Current Issue

Background: The second most common cancer and the main cause of death from cancer worldwide is lung cancer. The stage of the cancer, mutation, and histological type all affect the prognosis and course of treatment. There is no adequate data about histological subtypes lung cancer in our area. The aim of this study is to evaluate the smoking status, histological subtypes, clinicoepidemiological profile, and interdependencies among those suffering from lung cancer. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India. From May 2, 2021, until May 7, 2022. Histopathologicaly confirmed lung cancer patients were studied. The data was collected by using a semi-structured proforma, and SPSS 20 was used for analysis. Results: The mean age of the patients (n=124) was 63.42 + 9.11 (SD) years. The common symptoms were cough (71.8%), breathlessness (62.9%), chest pain (35.5%), and loss of weight (31.5%). Among the patients 86.3% are males and 80.6% are smokers. Adenocarcinoma was the commonest histopathological subtype (45.9%) followed by squamous cell carcinoma (37.9%), small cell carcinoma (10.5%) and other neuroendocrine tumors (5.6%). Squamous cell carcinoma was the commonest subtype among males (42.1%) and smokers (44.6%). Adenocarcinoma remained commonest among females (82.3%) and non-smokers (87%). Cough was significantly higher in squamous cell and small cell carcinomas (p=0.04). Dyspnea remained the most prevalent symptom in adenocarcinoma (64.9%). Conclusion: Adenocarcinoma was the commonest subtype. Squamous cell carcinoma had higher prevalence among males and smokers; adenocarcinoma was higher among females and non-smokers. The commonest symptom was cough. Cough was significantly higher in squamous cell and small cell carcinomas. Dyspnoea was the most prevalent symptom in adenocarcinoma. Keywords: Lung cancer, Smoking, Adenocarcinoma, Squamous cell carcinoma, small cell carcinoma.

Background: Skin is the largest organ of the body and is constantly harmed by a variety of environmental factors resulting in various kinds of neoplastic and non-neoplastic skin lesions. Among the non-neoplastic skin lesions, infective skin lesions are very commonly encountered in India, possibly due to the hot and humid environment, and lack of general awareness regarding infectious diseases. Very few studies, if any, have been conducted in the Garhwal region regarding infective skin lesions. Hence, present study was carried out to determine the spectrum of infective skin lesions. Aim and Objective: Present study was carried out to understand the spectrum of various skin lesions in correlation with age, sex and type of clinical lesion at a tertiary care hospital in Garhwal region. Materials and Methods: Study Design: Non-interventional, cross-sectional, retrospective study was carried out from January 2022 to December 2023, on all skin biopsies diagnosed as infective skin lesions in the department of pathology, Veer Chandra Singh Garhwali institute of medical sciences and research irrespective of age and sex. Results: Out of the 63 cases studies, leprosy was the most common infective skin lesion followed by tubercular dermatoses. Male predominance was present, with the most commonly encountered age group being 41-50 years. Presence of a hypopigmented patch was the most common clinical finding. Conclusion: Leprosy was the most common infective skin lesion encountered in our study followed by tubercular dermatoses. Due to the wide range of clinical presentation in infective skin diseases, histopathological examination is necessary to make an accurate diagnosis. Keywords: Infective skin lesions, leprosy, tubercular dermatoses.

Introduction: The utilization of laparoscopy in managing abdominal trauma, either diagnostically or therapeutically, has been on the rise. However, its comparative outcomes with conventional laparotomy, especially concerning therapeutic management, remain unclear. Methods: This retrospective cohort study involved patients from trauma center of an Indian medical college. 78 patients who underwent laparoscopic interventions for abdominal trauma were included in the laparoscopy group (LP group). Another 78 patients who underwent laparotomy (LT group) were matched based on baseline characteristics, causes of injury, and hemodynamic parameters. Perioperative clinical parameters and short-term survival were compared between these two groups. Results: Baseline characteristics were similar between the LP and LT groups. The most common cause of trauma was traffic accidents, and the predominant surgical intervention was bowel repair/resection. Operation time did not significantly differ between the two groups, while the post-operative complication rate was slightly lower in the LP group without statistical significance. Opioid use was lower in the LP group compared to the LT group. Additionally, hospital stay was significantly shorter in the LP group. One patient in the LT group died due to an intra-abdominal abscess and multiple organ dysfunction syndrome 20 days postoperatively, whereas all patients in the LP group recovered and were discharged. Conclusion: Laparoscopy is deemed feasible and safe for treating hemodynamically stable abdominal trauma patients when performed by experienced surgeons. Laparoscopy appears to offer advantages such as reduced pain and quicker recovery while maintaining similarly favorable clinical outcomes compared to conventional laparotomy. Keywords: Abdominal trauma, hemodynamically stable, laparoscopy, laparotomy

Background: Cardiac troponins (cTn) are specific biomarkers of myocardial injury and have a well-established role in guiding the management of chest pain.5,6 An elevated troponin-I (cTnI) has also been associated with a poor prognosis in critical illness, pulmonary embolism, cardiac and non-cardiac surgery, stroke, and end-stage renal disease. Materials and Methods: This study was conducted in Department of Medicine in RBM Hospital & Shree Jagannath Pahadia Medical College, Bharatpur, Rajsthan. This cases control study was included 100 control and 250 cases. The duration of study was over a period of one year. Results: Among the 250 cases examined, 96 tested positive for Troponin-I, while the remaining cases tested negative. Among the Troponin-I positive cases, 64 were male and 32 were female, indicating a higher predominance of Troponin-I positivity among males. Significant differences (p < 0.01) were observed in these variables between the cases & control groups. Conclusion: The present study shows in the patients who developed chest pain due to cardiac event as confirmed by positive troponin-I test were having lipid parameters in the risk level as suggested by ATP III. Keywords: Troponin-I (cTnI), Myocardial injury, Biomarkers.

Background: Despite control strategies, tuberculosis remains a significant public health problem in many countries. Along with effective control measures currently available, it is essential to identify and target the risk factors of developing active TB to tackle the heavy burden of the disease. This study aims to find out the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. Materials and Methods: A case-control study was done to assess the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. The study was done from a parent study conducted in South India to study the prevalence of diabetes mellitus among registered tuberculosis patients. Those patients diagnosed with both tuberculosis and diabetes mellitus were taken as cases, and those patients with tuberculosis without diabetes mellitus were taken as controls. Cases and controls were above the age of 15 years. The calculated sample size was 115:345, as there were only 92 cases in the parent study. All were taken. Social factors like age, gender, occupation, and socio-economic status, as well as clinical factors like various symptoms, symptom score, type of tuberculosis, category, and treatment outcome, were studied in this study. Data was coded in Excel and analyzed using SPSS version 16. Chi-square analysis was done to find out the association and odd’s ratio. Results: There was a significant difference in age between cases and controls. All symptoms are significantly higher (Chi-square 27.6p-0.0001) among those who have tuberculosis and diabetes co-morbidity when considering each symptom separately. Extrapulmonary tuberculosis was found more among controls. In this study, it was found that relapse and treatment after default were significantly higher among cases(Chi square 23.4 p-0.000034). Conclusion: A significant difference was found among TB patients with DM as co-morbidity when compared with patients without DM. Uncontrolled diabetes will be one challenge for TB elimination. Hence, periodic screening is necessary to find out DM and the proper measures to be followed to control. Keywords: Diabetes co-morbidity, Symptom score, treatment outcome.

Background: Medical undergraduates having lack of interpersonal skills may lead to severe deficiencies in health services. Currently these were not being trained or assessed at workplace for their behavior and communication skills during their medical curriculum. During this study, mini-CEX (mini clinical evaluation exercise) was used as a work place based assessment (WPBA) tool to assess the interpersonal skills of interns and providing them concurrent feedback. The aim of this study was to evaluate and improving the interpersonal skills of interns posted in orthopedic department during their rotatory internship while assessing the acceptability, feasibility and effectiveness of mini-CEX assessment as a tool. Materials and Methods: This prospective and interventional study was conducted in department of orthopedics of our hospital settings between July to November of 2022. The forty interns who participated in this study were on rotatory internship in our department and 06 volunteered faculty members were also included. The mini-CEX form as assessment tool structured by American Board of Internal Medicine was used in this study. Each intern undergone six rotatory assessment sessions, on mini-CEX forms with each of the faculty comprising a total of 240 sessions. Participants at the end of their internship submitted their perceptions on an anonymous validated questionnaire which contains both open ended and closed ended questions (Likert 5-point scale). Statistical Analysis: The descriptive data having frequencies were analyzed using Microsoft Excel software. Thematic analysis was used for qualitative data of open ended questions. Results: Most of interns (36/90%) and all included faculty members had shown that mini-CEX assessment tool has encouraged them and helpful in improving their communication skills. On comparison of their first through 6th encounters, interns had shown improvement in their mean min-CEX score for skill development and competencies with improvement in communication skills. This improvement was statistically significant. (p<0.05). Conclusion: Our study had shown that mini-CEX as WBPA too is an acceptable, effective as well as feasible method for assessing the interpersonal skills of interns in clinical settings. Keywords: interns, interpersonal, encounters, skills.

Background: To study the efficacy of teriparatide therapy in surgically corrected comminuted fractures. Materials and Methods: Prospective observational study was conducted in 50 patients of either gender who are skeletally mature presenting with comminuted fracture or nonunion after surgical correction, without comorbidities who are medically fit for taking the teriparatide are included in study. Results: One third of the patients belonged to the age group of 30-39 years and 40-49 years. 82% of the study population were males, 18% of them were females. 70% of the study population were injured on the right side, 30% of them were injured on the left side. 76% of the study population lower limbs were injured, 30% of them had injury on the upper limbs. 74% of the study population had Road Traffic Accident. 36% of the study population had fracture of femur. 6% of them had fracture of both tibia and fibula. 2% of them had fracture of both radius and ulna. Only one patient had fracture neck of humerus. 42% of the study population showed signs of radiological union after 3-4 months of drug administration, followed by within 3 months (30%), 5-6 months (20%). 92% of the study population had achieved complete radiological union at the end of one year follow up. 44% of the study population showed complete radiological union after 7-9 months of drug administration. Complete range of movements was achieved in 52% of the study population. The range of movements was increased in 40% of the study population. 8% of the study population had restricted movements at the end of the study period. 56% of the study population had experienced side effects. 52% of the study population had nausea, 28% of them had dizziness and 18% had hypercalcemia. Conclusion: The present study concluded that the efficacy of teriparatide in surgically treated comminuted fracture healing cases is 92%. The drug was tolerated well with minor side effects like nausea and dizziness. Keywords: Teriparatide, comminuted fracture, Radiological union.

Background: Acute appendicitis is one of the most frequent cause of pain abdomen. Acute Appendicitis can present as complicated or uncomplicated. Complication are abscess, gangrene, perforation. Most common cause of Appendicitis is luminal obstruction by appendicolith. Appendicolith is also known as faecolith/ stercolith/ coproliths is composed of faecal concretions or pellets, calcium phosphates, bacteria and epithelial debris and can lead to luminal obstruction followed by appendicitis. They are seen in 10% of patient with acute appendicitis. Objective: To study any association between appendicolith and its effect on recovery of patient with appendicitis. Materials and Methods: This is prospective study carried out from January 2021 to December 2023 in Command Hospital and Military hospital Jammu in all patients of Acute Appendincitis. Data was collected in terms of age, sex, presentation, TLC score, USG/CT, Mantrls score, surgery done, intra op finding, appendicolith seen or not and histopathology. Results: Out of 170 patients who underwent appendicectomy, 139 patients were more than 20 years of age (81%). Following appendicetomy, appendicolith was found 33patient (19.41%).11 patients were less than 20 years of age (33%).There were 36 female patients (21%) of appendicitis.139 patient presented in acute phase (82%) and operated upon. Rest were operated as cold cases as int appendicectomy. Lap appendicectomy was done in 143 cases (84.1%). Rest was open appendicectomy. Acute appendicitis was found in 9 cases with appendicolith (33%).Complicated appendicitis was found in 24 cases with appendicolth (72.7%). Conclusion: Appendicolith is commonly present in more than 20-year age group. Mantrls score is higher in appendicitis with appendicolith. TLC is also more than 10000 in majority of patients with appendicolith. Majority patient presented in acute stage and were operated upon. Presence of appendicolith was associated with higher TLC, higher Mantrls score and complicated intraop and HPE finding. Keywords: Acute appendicitis, Appendicolith, TLC, HPE finding, HPE finding.

Background: Aims: To find the ideal drug combinations which can be used during day care surgeries and procedures. This study was conducted to valuate and compare the efficacy, and haemodynamic stability of ketamine and entanyl combination with propofol. Also compared were the incidence of side effect, the time of awakening and recovery time. The discharge criteria in both groups was also compared. Materials and Methods: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I or II, were divided into two groups of 25 each. They underwent elective ERCP of approximately 1 hour duration. Group I received Propofol- ketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time ‘(by modified Aldrete scoring system) and discharge status (by modified post anaesthetic discharge scoring system) were recorded and compared in two groups. Results: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofol- fentanyl group as compared to Propofol-ketamine group. The recovery time in group II was longer than group I. Discharge criteria is significantly earlier in group I. Conclusion: Both Profol- ketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia, but recovery and smooth discharge was seen with propofol fentanyl group. Keywords: Propofol, Fentanyl, Ketamine, Day care surgery, ERCP, Endoscopic proceedures.

Background: Dexmedetomidine and Clonidine, both α2-adrenergic agonists, are commonly used in cardiac surgery for their hemodynamic stabilizing properties. However, comparative data on their efficacy in cardiac valvular surgeries remain limited. Materials and Methods: We conducted a prospective randomized controlled study involving 60 patients undergoing elective cardiac valvular surgeries between September 2019 and August 2020. Patients were randomized to receive either Clonidine or Dexmedetomidine. Intra-operative hemodynamics, anesthetic requirements, and post-operative recovery times were compared between the two groups. Results: Dexmedetomidine demonstrated superior efficacy in reducing heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure compared to Clonidine. Patients receiving Dexmedetomidine required lower doses of inhalational anesthetics, opioids, and muscle relaxants. Additionally, Dexmedetomidine was associated with shorter durations of mechanical ventilation (398.00 ± 51.47 vs. 475.67 ± 35.15 minutes, P < 0.0001) and length of stay in the post-operative ICU (53.90 ± 3.75 vs. 60.60 ± 3.78 hours, P < 0.0001) compared to Clonidine. Conclusion: Dexmedetomidine offers superior intra-operative hemodynamic stability, reduced anesthetic requirements, and faster post-operative recovery compared to Clonidine in patients undergoing cardiac valvular surgeries. Keywords: Dexmedetomidine, Clonidine, Cardiac surgery, Hemodynamics, Anesthetic requirements, Post-operative recovery.

Background: Mobile health applications are a relatively new phenomenon in the healthcare industry, but their use is expanding rapidly for both general health and specific medical needs. Objective: To compare the utilization of the health apps among patients visiting pharmacies and health stores hospital and it awareness among people. Materials and Methods: A cross-sectional descriptive study was conducted with the general population who were using mobile health apps in the state between January 2023 to June 2023. The participants in the study were recruited from retail pharmacies and health stores located in different areas in the cities. Clients visiting the pharmacies and health stores were approached and invited to participate in the study, and those who agreed were interviewed. The inclusion criteria included smartphone owners who were using health-related apps, of age ≥ 18 years old, and those who could speak the English language. Results: Out of 270 individuals, 52% of the sample were male and 48% were female, and the mean age (SD) of participants was 29.74 (11.74). In this study, 31% of the participants reported using their health apps on a daily basis, 40% at least once weekly, and 25% monthly. The main benefits of mobile health apps were tracking of health status (49%), followed by motivation (24%) and gaining knowledge about health and fitness (20%). The main issues reported by the participants included inaccuracy of the app (12.5%), inconvenience (5%), and not being user-friendly (8%). Conclusion: These apps inspired the participants to keep up their wellbeing and exercise while assisting them in tracking and better managing their health. To ensure evidence-based and efficient app use to achieve the desired health outcomes, further opportunities for improvement have been found. Keywords: Digital health, digital patients, health apps, mhealth, teleconsultation.

Background: Modified Electroconvulsive Therapy (ECT) under anesthesia is an important modality in the treatment of severe persistent depression, bipolar disorder and schizophrenia; specially in case resistant to pharmacological therapy; but this procedure has got many side effects, specifically the hemodynamic alteration is markedly observed. Aim: The aim of present study to compare between Dexmedetomidine and esmolol as effective pretreatment regimens on attenuation of hemodynamic parameters during electroconvulsive therapy. Materials and Methods: After getting approval of the study protocol by the institutional ethics committee (H) of Assam Medical College and Hospital, Dibrugarh and getting written informed consent from the patients and their relatives, fifty cases aged between 20-40 years belonging to ASA grade I and II scheduled for ECT are included in the study and grouped in 2 groups of 25 patients each. Group E received IV esmolol 1mg/kg body weight diluted up to 10ml of normal saline and infused within 2 minutes as premedication. Group D received IV Dexmedetomidine 0.5 mcg/kg diluted to 10ml of normal saline and infused within 10 minutes as premedication. Hemodynamic parameters heart rate (HR), systolic blood pressure, diastolic blood pressure and mean blood pressure at baseline (before induction), after study drug infusion and after ECT application were recorded at different time intervals and presented along with demographic data. Statistical analysis was done with SPSS software using student t-test and Chi square test. Results: In this study, the baseline systolic blood pressure, diastolic blood pressure and mean blood pressure was statistically insignificant. The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was significantly decreased in both esmolol and Dexmedetomidine group after drug administration and at 1,3,5 and 10 min post ECT shock. However, the decrease in MAP was statistically insignificant in both the groups after premedication, at 1,3,5,10 minutes of delivery of ECT shock. The mean time of return of spontaneous respiration was statistically insignificant. Conclusion: Based on the present hospital based observational study, we came to the conclusion that an intravenous premedication agent in ECT, both esmolol at a dose of 0.1 mg/kg and Dexmedetomidine at a dose of 0.5 mcg/kg results in attenuation of cardiovascular (HR, BP, MAP) effects but more reduction of hemodynamic parameters were seen in the Dexmedetomidine compared to esmolol. The mean blood pressure however was unaffected. Keywords: Dexmedetomidine, esmolol, modified Electroconvulsive therapy, hemodynamic parameters.

The co-occurrence of retroperitoneal liposarcoma and a giant colonic diverticulum poses diagnostic challenges due to their uncommon nature and overlapping clinical presentations. Here, we present a unique case report of a 76-year-old female with hypertension and myasthenia gravis who presented to Vishesh Jupiter Hospital, Indore and diagnosed with retroperitoneal liposarcoma complicated by a giant colonic diverticulum detailing its presentation, diagnostic journey and management strategies. Keywords: Retroperitoneal liposarcoma, Giant Colonic Diverticulum.

Background: To evaluate and compare efficacy of laparoscopic cholecystostomy and interval cholecystectomy versus open cholecystectomy in cases of difficult gallbladder. Materials and Methods: This study will be conducted in Department of General surgery, Kamineni Hospital, Hyderabad between October 2012 to December 2014. The facilities, expertise and the necessary Infrastructure are available in this hospital. A comparative observational study, which included 40 patients of difficult gallbladder who needs cholecystectomy. Ethics committee’s permission has been taken. Results: In the present study, there were difficulties associated with Laparoscopic cholecystostomy like subjecting the patient to a second surgery, carrying a drain, longer hospital stay and increased expenditure. Laparoscopic cholecystostomy followed by Interval chole- cystectomy was safe with less postoperative morbidity associated with faster patient recovery and satisfaction as documented by less postoperative pain, earlier resumption of oral feeds, earlier full mobilization and discharge home, as well as lesser complication rate with least possible scar. Conclusion: In conclusion, the study supports the view that laparoscopic cholecystostomy followed by interval cholecystectomy is safer and efficacious and offers definitive advantages over open conversion and should be an available option for all patients requiring emergency cholecystectomy. Keywords: Cholecystectomy, Laproscopic, Gall Bladder, VAS, Postoperative.

Background: To study the effect of nebulised 3% saline on hospitalized children aged 4weeks to 2 years with acute bronchiolitis with regard to decrease in respiratory distress and duration of hospital stay. Materials and Methods: This was a hospital based prospective interventional non blinded controlled trial done in the age group of 4 weeks to 2 yrs admitted with acute bronchiolitis with a Respiratory Distress Assessment Instrument (RDAI)score of 4 to 15 [on a scale of 0 (mild) to 17 (severe)] in a teritiary care centre. Results: The most common presenting complaint in our study was cold which was present in 43 (76.79%) cases followed by cough in 41 (73.21%). This was followed by hurried breathing in 31 (55.36%). Wheeze was present in 29(51.79%) cases and fever in 28 (50%). The two groups were comparable with respect to baseline characteristics. The number of children who improved with treatment in Study group was 19(63.3%) and in control group was 11(36.70%). When compared to control group, there was statistically significant (p=0.015) improvement in the study group. This showed that the nebulised 3% saline nebulisation was useful in symptomatic improvement in the clinical condition of significantly more number of children. There was significant reduction in RDAI scores and improvement in saturation after 6hr, 12hr and 24hrs of initiation of treatment in Study group. Conclusion: The present study concluded that there was significant decrease in Respiratory rate and RDAI scores with the use of 3% NS nebulisation. The duration of hospital stay was less and the time required for change of treatment was more in Study group, but statistical significance could not be established. Keywords: Bronchiolities, RDAI Score, NS nebulisation, wheeze.

Background: Empyema thoracis is a life-threatening complication of pneumonia in children, especially below 5 years of age. The treatment outcomes depend upon the nutritional state of the child and provision of medical care to administer appropriate antibiotics. This study was done with an aim to evaluate the risk factors and outcomes of children with empyema thoracis. Materials and Methods: A total of 100 children who presented to the OPD with empyema thoracis, over a period of 18 months were included in the study. Results: Majority of the children were below 5 years of age and most of them were males. Most of the participants belonged to lower socio-economic status. Anemia was the most commonly associated risk factor. ICD was removed within 1 week. Conclusion: Early initiation of antibiotics along with ICD tube placement can allievate the immediate clinical or delayed complication. Keywords: empyema thoracis, pediatric, pneumonia.

Background: While medically supervised abortion adhering to guidelines boasts a success rate of 92-97%, the widespread availability of abortion pills over the counter has led to rampant self-administration, resulting in frequent complications. Despite the perception of unsupervised medical abortion as unsafe, many women utilize it for pregnancy termination and birth spacing. Aim of the Study: The aim of this study was to study the implications of self-administration of abortion pills by pregnant women. Materials and Methods: Retrospective cross sectional study done in Government Doon Medical College & Hospital between the period of August 2022- july 2023. Case sheets were analysed to obtain data regarding self-administration of abortion pills and complications secondary to its administration. The following data were collected- Age, marital status, parity, duration of pregnancy as perceived by the women, confirmation of pregnancy, duration between pill intake and visit to hospital, whether any intervention done elsewhere, any known medical or surgical complications, Hb level on admission, whether patient was in shock, USG find-ings, evidence of sepsis, blood transfusion, treatment given and duration of hospital stay. Descriptive analysis of the collected data was done. Results: Among the 148 cases of abortion in the study period, 75 patients had self-administered abortion pills. Among these 75 patients 26.6% had consumed abortion pills after the approved time period of 63 days of which 20% had consumed pills after 12 weeks of gestation. The most common presentation was excessive bleeding (73.33%) Severe anaemia was found in 37.33% of the patients and 8% of patients presented with shock. The outcome was as follows: 66.66% of the patients were found to have incomplete abortion, 13.33% had failed abortion and 5.22% of patients had incomplete abortion with sepsis. Surgical evacuation was performed in 33.33% of the patients whereas 46.66% of the patients required surgical evacuation with blood transfusion. Medical methods were used in 9.33% of the patients whereas 6.66% required transfusion along with medical methods. Conclusion: The study sheds light on the increasing trend of self-administered MTP pill intake among women and underscores the importance of ensuring adequate education, counseling, and support for safe and effective self-administration practices. Further research is warranted to explore the long-term outcomes and implications of self-administered MTP pill intake in diverse healthcare settings. Keywords: Medical termination of pregnancy, Maternal mortality, abortion, complications.

Diarrhea causes an estimated 2.5 million child deaths in developing countries each year. It is the third leading killer of children in India today and is responsible for 13% of all deaths in children less than five years of age and kills an estimated 300,000 children in India each year. Diarrhea is one of the clinical manifestations of zinc deficiency in humans. 25 children (aged 6 months-5 years) of either sex suffering from diarrhea and admitted in paediatric ward and emergency of RDJMMCH, Muzaffarpur were selected for the study. Serum zinc levels were estimated by colorimetric kit method and compared with those of 25 healthy age-matched controls. It was observed that the serum zinc levels were significantly lower in children suffering from diarrhea (39.26 ± 12.18 vs. 78.60 ± 11.63 µg/dl, p<0.05). However, there was a negligible correlation between diarrhea and gender. Thus, diarrhea is associated with an increased loss of zinc in feces so that children with diarrhea would be at an increased risk of zinc deficiency. Zinc supplementation is now being recommended by WHO, UNICEF, and countries around the world for the supportive treatment of all diarrhea episodes among children, and this should be encouraged in routine clinical practice. Keywords: Diarrhea, Zinc, Children, Deficiency, Supplementation.

Background: Diabetes is a micro-macrovascular disorder with debilitating effects on many organs. Pulmonary complications in diabetes mellitus with the loss of pulmonary reserve may become clinically important. The relationship between DM and pulmonary function tests (PFTs) remains important because of potential epidemiological and clinical implications. Aim of the Study: The aim of this study was to measure pulmonary function tests (PFTs) in diabetes mellitus type 2(DMT2) subjects and to determine the correlation of glycosylated haemoglobin (HbA1c) with pulmonary function tests inDMT2 patients. Materials and Methods: This study was conducted in the Department of Physiology, Subharti Medical College in collaboration with Department of Medicine, Chattrapati Shivaji Subharti Hospital, Meerut A total of 100 non-smoker subjects of either sex in the age group of 30-50 years were recruited. The subjects were divided into 2 groups -Group A: 50 having history ofDMT2 and Group B: 50 Normal controls. The selected patients were evaluated by taking detailed history and thorough clinical examination was done. Test for Plasma Glucose and HbA1c was done. Pulmonary function tests was done by Spirometry recording FVC, FEV1,FEV1/FVC ratio and PEFR. The data so collected was subjected to standard statistical analysis. Results: Majority of subjects were between 40-50 years while only 6 were between 50-60 years of age. The sex distribution in both cases and controls was similar. All the respiratory parameters were lesser in subjects with diabetes than non- diabetics except FEV1/FVC ratio which showed slight increase in cases than control. Statistically significant decrease occurred in FVC, FEV1 (P<0.05) & PEFR (P<0.000) while increase in FEV1/FVC ratio was statistically insignificant giving an indication about probable deterioration in lung functions in asymptomatic diabetics. Conclusion: Lung functions need to be checked periodically to assess the severity of impairment in DMT2 patients. Keywords: Pulmonary Function Tests, Diabetes Mellitus Type 2, Glycosylated haemoglobin (HbA1c), complications.

Background: Aims: To study various cutaneous manifestations in early neonates that is within 7 days from the birth, fromAntenatal wards, dermatology outpatient department and Neonatal intensive care unit(NICU). Materials and Methods: It is a cross-sectional study including 150 neonates from OPD of Department of Dermatology, obstetrics and gynecology ward and NICU. Results: The percentage of consanguineous marriage and non – consanguineous marriage in the parents of neonates were seen as 16% and 84% respectively. The commonest cutaneous manifestations found in our study were that of pigmentary type i.e. Mongolian spot amounting to 22% of the cases most commonly over the lumbosacral region. The physiological desquamation was the commonest finding of papulosquamous changes that were seen in our study amounting to 18% of cases. The next commonest condition was of Erythema toxicum neonatorum amounting to 12% of the cases most frequently observed on the trunk. Acrocyanosis amounted to 8% of the cases in this study. The nasal lesions were demonstrated in all the cases of Sebaceous gland hyperplasia amounted to 6% of our case study. 5.3% of the cases were hypertrichosis lanugosa occurring over the shoulder, trunk and limbs. Miliaria accounted for 5.3% of the cases. It was more common in neonates admitted in NICU. Milia was found in 4% of the cases and most commonly occurred in neonates with birth weight >2.5kg. Of the solitary lesions Café au lait macules which were seen in our study amounted only to 2 %. The 2 % of cases wherein vernix caseosa seen were prominently observed in the axilla. Axillary hyperpigmentation amounted to 2 % of the cases. In our study two neonates demonstrated congenital melanocytic nevi amounting to 2 % of the cases. Other skin changes included amounting to 10 % of the total cases. Conclusion: Awareness of cutaneous manifestations in neonates helps us to differentiate between the benign transient lesions from the pathological conditions, so that timely intervention and necessary follow-up may be done where needed as well as to give assurance to the anxious parents. Keywords: Mongolian spot, papulosquamous, Erythema toxicum neonatorum, hypertrichosis lanugosa.

Background: Proper education and menstrual hygiene management facilities form a pathway for the overall growth and development of an adolescent girl. Poor availability of menstrual hygiene facilities in school can have a negative impact on the reproductive health of a girl as well as contribute to school absenteeism, sometimes resulting in school dropout. This study evaluates the various factors associated with school absenteeism during menstruation, and to assess knowledge of reproductive health. Objectives: 1. To assess the various factors affecting school absenteeism among adolescent girls. 2. To assess the availability and quality of sanitation facilities available in school washrooms 3. To evaluate the knowledge and practice of reproductive health in adolescent school going girls. Materials and Methods: A school based cross sectional study was conducted among 505 school girls urban and rural areas (Government and Private schools) in Dehradun, Uttarakhand. A semi-structured, pretested close and open-ended questionnaire was prepared in both Hindi and English language to obtain maximum results. Data Entry was done in MS excel and was analysed in SPSS software. Results: 51.56% girls in urban areas and 31.33% girls in rural areas remained absent from school during menstruation. Despite good level of knowledge of RTI/STIs 21, 48% girls in urban areas and 24.10% girls in rural areas said that they have had infection during or around menstruation. The sanitary facility in rural schools was less than that available in urban areas. Only 34.94% girls in rural areas reported of having soaps available in their school washrooms. Conclusion: Adolescent girls should be given appropriate knowledge regarding menstruation and reproductive health. This study is able to identify the lack of knowledge and hygiene facilities which can be improved in bringing them out of misconceptions and promote menstrual health and hygiene and increase the education among girls. Separate functioning sanitary facilities are necessities that should be in school at all girls empowerment and improvement in reproductive health is to be achieved. Keywords: Adolescent girls, Menstrual hygiene, Practices, School sanitation, School absenteeism, RTI, STI.

Background: The intertwined narrative of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) unfolds like a historical epic, with each chapter revealing new layers of complexity and challenge. This study aims to the prevalence ofdiastolic dysfunction in type 2 diabetes mellitus patients and to study the clinical profile of patients with diastolic dysfunction. Materials and Methods: The study was conducted on 100 patients. Patients with clinical features of acute appendicitis aged between 15 and 65 years were included in this study. he neutrophil Lymphocyte ratio would be obtained by dividing the percentage of neutrophils to the percentage of lymphocytes from the data available from differential leukocyte count. All patients was subjected to ultrasound examination of abdomen. Based on evidence in medical literature diagnostic categories for ultrasound abdomen are as follows. Results: The prevalence of diastolic dysfunction was found to be 59.37%. Within this subset, 5.3% were aged between 30 and 40 years, 17.5% were aged between 41 and 50 years, majority comprising 43.8%, were aged between 51 and 60 years, and around 33.4% were aged between 61 and 70 years. Notably, the majority of individuals with diastolic dysfunction were male, accounting for approximately 52.6% of the cases. Regarding the duration of diabetes among those with diastolic dysfunction, approximately 73.7% had been diagnosed within the past 1 to 10 years, while 22.8% had been diagnosed between 11 and 20 years ago, and only 3.5% had been diagnosed for over 20 years. Furthermore, in terms of body mass index (BMI), the majority fell within the range of 25.0 to 29.9 (50%), followed by 37.5% falling within the range of 18.6 to 24.9. The ejection fraction (EF) levels averaged 58.055.48 in the diastolic dysfunction group and 61.215.04 in the non-diastolic dysfunction group. Conclusion: The findings of this study underscore the multifaceted nature of diastolic dysfunction in the context of diabetes mellitus, emphasizing the need for comprehensive assessment and management strategies to address this significant cardiovascular complication in diabetic patients. Keywords: Ventricular dysfunction, diabetes mellitus, age, Type 2, risk factors, prevalence.

Background: The prevalence of systemic lupus erythematosus (SLE) in the general population ranges from 8 to 180 cases per 100,000 individuals. The female to male ratio varies from 6 to 13 cases in females for every 1 case in males. Several observations suggest an estrogen effect as a potential explanation for this gender difference. In children, the impact of sex hormones is assumed to be minimal, resulting in a female to male ratio of 3 to 1. We report a case series of five male patients who presented at the Kurnool Medical College, Kurnool in the state of Andhra Pradesh and were diagnosed to have lupus nephritis (LN). Male patients with SLE typically present with renal involvement and seizures rather than photophobia and skin manifestations. The prognosis for male patients also appears to be more severe. Therefore, despite the rarity of male patients with lupus, the symptoms are life-threatening, and early detection of the disease is crucial for improving patient outcomes. Keywords: Lupus Erythematous, Estrogen, Seizurs, Photophobia, Luupus Nephritis.

Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or more, or a diastolic blood pressure (DBP) of 90 mm Hg or more. Globally, an estimated 26% of the world’s population (972 million people) has hypertension, and the prevalence is expected to increase to 29% by 2025, driven largely by increase in economically developing nations. Hypertension affects one in four individuals worldwide. ARBs, CCBs are first line of therapy of hypertension and has out shifted the use of ACEIs. Telmisartan is the preferable ARB, Amlodipine a third generation CCB are commonly prescribed for hypertension in INDIA. Telmisartan has a very high lipophilicity and high volume of distribution which offers advantage of good tissue penetration over other sartans. Amlodipine a DHPs of CCBs is prescribed because of less negative inotropic and high vascular selectivity. The present study comprises of 60 patients (both men and women) of 18 and above age, who are suffering from idiopathic hypertension to know the efficacy of low dose combination therapy of Telmisartan(40mg) with Amlodipine (5mg) against high dose monotherapy of Telmisartan(80mg). In present study, a low dose combination therapy of Telmisartan 40mg + Amlodipine 5mg has demonstrated significantly greater BP reduction in both SBP and DBP compared to high dose monotherapy with Telmisartan 80mg.The combination therapy with Telmisartan 40mg + Amlodipine 5mg is well tolerated with a safety profile similar to the monotherapy with Telmisartan 80mg. Keywords: CCB- Calcium channel blocker, ARB- Angiotensin receptor blocker, SBP-Systolic blood pressure, DBP- Diastolic blood pressure.

Background: Foot defects requiring reconstructive surgery pose significant challenges in plastic and reconstructive surgery. Understanding the demographic characteristics, clinical presentations, surgical interventions, and outcomes of foot reconstruction is essential for optimizing patient care. This prospective observational study aimed to analyze the demographics, clinical presentations, surgical interventions, and outcomes of elective foot reconstruction surgeries. Materials and Methods: Over a 24-month period, 50 cases undergoing elective foot reconstructive surgery were studied. Demographic data, including age, sex, etiology, and comorbidities, were recorded. Clinical characteristics such as foot involvement, defect size, structures exposed, associated fractures, and vascular status were assessed. Surgical interventions and complications, including type of reconstruction and post-operative outcomes, were documented. Functional outcomes and patient satisfaction were evaluated during follow-up. Results: The majority of patients (72%) were aged 18-40 years, with males comprising 84% of the study population. Trauma was the leading etiology (88%) of foot defects, and 22% presented with associated comorbidities. Most defects were right-sided (68%) and ranged from 5-10 cm in size (70%). Bones and tendons were commonly exposed (48%), and 60% of patients had associated fractures. Lateral supramalleolar flap and RSA flap were the most common reconstruction procedures (both 26%). Flap necrosis and donor site morbidity affected 8% and 24% of patients, respectively. Despite challenges, 94% of patients reported satisfaction with the outcome of their reconstruction. Conclusion: Elective foot reconstruction surgeries present complex clinical scenarios. This study provides insights into the demographics, clinical characteristics, surgical interventions, and outcomes of foot reconstruction, aiding in optimizing patient management and improving surgical outcomes. Keywords: Foot reconstruction, plastic surgery, reconstructive surgery, clinical characteristics, surgical interventions, outcomes.

Background: Hemoglobinopathies, a diverse group of genetic disorders affecting hemoglobin synthesis or structure, pose substantial public health challenges worldwide. Understanding their prevalence and spectrum, especially among reproductive-age females, is crucial for planning effective prevention and treatment strategies. Aim: This prospective observational study aimed to investigate the frequency of hemoglobinopathies among reproductive-age females in a rural tertiary care centre in Haryana using high-performance liquid chromatography (HPLC). Materials and Methods: Over the course of one year, 149 females aged 15 to 45 years were included in the study. Blood samples were collected and analysed using HPLC to identify haemoglobin abnormalities. Results: Haemoglobin HPLC analysis revealed haemoglobinopathies in 14.1% of cases, with β-thalassemia trait being the most prevalent (11.4%). Other hemoglobinopathies identified included HbD Punjab trait and HbE trait. Haematological indices provided insights into different parameters across various hemoglobinopathies. Conclusion: Hemoglobinopathies represent a significant healthcare challenge in India, particularly among women of reproductive age. This study emphasizes the importance of screening for carriers using haemoglobin HPLC, as it facilitates the provision of tailored counselling and management strategies to alleviate the impact of these disorders. Keywords: Haemoglobinopathies, reproductive-age group, blood disorder, Anaemia, haemoglobin.

Background: Extensor tendon injuries are common and can significantly impact hand function. The treatment and management of these injuries vary widely, influencing the functional outcomes. To evaluate the efficacy of different management protocols (early active mobilization vs. immobilization) in the repair of uncomplicated isolated extensor tendon injuries and to assess the outcomes based on the Total Active Range of Motion (TAM). Materials and Methods: This prospective analytical study included all cases of extensor tendon injuries treated in the Department of Plastic and Reconstructive Surgery. Patients were assigned to either an early active mobilization/physiotherapy protocol or to immobilization due to non-compliance based on specific criteria. The primary outcome measure was the improvement in TAM as suggested by the American Society for Surgery of the Hand. Results: A total of 66 patients with 100 tendon injuries were included. The majority were males (87.8%), with the most affected age group being 10-30 years (77%). The index finger was the most frequently injured. Outcomes showed 70% of tendons had good to excellent recovery. Early active mobilization yielded fewer complications and better functional outcomes compared to immobilization. Conclusion: Early active mobilization significantly enhances recovery in extensor tendon injuries of the hand. This protocol also demonstrated lower complication rates, making it a preferable treatment strategy in compliant patients. Keywords: Extensor tendon injuries, early active mobilization, immobilization, hand surgery, Total Active Range of Motion (TAM), functional outcomes.

Background: Genetic testing for Breast Cancer (BRCA) gene 1 and 2 mutations in epithelial ovarian cancers is recommended to guide prognosis, adjuvant treatment and prevention of second malignancies in the patient and in the carrier family members or relatives. Prevalence of BRCA and other cancer- causing mutations is not known in most regions in India and is inadequately explored. Main-streaming genetic testing has the potential to increase uptake of testing in patients and identify at-risk carrier population in whom primordial or primary prevention of genetic cancers can be implemented with good outcomes. Materials and Methods: A mixed method study was conducted with aim to explore feasibility of a primary care nurse based genetic counselling modality for ovarian cancer patients, along with exploration of factors affecting its uptake, using a structured objective survey questionnaire followed by key informant interviews to develop qualitative questionnaire for further phase of the study. Results: The uptake of genetic testing among patients was good and among healthy relatives was negligible. The affecting factors were lack of awareness and economic. The qualitative study interview explored reasons for low uptake of tests, satisfaction with the counselling and impact of test results on patients. Conclusion: The pretest counselling was effective and post-test counselling necessitated counselling by specialist oncologist. The uptake of genetic testing was affected by level of awareness and costs. Keywords: Mainstreaming genetic testing, Nurse led counselling, Ovarian cancer.

Background: The proximal humerus is the third most common fractured bone in the body, making up about 4%-5% of all fractures. Incidence occurs mostly after distal radius fractures and hip fractures. Fractures of the proximal humerus are more common among the elderly. Studying the outcomes of proximal humeral nailing fixation for two- and three-part proximal humeral fractures was the primary focus of this prospective observational study. This study was conducted to assess the clinical, radiological and functional outcome of treating Neer 2, 3-part proximal humerus fracture using intramedullary proximal humerus nailing and to know the advantages, disadvantages and complications of the procedure. Materials and Methods: A prospective study was conducted in K A P V govt Medical College& MGMGH, Trichy. This study included the patients with fracture of proximal humerus requiring surgical interventions, after taking their consent, were analyzed clinically and radiologically. All the patients selected for the study were evaluated as per the history & mode of injury, necessary clinical and laboratory investigations. The pre-operative and immediate post-operative X-ray were evaluated. The patients were evaluated clinically and radiologically in their subsequent follow-up every 6 weeks till fracture union and at 1 year after surgery. Results: The time for union (weeks) was 11 to 14 weeks in86.66% of the participants. Most of the patients had follow-up till one year. The mean post op NEER score 75.17 ± 5.85 at 6 weeks, it was 79.63 ± 5.3 at 3 months, it was 83.23 ± 5.28 at 6 months, it was 88.5 ± 5.48 at final score.36.67% and 63.33% of the participants had NEER 2 and 3part type of fracture injury. Among the study population with post-op complication, 10.00% of them had varus malunion, 6.67% of them had rotator cuff injury, 3.33% of them had glenohumeral protrusion. We found that 63.33% of them had excellent outcomes, 26.67% of them had satisfactory outcomes, 10.00% of them had unsatisfactory outcomes. Conclusion: We discovered that individuals with both two and three-part fractures exhibit successful fracture union. Post-operative NEER score was improved with the patients treated. We found that there was a good outcome with a smaller number of complications found in the treatment of proximal humeral nailing. Keywords: Proximal Humerus, NEER scores, Post-operative, Proximal Humerus Nailing.

Background: Lateral neck swellings in ENT have various causes, commonly found in the anterior triangle of the neck. Accurate diagnosis through imaging, FNAC, and biopsy is crucial for appropriate treatment, ranging from conservative management to surgery. Understanding incidence, etiology, pathology, and clinical behaviour is important for effective management and follow- up. Materials and Methods: Institutional Ethical committee approval was obtained and informed consent was taken from the study subjects. Patients with lateral neck swellings underwent clinical examination and FNAC, followed by further investigations based on FNAC reports. Lymph node biopsies were taken for histopathological examination. Management was based on the final diagnosis, and patients were followed up for six months. Results were analyzed and tabulated. Results: In our study of 96 patients, lateral neck masses were most common in individuals aged 46-59, with an equal male-to-female ratio. The majority of cases (82.29%) were from low socioeconomic status. Metastasis in cervical lymph nodes was the most frequent cause of lateral neck swellings, primarily in males aged over 45, and tubercular lymphadenitis was the second most common cause in females aged 18-30. The clinical diagnosis had high sensitivity (87.18%) and specificity (92.98%) for detecting malignant lesions, and these values increased when the histopathological examination was used as the gold standard. Conclusion: To evaluate and manage lateral neck swellings, a multidisciplinary approach is necessary, including medical history, clinical examination, imaging, and pathological investigations like FNAC and HPE. Prompt and accurate diagnosis is critical to prevent morbidity and mortality, and management depends on the underlying cause. Effective management requires close communication between the clinician and the pathologist. Keywords: Cervical Lymphadenopathy; non-thyroid neck swellings; Benign; Malignant; Fine-needle aspiration cytology; Histopathological examination; Neck metastasis; Tuberculosis; Lymphoma.

Background: Neural tube defects, serious birth defects affecting the brain & spine, are a major, preventable public health burden. Aim and Objectives: 1) Periconceptional folic acid intake in any means to prevent NTDs in unplanned pregnancy. 2) To understand the need to implement the fortification of staple food with folic acid. Material and Methods: Total of 10 cases (from March 2022 to March 2023 in KIMS, Koppal) with neural tube defects. Results: Various presentations with neural tube defects were seen in this case series. Unplanned pregnancies and unawareness regarding benefits of folic acid supplementation leading to higher incidence of neural tube defects. Conclusion: New efforts that is implementation of fortification of staple food with folic acid along with practicing primary prevention such as dietary folate intake, periconceptional folic acid intake are needed to implement a combined strategy to reduce the incidence of neural tube defects. Keywords: Neural Tube Defects, Folic Acid, Fortification, Food.

Background: Stroke, a cerebrovascular accident, is prevalent across patient populations and can be a significant cause of morbidity and mortality. Ischemic occlusions contribute to around 85% of casualties in stroke patients, with the remainder due to intracerebral bleeding. Hyperlipidemia is a major contributor to coronary heart disease, but its relationship to stroke is complicated. Hence; the present study was conducted for assessing the role of serum lipid profile as risk factor for development of ischemic stroke. Materials & Methods: A total of 100 patients with ischemic stroke and 100 controls who came for routine medical check-up were enrolled. Complete demographic and clinical details of all the patients was obtained. The diagnosis of stroke was confirmed by taking CT scan of brain. Lipid profile was taken following a 12 hour fasting on the next day of admission. Serum total cholesterol less than200mg/dl, LDL cholesterol<100 mg/dl, triglyceride less than150mg/dl, and HDL more than 40 mg/dl was taken as normal. Data was analyzed using SPSS software. Results: Mean age of the stroke patients and controls was 53.9 years and 55.1 years respectively. Majority proportion of patients of both the study group and control group were males. Significant difference was obtained while comparing TC, LDL-C and HDL-C among the stroke patients and controls. While comparing the dyslipidemia, is was seen that ischemic stroke group had significantly higher proportion of patients with dyslipidemia in comparison to controls. Conclusion: Lipids give significant contribution to stroke risk and that lipid profile assessment must be taken into account in estimating the individual risk of stroke. Key words: Lipid, Ischemic, Stroke.

Background and Objectives: Infertility is a significant concern affecting many couples of reproductive age. This condition arises due to a myriad of factors, and relying solely on pelvic examinations may not adequately detect all infertility-related abnormalities. Therefore, there is a need for additional diagnostic and therapeutic investigations. Transvaginal Ultrasound (TVS) has emerged as a crucial initial step in assessing uterine abnormalities, although numerous studies have established hysteroscopy as the gold standard. The aim of this study was to compare the findings of transvaginal ultrasound with hysteroscopy in evaluating uterine cavity and its abnormalities in infertility patients prior to undergoing in vitro fertilization (IVF). Methods: This prospective, hospital-based study was carried out at a tertiary healthcare facility in India. It involved a cohort of 123 patients experiencing infertility, who were assessed using transvaginal sonography (TVS) followed by hysteroscopy. Data from these evaluations were documented and subjected to statistical analysis using SPSS 20 with significance level set at 5%. Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TVS were found to be 82.50%, 73.00%, 91.80%, 66.50%, and 80.50%, respectively. In comparison, hysteroscopy demonstrated sensitivity, specificity, PPV, NPV, and accuracy of 97.50%, 97.90%, 99.50%, 86.50%, and 92.50%, respectively. When both hysteroscopy and TVS were combined for intrauterine pathology evaluation, the values significantly increased to 98.80%, 99.80%, 99.80%, 98.00%, and 95.50%, respectively. Conclusion: Transvaginal ultrasound serves as a sensitive, cost-effective, and non-invasive tool for detecting pelvic pathologies in infertility patients. However, hysteroscopy emerges as a more sensitive method for uterine evaluation. Combining both techniques enhances diagnostic yield in terms of sensitivity and specificity, thus improving overall diagnostic accuracy. Key Words: Ultrasound, Infertility, Hysteroscopy, Uterus

Background: The objective of this study was to assess the impact of obesity on pulmonary functions, such as FEV1/FVC ratio, PEFR, and MVV, in adults aged 26 to 55, comparing those with abdominal obesity against non-obese individuals. Materials and Methods: Over one year, the present cross-sectional study was carried out at the Academy of Medical Sciences in Pariyaram. The study comprised 200 non-obese patients and 200 subjects with abdominal obesity, including both males and females. The study sample comprised individuals between the ages of 26 and 55. Spirometry measurements were conducted on all subjects while they were seated, following the procedures advised by the American Thoracic Society. A proficient technician conducted a spirometry examination in the morning. The pulmonary functions that were evaluated include the FEV1/FVC ratio, PEFR, and MVV. The BMI was determined by recording the weight and height. The statistical analysis was conducted using IBM SPSS for Windows (Version 26.0). An Unpaired t-test was employed to evaluate the PFT of those classified as non-obese and those with abdominal non-obesity. A p-value of less than 0.05 was deemed statistically significant. Results: The participants were categorized into three distinct age groupings, namely 26-35 years, 36-45 years, and 46-55 years. BMI cut-off values of more than 25 kg/m2 were used to divide the participants into two groups: those with abdominal obesity and non-obese. In the abdominal obesity group, 49.5% of the 200 participants were men and 50.5% were women. In the group of non-obese individuals, there was an equal distribution of males and females. The study sample revealed a statistically significant difference in the average FEV1/FVC ratio between individuals with abdominal obesity and non-obese across all age categories. The study observed a decline in mean PEFR levels as individuals aged in both groups. The participants with abdominal obesity and non-obese showed a statistically significant difference in mean PEFR values (p < 0.01). The abdominal obesity group aged 46-55 years exhibited an MVV of 69.58±12.56 L/min. The statistical analysis revealed a significant difference in the average MVV values between individuals with abdominal obesity and non-obese in the age ranges of 26-35, 36-45, and 46-55 years. Conclusion: The results of the study indicated that there was a consistent decrease in lung function measures as individuals aged in both groups. The abdominal obesity group exhibited a notable decrease in FEV1/FVC, PEFR, and MVV when compared to the non-obese group. Keywords: Abdominal obesity, Body mass index, Maximum voluntary ventilation, Peak Expiratory Flow Rates, Pulmonary function tests.

Background: Inadequate biomedical waste management can directly impact health. As per ministry reports, India produces over 62 million tons of waste annually, of which 15% is biomedical waste. Objectives: To assess the awareness of healthcare staff regarding biomedical waste management practices in the selected government hospitals of Madhya Pradesh. To determine the current practices of biomedical waste management in the hospitals. To assess the needle stick injury rate. Materials and Methods: Hospital-based cross-sectional study. The study conducted over a period of 2 months Feb 2024 to March 2024 across two randomly selected government hospitals in Madhya Pradesh. Healthcare staff (doctors, nurses, lab technicians and sanitary staff) involved in handling of biomedical waste were included. Simple random sampling was used to select the study participants in each hospital after allocating proportionate samples for the different staff categories. Data was collected using a pre-tested, semi-structured questionnaire. Results: The assessment found that 52% had moderate knowledge of BMW management while 8% had poor knowledge. Most reported following safe practices with over 80% doing things like 92% wearing gloves and 88% separating BMW. However, sometimes only 63% followed correct hospital waste disposal. 10% reported a needlestick injury in the last year, with individual carelessness and poor needle disposal being the top causes each at 40%. Conclusion: While over half demonstrated moderate knowledge of appropriate BMW procedures, there remains room for improvement as 8% exhibited poor knowledge. Keywords: Biomedical waste; Awareness; Practices; Needlestick injuries; Healthcare workers.

Background: Sleep is a physiological process essential to life. Its quality is strongly related to psychological and physical health and other measures of well-being. Sleep also allows the brain to better process new experiences and knowledge which increases understanding and retention. Aims and Objectives: To find out the percentage of altered sleeping pattern among students preparing for medical entrance. Materials and Methods: Data was collected using a Pre-Designed Semi Structured Questionnaire based on The PSQI (Pittsburgh’s Sleep Quality Index) consists of 19 self-rated question and five question rated by the bed partner or roommate. Data was entered in Microsoft excel spread sheet and analysed using Epi-data software. Chi square test was applied. Results: It was found that 55% of study population is having a sleep quality index score >5 i.e. their sleep quality is poor. There were 43% students who sleep for 6-8 hours, 27.5% who sleep for 4-6 hours, 9% sleep for 7-9 hours and 2.5% sleep >10 hours a day. Conclusion: The prevalence and effect of insufficient sleep is high among the aspirants preparing for medical entrance exams due to increasing competition, due to which they keep on delaying their urge to sleep which in turn is affecting their normal sleep-wake cycle. Also, the students are facing many sleep movement disorders at a very young age. Keywords: Sleeping pattern, Medical entrance, Students, Sleep-cycle.

Background: Understanding the variations in human skull morphology due to age and gender is crucial for applications in forensic anthropology, clinical medicine, and related fields.This study aims to assess the impact of age and gender on various skull morphological parameters across a sample of 50 individuals. Material and Methods: A cross-sectional analysis was performed using high-resolution imaging to measure cranial volume, facial angle, jawbone structure, orbital size, skull length, zygomatic width, and mandibular angle. The sample was balanced for gender with 25 males and 25 females ranging in age from newborns to the elderly (over 60 years). Results: Age-related changes were significant, with cranial volume peaking during late adolescence and decreasing slightly in older age. The facial angle and other parameters expanded or increased until reaching stability in adulthood. Notable gender differences were also observed, where males generally exhibited larger values in nearly all parameters measured. These findings are comprehensively detailed in Tables 1 and 2. Conclusion: The study highlighted significant morphological changes associated with both age and gender. Early life featured rapid growth in most parameters, which stabilized in adulthood and slightly declined in the elderly. Males displayed consistently larger skull dimensions than females. These distinctions are essential for enhancing accuracy in forensic applications and improving anthropological understanding of human skull development. Keywords: Skull morphology, age-related changes, gender differences, cranial volume, forensic anthropology, zygomatic width, mandibular angle.

Background: Inguinal hernia repairs are the one of most common type of surgeries performed worldwide. Surgical treatment of the defect is the only permanent solution. This study was done to evaluate the effectiveness of using pre-peritoneal mesh to repair the defects in patients with bilateral and recurrent inguinal hernias. Materials and methods: this prospective study was conducted including 100 patients presenting with bilateral inguinal hernias or recurrent inguinal hernia to the OPD of Department of surgery of KIMS, Narketpally over a period of 1 year. Results: 98% of the patients were males and majority of the patients were in their middle age group. Most of the patients had groin swelling as the most common presenting complaint. Most of the patients were in occupations involving heavy strength work. Smoking and lifting of heavy weights are the most commonly observed risk factors in present study. Majority of the patients had their procedures finished within 30-45 min. most of the patients had mild post-operative pain and were discharged within 2 days of the procedure. Conclusion: Open pre-peritoneal mesh repair is a cost-effective procedure with few post-operative complications, less requirement of anesthesia and short duration of surgery, early discharge from the hospital. Keywords: Hernia, pre-peritoneal mesh repair, open approach, bilateral, recurrent hernia.

Background: Uromodulin (Tamm–Horsfall protein), the most common protein in normal urine present in a bundant quantity, is increasingly considered as a potential biomarker relevant to kidney function and tubular reserve, chronic kidney disease and hypertension. A reduced number of tubular cells, is paralleled by reduced urinary and serum concentrations of uromodulin. Therefore, uromodulin might represent a promising biomarker for CKD. Aim: To evaluate the use of serum uromodulin as a biomarker in chronic kidney disease patients. Material and Methods: In an observational study, on 100 subjects with 50 normal healthy and 50 with CKD 1 – 5 stages patients attending Nephrology department in a tertiary care hospital for two years were enrolled. Lipid profile, Serum calcium, proteins, creatinine and serum Uromodulin along with e GFR was investigated. Data was analyzed using SPSS 16 and by using t test, ANOVA and correlation coefficients. Results: Mean age of the study participants was 47.47 ± 10.66 years. And 71% were male. On comparison between cases and controls, Serum Uromodulin, calcium, HDL was lower and other lab findings were significantly more in Cases than in controls. Serum Uromodulin was significantly decreased with severity of CKD. Conclusion: A comparative analysis of serum uromodulin with e GFR shows that eGFR is positively correlated with uromodulin. Lower serum uromodulin reflects a decline in kidney function. Thus serum uromodulin is a helpful marker in diagnosis of CKD at a nearly stage. The estimation of serum uromodulin level may aid in early diagnosis of kidney dysfunction and also in predicting the progression of disease. Keywords: Biomarker, Chronic Kidney disease, Renal function, Serum Uromodulin.

Background: Suspected cases of pediatric abuse often involve the administration of anaesthetic drugs, posing significant risks to the well-being of affected children. Understanding the patterns and clinical implications of anaesthetic drug usage in such cases is crucial for effective detection and intervention. This study aimed to analyze the prevalence, types, dosage patterns, clinical presentations, and forensic implications of anaesthetic drug usage in suspected cases of pediatric abuse. Material and Methods: A comprehensive observational study was conducted, involving the analysis of 100 suspected cases of pediatric abuse. Anaesthetic drug usage was meticulously examined, and data were collected regarding the types of drugs administered, dosage patterns, clinical presentations, and forensic implications. Results: Among the suspected cases, 65% exhibited evidence of anaesthetic drug usage, with Propofol being the most prevalent (40%), followed by Ketamine (30%) and Benzodiazepines (20%). High dosage administration was observed in 25% of cases, while 15% involved low dosage administration. Respiratory depression (60%) and CNS depression (45%) were the most common clinical presentations associated with anaesthetic drug usage. Additionally, 45% of cases involved the simultaneous administration of multiple anaesthetic drugs. Forensically, the identification of specific anaesthetic drugs and their dosage patterns served as crucial evidence in cases of suspected pediatric abuse. Conclusion: Anaesthetic drug usage is prevalent in suspected cases of pediatric abuse, with significant clinical and forensic implications. Our findings underscore the importance of vigilance among healthcare providers and the implementation of robust child protection measures to detect and intervene in cases involving anaesthetic drugs. Enhanced awareness and understanding of these patterns are essential for safeguarding the well-being of vulnerable children. Keywords: Pediatric abuse, anaesthetic drugs, prevalence, dosage patterns, clinical presentations, forensic implications.

Background: The physiological and psychological distinctions between children and adults pose challenges for pediatric anesthesia. The backbone of pediatric surgeries has always been general anesthesia; however, toxic consequences, especially in younger children, have prompted a reevaluation of anesthetic procedures. This concern has led to research into alternatives such as regional and neuraxial procedures. The purpose of the study is to investigate how various anaesthetic techniques affect paediatric outcomes. Material and Methods: This is prospective observational research with 120 paediatric patients having surgery that is elective. Patients who underwent general, regional, neuraxial, anaesthetic procedures were divided into 3 groups. Data on demographics, intraoperative parameters, and postoperative results gathered and analysed. Results: A total of 120 study participants were chosen for the study in order to investigate the effects of different anaesthetic techniques. Patients in Group B (regional anaesthesia) experienced 25% less postoperative pain than those in Group A (general anaesthesia) (p < 0.05). On the other hand, Group A saw a 20% greater incidence of emerging delirium than Group B (p < 0.05). Group C (neuraxial procedures) and Group A did not show statistically significant differences in postoperative pain evaluations. Instead, the scores were determined to be similar. Conclusion: Our study unfolds the importance of assessing different anaesthetic procedures in paediatric surgery. While general anaesthesia was associated with a higher incidence of emerging delirium, regional anaesthesia demonstrated improved pain control. Postoperative pain results from neuraxial surgeries were similar to those from general anaesthesia. In order to maximize patient care and outcomes, our data highlight the significance of personalized anaesthetic techniques in paediatric surgery. Keywords: Pediatric anesthesia, Anesthetic techniques, Customized anesthesia, Pediatric surgery, Anaesthesia safety.