Study also aims to gather opinion of health care staff and patients about need for podiatry services.  Materials and methods: The data gathered with questionnaire is from various participants of sample size approximately 100. Qualitative and quantitative form of analysis are being used in this study. Qualitative analysis is used for purposive sampling and quantitative analysis is used for convenience sampling.  Results: There is statistical significance impact of opinion of patients in the overall experience on foot ulcer treatment towards the overall ease of podiatric equipment availability for the patients for the treatment. Overall experience in management varies high then there is a variation occurring in the other two variables, the seeking support and the availability of podiatry equipment’s.  The significance value in the above regression test, explains about the significance correlation among those variables the preparedness of patients to acquire surgery from same tertiary care centre and overall experience of the patients in management for foot ulcers. Nearly 37% of probability of predictor variable is prevailing to have specific relation on the dependent variable Ease of availability of Prescribed podiatry equipment including removable cast walkers and dressings. Conclusion: The podiatry consists of delivery of services associated to the issues in foot health. The prominent challenge to provide the podiatry-services seems complex and it necessitates on-going variation of role flexibility, knowledge, skills and working practices

Aim & Objectives of the study: The aim of this present study is to compare between laparoscopic and open hernioplasty in noncomplicated ventral hernia regarding operative data, postoperative pain and recurrence rate, intra and postoperative complications, and return to normal activity Materials And Methods Source of data: Patients admitted with ventral hernia during January 2021 to October 2022 at Rama Medical College and Research Institute, Hapur were taken up for study with the help of relevant history, clinical examination and appropriate investigations. Study design: Prospective Study Data Collection: Clinical features, symptomatology, investigations, operative findings, post operative wound complications, and length of hospital stay were analysed using the performa. Conclusion: No one technique is the “best” procedure for all patients. Knowledge of the wide variety of surgical options will be of benefit to all patients. In our study the laparoscopic approach appears to be as effective as open repairs in the treatment of ventral hernias. Advanced surgical skill, laparoscopic experience and high technology are the major factors for successful ventral hernia repair

Silicosis is an occupational hazard for those working in mines & in construction works. These patients are exposed to long term complications and chronic morbidity. In patients with silicosis, the involvement of pleura in the form of pneumothorax is uncommon. In our study, we have made an attempt to study the risk factors, pathophysiology & clinical profile of patients with silicosis presenting with pneumothorax,its treatment outsome and recurrence rate of pneumothorax . Silicosis has no definitive treatment. An awareness of safety & preventive measures to reduce the incidence of the disease, morbidity & mortality are needed to improve the health of people working in such places

Introduction: One of the most frequent causes of acute abdomen in nearly all age groups is acute appendicitis and emergency appendectomy is one of the most common surgeries being performed worldwide.This classic presentation occurs in only 50%– 60% of patients and the diagnosis may be missed or delayed when atypical patterns of disease are encountered.Material and Methods. This study was conducted study at Government Medical College Srinagar J&K India over a period of 2 years.117 patients above the age of 14 years who underwent emergency appendectomy for suspected acute appendicitis were enrolled as study subjects. This study aims to study the diagnostic accuracy of ultrasonography, total leucocyte count and neutrophil percentage in diagnosing acute appendicitis. Results Ultrasonography, Neutrophil Percentage andLeucocyte count had a sensitivity of 81%, 74% and 70% respectively for acute appendicitis.  Sensitivity decreased (53%) when raised TLC, NP and USG were used together to predict appendicitis but specificity increased markedly (94.1%) pointing to the fact appendicitis was highly unlikely if all these tests were simultaneously negative.Conclusion.The results showed that normal blood parameters (total leucocyte count and neutrophil percentage) along with normal ultrasonography have a high combined diagnostic accuracy for acute appendicitis

Background: Despite advances in diagnosis, management and critical care of patients with peritonitis due to hollow viscus perforation, prognosis remains poor. Early assessment by scoring systems will influence the management and prognosis. Aim: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the outcome in patients with peritonitis. Materials and Methods: Prospective study of 60 patients admitted and operated for peritonitis in. The structured scoring system i.e. MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. Data was analysed for predicting mortality and morbidity using EPI info and SPSS software. Results: The overall mortality was20%. MPI scores of <21, 21-29, and ≥ 30 had a mortality of 6.67%, 13.4%, and 0% respectively. In our study ACCURACY of  Mannheim peritonitis index (MPI) to grade the severity of acute peritonitis is 72.9%, SENSITIVITY is16.7%, SPECIFICITY is 79.2% Conclusion: MPI is disease specific, easy scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice

Background: High grade fever (103-106°F), headaches, backaches, sharp painful joints, pain behind the eyes, nausea, vomiting, and a generalized erythematous rash are among the common symptoms of dengue. The febrile, critical, and recovery stages can be used to describe the disease's clinical course. WHO published a recommendation in November 2009 that categorizes symptomatic patients as severe dengue or dengue (with or without warning signs). Method: The present study was conducted under the Department of General Medicine, Rajshree Medical Research Institute, Bareilli. It was a Prospective cohort study conducted between February 2021 to July  2022. Study population comprised of those admitted in IPD in RMRI of 18-59 years of age, having fever more than 38.5oC with NS1 antigen positive or IgM dengue positive or both.  Result : Out of 90 patients, studied that Vomiting are present in 51(56.7%) patients whereas 43.3% subjects do not had vomiting. Out of 90 patients, studied 54.4% study subjects had headache whereas it is absent in 45.6% patients. Out of 90 patients, studied that URI are present in 12(13.3%) patients.86.7% study subjects do not had URI. Abdominal pain are present in 8(8.9%) patients.,91.1% study subjects do not had abdominal pain.  Conclusion: In this study, dengue infection affected a large portion of the young population and was more prevalent in men than in women. The bulk of the patients had fever. In addition to the typical headache, body aching, and fatigue, many patients also presented with gastrointestinal and respiratory symptoms such stomach discomfort, nausea, vomiting, diarrhea, and dry cough

Background: To treat coronary artery disease, PCI is a well-established method. Its efficacy in treating symptoms is widely known. In patients with baseline intact left ventricular function, the impact of PCI on systolic and diastolic function is uncertain. We postulated that individuals with chronic stable angina may have impaired regional contractile performance and that PCI would have the potential to enhance ventricular systolic and diastolic function following successful coronary angioplasty. Methods: The diagnosis of CSA was made based on the history of exertional substernal chest discomfort suggestive of typical angina, physical examination, ECG changes, and 2D Echo features. Coronary angiography was performed after taking consent and PCI was performed based on the results of coronary angiography if deemed appropriate based on the existing guidelines. Patients with a SYNTAX score >22 on CAG were referred to undergo CABG. All patients were kept under follow-up and assessed for symptomatic improvement of chest pain and echocardiography along with tissue Doppler analysis was performed on day 1 and 6 weeks after PCI. Results: In this study, overall there is an insignificant improvement in trans-mitral E wave velocity compared to baseline value and 6 weeks after PCI with a p-value of 0.8. Trans-tricuspid E wave velocity also showed an insignificant (p=0.5) improvement 6 weeks after PCI. Trans mitral and trans-tricuspid late diastolic filling velocities also showed an insignificant improvement 6 weeks after PCI with a p-value of 0.4 and 0.6 respectively. Deceleration times of the E waves across mitral and tricuspid valves did not improve significantly after PCI. Conclusion: The study showed conventional echocardiographic parameters of mitral and tricuspid diastolic flow patterns failed to show significantly, the impact of PCI on myocardial function. Tissue Doppler parameters of myocardial systolic and diastolic function across the mitral and tricuspid valves were able to show a significant improvement in myocardial function soon after PCI and this persisted till 6 weeks after PCI

Omicron, a new variant of Covid-19 has hit the India in the third wave during 2022. The outbreak of this new variant has increased globally. At this time, there is an urgent need of fast, reliable and effective detection method. The real time RT-PCR is the most used technique for the detection of viral DNA. In the present study ‘OmiSure’ kit developed by Mumbai-based Tata Medical and Diagnostics Ltd (TATA MD) in partnership with The Indian Council of Medical Research (ICMR) was used for direct detection of Omicron variant in the SARS-CoV-2 positive samples via multiplex real time RT-PCR as a diagnostic tool. The reaction was tested targeting viral RNA and human target mRNA sequence using S gene target failure and S- gene mutation amplification strategy. In the present study 532 samples were tested for the presence of Omicronin the SARS-CoV-2 positive samples. The study found that a total of 501 individuals were positive for Omicron variant while 31 individuals were detected to be of other variants. Further these 31 SARS-CoV-2 positive samples were processed by nanopore whole genome sequencing and identified as Delta and its sub variants of SARS-CoV-2. These sequences were submitted in Indian SARS-CoV-2 Genomic Consortium (INSACOG) and Global Initiative on Sharing Avian Influenza Data (GISAID). The study showed that OmiSure kit is an accurate, fast and easy to use rRT-PCR Omicron diagnostic assay

Introduction: Diabetes mellitus a group of metabolic disorder leading to chronic hyperglycemia. The most common symptoms are polyuria, Polydipsia and polyphagia. There are different classes of antidiabetic drugs that can be prescribed in T2DM. the main aim is to study is to observe the suitable antidiabetic drug for the treatment of T2DM. Aim:  The aim is to study the prescription pattern, comorbidities and complications in type 2 diabetes mellitus in tertiary care hospital. Material and methods: Patients under inclusion criteria was selected for the study. A total of 100 T2DM patients were selected for the study. the patients were divided into two groups, group A – newly diagnosed T2DM and group B – Already diagnosed T2DM. the information was taken from the based on risk factors, ranges of HbA1c, FBS & PPBS, BMI, Duration of diabetes and comorbidities. Results: The study was conducted on 100 T2DM patients. the majority of the patient were male with a age group of 51 – 60 years. In group A patients majority of the patients were prescribe with metformin as monodrug therapy and in group A & B, metformin + glimepride as combination therapy. As per our study most of the patients having hypertension, smokers, and overweight respectively. Conclusion: Metformin and combination of metformin with glimepiride are most commonly prescribed drugs in treatment of type 2 diabetes mellitus

Background: To assess antimicrobial sensitivity profile of ESBL producing E. coli isolates from various clinical samples. Methodology: Seventy- Eight E. coli isolates recovered from samples including pus, urine, blood, cerebrospinal fluid (CSF), stool, sputum, and different body fluids from inpatient and outpatient department received in the bacteriology laboratory in the department of microbiology were selected. ESBL screening and confirmation along with antimicrobial susceptibility test was done by Kirby–Bauer disk diffusion method according to the Clinical Laboratory Standards Institute (CLSI) guidelines. Results: Out of 48 inpatients samples of E. coli, 11 were found in pus, 20 in urine, 10 in blood, 4 in stool and 3 in sputum. Out of 30 outpatient samples, 7 were found in pus, 13 in urine, 5 in blood, 3 in stool and 2 in sputum. The difference was significant (P< 0.05). Antimicrobial susceptibility pattern of E. coli in pus, urine and blood against Ampicillin was 34%, 27% and 35%. Against Piperacillin was 43%, 42% and 60%. Against Piperacillin/Tazobactam was 91%, 85% and 82.4%. Against Amoxicillin/Clavulanic acid was 82%, 70% and 72%. Against Cefoperazone/Sulbactam was 80%, 78% and 84%. Against Cefoperazone was 32%, 27% and 54%. Against Cefoxitin was 27%, 35% and 32%. Against Ceftriaxone was 26%, 25% and 31%. Against Aztreonam was 37% , 23% and 20%. Against Imipenem was 100%, 100% and 100%. Against Gentamicin was 76%, 49% and 66%. Against Amikacin was 81%, 62% and 45%. Against Ciprofloxacin was 55%, 52% and 48%. Against Ofloxacin was 52%, 56% and 53% respectively. There was 62% ESBL producer in inpatients and 47% outpatient samples. There was 38% non-ESBL producers in inpatient and 53% outpatient samples. A significant difference was observed (P< 0.05). There was significant difference in antimicrobial susceptibility pattern of ESBL producing E. coli in urine and blood against various antibiotics (P< 0.05). Conclusion: There was high prevalence of ESBL against inpatient and outpatient samples obtained from blood, pus and urine

Although there are innumerable studies on vitamin D deficiency in India, there is limited data in Mizoram. Keeping this in view the aim of our study is to find out the deficiency of Vitamin D in our region, Mizoram (NE India). Our study population included patients attending Genesis Laboratory, Aizawl, Mizoram (November 2021 – November 2022) for various ailments who were advised serum Vitamin D level estimation. The study population was grouped according to gender and age in decades. Blood was collected in plain vials and serum obtained was used for vitamin D estimation. Out of 480 patients, 180 were male and 300 were female. Age of the study population ranged from 11 – 79 years. 17% of the total study population had normal values, 62.7% was vitamin D Deficient and 20.3 % showed Vitamin D insufficiency. The prevalence of Vitamin D Deficiency was high in all age groups, there were a higher percentage of females in the vitamin D insufficient and deficient groups. Maximum numbers of patients with vitamin D deficiency were in the age group of 60-69 years with a female predominance. Prevalence of Vitamin D deficiency is very high in our region that is in Mizoram, as is reflected from our study. This pattern is seen in other parts of our country too. Also, the deficiency is high in the age groups N – N years and females outnumbered male

Introduction: Peptic ulcer disease is a disease of gastric and duodenal ulcers. This ulcer is a major threat worldwide over the past two centuries with a high morbidity and mortality. There are also some studies suggested that there is a complications that is seen after post operative peptic ulcer. Objective: To study postoperative complication in peptic ulcer disease patients in tertiary care hospital. Material:  A prospective study conducted on 180 post operative peptic ulcer patients. This study was conducted in department of surgery and patient ready to give inform consent form. This study was carried out after taking approval from institute ethical committee permission. Results: The present study was carried out on 186 pre operative peptic ulcer patients among them majority of the patients were males with a age group under 41 to 50 years. Out of 186 patients, 45.16% patients having ulcers among them multiples ulcer was observed in 61.90% .symptoms such as epigastric pain (90.32%) and gastritis (74.19%) was observed in most of the patients. 83.33% not taken any  drugs 16.66% has taken drugs like NSAIDs taken by 74.19%. surgery 34.40% having no complication and 65.59% having complications, majority of the patients having surgical site infection (26.22%) followed by pleural effusion and diarrhea respectively. Conclusion: Mostly this peptic ulcer is seen in employs and students, patients taking NSAIDs, mostly seen in diabetes patients, symptoms like epigastric pain and post-operative complication like infection at the surgical site is mostly seen

Objective: The primary goal of the intraoperative Frozen Section biopsy in a clinically suspected Central Nervous System (CNS) neoplasm is to evaluate the submitted tissue for rapid diagnosis, which helps in proper management during open craniotomy. In this study, the accuracy of frozen section in the diagnosis of CNS neoplasms and discrepancies in diagnosis were analyzed. Material & Methods: Ninety cases of CNS neoplasms were examined over a period of one year. All the cases were open biopsies performed at Neurosurgery Department &intra-operative frozen section (by cryostat) was performed & reported in the Histopathology section of a referral center in Eastern Odisha. The diagnoses given on FS were compared with the final diagnosis given on permanent paraffin embedded tissue sections. Results: In all cases, cryostat sections were prepared and a provisional diagnosis was given. Final histopathological diagnosis was given by studying the Hematoxylin & Eosin (H&E) section. Out of these 90 cases, 81 cases (90.0 %) were concordant, 9 cases (10.0 %) were discrepant. The discrepancies occur in mainly differentiating astrocytomas from oligodendrogliomas & schwannoma from meningioma along with few over-grading of glioma cases. Conclusion: Our results showed a reasonably high percentage of accuracy in the intraoperative diagnosis of CNS lesions. However, freezing artifact, obscuring cytological detail, heterogenous features of gliomas and lack of proper clinical inputs were the major causes for discrepancies

Introduction: Acute intestinal obstruction is one of the commonest and potentially dangerous surgical emergencies with a high frequency of morbidity and mortality if managed inappropriately. Although the mortality is decreasing with a better understanding of pathophysiology, improvement in radiological diagnostic techniques, fluid and electrolyte correction, potent antimicrobials, surgical management, and improvement in anaesthesia. The present prospective study was conducted to find out various etiological factors of mechanical intestinal obstruction and to evaluate morbidity and mortality in adult patients. Material Methods: The present prospective observational study of 290 patients with adult intestinal obstruction was carried out from December 2016 to October 2018 in the Department of Surgery at a Tertiary Care Hospital. The study included a total of 290 patients out of which 218 underwent surgical management and 72 underwent management conservatively, hence aetiology of intestinal obstruction was studied in the operative patients. Results:The peak age incidence was seen between 31-60 years in small bowel obstruction. Abdominal pain 283(98%) and distension 278(96%) were the most common presenting complaints. Out of 290 patients 218 (75.17%) patients underwent a surgical procedure in whom the most common intraoperative findings were adhesions and bands seen in 84 cases (38.53%) which were post-operative. Malignancy was seen in 6 cases (9.17%) involving small bowel. Adhesiolysis was the most common procedure done in 94 cases, with 78 cases of postoperative adhesive intestinal obstruction. Surgical site infection was the most common complication 109(50%). Conclusion: Clinical, radiological, and operative findings put together can bring about the best and most accurate diagnosis of intestinal obstruction. Among the factors influencing mortality and morbidity are age, state of hydration, the viability of the bowel, aetiology of obstruction, site of obstruction, delay in diagnosis and surgical intervention and associated medical illness

Purpose: The purpose of the study was to develop a new scoring system for predicting difficult intubation based on the ratio of the patient’s height to thyromental distance, upper lip bite test(ULBT), head and neck movements, modified Mallampati test(MMT), and neck circumference and compare it with Wilson score. Methodology: This prospective observational study was conducted on 300 ASA I, II, and III patients, who underwent elective surgeries under general anesthesia with endotracheal intubation as per inclusion and exclusion criteria. Results: In this study, among the individual parameters, MMT had the highest sensitivity (61%), while head and neck movements had the highest specificity (95.5%). ULBT had the best positive predictive value (42.9%), negative predictive value (94%), and positive likelihood ratio (5.5). Taking the cutoff for the new score as >=2, it predicted 34 out of 36 difficult intubations. Sensitivity was high at 94.4%. But specificity was low (41.7%). Kappa was 0.13. Wilson score with a cutoff of >=2 predicted only 16 difficult intubations out of 36. Sensitivity was low (44.4%), and specificity was 70.8%. Kappa was 0.09. On comparing the two scores, the sensitivity was very high for the new score >=2 compared with the Wilson score and was statistically significant (94.4% vs. 44.4%, p < 0.01). Specificity was less for the new score than the Wilson score and was statistically significant (41.7% vs. 70.8%, p <0.01). Accuracy was poor for the new score compared to the Wilson score and was significant (48% vs 67.7%, p<0.01).  Positive (PPV) and negative (NPV) predictive values were comparable for both. Using a cut off for New score >=3 resulted in higher sensitivity and specificity (88.9% and 82.6%, respectively) and accuracy of 83.3%. The new score with a cut off of >=3 yielded significantly higher sensitivity (88.9% vs. 44.4%, p <0.01), specificity (82.6% vs 70.8%, p <  0.01), and accuracy (83.3% vs. 67.7%, p <0.01) than Wilson score. PPV (41% vs. 17.2%, p <0.01) and NPV (98.2% vs. 90.3%, p <0.01) were also significantly higher for a new score >=3 than Wilson score. Conclusion: The modified Mallampatti test, the upper lip bite test, the ratio of height to thyromental distance, neck circumference, and, head and neck movements failed to meet the criteria for an ideal predictive test, when used as an independent predictor. When these parameters were combined to derive a new score, the predictive accuracy was much better. We had hypothesized that a new score with a cutoff of >=2 would accurately predict difficult intubation. It was inferior to Wilson score in predicting difficult intubation. By increasing the cutoff to >=3, sensitivity and specificity were equally good, and positive and negative predictive values were also high. On comparing it with the Wilson score, the predictive accuracy of the former was better. A combination of predictors is always better than a single predictor in identifying difficult intubation, and the new score with a cutoff score >=3 predicts difficult intubation better than Wilson score

Background: Grades of malnutrition can be classified and diagnosed by various available methods like IAP, WHO-Z score, Waterlow, Gomez and various parameters like anthropometric measurements. All these methods are also used to compare incidence and prevalence of malnutrition between different age groups. This study was done to compare the IAP vs WHO-Z score classification in precisely assessing the malnutrition status of children aged 0 to 5 years. Methods: This multicentric prospective comparative study was conducted at twenty-five ICDS centers in Karaikal, Puducherry between 2017-2019. Eligible study population included 0-5 years old children whose parents were willing to give consent at the time of enrollment. A thorough clinical examination was done to diagnose various nutritional deficiencies. Comparison was done between IAP and WHO classification of degrees of malnutrition. The comparison groups were analyzed using chi-square test. Results: A total of seven-hundred children were assessed for malnutrition, classified into various grades using IAP and WHO-Z score. Comparative analysis was done between two groups from each grade of malnutrition and it was observed that WHO-Z score classification and IAP classification didn’t have significant difference in identifying moderate malnutrition but WHO-Z score was significantly better (P=0.0001) in precisely identifying severe malnutrition. Conclusion: This study indicates that severe malnutrition which is still prevalent as assessed by IAP and WHO-Z score can be more precisely diagnosed using WHO-Z score [WAZ-7.8%, WHZ-3.8%, Grade III & IV-3.5%]. IAP grading is a time-tested method, which is easy to use and all categories of health workers were already accustomed to use it. A new tool incorporating WHO-Z scores in the existing IAP grading can be evolved for an accurate assessment of severe malnutrition

Objective: To analyse Non-Stress Test as a Predictor for High-Risk Pregnancy-In Background of Fetal Color Doppler in Umbilical and Middle Cerebral Artery  by  means  of categorization intofour groups and comparing the prediction of perinatal outcome in high -risk pregnancies. Material and Method : This was  a  Prospective Observational study conducted on all ‘High Risk  Pregnancies’  in  Department  of  Obstetrics  &  Gynaecology,   Ruxmaniben  Deepchand   Gardi Medical  College,  Ujjainfrom  Oct 2020 to Nov 2021. A  total  of  182  antenatal  women  with ‘High  Risk’patients were  recruited.  They  were examined clinically,  and  Doppler  velocimetry  andnon- stress  test  were  performed.  The  main   vessels   studied   by  Doppler  were   umbilical   artery and   middle  cerebral  artery, to study and analyse the indices.   The  results  of   Non-Stress testwere  interpreted as  Reactive and Non-Reactive.  Based   on  the  results  of  Doppler  and   Non- Stress,  the  182 cases  were  categorized  into  four  groups  and  interpretation  of  results  was  done.Fetal outcome was considered on the basis of.APGAR score and NICU admissions Results: Among the182  cases of high-risk pregnancies, those with a normal Doppler study and a  reactive non-stress test had good perinatal outcome. When both were abnormal, there was a higher percentage of adverse out-come as compared to that of either Doppler or NST alone being abnormal or non-reactive. It was observed in this study that Abnornal Doppler  study  with Reactive  non-stress  test  had relatively  bad perinatal  outcome as compared  to  Normal  Doppler study  with  non reactive non stress test.In this study sensitivity and specificity of Doppler was 71%  and 73% while that of NST was 69%   and  54%  respectively  for  NICU  admissions. Conclusion: Color Doppler is comparatively a better in  predicting adverse  perinatal  outcome. However,  when  both test  are abnormal  perinatal  outcome  is  definitely  poor.NST can be used as an alternative in absence of colour doppler at rural PHCs and CHCs to identify adverse perinatal outcome and timely referral.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnoea, cough, sputum production, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. Aim: To study RCI as a marker for severity of COPD. Material and Methods: An observational study was conducted in Department of Pulmonary Medicine, K. N. Chest hospital, after approval from institution ethical committee, Dr. S. N. Medical College, Jodhpur. Result: In our study, 58 (58.0%) patients were Cigarettes, 36 (36.0%) patients were Ex-smoker and 6 (6.0%) patients were Non-Smoker. Conclusion: We conclude that, majority numbers of patients were Cigarettes in Stage 1 compared to Stage 2, Stage 3 and Stage 4 though it was not statistically significant.

Introduction: A pleural effusion is accumulation of excessive fluid in the pleural space due to an imbalance between the production and absorption of pleural fluid by pleurae (visceral as well as parietal). Pleural effusion is a common clinical manifestation and about 3000 per Million people in the world suffers from pleural disease. Aims: To assess usefulness of ratio of serum LDH to Pleural Fluid ADA in differentiating Malignant Pleural Effusion and Tubercular Pleural Effusion.  Materials and Methods: The study was a Descriptive Observational Cross-sectional study was conducted in Department of Respiratory Medicine, Kamala Nehru Chest Hospital, Dr S N Medical College Jodhpur (Rajasthan), and a tertiary care centre for Respiratory Disease in Rajasthan, India after getting clearance from the Ethical committee. Result: found that most patients with tubercular pleural effusion (n=20) had Pleural Fluid ADA levels >35 and majority of the patients had Biopsy proven Malignant pleural effusion [22 (44.0%)] and it was statistically significant (p< .00001), (z=4.1036). Conclusion: We found that, most number of patients had Tubercular Pleural Effusion. It was statistically significant and majority of the patients had Biopsy proven malignant pleural effusion and it was statistically significant.

Background: Elderly patients typically suffer from intertrochanteric femoral fractures1, which are the most frequently operated-on fractures and have the greatest rates of morbidity and mortality2. Because of urbanization's increased sedentary lifestyle and longer life expectancy, these fractures are occurring more frequently. Aim: To evaluate the efficacy of PROXIMAL FEMORAL NAIL in the surgical management of unstable Intertrochanteric fractures of hip. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Orthopaedics, KLES JGMMC Medical College, Hubli, Karnataka.  Study Period: March 2022 – Feb. 2023. Study population: Patients admitted with intertrochanteric fracture in department of Orthopaedics who underwent surgical treatment with proximal femoral nail. Sample size: study consisted of 25 subjects.  Sampling method: Purposive sampling technique. Study tools and Data collection procedure: After the patient with intertrochanteric fracture was admitted to our hospital, all the necessary clinical details were recorded in the proforma prepared for this study. After the completion of the hospital treatment patients were discharged and called for follow-up to outpatient department at regular intervals (6weeks,12weeks, 6months,12months) for clinical and radiological evaluation. The patients were followed up till fracture union & yearly once from then-on. Results: Most of the patients were able to do partial weight bearing by 1-3 weeks and by the end of 3 months total 21 patients could do partial weight bearing and 1 patient didn‟t follow the postop protocol and did full weight bearing immediately after surgery. Out of total 25 cases 2 cases expired and 1 case lost follow-up. Breakage of nail was seen in a case of subtrochanteric fracture where there is nonunion of the fracture for which we have done revision nailing.  Conclusion: From our study it can be concluded that Intramedullary implants for internal fixation of the proximal femur withstand higher static and a several-fold higher cyclical loading than DHS types of implants.

Introduction: Systemic lupus erythematosus (SLE), also known as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissues of the body. Symptoms vary among people and may be mild to severe.  Common symptoms include painful and swollen joints, fever, hair loss, mouth ulcers and skin rash most commonly seen on face. Aims: To determine the clinical profile of Systemic Lupus Erythematosus patients at presentation. Materials and Methods: This is a cross sectional, observational study of 60 cases of Inpatients and outpatients fulfilling the 2015 SLICC criteria for diagnosing SLE in Vivekananda Institute of Medical sciences (VIMS), Ramakrishna Mission Seva Pratishthan (RKMSP), Kolkata, during the period of Jan 2017- Jan 2018. Result: In our study, we found that 43(71.7%) patients had acute/ subacute cutaneous lupus rash. 30(50.0%) patients had discoid lupus erythematosus(dle)rash or hyertrophic lupus rash. 24(40.0%) patients had non scarring frank alopecia. 33(55.0%) patients had oral /nasal ulcer. 48(80.0%) patients had joint disease. 19(31.7%) patients had pleurisy and / or pericarditis. Conclusion: SLE is more common among young females in third decade. In our study, most common features were joint and hematological manifestations followed by skin rash, oral/ nasal ulcers and frank alopecia. All patients were ANA positive. SLE patients assessed their quality of life as rather low. Increased disease activity was seen among 80% of SLE patients.   Measurement of quality of life along with modified SLEDAI 2000 index will help in providing better therapeutic management to SLE patients.

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality. India suffers the highest loss in potentially productive years of life, due to deaths from CVD.There are various investigations that have been utilised for diagnosis and management of acute coronary syndrome such as troponin ,CK-MB and 2D echo.There are few expensive investigations such as NT pro BNP that have been used as the prognostic factor in acute coronary syndrome.There is thus need of an investigation that can be done in peripheral setting which can be done easily and and has good prognostic value in acute coronary syndrome.  Objective: To study of neutrophil to lymphocyte ratio in acute coronary syndrome and its correlation with outcome Methods: This cross-sectional observational study was conducted in tertiary care hospital in Central India. Patients who were admitted to tertiary care centre with a diagnosis of ACS fulfilling the inclusion criteria were included in the present study. The study was conducted from June 2020 to Nov 2022. Results: Among the patients with N/L≤4, 36.1% had Killip class 1, 36.1% had Killip class 2, 19.4% had Killip class 3 and 8.3% had Killip class 4. Among the patients with N/L>4, 11.1% had Killip class 1, 30.6% had Killip class 2, 29.2% had Killip class 3 and 29.2% had Killip class 4. There was statistically significant difference. The mean CK MB of the patients with N/L≤4 was 570.90±36.29 and the mean CK MB of the patients with N/L>4 was 177.42±107.76. There was statistically significant difference. The mean 2D ECHO EF of the patients with N/L≤4 was 44.16±6.39 and the mean 2D ECHO EF of the patients with N/L>4 was 34.58±5.45. There was statistically significant difference. Among the patients with N/L≤4, all of them survived (100.0%); among the patients with N/L>4 15.3% died and 84.7% survived. There was statistically significant difference. Conclusions: The results of this study revealed that NLR is the strong predictive marker of ACS, so the study recommends using NLR as a good prognostic indicator for predicting short-term MACE and death in ACS patients.

Background: Diagnosis and delay in management of encephalopathy in elderly patients is challenging due to the paucity of presenting symptoms and signs. Objectives: To assess theetiologies, clinical profile, and outcome of encephalopathy in elderly. Method: This was a prospective observational study conducted over a period of two year (November 2020 to October 2022) on all elderly patients presenting with encephalopathy.Their demographic profile along with clinical presentation, laboratory, imaging results and outcome were recorded and analysed.Results: Majority of patients belonging to age group of 60-70 years (41.5%), with males’ predominance (59.9%). Maximum 56(39.4%) patients had 7-12 hours of altered mental status, (p<0.00001).47.2% presented with fever. Most patients had raised blood pressure (45.07%), neurological abnormalities (motor weakness) (27.4%), GCS score of 6-10 (57.7%), respiratory findings(47.8%). 29.5%had hyponatremia, 22.5%hypocalcaemia and 22.5% hypokalaemia. Higher number ofpatients had CT/MRI brain findings suggestive of haemorrhage and infarction. Most of the patients had ECG abnormalities in form of atrial fibrillation (11.2%). Etiology of encephalopathy in elderly was most commonly due to neurological causes (37.3%). Out of 142 patients, 64.8% were survivors and 35.2% was non-survivors.Most common cause of death were neurological (cerebro-vascular episode) followed by infections (meningitis). Patients who presented late or with more duration of altered mental status has more mortality than patients who presented early signifying that early diagnosis and treatment can reduce mortality significantly. Patients who presented with low GCS has higher mortality then patients with higher GCS. Conclusion: Elderly patients present late with paucity of symptom and signs. Hence, early presentation, early diagnosis and treatment will facilitate better outcome.

Labour and delivery are focus and climax of the reproductive process. They are both physical and emotional challenge for the mother and a hazardous journey for the fetus. Labour is a dynamic phenomenon characterized by a progressive increase in the frequency, intensity and duration of uterine contractions with progressive dilatation and effacement of the cervix and the  fetal  descent  through  the  birth  canal.   This physiological process may lead to pathology and failure to recognize this would result in prolonged labour resulting in increased morbidity and mortality of mother and baby.2 Material And Methods A hospital-based prospective study of 100 pregnant women with high-risk pregnancy  attending  the  department  of  Obstetrics  and  Gynaecology, Gayatri vidyaparishad medical college, Vishakhapatnam, from December 2021- November 2022. The study groups randomly selected a hundred primigravida with high-risk pregnancy fulfilling the inclusion and exclusion criteria. Informed and written consent was taken from all the women participating in the study. The study's primi pregnant women fulfilling inclusion and exclusion criteria were divided into the PARTOGRAM GROUP (P) and the other NO PARTOGRAM (NP). Each group consists of 50 primi  pregnant  women.  In the partogram group,  the progress of labour was documented on MODIFIED  WHO PARTOGRAPH and the notes on the progress sheet of case record file while standard notes only in no partogram group. Results In our study, 80% of pregnant women gestational age was below 39 weeks. In the NP group, 34% of women at 38 weeks, followed by 32% at 39 weeks. In the P group, 54% were at 38weeks, followed by 18% at 39 weeks and 18% at 40 weeks. Oligohydramnios  was  predominantly  observed  in  women  presented  in  39 weeks  (48%)  gestational  age.  Gestational  hypertension  (38.6%)  and  gestational diabetes mellitus(18.1%) was commonly observed in women in 38 weeks of gestation as both conditions are delivered at 38 weeks. Hypothyroidism was predominantly observed in women at 37 weeks(36.3%) and 39 weeks(24%) of gestation.  In individuals' groups, among the NP group, most pregnant women were delivered by FTNVD (60%) followed by 30% cases by LSCS. In P group out of 50 deliveries, 78% of cases delivered by FTNVD, followed by 14% undergone LSCS.  Conclusion: Partogram is an excellent tool for reflecting quick and consistent review of labour events, handing over the patient in changing shift duties, especially in low resource settings. It leads to earlier decision making in labour management and shown to reduce cesarean section rates.

Diabetes Mellitus is a metabolic disorder of multiple aetiology characterized by presence of hyperglycaemia with disturbances of carbohydrate, protein and lipid metabolism due to defects in insulin secretion, action or both. The link of vitamin D with insulin insensitivity or abnormal glucose metabolism gained much more scientific attention in the last 10 years. Various observations or associations were cited. Exploring the possible role for either altered vitamin D status and its metabolites or altered Insulin sensitivity in the pathogenesis of the each disease. In view of increased prevalence of diabetes mellitus, vitamin D deficiency and association of vitamin D with diabetes mellitus the present study is undertaken to evaluate vitamin D levels in type 2 diabetes mellitus and its correlation with HbA1c levels Aim: To study vitamin D levels and its correlation with HbA1c level in type 2 diabetes mellitus. Methods: An observational study was carried out over a span of 1.5 years who were previously diagnosed case of type 2 Diabetes Mellitus attended Medicine department OPD and IPD between age group 30-70 years were included in study Serum vitamin D3, HbA1c, FBS, PPBS and other clinical features were noted based on history and clinical examination of these patients. Results:  25% had HbA1c of less than 7, 39 patients (39%) had HbA1c more than 9. The mean HbA1c level was 8.65 ± 1.93. We observed in 41 patients (41%) the level of Vitamin- D were deficient, in 17 patients (17%) the levels were inadequacy and in remaining 42 patients (42%) the levels were either normal or more than normal. In our study Vitamin D levels were found to be lower in the diabetic cases with >5 years of duration compared to recently diagnosed diabetic cases. The difference is statistically significant (P value 0.001) as compared with recently diagnosed (P value 0.63). It was found that patients with poor glycaemic control had maximum Vitamin D deficiency (12%) which was statistically significant with p value of  0.001 than those with good glycaemic control had sufficient Vitamin D levels (9%) with p value of 0.07. We compared the mean Vitamin D levels with duration of diabetes of mellitus and HbA1c and it was observed that the mean levels of Vitamin D were reduced with increasing duration of diabetes mellitus and increasing HbA1c levels. This difference was statistically significant. (P<0.05). Conclusion: There was an association between Vitamin D levels and HbA1c in patients with type 2 diabetes mellitus. In the present study of 100 patients with type 2 diabetes mellitus we found that lower vitamin D levels were associated with poor glycaemic control

Background: Women experience onset of labour in a variety of different ways & cervical anatomy at labour onset is also highly variable from women to women. During latent phase, women may experience painful uterine contractions and need a lot of support. High level of pain and anxiety in latent phase are linked with increased interventions in labour. Objectives: 1. To study maternal and fetal outcomes of low risk women admitted in latent phase as compared to those admitted in active phase of labour in primigravida. 2. To compare the mode of delivery and maternal and neonatal complications between two groups. 3. To compare the neonatal APGAR Scores and admission to NICU in both groups. Material & Methods: Study Design: Prospective Observational study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Berhampore, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Patients admitted in antenatal ward and labour room. Sample size: 300 (200 in latent phase and 100 in active phase). Sampling Technique: Simple Random sampling method. Study tools and Data collection procedure: Data collection tool was used to collect the different information. Face to face interviews were conducted using data collection tool by the investigator including detailed history taking and relevant physical examination. A detailed history was taken from the patient (if the patient was in shock the history was taken retrospectively). Results: Perineal tears, cervical tears needing exploration; prominent blood loss in the form of either atonic or traumatic PPH and cases of retained placenta requiring either manual removal with/without anaesthesia was more in LPA gp compared to APA gp. The p values are 0.02, 0.19, 0.15, 0.5 for perineal tears, cervical tears, PPH, retained placenta respectively which are insignificant except for perineal tears, that is 0.02 which is significant. Conclusion: The present study has shown that early admission to the hospital in low risk women may negatively affect the outcome of labour. There is a significantly increased risk of early initiation of augmentation, increased rate of caesarean section for dystocia, increased rate of instrumental delivery, increased third stage complications in latent phase admitted group compared to active phase admitted group.

Introduction: Despite advancements in supportive care, antimicrobial therapies, and mechanical ventilation, VAP continues to be a major disease entity among ICU patients. There are variable factors making it difficult to document the epidemiology, associated risk factors, and outcomes of VAP in pediatric patients as they are available in adult patients, [8] hence this study has been undertaken to evaluate the prevalence, causative organisms and risk factors of VAP. Aims: To determine the prevalence, causative organisms and risk factors of Ventilator Associated Pneumonia (VAP) in preterm newborns (<37weeks) in Neonatal Intensive Care Unit. Settings and Design: Settings: Neonatal Intensive Care Unit of Shri Ram Murti Smarak Institute of Medical Sciences, a tertiary care hospital of Rohilkhand region. Study Design: Hospital based, prospective, observational study. Methods and Material: All preterms (<37weeks) admitted to the Neonatal Intensive Care Unit in this hospital or any other hospital and ventilated for more than 48 hours fulfilling the CDC criteria for VAP were included in the study. Vitals, general examination, blood gas, blood investigations, Chest X Ray, risk factors and tracheal secretions were evaluated before and after 48 hours of ventilation. Risk factors and organisms grown on tracheal and blood cultures were documented and studied. Statistical analysis used: Means and Standard Deviation of different variables. Chi square test for association was applied to get association between different variables. t- test was also applied to compare the means of different variable. Results: In this study, the prevalence of VAP was 56.67 %. Out of the 37 preterm neonates enrolled in the study, 21 had microbial growth on tracheal aspirates. The most common causative organism was Acinetobacter baumannii (47.67%) followed by Klebsiella pneumonia (33.33%). There was no significant difference (p>0.01) found on vital parameters, blood investigations like hemogram, CRP and ABG before and after 48 hours of ventilation. There was significant difference (p>0.01) in chest X ray, blood culture and new secretions of patients of neonates before and after 48 hours of ventilation. Conclusions: More than half of the ventilated neonates developed VAP (56.67 %). The most common causative organisms were gram negative organisms. The most common risk factors for VAP were reintubation and primary blood infection.

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

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

Background: The technique of intra-focal pinning described by Kapandji is used in the paediatric patients. We present the series of paediatric patients treated with Kapandji technique for unstable displaced distal radius fractures. Methods: We retrospectively reviewed medical records and radiographs of a consecutive series of 36 paediatric patients who underwent closed reduction and fixation with Kapandji technique for unstable displaced metaphyseal fractures from 2021 september to September 2022. percutaneous K-wires were inserted intra-focally to lever out, reduce and stabilize the distal fragment. The arm was immobilized with an above-elbow cast, and radiographic controls were scheduled at 1, 4, 8weeks, at least. Results: The mean age at the time of the trauma was 11.5 years. The K-wires were removed at a mean of 5.6 post-operative weeks. An above-elbow cast was used for the first 3 weeks, afterwards a below-elbow cast for 2 weeks and a short-arm brace until the full recovery of motion. The mean follow-up was 9 months (range 3.5-12 months). No pin-related complications were seen. All fractures showed good healing, and the full function of the wrist was achieved in all the cases. Conclusion: Kapandji pinning is a better technique in paediatric patients with unstable displaced distal radius fractures. It shows a lower complication rate and good outcome compared to other techniques.

Background: It is estimated that 17.7 million people died from CVDs in 2015, representing 31% of all deaths taking place worldwide; more people die every year from CVDs than from any other cause. Cardiovascular diseases are showing an increase among the Indian population. There has been a rapid and significant growth in the measurement of quality of life as an indicator of health outcomes in patients with CVD. In the clinical course of cardiovascular diseases, the interaction between stress and its impact on quality of life will alter and aggravate theclinical condition. Thus, an improvement in health-related quality of life is considered to be important as a primary outcome and overall therapeutic benefit. Most of the patients cannot cope with the stress due to the burden of cardiovascular disorder and require psychiatric intervention. This study will be focusing on the psychological problems faced by these patients and suggest a plan for improving their quality of life. Aims: To assess the quality of life in patients with known cardiovascular disorders i.e. hypertension, congestive cardiac failure and coronary artery disease. Methods: Patients attending Medicine OPD/IPD with a diagnosis of Hypertension, Congestive Cardiac Failure or coronary artery disease who satisfy the inclusion criteria will be selected. Socio-demographic data will be recorded via semi-structured proforma and the WHO Quality of Life Scale (WHOQOLBREF) will be applied. The data will then be evaluated and computed for statistical analysis of various interactions and correlations. Results: Out of 120 patients, 40 patients were selected in each diagnosis of hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The overall mean (SD) HRQOL was observed as 54.65 ± 14.23 with a range between 18.75-81.5. Among them, domain 4 has been observed with the highest score of 14.62 ± 2.3 and 66.54 ± 14.31 with 4-20 TS and 0-100 TS. However, the HRQOL distribution was varied as per different cardiovascular disorders, like highest mean ± SD score was observed with CHD (57.43 ± 13.33), followed by HTN (56.1 ± 14.66) and CAD (50.42 ± 14.04). Conclusion: Cardiovascular disorders are an important public health problem with a significant psychological impact and impact on the QoL of patients. There is a slight male preponderance observed in patients with cardiovascular disorders. QoL was affected in patients with cardiovascular disorders with psychological and physical health domains being primarily affected.

Introduction: Acute kidney injury is a common clinical condition encountered in our hospital. This study is an attempt to evaluate the clinical profile and to investigate the risk factors for poor prognosis among critically ill patients with acute kidney injury. Materials & Methods: A hospital-based cross-sectional study was conducted after ethics committee approval in an ICU of a tertiary care hospital. Study included 70 cases admitted in ICU during the study period, and also having acute kidney injury. Etiology for development of AKI was identified using appropriate investigations. Outcome was studied in the form of recovery, death, or discharge on dialysis. Data was analyzed by SPSS ver 26.0. Results: Mean age of the study cases was 46.58 years with 61.4% males. Intrinsic etiologies for development of AKI were seen in majority of the cases (71.4%) followed by pre-renal etiologies (27.1%).  Mortality was observed among 28.6% cases. On univariate analysis, elderly age (>60 years), high APACHE II Score and co-morbidities like cirrhosis, sepsis, ARDS and IHD were observed to be significantly associated with mortality among AKI cases. On multi-variate analysis, only APACHE II score was observed as significant predictor of mortality in ICU cases developing AKI. Conclusion: Acute kidney injury is a serious problem in critically ill cases with over one fourth of the ICU cases developing AKI succumbed to death. Advancing age, high APACHE II score and presence of associated co-morbidities were associated with poor prognosis.

Background: Woman oriented contraceptives have gained acceptance compared to male contraceptives. Vasectomy was introduced in India in 1992 to increase male participation in family planning. However, despite being a safe and simple method, it is rarely accepted as a method of contraception. Aims And Objectives: To assess the attitude of men towards No Scalpel Vasectomy (NSV). To study the reasons for low acceptance of NSV among husbands of women who underwent permanent methods of contraception. Materials And Methods: A cross sectional questionnaire based survey was conducted at Government Medical College, Thrissur from November 1st 2022 to January 31st 2023. Healthy male attendants of 150 women who underwent permanent methods of contraception in the Obstetrics and Gynecology Department, were included. Socio demographic data, knowledge about NSV and reasons for its low acceptance was collected using a self-made validated questionnaire. Results: In our study, majority (85.3%) of the participants were aware that NSV is a permanent method. 58.8% of the subjects knew that NSV has a high success rate. 55% believed that NSV required prolonged rest and affect sexual function. 54% perceived socio cultural barriers as reasons for low acceptance. 80.8% had procedure related misconceptions. Fear about procedure related pain and complications was seen in 44.1%. Conclusion: Though, a large majority of the spouses of women who underwent sterilisation, were aware of NSV, misconceptions regarding the procedure was common. Health education and counselling are needed to bring about a change in this attitude.

Introduction: Breast carcinoma is found to be the leading cancer in women, both in developed and developing countries across the world. Though breast cancer is thought to be a disease of developed countries, 50% of the cases and 58% of the deaths occur in developing countries. It is found to have increased in developing countries due to lack of awareness and its later stages detection. Detection of cancer in early stage can improve the survival chances of the patient, and cancer control can be achieved. Aims: The objective of my study is to find accuracy of FNAC in diagnosis of breast malignant masses and to correlate the benign and malignant FNAC feathers with ultrasound diagnosis for early detection of Breast Carcinoma.  Screening of the breast lesion using ultrasonography followed by FNAC of the lesion will help early detection and treatment of the disease. Materials and Methods: The study was prospective, cross sectional and hospital-based on 100 female patients of age ranging between 15-85 years with history of palpable breast masses referred to Radiological Department of DMCH for USG scan independently and in combination with FNAC correlation in the Department of Pathology of DMCH. Result: Out of the total 62 breast lump examined, 42 (67.74%) breast lumps were reported as benign and 19 (30.65%) were reported as malignant. In one case the result was indeterminate as the cytopathologist reported as “papillary lesion”. The final histopathological result, however, turned out to be “ductal carcinoma in situ with solid, cribriform and micropapillary patterns”. Conclusion: A breast tumour must be evaluated to rule out cancer. FNAC is a tissue diagnostic method, while ultrasonography is an imaging approach. In our research, the specificity of both diagnostic instruments in identifying malignant breast lump was found to be 100%, implying that a positive (malignant) result of either test can exclusively determine the treatment choice without further diagnostic inquiry.

Background This study was conducted to compare hippocampal volume in patients with TLE with that of a normal control group, and examine the degree and frequency of reductions in hippocampal volume in patients with prolonged epilepsy. Methods This was a hospital based cross-sectional observational study conducted among 228 patients who presented with epilepsy to the Department of Radio-Diagnosis at Ashwini Neuro-Trauma Center Cuttack, from 2015 to 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results Hippocampal volume distribution in the left lobe as well as the right lobe was found to be significantly lower in epileptic subjects as compared to non-epileptic subjects. Using the Mann-Whitney U Test, the mean rank of left and right hippocampal volume comparisons among the group of subjects was found to be statistically significant. There was a significant difference in duration of seizure between epileptic and non-epileptic groups using the Mann-Whitney U test. It was seen that with an increase in seizure duration, there was a decrease in hippocampal volume, both left and right. The correlation was, however, poor but was found to be statistically significant for both left and right hippocampal volumes. Conclusion The ability of volumetric 3D imaging to predict the presence and laterality of hippocampal atrophy plays an integral role in the evaluation of patients with epilepsy, especially in patients with subtle findings and no perceptible hippocampal atrophy on visual inspection and, should be utilized on a regular basis in clinical practice as it is superior to visual analysis in detecting hippocampal atrophy, which can help in guiding surgical resections.

Introduction: Type 2 diabetes (T2D), a frequent comorbidity in AMI, has been associated to an increased risk of long-term in-hospital mortality and upcoming cardiovascular events. "Inflammation underlies both the complicated diseases diabetes mellitus and atherosclerosis. Acute myocardial infarction is really a risk factor for type 2 diabetes, which is assessed in a state of low-grade inflammation. Aims: To identify the “CRP level at the time of admission as a reliable indicator of hospital mortality and morbidity in both patients with and without diabetes mellitus who experienced an acute myocardial infarction Materials and Methods: The material for the present study was collected from patients who are admitted in Katihar Medical College and Hospital over a period of one and a half year from December 2020 to May 2022.100 Patients were included in this study. Result: This study found that diabetes patients with acute myocardial infarction had statistically significant higher admission CRP levels than non-diabetic patients . Patients with diabetes who had higher CRP levels had a greater incidence of death and morbidity when compared to non-diabetic patients. Conclusion: According to the results of this investigation, CRP is a potent predictor of hospital morbidity and mortality in both diabetes and nondiabetic individuals with acute myocardial infarction.

Background: Preloading or the infusion of intravenous fluid prior to the induction of spinal anaesthesia has remained the cornerstone in the prevention of spinal induced hypotension for a long time. However, its efficacy in the adult young non-parturient population still has to be conclusively determined as most previous studies have been conducted in the parturient or the non-parturient elderly population. This prospective study was undertaken for the comparative evaluation of the clinical parameters associated with spinal induced hypotension following spinal anaesthesia among three groups, i.e. a no preload group, a crystalloid (Ringer’s lactate solution or RL group) preload and colloid (3.5% polygeline solution or polygeline group) preload, in elective   lower-abdominal or lower-limb surgery involving minimal blood loss, in a young adult (20 - 50 years) non-parturient population.  Material and Methods: 75 ASA-I and ASA-II, young adult (20 - 50 years), non-parturient patients undergoing elective lower abdominal or lower limb surgery, involving minimal blood loss, were randomly allotted into three groups of 25 patients each, in a double-blind clinical trial, to receive either no preload, 3.5% polygeline solution (10 mL kg-1), or Ringer’s lactate solution (20 mL kg-1), as a preload before spinal anaesthesia. The measurements of the heart rate (HR), systolic arterial pressure (SAP), mean arterial pressure (MAP) and the peripheral arterial oxygen saturation (SpO2) were recorded on a serial basis. Hypotension was defined as a decrease in the SAP of 25% or more from the baseline (before-preload) values. The various parameters indicative of the incidence, severity, duration and timing of spinal-induced hypotension (SIH) and the incidence of cardiovascular side-effects  such as bradycardia and arrhythmias in all the three groups were recorded.  Results: There was a significant difference in the incidence of SIH [68% (no-preload); 24% (polygeline) and 32% (Ringer’s lactate); P = 0.003], mean therapeutic requirement of vasopressor (mephentermine) (P = 0.001), mean minimum systolic arterial pressure    (P = 0.000), mean minimum systolic arterial pressure (as percent of baseline) (P = 0.000), mean maximal heart rate (P = 0.038), mean number of hypotensive episodes (P = 0.001), mean total duration of hypotension   (P = 0.000), and mean peripheral arterial oxygen saturation (SpO2)   (P = 0.000) following spinal anaesthesia between the control, polygeline and Ringer’s lactate groups. There was no significant difference in the incidence of SIH [24% (polygeline) vs. 32% (Ringer’s lactate);     P = 0.529], mean therapeutic requirement of vasopressor (mephentermine) (P = 0.781), mean maximal heart rate  (P = 0.923), mean number of hypotensive episodes (P = 0.923), mean total duration of hypotension (P = 0.926), mean peripheral arterial oxygen saturation (SpO2) (P = 0.803) following spinal anaesthesia between the polygeline and Ringer’s lactate groups. The mean minimum systolic arterial pressure (P = 0.037) and the mean minimum systolic arterial pressure (as percent of baseline) (P = 0.012) following spinal anaesthesia remained significantly higher in the polygeline group than in the Ringer’s lactate group. There was no significant difference in the mean time of recording of the minimum systolic arterial pressure   (P = 0.592), the mean duration of a hypotensive episode (P = 0.145) and the incidence of bradycardia [20% (no-preload); 12% (polygeline) and 16% (Ringer’s lactate); P = 0.743] following spinal anaesthesia between the control, polygeline and Ringer’s lactate groups. A significant difference, if any, in the incidence of arrhythmias following spinal anaesthesia between the three groups could not be found out because of the number of patients developing this side-effect was very less. Conclusion: The polygeline and Ringer’s lactate preload were effective in significantly reducing the incidence, severity and duration of SIH, and in maintaining significantly higher mean SpO2 following spinal anaesthesia, when compared to a  no-preload. However, there was no significant difference in the mean time of recording of the minimum systolic arterial pressure, the mean duration of a hypotensive episode or the incidence of bradycardia following spinal anaesthesia, between the three groups. There was no definite advantage of a polygeline preload over a Ringer’s lactate preload, as there was no significant difference between the two in so far as reducing the incidence, severity and duration of SIH is concerned, or in maintaining significantly higher mean SpO2 following spinal anaesthesia.

Introduction: Intracranial metastases are most frequent in the brain and dura. 80% of the brain metastasis are located in the anterior border zones of the cerebral hemispheres, 3% are found in the basal ganglia and 15% in the cerebellum. In the cerebrum, metastasis occurs typically near the junction of cortex and white matter. Aims: To study the presenting symptoms in asymptomatic and known cases of malignancy and its correlation to the type of malignancy. Special emphasis will be on asymptomatic patients with their first presentation and correlation with age and sex, to estimate the incidence of metastatic lesions of CNS. Materials and Methods: The present study has been performed predominantly on CNS metastasis cases admitted in the department of Neurosurgery, SMS Medical College & Hospital Jaipur. 50 cases have been studied and cytological as well as histological diagnoses were compared. This diagnosis was then compared with diagnosis given on CT & MRI. Result: Backache was the symptom found in only spinal metastasis, not intracranial. 100% of spinal metastasis in our study complained of this symptom. In the Intracranial metastasis from unknown primary, moet were adenocarcinomas and surprisingly either from GIT or overy the patient remained asymptomatic for prolonged periods. This fact Is probably attributed to occull carcinoma. Conclusion: In the Intracranial metastasis from unknown primary, moet were adenocarcinomas and surprisingly either from GIT or overy the patient remained asymptomatic for prolonged periods. This fact Is probably attributed to occull carcinoma.

Background: This prospective study aimed to assess the clinical and demographic profile of adolescent poisoning cases admitted to the Department of Pediatrics at HIMS Hassan, India. Methods: A total of 105 patients aged between 10 and 17 years were included in the study, with data collected regarding their clinical-demographic profile and consumption details.  Results: The majority of cases were female (79%) and from a rural area (63.8%). In terms of socioeconomic status, the largest proportion of cases were from the upper lower class (32.3%). Insecticide (26.6%), rat paste (13.3%), acid (11.4%), and tablet consumption (24.7%) were the most common poisons consumed by the adolescents. Suicidal consumption accounted for 85.7% of cases, while 14.2% were accidental. Regarding treatment, 80% of patients received supportive and symptomatic management, while 20% received a specific antidote. Conclusion: The study provides valuable information about the clinical and demographic profile of adolescent poisoning cases in India, which can be used to inform prevention and management strategies.

Background In this study, we wanted to assess the menstrual awareness among urban and rural adolescent girls and compare the menstrual hygiene practices among them. Methods This was a hospital based cross-sectional study conducted among 170 adolescent girls attending the OPD of Gynaecology, Paediatrics and General Medicine at Government Medical College, Thrissur District, Kerala. It was carried for a period of one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. They were provided with a validated questionnaire to assess menstrual awareness hygiene practice among them. Results Majority (89.4%) from the urban area of residence believed that it was physiological, while majority (54.1%) from the rural areas didn’t know the actual cause for menstruation. This difference between the rural and urban areas on awareness about the cause of menstruation was found to be statistically significant. More than half of the subjects used sanitary pads during menstruation. The frequency of changing pads at school was less in both urban and rural groups. The reusage of pads was almost similar among rural and urban study subjects with around 23.5% and 22.4% of them reusing the pads respectively in both the groups. Awareness regarding menstrual cup was more in urban group compared to rural. But restrictions during menstruation was practised more in rural group that is 70% compared to urban group which was roughly 52%. Conclusion Menstrual health forms the most important stepping stone to women’s sexual and reproductive health. One third of the study population was not at all aware of the cause of menstruation. There was significant difference in various menstrual hygiene practices among urban and rural girls. Many restrictions were practiced during menstruation more in rural group. A concerted effort from parents, educational institutions and existing healthcare institutions along with media may ensure safe and secure reproductive health prospects for adolescents in the region.

Background and Objectives: Intramedullary interlocking nailing is currently considered the treatment of choice foropen(grade 1 and grade 2)tibial shaft fractures, with high rates of fracture union, advantages of early stabilization which decreases the morbidity and mortality rates in patients, allows early mobilization, reduces the incidence of infection,malunion,nonunion, or implant failure. This study is done to assess compound diaphyseal fractures of tibia and to evaluate the functional outcome of patients with open tibial shaft fracture treated with locked intramedullary nailing without reaming. Methods: Twenty adult patients of both sexes presented with open tibial shaft fractures to Princess Esra Hospital, Deccan College of medical sciences,Hyderabad who satisfies our inclusion criteria and are surgically fit are included in this study. All enrolled Patients were admitted from March 2020 to December 2021 were treated surgically with locked intramedullary interlocking nailing tibia without reaming and evaluated. Final assessment of functional outcome is done using JOHNER and WRUH’S Criteria. Results: The results of interlocking nail for fracture tibia without reaming were excellent in 15 patients (75%), good in 3 patients (15%) and fair in 2 patients (10%).  The average healing time was 20.13 weeks. In our study valgus deformity of 3 degrees (3 patients) and varus deformity of 3 degrees (1 patient) is seen. There were 1 superficial infection (5%), 2 patients with anterior knee pain (10%), 1 patient with delayed union (5%) and 1 patient with shortening of 1cm seen (5%). Conclusion: The method of treatment employing closed intramedullary interlocking nailing without reaming to stabilize open (type 1 and type 2) diaphyseal fractures of tibia is ideal because of its excellent and good results. The method has a long learning curve but with the excellent results. The advantages of rapid rehabilitation and relatively few complications serve to recommend it for wider use.

Background:  Hypertension is becoming a major public health concern in low-income countries due to rising trend of prevalence in past years. Primary factors which lead to poor treatment outcome is the patient non-adherence to medicines. It is therefore, important to analyse the factor responsible for non-adherence to obtain better prognosis. Objective: The present study aimed to determine various sociodemographic and pharmacological factors which influence adherence to medicines in patients with systemic hypertension. Methods: Adherence to antihypertensive medications was measured by using therapeutic adherence scale for hypertensive patients (TASHP). Results: A significant association was observed between satisfactory drug adherence and lower pill burden (one pill/day) and combination drug therapy (1 pill with >2 drugs combination). Lower frequency of drug intake was associated with higher drug adherence though the association was not statistically significant (p=0.241). Presence of side effects was associated with statistically significant low drug adherence (p=0.001). Conclusions: Satisfactory compliance to antihypertensive therapy was associated with combination therapy and limited pill burden. Absence of side effects with antihypertensive medication and better blood pressure control were also associated with better drug compliance. Identifying these pharmacological factors would be of value for physicians in focusing strategies to enhance patient compliance to antihypertensive medication.

Conclusion: Serum homocysteine, vitamin B12and folic acid are easily available investigations which may predict the severity and outcome of patient s    of acute ischemic stroke.

Background: Respiratory conditions are the most common cause for admission to a NICU in term and preterm infants and comprise around 33.3% of neonatal admissions at >28 weeks gestation. Chest radiography is considered the gold standard for diagnosing lung disease, but it unavoidably causes radiation damage to the neonate. Ultrasonography is non-invasive, non-ionizing, easily operable, and performed in real-time, making it an accurate, reliable technique for the diagnosis of neonatal lung diseases. Due to the lack of research on ultrasonography in Indian neonates with pulmonary diseases, this study was done to determine the role of ultrasound as a diagnostic tool in neonates with respiratory distress and decreasing radiation exposure. Objectives: 1) To determine the accuracy and effectiveness of lung ultrasonography as a diagnostic tool in neonates with pulmonary diseases. 2) To determine if Ultrasound based analysis can play an effective role in reducing radiation exposure in neonates with pulmonary diseases. Material & Methods: The study was conducted on neonates with respiratory distress in the Neonatal Intensive Care Unit of KLE’s Dr. Prabhakar Kore Hospital. (Respiratory distress in the neonate is diagnosed when one or more of the following is present; tachypnoea or respiratory rate of more than 60/ minute, retractions or increased chest in drawings on respirations (subcostal, intercostal, sternal, suprasternal) and noisy respiration in the form of a grunt, stridor or wheeze).  Neonates admitted in the NICU with any cardiac diseases and other non-pulmonary diseases and neonates with congenital anomalies such as congenital heart diseases, Congenital Diaphragmatic hernia, Tracheoesophageal Fistula, and Esophageal Atresia were excluded from the study. Institutional Ethical Clearance from the Institutional Ethics Committee for Human Subjects Research of Jawaharlal Nehru Medical College, Belagavi, Karnataka was obtained, and informed consent from the parents of all the study subjects. Results: Out of 51 neonates enrolled in the study, 23 neonates were diagnosed with respiratory distress syndrome, 11 neonates were diagnosed with transient tachypnea of the newborn, 5 neonates were diagnosed with meconium aspiration syndrome, 3 neonates were diagnosed with pneumonia and 2 neonates were diagnosed with pneumothorax. Lung ultrasound demonstrated a sensitivity of 92.7 % and specificity of 87.21 % as a diagnostic modality in our study. Conclusion: Lung ultrasonography serves as an alternative diagnostic imaging modality to chest radiographs in detecting neonatal pulmonary diseases.

Background: High Resolution CT has a potential role in the diagnosis, detection of complications and in predicting clinical recovery of patients or progression of coronavirus disease 2019. Degree and severity of lung involvement can be assessed by 25 point CT severity score. This quantification plays an important role to modify the treatment plan at times in critically ill patients of COVID-19. Objectives: The purpose of the present study is to characterize the typical & atypical HRCT imaging features in patients with COVID-19 infection and to additionally establish a correlation between the CT severity score & clinical lab parameters to facilitate an expeditious management protocol. Materials & Methods: A prospective observation study of 2years duration including 75 patients with RTPCR positive proven COVID-19 disease were evaluated with HRCT and the findings were systematically documented and analysed by experienced radiologists. Results: >90% participants were found to have ground glass opacities  (GGO) on Chest CT,76%hadGGOwithsmoothinterlobularseptalthickening; whereas 64% had GGO with smooth intra lobular septalthickening.54.7% (41/75) patients had severe grade of Covid Pneumonia; followed by moderate(26;34.7) and mild (8; 10.6%). There is positive correlation of Chest CT severity scores with urea, D-dimer, CRP, IL-6 , TLC and ferritin. Conclusion: Better understanding of spectrum of CT findings in COVID-19 pneumonia may help to reach accurate diagnosis in clinically and laboratory equivocal cases. It also aids in prognostication of clinically ill cases and cases with co-morbidities.

Background: The ninth most prevalent cancer in women and the fourth most common cancer in men, respectively, is bladder cancer [1]. More than 95% of all bladder cancer cases are caused by transitional cell carcinoma (TCC), the most prevalent histological type [2, 3]. Only 5% of UCs occur in the upper urinary tract (UUT), compared to 95% in the bladder [1]. Renal pelvic tumours are 3–4 times more common than ureteral tumours among all urothelial carcinomas (UC) in the UUT [4]. OBJECTIVES:  1. To evaluate transabdominal USG findings for detection of new cases and recurrence in the follow up of patients with bladder cancer or tumors. 2. To evaluate cystoscopy findings for detection of new cases and recurrence in the follow up of patients with bladder cancer or tumors.  3. To evaluate Comparision of transabdominal USG findings with cystoscopy findings for detection of new cases and recurrence in the follow up of patients with bladder cancer or tumors. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Radio diagnosis, Mamata Academy of Medical Sciences, Bachupally, Hyderabad.  Study Period: Dec. 2022 – May 2023. Study population:  Subjects attending the Department of Medicine and Urology Department all age group and diagnosed with urinary bladder tumors. Sample size: study consisted of 30 subjects. Study tools and Data collection procedure: The present study includes total of 30 subjects attending the Department of Medicine and Urology Department all age group and diagnosed with urinary bladder tumors. The patients were examined by transabdominal USG and cystoscopy. The demographic details, clinical history were taken as per the detailed prescribed proforma followed by well informed consent from all the study subjects. The present study was conducted after approval from ethical committee. 30 patients clinically suspected to have bladder tumors were investigated by transabdominal ultrasonography. The examination was performed with Siemens acuson X 300 premium edition CH5-2, VF10-5 ultra sound machine. Results: All tumors had a wide area of attachment. 70% of the tumors had irregular out line, 30% smooth out line and 73.33% had heterogenous echotexture, 26.67% uniformly homogenus, 63.33%, 20%, 16.67% frond shaped, flat, and small nodules were present respectively. Ultrasound and cystoscopy was correlated in the aspect of site of involvement 100% in 18 cases at Right postero- lateral, 100 trigones in 6 cases, 100% dome 2cases, 75% of the left postero lateral wall in 12 cases, 50% anterior wall in 2 was accurately demonstrated on ultrasonography. Conclusion: Sensitivity of transabdominal ultrasound for bladder tumors varies from 26% to more than 80% in the literature. Most studies show that transabdominal bladder ultrasound is especially poor in detection of tumors smaller than 5 mm. Another important point is bladder tumor site influences on the ultrasound detection rate. Anterior wall tumors have a lower detection rate because of reverberation artifacts.

Background: The factors that determine acute exacerbations and hospitalization in COPD patients are poorly understood. Factors that have been studied as predictors of mortality and other outcomes include FEV1, blood gases, co-morbidity, chronic mucus hypersecretion (CMH), muscle weakness, poor nutritional status, low BMI, socioeconomic status and support, number of previous physician visits or hospital admissions, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, inhaled corticosteroids and long-term oxygen therapy. Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. Materials and methods: This study was a prospective study in a tertiary care hospital over a period of 48 months. During the initial 24 months, the patients were recruited in the study and for the next 24 months all these patients were followed up systematically for stability of the disease or any adverse impact. Patients who had acute exacerbation of COPD during the initial entry period of 24 months were included in the study. The inclusion criteria were: (i) patients with a principal diagnosis of AECOPD; (ii) age over 50 years; (iii) current smokers or ex‑smokers with a history of smoking equivalent to at least 20 pack‑years; and (iv) surviving patients with stable COPD status on discharge.  Result: Of 115 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex‑heavy smokers, associated co‑morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.43; 95% CI: 0.15‑0.91), use of Tiotropium (OR = 3.33; 95% CI: 2.16‑6.74) and use of co‑amoxiclav during first admission (OR = 3.48; 95% CI: 2.28‑6.84) were significantly associated with higher immediate failure rates.  Conclusion: it has been shown that half of all chronic obstructive pulmonary disease patients hospitalised with acute exacerbations died within 3 yrs. These findings may help clinicians with important information about the probable short- and long-term survival of these patients. Thus, low levels of serum albumin strongly predict poorer long-term outcome, and longer duration of disease and longer time elapsed since first hospitalisation appear as new mortality related independent factors. The authors believe that the current findings will provide clinicians with new insights, allowing them to implement more individualised treatment strategies by better predicting the life expectancy of chronic obstructive pulmonary disease patients.

Purpose: The aim of this study was to evaluate the therapeutic effects and safety of oral propranolol along with topical timolol maleate or oral propranolol alone for treatment. To study the increases in the success rate of propranolol when used along with timolol solution. Whether there is a decrease in the duration of therapy.To study the speed of improvement in haemangioma treatment with propranolol therapy when used along with timolol solution. Methods:  From March 2019 to June 2020, 40 cases of Surface Infantile Patients were treated. The experimental group (20 patients with 7 males and 13 females) was treated using oral propranolol combined with topical timolol maleate, whereas the control group (20 patients with 5 males and 15 females) was treated with oral propranolol alone. Vas scale is used to grade the improvements. Results:  In terms of the volume reduction of the lesion at the endof the study, the combination therapy (P+T) was found to be more efficacious than the monotherapy (only Propranolol),  volume reduction percentage was(67.28 ± 17.11 %) for the combined therapy group (P + T) and (55.547 ± 16.39 %) for the single therapy group i.e only Propranolol,  with P value (P=0.033), when the analysis was further carried on for the earlier age group, Reduction in terms on depth was found to be better in the Propranolol + Timolol group (Depth 0.765 ± 0.437 cm) thanthe propranolol alone, the combination therapy failed to show better results in terms of shortening of the duration of treatment and ameliorating the efficacy of propranolol However it was found that volumetric reduction was better in combination therapy than propranolol alone. Effects were seen better when the treatment was started in early age groups that is 0-6 months. Conclusions: In our study, we found out that the Propranolol 2-3mg per kg and Timolol solution of 0.5% applied thrice over the lesion were well tolerated by all the patients without any serious adverse events. The Propranolol and Timolol combination therapy fails to demonstrate a statistically approvable shorter period of treatment as well as efficacy when compared to Oral Propranolol alone. But clinically there is Volumetric reduction in terms of depth reduction and a decrease in duration of treatment. This was found to be better in the combination group than propranolol alone and was significant for early-age group patients. 0-12 months.

Material & Methods: Study Design:  Case-control study. Study area: Department of General Medicine, Nimra Institute of Medical Sciences, Vijayawada. Andhra Pradesh. Study Period: April 2022 – March 2023. Study population:  Patients with acute myocardial infarction admitted in department of medicine. Sample size: Study consisted a total of 50 cases and 10 controls. Sampling Technique:  Simple random method. Study tools and Data collection procedure: 50 acute myocardial infarction cases and 10 healthy controls were selected. The subjects were informed about the nature and purpose of the study and consent was taken from subjects themselves or family members in case of unconscious patients. Patients presenting with chest pain suggestive of myocardial infarction, who showed E.C.G. evidence of acute infarction changes were assessed by detailed history and physical examination as outlined in proforma. The infarction was confirmed by elevated CPK/troponin levels. Serum magnesium is estimated within first 24 hours of chest pain. Serum magnesium estimated by Colorimetric method using calmagite. Clinical findings, and serum magnesium levels are used as parameters to assess the incidence of complications likes arrhythmias, left ventricular failure, cardiogenic shock, supraventricular arrhythmias. Bundle Branch Block, Hemi Block, AV Block and Mortality in patients with AMI. Results: There were more number of deaths in AMI patients with hypomagnesemia than in patients of AMI with normal serum magnesium levels. There is no statistically significant association of hypomagnesemia with death in cases of AMI as p value is 0.091. Conclusion: Prophylactic administration of the intravenous magnesium sulphate may be considered in all cases of Acute Myocardial infarction as an adjuvant to thrombolytic therapy and in patients not suitable for thrombolysis to prevent cardiac arrhythmias & reduce short term mortality irrespective of serum magnesium levels as it is safe and cheap.

Objectives: Adding adjuvants to local anaesthetics hastens the onset and prolongs the duration of blocks with favourable postoperative analgesia. The principal objective of our study was to compare the duration of postoperative analgesia between the two intrathecal opioids (as adjuvants with bupivacaine). This prospective, randomized, double blind study was conducted at a tertiary care centre. Techniques: After institutional ethical committee approval and informed patient consent, sixty healthy patients who were scheduled for elective lower extremity surgery under spinal anaesthesia were divided into two equal groups and enrolled in the study. They received 15 mg of hyperbaric bupivacaine 0.5% with either nalbuphine 0.4mg (Group N) or fentanyl 25 mcg (Group F) Onset time and duration of sensory blockade along with 2 segment regression of sensory blockade were noted. Time for onset of complete motor block and duration of effective analgesia were also noted. Adverse effects, if any, were noted. Quantitative data are presented as means and standard deviations and confidence intervals, while qualitative data are presented as proportions. An independent t-test and a chi-square test for proportions were used to compare the significance of differences in the means using R software 3.2.2 version. P ≤ 0.05 was considered statistically significant. Results: Post operative analgesia lasted significantly longer in the nalbuphine group compared to the fentanyl group. Conclusion: Thus, nalbuphine is a better adjuvant to bupivacaine than fentanyl when administered intrathecally for lower extremity surgical procedures in terms of duration of postoperative analgesia.

Background: Bipolar disorder is the sixth leading cause of disability worldwide, affects about 60 million people worldwide3 and has a lifetime prevalence of about 1-3% in the general population worldwide. Objective: To assess the level of perceived Stigma, Self-esteem and Quality of Life in euthymic patients of Bipolar Affective Disorder. Methods: This cross-sectional study was conducted among all euthymic patients of Bipolar Affective Disorder, attending Psychiatry services in the Department of Psychiatry, Tertiary care center of a General Hospital. Results: Bipolar Affective Disorder patients have significantly higher stigma associated with illness even when they are euthymic. Their self-esteem is significantly lower even when they are not symptomatic and it is significantly associated with number of relapses. Their quality of life is also significantly lower than healthy population across all domains specially social relation and psychological heath domain. High level of Stigma and lower Self-esteem significantly affect the Quality of Life in patients of Bipolar Affective Disorder and can predict change in it, though stigma and self-esteem show significant association but they do not seem to be predictive of each other’s severity. Conclusions: This study is a small step in demonstrating that Bipolar Disorder patients, even when they are in a euthymic period, experience lower Quality of Life, have lower Self-esteem and experience higher internalized Stigma associated with illness.

Background: This study was conducted to evaluate and compare the effect of adding two different doses (10 mg and 20 mg) of intrathecal meperidine with 0.5% hyperbaric bupivacaine on the onset, incidence and intensity of shivering during lower limb surgeries under spinal anaesthesia. Methods: This was a hospital-based randomized controlled trial study conducted among 60 patients aged between 18 and 60 years of physical status ASA grade 1 and ASA grade 2 of either sex undergoing elective lower limb surgeries at the Department of Anaesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, from December 2015 to September 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: The onset and intensity of shivering were greater in group 1 than in group 2 (p =0.007). The duration of shivering was significantly prolonged in group 1 compared to group 2 (p=0.004). There was a significant drop in temperature in both groups at 25 minutes (p<0.001) and 1 hour (p<0.001). The noted side effects were vomiting and pruritis. Conclusion: 0.5% hyperbaric bupivacaine with 20 mg of meperidine prevents shivering better with respect to incidence, intensity and duration of shivering when compared to 10 mg meperidine. Hence, we conclude that meperidine can be safely used at dosages of both 10 mg and 20 mg for the prevention of shivering with no significant difference with respect to complications.

Study Conducted: AT dept of generalsurgery, gajra raja medical college and JahGroup of Hospitals, Gwalior Madhya Pradesh Background: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods: This study was conducted on 100patients of diabetic foot in the Department of Surgery, JA Group of Hospitals and GR Medical College, Gwalior (MP) from January 2020 to June 2021 Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21 Results: A total of 100 cases of diabetic foot wounds were studied from January 2020 to August 2021 in the Department of Surgery JAH Hospital and G.R. Medical College, Gwalior.In our study,most diabetic foot wound patients presented in the 50-69 years age group with a mean age of 52.23±14.92 years. Male to female ratio of 4.5:1 was shown in our study.Total of 56% of patients presented with a diabetic foot wound within <10 years of duration of diabetes mellitus.67(67%) out of 100 patients gave a positive family history of diabetes.The most common cause was trauma/injury (65%) and the most common presentation was an ulcer (70%).Out of 100 patients, 66(66%) patients belonged to rural areas and 75% were illiterate.The most commonly affected patients are farmers (47%) and labors (29%) by occupation. Most of the patients were using ill-fitted shoes or barefoot walking.Most of the patients developing complications had uncontrolled RBS with delayed presentation and longer duration of diabetes and not took proper precautions and treatment.50% of patients underwent surgical debridement and 15 % of patients underwent amputation.Mortality was 2% in our study. Conclusions: Several risk factors for LEA were identified. , PAD, hypertriglyceridemia, and hypertension have been recognized as predictors of LEA in this study. Good glycemic control, the active investigation against PAD, and management of comorbidities such as hypertriglyceridemia and hypertension are considered important to reduce amputation riskNot all diabetic foot complications can be prevented, but it is possible to reduce their incidence through appropriate management. The multidisciplinary team approach to diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in high-risk diabetic patients.

Background: Identifying the women who are likely to miss receiving complete ANC care during their pregnancy and understanding the causal factors is essential towards the development of effective and targeted public health interventions. Objectives: To assess the sociodemographic profile and the factors influencing the utilisation of antenatal services among pregnant women in rural Coimbatore. Methods: A community based cross-sectional study was conducted among antenatal women residing in the field practice area of Rural Health Training Centre using multi-stage sampling method from June 2021 to May 2022 (one year) in the Rural Field Practice Area of a Medical College in Coimbatore district using pre-tested, validated, semi-structured questionnaire. Results: Majority (55.2%) of the participants were aged between 18-25 years. Only 10% of the women were currently employed. Tests of association showed that sociodemographic factors were significantly associated with ANC utilization (p<0.05). Among the study participants, 80.4% utilized the services completely (ANC visit to healthcare facility, consumption of IFA tablets, Td vaccination, basic blood, and urine investigations and ultrasonogram); 19.6% had incomplete ANC care and none had “No ANC”. Conclusion: The overall high ANC utilisation in the study area could be attributed to the favourable knowledge, attitude, and practice of the antenatal women towards maternal and child health as a result of high literacy rate, ongoing IEC and health promotional activities. Attention should be given to regular and sustained contact between healthcare workers and antenatal mothers especially through home visits to develop mutual confidence in preparing them for pregnancy, childbirth, and care beyond.

Introduction: Acute appendicitis is a common surgical emergency, with appendectomy being the gold standard treatment for this condition. Traditionally, early appendectomy has been advocated to prevent the potential complications associated with delayed intervention. However, recent studies have questioned the necessity of immediate surgical intervention and proposed a conservative approach with delayed appendectomy or even non-operative management. The debate between early versus delayed appendectomy in the treatment of acute appendicitis has gained significant attention among surgeons, researchers, and healthcare providers. This comparative study aims to provide a comprehensive analysis of the outcomes, efficacy, and safety of these two approaches. Aims and Objectives: This study aims to compare the morbidity, mortality, postoperative length of stay and 30 days readmission rate of acute appendicitis patients who had appendectomy within 8 hours of visiting the emergency room with those who had surgery after that period. Material and Methods: This study was conducted on 175 patients retrospectively who underwent appendectomy procedures from January 2021 to December 2021 at Adesh Medical College and Hospital, Shahabad, Kurukshetra, Haryana, India. The study population was divided into two groups based on the length of time before the intervention: early appendectomy (group 1), which included patients who underwent surgery within 8 hours, and delayed appendectomy (group 2), which included patients who underwent surgery after that time. The underlying characteristics of the two study groups were then compared, including demographic, clinical, radiological, and perioperative data. The 30 days readmission rate, postoperative length of stay, and mortality and morbidity were all regarded as outcome measures. Data were manually collected by reviewing patient charts in the electronic medical record. The Statistical Package for the Social Sciences (SPSS) 24.0 was used for the statistical analysis. Statistical significance was evaluated at p<0.05.  Results: A total of 175 patients met the inclusion requirements for the study population over the course of the twelve months of the trial period. Within 8 hours of their arrival at the emergency department, 100 patients (57.1%) underwent early appendectomy, while 75 patients (42.8%) did so after that time. The age was 43.8±11.85 years on average. A total of 54.28% (n = 95) of the population were male patients and the rest were females. Twenty patients (11.43%) overall experienced postoperative problems, including two postoperative hemorrhages (1.1%), five surgical site infections (2.86%), eight pneumonia (4.57%), one urinary tract infections (0.5%) and four patients (2.28%) who experienced multiple organ system failure. Within 30 days of surgery, six patients (3.4%) were readmitted. The 30‐day readmission rate (2% vs. 4%, p = 0.569) did not differ significantly between the two groups. The postoperative duration of stay did not differ significantly between the two groups: Median (IQR) 24.8 (11.2‐38.4) vs. 26.9 (11.6‐26.9) hours (p = 0.692). Conclusions: Our results concluded that eight hours delay in the appendectomy did not lead to longer postoperative stays, an increase in mortality or morbidity, or a higher 30‐day readmission rate, of patients with acute appendicitis. This comparative study investigated that early versus delayed emergency appendectomy in the treatment of acute appendicitis holds significant importance in guiding clinical decision-making. By critically analyzing the available evidence, this research aims to provide evidence-based recommendations to enhance patient care and optimize outcomes.

Background: The profile of cirrhosis may vary with different age and ethinic groups, geographical, social and etiological factors. So the present study will be undertaken  to study the  clinical profiles of patients with cirrhosis of liver in the form of demography, aetiology, clinical presentation, laboratory evaluation and  complications in this region of north Karnataka. Methodology: A two  years observational study after ethical committee approval was conducted at a tertiary care hospital among 200 cirrhotic patients in whom after explaining the purpose of the study,  detailed history, clinical and laboratory data was collected. The DATA was analyzed using  IBM SPSS Statistics for Windows, Version 25.0. Result. In our study the commonest age group was 31-50 years, mean age 44.10±13.08 years. Majority (88.5%) were males. Symptoms were abdominal distension (85.5%), lower limb edema(63.5%), jaundice (48%), gastrointestinal bleed(18.5%), altered sensorium in 14%. Aetiology were alcohol related (57.5%), HBV (13.5%), NAFLD(11.5%), viral and alcohol(5%), HCV (3%), Cryptogenic cirrhosis (4.5%) and Autoimmune Hepatitis (2.5%). Commonest   complications were hepatic encephalopathy (14%), Spontaneous bacterial peritonitis(14%), major renal impairment(12%) and Hepatocellular carcinoma (0.5%). 49% had CTP category B disease and 47.5% had CTP category C, 165 patients had MELD Na of >15. Conclusion: Cirrhosis is common among the most productive age group of society with change in lifestyle habits and increased alcohol use this has gained more importance. Recent advances in treating these patients may take a few more years in yielding new results and this article will act as a benchmark for comparison.

Background: General anaesthesia is associated with marked cardiovascular changes. Previous studies say that etomidate can be used in patients with limited hemodynamic reserve and propofol can lead to more hemodynamic instabilities. Hence, the present study was undertaken to compare the effects of propofol and etomidate on hemodynamicA changes during induction of general anaesthesia. Method: total 70 patients of ASA grade I & II, aged 18-60 years, weighs 40-80 kg, undergoing surgeries with general anesthesia were included and randomly divided into two equal groups.Induction of anaesthesia was carried out by using 0.3 mg/kg of etomidate in group A patients and 2.0 mg/kg of propofol in group B patients. Hemodynamic parameters such as: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and O2 saturation (SpO2) was measured and recorded at 1,3,5 and 10 minutes after intubation.Results: Both the groups were comparable and found no significant difference regarding demographic profile of patients, (p>0.05).At various time intervals i.e., T0 (before induction), T1 (after 1 min), T2 (after 3 mins), T3 (after 5 mins) and T4 (after 10 mins) the mean values of HR and SpO2 was comparable between two groups, (p>0.05) while the mean values of SBP, DBP and MAP were significantly lower in group B compared to group A, (p<0.05). Conclusion:Etomidate is haemodynamically more stable compared to propofol as the incidence and severity of hypotension are higher with propofol. Etomidate is a better option in patient’s particularly prone to hemodynamic instability at induction.

Background: Stroke rank high among the leading causes of death and permanent disability in India. Due to shifting demographics and rising rates of important modifiable risk factors. The purpose of this study was to compare the blood sugar levels of people with and without diabetes in the early stages of ischemic stroke. Material and Methods:  40 patients who had been admitted to the Department of General Medicine, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India for the diagnosis of acute ischemic stroke between the April 2022 to March 2023 were included in this study. The Patients were on the basis of the inclusion and exclusion criteria. Results: In our analysis of 40 patients, the majority of them were male, indicating a male preponderance, which is prevalent in most investigations. Twenty-eight of the forty patients had hypertension, 34 had diabetes, three had a history of myocardial infarction, and one female patient had atrial fibrillation. The majority of the patients (15) were between the ages of 51 and 60, with 11 between the ages of 27.5 and 12.5% between the ages of 40 and 50. Conclusion: Ischemic stroke severity, magnitude, and outcome are linearly related to admission day hyperglycemia. Diabetes and stress hyperglycemics have greater severe strokes and worse functional outcomes and higher death. Admission day glucose levels predict ischemic stroke outcomes.

Background: Plantar fasciitis is a degenerative condition, which is the most common cause of heel pain seen in nearly 10% of population. Though it is usually a self-limiting disease, symptoms may require treatment. Methods: 120 (n=60) adult patients with chronic plantar fasciitis, who met the inclusion criteria were evaluated from November 2020 to June 2021 in IGGGH & PGI, Puducherry. In this prospective comparative study, Group-A was given Platelet-Rich Plasma (PRP) and Group-B was given triamcinolone acetonide injections intra-lesionally. Follow-up was done at 4th, 8th and 12th week post-injection and improvement was assessed by Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AHFS) and Foot & Ankle Ability Measure - Activities of Daily Living (FAAM-ADL) subscale. Results: 63 males and 57 females in the age group between 23 and 81 years with a mean duration of symptoms of 6.74 ± 2.75 months were included. Right side was predominantly involved. There was a statistically significant improvement in VAS and FAAM-ADL at 4 weeks follow-up in group B, whereas there was no difference in effectiveness at 8th and 12th weeks. AOFAS-AHFS scores were similar in both with “excellent” results in 23 Group-A and 45 Group-B patients. Conclusion: Both PRP and corticosteroid injections are effective in treating chronic cases of plantar fasciitis with better immediate results with corticosteroid. As PRP is an autologous product it is a safer option. Further studies with longer follow-up period are needed to confirm our findings.and lignocaine alone.

Background: In this study, we wanted to compare the safety and efficacy of clear fluids until 3 hours as compared to 6 hours of starvation before and after minor surgical procedures. Materials And Methods: This was a hospital based prospective randomized comparative interventional study conducted among patients age group of 18 to 60 years of either sex who presented with minor surgeries to the Department of Surgery, ENT, Obstetrics & Gynaecology and Ophthalmology after obtaining clearance from institutional ethics committee and written informed consent from the study participants.  Results: The sense of wellbeing parameters in the starvation group that were not statistically significant were dizziness, anxiety, nausea or loss of appetite, headache and weakness than the clear fluid group at 3 and 6 hours of starvation post operatively. The difference was statistically significant with regard to thirst and dryness of mouth. Conclusion: Wellbeing parameters were significantly improved in patients who were given clear liquids before surgery and after surgery and significance reduced as fluids replaced over time.

Introduction: Cystic fibrosis is a life-shortening disease of young children but it has been present in adults in recent days. Studies on epidemiology and microbiota of cystic fibrosis from the southern part of India are very few. So we tried to project the data of bacteria responsible for pulmonary exacerbations in cystic fibrosis patients and their antibiotic sensitivity. Materials and Methods: A total of 75 samples were collected from confirmed cystic fibrosis patients attending outpatient clinical departments and were processed for culture and sensitivity according to CLSI protocols. ESBL and MBL production among non fermenters were detected using antibiotic discs using modified Kirby bauer method. Results: Out of all isolated pathogens Pseudomonas aeruginosa isolates were 29 (40.8%), 15 (21.1%) isolates were Klebsiella pneumoniae, 12 (16.9%) Staphylococcus aureus, 7 (9.8%) Candida albicans, 4 (5.6%) Enterobacter cloacae, 2 (2.8%) Burkholderia cepacia, and 2 (2.8%) Burkholderia species. Out of 29 Pseudomonas aeruginosa isolates 68.9% showed ESBL production and 17.2% showed MBL production. All the Burkholderia cepacia tested were ESBL and MBL producers. 100% and 50% of Burkholderia species expressed ESBL and MBL enzymes respectively. Conclusion: Co-existence of S.aureus and P.aeruginosa in cystic fibrosis patients is still a matter of debate. Many hypotheses including the present study concluded that microorganisms are antagonistic invitro after a prolonged co-existence.

Uterine inversion is a rare event, out of which chronic puerperal uterine inversion is rarest of all, with only handful of cases reported in literature. We reported two such cases of chronic uterine inversion and one case of acute uterine inversion in our practice of 10 years which were promptly diagnosed and managed  surgically .Our 1st case was 34 years old p2l2 lady with history of irregular bleeding per vaginum and heaviness in lower abdomen since last 3 months after delivery of her 2nd child ,which was  delivered at home in absence of trained birth attendant .2nd case was p1l1 lady which was attended in OPD as a case of irregular uterine bleeding with heaviness in lower abdomen and something coming out per vaginum on straining ,she also gave history of  history of post-partum hemorrhage  after delivery  of her baby 5 months back and 1 unit of blood transfusion in some peripheral center.  Both these patients were examined, and a differential diagnosis of uterine inversion and cervical polyp was made for which they were investigated, and an USG followed by MRI was done which confirmed the diagnosis of uterine inversion.3rd case was a patient with acute uterine inversion after home delivery were the diagnosis was made clinical. All these patients were immediately taken up for laparotomy and surgical correction was done by Haultain’s method and uterus was preserved.

Background & Objectives: Postpartum depression (PPD) is defined as presence of depressive symptoms in the postpartum period. A seemingly innocuous disorder, if untreated can lead to foeticide or maternal suicide. Furthermore, there is currently no screening tool designated for use in clinical practice and no data are routinely collected on the proportion of perinatal women with postpartum depression. Hence the current study is taken to accurately estimate the burden of postpartum depression using valid tool. To assess the prevalence of postpartum depression among postnatal mothers in rural India Methods: A cross-sectional study was done among the 110 postnatal mothers attending immunization clinics and general OPD in the field practice area of department of Community Medicine, GMC, Srikakulam. Modified EPDS scale validated in local language was used to collect data. Results: The mean age of the mothers 23.7 ±2.6 ,most(42.7%) of them were intermediate educated and upper lower class(70%) of SES. The prevalence of possible depression (score ≥10) is 19.1% and the prevalence of Depression of varying severity (score >13) is 10%. Post partum depression is associated with age, SES, type of delivery, immediate outcome of delivery. Conclusion: EPDS tool can be effectively used to screen post partum depression at primary health care level.

Objective: Congenital heart disease (CHD) is the most common congenital anomaly in newborns and is a significant cause of mortality. The distribution pattern varies with different regions.   The aim of this study was to evaluate the pattern of CHD among referred pediatric population in south India. Methods: This was a single centre cross-sectional observational study done over a period of one year. A total of 616 infants and children referred with suspected CHD to a tertiary care centre in Kerala, from January to December 2019 were included. They underwent routine clinical examination, pulse oximetry and echocardiography. Results: Among the 616 enrolled subjects, 553 had CHD of which 526 (95%) had acyanotic lesions, 20 (3.6%) cyanotic lesions and 7 (1.2%) non-specified CHD.  Among acyanotic CHD, shunt lesions were much common (87%) than obstructive/ regurgitant lesions (13%). Atrial septal defect (ASD) accounted for 54.9% followed by Ventricular septal defect (14.5%) and patent ductus arteriosus (PDA) (13.9%). Pulmonary stenosis was the most common obstructive lesion (4.5%). Tetralogy of Fallot was the commonest among cyanotic CHD (2.1%). In 47 (8.4%) cases a combination of simple defects was seen, the commonest being ASD with PDA in 17 (3%) cases. Only consanguinity (2.6% vs. 0.3%, p 0.02) prematurity (16% vs. 4.4%, p 0.0001) and low birthweight (2.65 Kg vs. 2.89 Kg, p 0.001) were significantly associated with CHD. Conclusion: Among a referral pediatric population, ACHDs were far more common than CCHDs.  Shunt lesions formed the majority of ACHD. While prematurity, low birth weight and consanguinity were the risk factors associated with CHD, parity, birth order and parental age were not. Inclusion of neonates in the study is one probable reason for the large proportion of shunt lesions like ASD in the study.

Background: Postoperative pain is the major cause of fear and anxiety leading to prolonged hospital admission and delayed discharge rates in hospitalized patients. So, to make the patient pain free, multimodal analgesia has been used since long time. Opioids as an adjunct to epidural local anaesthetics by many people, but opioid free analgesia is a major concern in recent times to avoid its respiratory depressant and other adverse effects. Objective: studying non opioid drugs namely α2 agonist dexmedetomidine and magnesium sulphate as an adjunct to epidural bupivacaine and to compare their hemodynamic, sedative and analgesic effects. Methods: A randomized double blinded study was conducted in 60 patients of either sex belonging to ASA class I and II scheduled for elective lower abdominal and lower limb surgeries under epidural anaesthesia. They were divided randomly into two groups (n = 30). After epidural block, test dose was given with 3 ml 2% lignocaine with adrenaline. Both the groups received 15ml 0.5% bupivacaine, group MB received 50mg magnesium sulphate and group DB received 25µg dexmedetomidine. Onset and duration of sensory blockade, motor blockade; time required for first rescue analgesia; Ramsey sedation score; cardiorespiratory parameters and adverse events were recorded. Result:   Onset of sensory and motor blockade was rapid: duration of sensory and motor blockade; and the time for rescue analgesic was prolonged with higher sedation in group DB. Cardiorespiratory parameters and adverse effects were comparable between the two groups. Conclusion: Addition of dexmedetomidine to epidural bupivacaine can be advantageous with increased duration of sensory and motor blockade with arousable sedation, acceptable side effects and better patient comfort compared to addition of magnesium sulphate.

Background: In a clinical setting assessment of airway needs to be simple and convenient3. There is no single test with absolute accuracy to predict difficult airway2. In our study we assessed airway difficulty in elective surgeries for adults by comparing ULBT and MMS individually as well as in combination to that of Cormack-Lehane grading. Method: The single blinded prospective, comparative and observational study was conducted at SDMCMS& Hospital Dharwad. A total of 150 patients aged 18-60 years of either sex with ASA physical status 1,2&3 who underwent elective surgery under general anaesthesia were included. CL grade 3&4 deemed as difficult laryngoscopy. Diagnostic testing was carried out to compare MMS and ULBT with CL grade in predicting difficult intubation. McNemar test was used to compare difference between diagnostic parameters. P-value less than or equal to 0.05 was considered statistically significant. Results: Demographic data and ASA grades were same for participants. We observed that at 95% Confidence Interval (CI) for ULBT sensitivity (92%), specificity (68%), positive predictive value (93.5%) and negative predictive value (62.96%) was better compared to that of MMS whose sensitivity was 64.8 %, specificity 24%. Also, ULBT had a better accuracy 88% than that of MMS with 58%.  Conclusion: Our study and analysis concluded that the upper lip bite test is good option for predicting difficult intubation than Modified Mallampati Score.

Introduction: Diabetes mellitus is the most common endocrine disorder of humans characterized by metabolic abnormalities leading to long term complications involving kidneys, gastrointestinal tract, nerves and blood vessels, thereby causing morbidity and mortality. Human diabetic neuropathy is characterized by dysfunction of somatic and autonomic nervous system. A simple definition it Was recently agreed on at an international consensus meeting. “The presence of symptoms and/ or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes”. Vagal innervation of the heart is essential efferent pathway to sustain this variation which is decreased as age advantage due to lowered vagal tone. Asymptomatic but striking reduction or absence of this variation is observed in autonomic neuropathy.  Materials And Methods: Diabetes mellitus patients who have been attending Department of General Medicine, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka from January 2022 to December 2022 were taken for study considering the inclusion and exclusion criteria. This is a cross sectional study. All the Selected patients will be investigated with RBS, FBS, PPBS, HbAIc for glycemic control. Ultrasonography was done to study the fasting gall bladder volume in patients. Cardiac autonomic neuropathy will be assessed clinically by using simple non invasive bed side tests like heart rate variation during to standing, deep breathing.  Results: The youngest patients was 41 years old and the oldest was 76 years old. The maximum number of patients were in the age group of 41-50 ( 55%). Mean age in the present study was 52.6 years. In our study 60 (75%) were male and 20 (25%) were female. In the present study the mean gall bladder volume in diabetes with diabetic Severe autonomic neuropathy was 55.8 + 9.9ml and as a whole mean gall bladder volume in persons with autonomic neuropathy was 30.13 ± 18.73ml and the mean gall bladder volume in diabetes without diabetic autonomic neuropathy was 18.5 +5.01ml. P value is <0.05 there is statistically significant correlation between diabetic autonomic neuropathy and Gall bladder volume. Conclusion: The gall bladder volume was significantly higher in diabetic patients with autonomic neuropathy when compared to diabetics without autonomic neuropathy. Diabetic autonomic neuropathy was seen in diabetic patients who had poor glycemic control when compared to those who had good glycemic control. The gall bladder volume was more in diabetic patients with higher age group patients. A definite association of cardiac autonomic neuropathy with cholecystomegaly has been established by our study.

Due to advent of technology and internet, teaching too is now largely utilizing these modern devices and internet to impart education to the children. When it was mandatory to keep social distancing and hence avoid regular classes for medical students during the dreadful COVID pandemic, it was decided to teach the 1st year MBBS students online using the technology and the internet. This study aimed at determining if the students found this novel online teaching to be helpful or not. Methodology: A total of 100 1st year MBBS students in a tertiary medical college in central India were included in the study from September 2020 to February 2021 for 6 months. It was an observational study and an informed consent from the students was taken prior to the study. Classes were conducted as usual as per the institutional guidelines and feedback forms were collected after that. Results: Out of total 100 students, 65 were girls and 35 were boys. Average age of the class was 19.2  1.1 years. 85% had used mobile phones and internet for education before and 15% had never used it for education purpose. 75% had a concentration time of 30 minutes. About 50% students faced internet issues and faced moderate disturbance during the classes. 85% used mobile phones for the classes. 60% students opined that such online classes are effective for teaching anatomy while 40% told that it was not effective. Conclusion: The study concludes that currently online classes for the subject like anatomy are not as effective as regular classroom teaching. The factors could be low motivation, technology and internet problems, low attention span etc.

Background: Alopecia areata is a common cause of non-scarring alopecia of hair characterized by single or multiple patches of hair loss.  It is an autoimmune disease with an unpredictable course and has a profound impact on the psychosocial well-being of the patients. Aims: Our present study aimed to assess the demographic pattern, clinical patterns, and associations with diseases in a tertiary care teaching hospital in Bihar. Materials & methods: All patients diagnosed with alopecia areata visiting dermatology opd and fulfilling the inclusion criteria were included in the study. A detailed history-taking and clinical examination was conducted and recorded in a predefined performa. All routine blood and radiological investigations, dermoscopic and histopathological examination in doubtful cases. All data were recorded and analyzed with Descriptive statistics and Chi-Square Test. Analyses of collected data were done by SPSS software, version 18.0. Results: A total of 82 patients suffering from alopecia areata were included in our study. 53(64.6%) patients were male and 35(29%) were female. The male-female ratio was 1.5. Classical alopecia areata was the commonest (87.8%) variant noted. Alopecia totalis (6.1%), alopecia universalis (3.6%), and ophiasis pattern (2.4%) were also identified. Scalp (67.3%) was the commonest site involved. Majority of our patients presented to us within 6 months of disease onset. 23 patients (28%) had nail involvement. In our study, Atopy was the most common condition associated condition seen in 10.8 % of cases followed by vitiligo in 4(4.8%), leucotichia in 2(2.4%), lichen planus in 3(3.6%), androgenic alopecia in 4(4.8%) and verruca in 3 (3,4%) cases. Ocular changes were present in 11(13.4%) cases. Conclusion: Alopecia areata mainly affects young and adolescent age group patients. Poor prognostic factors are extensive involvement, early age of onset, and positive family history. The scalp region is most commonly involved. The most common associated condition noted was atopy.

Background:  Tuberculosis is a specific infectious disease caused by bacteria belonging to the "Mycobacterium tuberculosis complex". It presents a great social and economic problem and is one of the major factors responsible for high morbidity and mortality in India. The incidence of tuberculous cervical lymphadenopathy accounts for two third of extra pulmonary tuberculous lymphadenopathy. Higher proportion of tuberculous origin is because of greater incidence of pulmonary tuberculosis in our country. Perhaps there are many other causes of lymphadenopathy which are usually misdiagnosed as tuberculosis. Thus, it has been a common problem for both the clinicians as well as the pathologists to diagnose tuberculosis. Methods and Materials: The present work is carried out in 100 clinically suspected cases of tuberculous cervical lymphadenitis attending E.N.T., Surgery, Paediatrics and Medicine Department of central India institute as an outdoor/indoor patient during the period of one year. Patients with enlarged cervical lymph nodes with a history suggestive of tuberculosis were included after taking an informed consent. Results: Study was conducted on 100 clinically suspected cases of tuberculous cervical lymphadenitis, Tuberculosis was diagnosed in 57% cases by FNAC, smear and culture together, the maximum incidence of tuberculosis was observed in second and third decades, Females were more affected (64%) than males with the ratio of 1:2.3. FNAC showed accuracy of 42%, 30% cases were AFB smear positive in our study which nearly matches to other authors. The culture studies could diagnose 57 cases as tuberculous and 4 cases as non-tuberculous cervical lymphadenitis. Culture positive was higher in granulomatous necrotic lesions. Sensitivity, specificity and predictive values of culture study were significantly higher than FNAC and smear. These methods of investigation require considerable experience and confidence of the pathologist who perform the procedure for better results. When culture was taken as Gold Standard, cytology was found to be more sensitive than smear. Conclusions: From this study we concluded that Both FNAC and smear are quick, simple, less traumatic and cost-effective methods and are used as routine investigating procedures in OPDs of urban and semi-urban hospitals. Simplicity of these techniques (FNAC & Smear) combined with early availability of results and good diagnostic accuracy warrants their clinical application. Missed cytological diagnosis and isolation of non-tuberculous mycobacteria justify the use of culture studies in all suspected tuberculous lymphadenitis cases.

Background: Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality all over the world. It causes about one-third of all deaths in people older than 35years. We carried out this study because there was no such study carried out in Andaman and Nicobar Island to ascertain the incidence of CAD and the risk factors which lead to CAD in Andaman and Nicobar population. The health sector in Andaman and Nicobar is developing. Due to the increasing load of CAD patients recently the Cath Lab was started as the ANIIMS Port Blair / GB Pant Port Blair is the only tertiary care hospital in the whole of Andaman and Nicobar Islands. To get a better insight into the disease prevalence and how to lower the risk factors. Material and methods: This cross-sectional study was done in a tertiary hospital in Port Blair to find out the prevalence of risk factors among patients with coronary artery disease. A total of 315 patients were screened based on a questionnaire, ECG (Electrocardiography) and laboratory investigations. Data was analysed in SPSS and Microsoft Excel and was presented as tables and graphs. There was significant observation based on age, clinical features, risk factors, ECG patterns and laboratory diagnosis. The result was conclusive of increased prevalence of risk factors among CAD patients which was also reported in various studies conducted in India and across the world.  Results: This study has estimated that the overall prevalence of Hypertension is 86.03%, Type 2 diabetes mellitus is 88.89%, Smoking is 55.87%, Hypercholesterolemia is 71.43%, Hypertriglyceridemia is 68.25%, Obesity is 65.40%, Stress is 61.9%, and Family history is 12.38%.  Conclusion: The present study demonstrates a high prevalence of CAD risk factors in the population of Port Blair, Andaman and Nicobar Islands. The study population reflects the rising trends of CAD in urban India. The incidence of CAD has increased further because of rapid urbanization and its accompanying effects like sedentary lifestyle changes, change in food habits, lack of outdoor activity. There should be an early detection of a risk factor to prevent morbidity and mortality in the community. Therefore, there is an immediate need to raise awareness among the general population regarding these risk factors, signs and symptoms of coronary heart disease promote the correct diet and physical activity, meditation,yoga and others and at the same time develop guidelines for screening and preventive therapeutic programs to identify and manage individuals at high risk for future CAD.  CAD can be prevented by dietary modification, changing lifestyle, decrease tobacco consumption and regular physical exercise. Screening and regular medical check-up of patient helps in early detection of CAD.

Material & Methods: Study Design: Hospital based prospective cross-sectional study. Study area: The study was conducted in the Department of Paediatrics.  Apollo Institute of Medical Sciences and Research, Hyderabad. Study Period:  JAN 2021 TO DEC 2022.  Study population: Children aged between two months and two years, presenting with first episode of acute bronchiolitis and respiratory distress attending department of paediatrics.  Sample size: Study consisted a total of 88 subjects. Sampling Technique:  Simple Random technique. Results: Among 88 cases, 23 cases (26.1 %) showed negative in viral panel, 33 cases (37.5%) showed Respiratory syncitial virus, Rhino virus was the 2nd most common virus seen in 18 cases (20.5 %), Adeno virus in 3 cases (3.4 %), Para influenza seen in 3 cases (3.4%), Boca virus in 2 cases (2.3%), Human metapneumo virus seen in 2 cases (2.3%), Influenza and Para influenza seen one in each. Conclusion: Infants with Bronchiolitis typically present with upper respiratory tract symptoms. Bronchiolitis is common in young infants, with male predominance and severity of bronchiolitis also has male predominance. Our study very interestingly found that none of the cases required invasive ventilation, majority were treated with only humidified high flow nasal canula. Severity of bronchiolitis is more among RSV positive cases.

Background: Vitiligo is an acquired disorder of the melanocytes characterized by depigmented macules and patches. The chronic, unpredictable course of the disease and the visible cosmetic disfigurement leading to social discrimination lead to a decline in the quality of life (QoL) of patients suffering from Vitiligo. Aims and objectives: This study aims to assess the impact of Vitiligo on the quality of life of patients using two questionnaires – Dermatological Life Quality Index (DLQI) and Vitiligo Quality of Life (VitiQoL). Materials and methods: All patients above the age of fifteen years presenting with Vitiligo were included in the study after taking written informed consent. Patients with any other co-existing debilitating disease or disability, psychiatric problems, systemic or personal conditions which might have an impact on the Quality of life (QoL) as well as pregnant and lactating women were excluded from the study. Socio-demographic data and detailed history regarding the symptoms, duration of disease, and treatment history was recorded. A thorough general physical, systemic, and cutaneous examination was done. Patients were requested to answer the questions of the DLQI questionnaire and VitiQoL questionnaire after clearly explaining the meaning of the questions to them in their preferred language. The answers were noted by the same dermatologist in every case. The DLQI and VitiQoL score was then calculated. The scores were evaluated and compared at the end of the study. Results: A total of 78 patients were included in the study in the age group of 15-78 years and the mean age was 34.6 ± 4.4 years. There were 46 males and 32 females included in the study and the male-female ratio was 1.4:1. According to the DLQI scores, a moderate effect was seen in 27(34.6%) patients, followed by a very small effect in 24(30.7%) patients, very large effect in 18(23%) patients, no effect in 6(7.6%) patients and extremely large effect in 3(3.8%) patients. The mean DLQI score was 7.8 ± 5. There were 19(24.3%) new patients, and 59(75.6%) patients already under treatment for vitiligo. The commonest type was non-segmental (generalized vitiligo) seen in 38(48.7%) patients followed by acro-facial in 14(17.9%) patients. Segmental vitiligo was present in 8(10.2%). The duration of symptoms was greater than one year in 44(58.9%) patients and the mean duration was 1.8 years. Around 21(26.9%) patients had patches of overexposed parts of the body and a family history of vitiligo in first–degree relatives was positive in 3.8% of patients. The VitiQoL score in our study had a mean value of 37.8 with a standard deviation of 4.2. Higher mean values were seen in questions pertaining to frustration regarding the disease (3.8± 2.4), fear of progression (3.3±1.9), and worrying about what other people might think of them (3.1±2.7). Conclusion: Vitiligo is a disease that is still significantly associated with tremendous social stigma which greatly impacts the personal, professional, and social aspects of the patient’s life. Understanding the degree of impairment that Vitiligo can have on the quality of life (QoL) of patients will help us understand the magnitude of the problem and thereby take adequate steps like treatment with psychological support as well as counseling, along with community awareness programs to improve the QoL of patients.

Introduction: Hospital waste is “Any waste which is generated in the diagnosis, treatment or immunization of human beings or animals or in research” in a hospital. “Hospital waste is a special type of waste produced in small quantities carrying a high potential of infection and injury and high potential to transmit infection to others. There are serious health effects from public health standpoint if hospital waste is not handled properly. Usually, the terms medical waste, hospital waste, infectious, and regulated medical wastes are often used interchangeably with medical wastes since there is no universally accepted definition for these terms.  Material and Methods: This is a Facility based cross-sectional study conducted at Health care facilities at various levels in Ganjam district.  In each health care facility, the medical officer, the pharmacist, the staff nurse and attendant comprised our study population. Those health care providers who gave consent to participate in the study. Using the observation checklist, the facilities were observed for infrastructure, logistics and practice of the stake holders. Then, the respondents were interviewed using the structured questionnaire for knowledge. A value of 1 and 0 was assigned for correct and incorrect practices respectively. For knowledge a value of 1 and 0 was assigned for correct and incorrect responses respectively. The total knowledge and practice score for each facility was calculated and then mean score was calculated. They were asked for their valuable feedback. Finally, they were thanked for their valuable support. Results: Only 12 (46.1%) of the doctors agreed that their facilities generate biomedical wastes, 15 (57.7%) of the doctors had opined that biomedical wastes associate with health hazard, 17 (65.4%) of the doctors were concerned regarding needle stick injury, 15 (57.7%) doctors believed wearing PPE reduces infection.  Color coding of the waste segregation could be answered by 17 (65.4%) doctors, 13 (50%) of the doctors agreed that the BMW containers need to be labelled and 16 (61.5%) doctors agreed that the wastes need to be segregated at point of generation. Regarding color coded bins, 19 (73.1%) doctors practiced putting wastes in color coded bins. 20 (76.9%) doctors had the practice of displaying segregation instructions at their work place.  16 (61.5%) doctors were properly segregating wastes and aided in its proper transport. 18 (69.2%) doctors were not in practice of getting dustbins filled more than 3/4th. Conclusion: Findings from our study reveal that though the participants in our study have a fair knowledge regarding biomedical waste management still there is a lot of scope in not only improving the knowledge but also in changing the attitude and inculcating more rational practices towards the same. Majority of attendants had poor knowledge and practice regarding BMWM. Thus, there has to be a regular training programmes on biomedical waste management and its hazards for all the healthcare workers including group D workers. Along with educational intervention, strict implementation of biomedical waste management guidelines with its monitoring at all levels is also very much essential.

• Objectives To predict the  risk  of amputation .
• Prognosticate diabetic foot ulcer healing & complications
• Average length of Hospital stay(ALOS)

Material and Methods: This Is Prospective Study Conducted In Belgavi Institute Of Medical Sciences Belgavi From 2018 Till 2020. Total of 90 Diabetic patients with diabetic foot ulcers irrespective of their duration, attending surgical outpatient clinic or admitted into the BELGAVI INSTITUTE OF MEDICAL SCIENCES BELGAVI were recruited into the study based on the inclusion and exclusion criteria. ulcers were followed up for a minimum period of 6 months. Once a patient’s ulcer had healed completely either by primary healing or skin grafting or a lower-limb amputation performed, the outcome was noted and the patient was deemed to have completed the study Results AND Interpretation: Most Of The Patients Were Male In Thr 5 N 6 Decade ,Scoring Done Using Duss Score 11% Requiring Major Ampuatation And 44 % Minor Ampuatation. With Increases In Duss Score Ampuatation Chances Are More. Conclusion: DUSS scoring system provides an easy diagnostic tool for predicting probability of healing or amputation by combining four clinically assessable wound based Parameters.

Background: majority of the time, giant cell tumours (GCT) of the bone develop in the region of the long bones' metaphysis, frequently in contact with the articular cartilage. Their treatment remains controversial because of their high recurrence rate. Many studies have been conducted using various treatment techniques for GCT’s resection but less emphasis is given to managing it with curettage and cementation with internal fixation. Aim: Our study aims to evaluate the functional outcome of curettage and cementation with plate fixation in a giant cell tumor of a long bone.  Methods: This Interventional study was conducted between November 2020 to October 2021 in our orthopaedics department after clearance from the ethical committee. 27 GCT patients received treatment using extended curettage and cementation followed by plate fixation. All of these tumors were present around the knee: 21 at the distal femur and 6 at the proximal tibia. Preoperative radiological evaluation with standard X-rays showed that the tumour measured a mean 65 × 41 mm, for a mean volume of 70 cm3. Seventy-eight percent of these GCTs were in direct contact with the articular cartilage and 45% extended to the soft tissues as seen on the MRI. All patients were treated with extended curettage and cementation with plate fixation. Follow up was done after 1,3,8,12,24 weeks. All patients continue to be monitored, with none lost to follow-up. Functional evaluation was done using the Musculoskeletal Tumour Society (MSTS) scoring system for the lower extremity Results: The overall MSTS score was excellent in 22 patients (84%), good in 3 patients (11%), fair in 1 patients (0.03%), and poor in 1 patient (0.03%). The overall local recurrence rate was 0.07% (2 cases) and a 10% complication rate. There were no cases of fracture non-union or distant metastasis till 1 year follow up in all patients. Conclusion: GCTs around the knee with associated pathological fractures at diagnosis can be treated with curettage and cementation as cavity filling with cement has its own advantage of cytotoxic effect and mechanical support synergizing with the stability given by the plate to achieve an anatomic reduction and stable fixation. This procedure also has an added advantage of joint preservation in a younger age and varied mega-prosthetic procedures. This technique is a good and equivalent option along with other techniques using extending curettage.

Introduction: Essential hypertension is a common circulatory system disease, which is affected by both genetic and environmental factors, and accounts for more than 40% of the cardiovascular disease total burden. Aim: To study 24 hour sodium and correlation to blood pressure and left ventricular hypertrophy in essential hypertension. Materials and methods: It is Hospital based Analytical Observational Cross-sectional study done in 100 patients comprised of hypertensive individuals presenting to Medicine op and patients admitted under the department who are fulfilling the inclusion and exclusion criteria.  Results: There was a strong positive correlation between Systolic BP , diastolic BP , MAP , duration of HTN (Years) and Urinary Sodium (mmol/L), and this correlation was statistically significant. There was a significant difference between the 2 groups in terms of urinary sodium(mmol/L), with the median Urinary Sodium (mmol/L) being highest in the LVHI. There was a significant difference between the various groups in terms of distribution of LVMI.There was a positive correlation between Systolic BP, Diastolic BP, MAP (mmHg) and LVMI (g/m2), and this correlation was statistically significant . There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2) (rho = 0.17, p = 0.084). There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2). Conclusions: Hypertension is one of the preventable causes of cardiovascular mortality. Hypertension can be prevented by modifiable risk factors such as low-salt diet, physical activity, blood sugar control, and smoking cessation.