Current Issue

Background: The aim is to assess functional outcome of extra articular deformities corrected with intra articular corrections in primary total knee replacement. Materials and Methods: A prospective study was conducted over 18 months at Osmania General Hospital, Hyderabad, Telangana, India, involving 20 patients aged 50-70 years with extra- articular varus deformity of less than 20 degrees in the femur and less than 30 degrees in the tibia. Preoperative evaluations included sociodemographic details, blood investigations, imaging results, Knee Society scores, and Hungerford scores. Surgical corrections involved intra-articular bone resections and soft tissue release. Results: A majority of participants (75%) had their alignment fully corrected, and 85% reported advantages from the single-stage procedure. Radiological corrections were observed in varying degrees, with 50% of participants showing moderate improvement and 40% showing significant improvement. Notably, there were no reported complications, demonstrating the safety and efficacy of the interventions. The absence of complications and the high rates of alignment and radiological improvements reinforce the positive impact of the surgical procedures on the participants' health and quality of life. Conclusion: One-stage total knee arthroplasty is a viable and effective option for correcting extra-articular varus deformities, providing significant clinical and functional improvements while maintaining a favourable safety profile. Keywords: Functional outcome, Extra-articular varus deformities, Radiological corrections, Quality of life.

Background: Coronary artery disease is one of the leading causes of death globally, with coronary artery bypass grafting remaining the gold standard of treatment, especially in multivessel disease. However, diffuse disease poses an unforeseen difficulty of distal revascularisation by standard Coronary Artery Bypass Grafting (CABG) alone. Coronary endarterectomy as an adjuvant, even if unplanned preoperatively is essential in these cases for adequate revascularisation. In this study, we have compared the technical procedures and outcomes of coronary endarterectomy. Materials and Methods: In this retrospective observational study, we intend to compare the technique used, the vessel addressed and the outcomes recorded in patients who have undergone CABG with Coronary Endarterectomy at two separate tertiary care speciality hospitals between the period from February 2023 to February 2025, done by a single surgeon. Results: Data of 57 patients who had undergone CABG with coronary endarterectomy during the study period were analysed and assessed. There was a male preponderance in the study population, with the majority of patients falling in the 50 – 60-year age group. More patients underwent closed endarterectomy with off-pump or on-pump beating heart CABG while open endarterectomy was more common in on-pump arrested heart CABG. RCA was the most commonly endarterectomised vessel in our study. Conclusion: This study shows that successful coronary endarterectomy with CABG can show a drastic improvement in cardiac function and symptom relief of the patients due to improved perfusion and distal run off as the plaque causing obstruction is completely removed. However adequate postoperative anticoagulation and antiplatelet regimen as well as strict follow-up are necessary to ensure adequate maintenance of vessel patency and prevent reocclusion. Key Words: Coronary Artery Bypass Grafting, Coronary Endarterectomy, Coronary Artery Disease

Background: Student-centric teaching methods like Problem-Based Learning (PBL) and Small Group Discussions (SGD) focus on interactive, particularly beneficial in teaching clinical medical subjects. These methods help in developing diagnostic and decision-making skills which are essential in clinical practice. However, literature comparing the efficacy of these methods in undergraduate clinical teaching is limited. Materials and Methods: A quasi-experimental study was conducted among 124 final-year MBBS students at Dr Moopen’s Medical College, Wayanad, from October to December 2024. Students were divided into PBL (n=61) and SGD (n=63) groups based on roll numbers. Each group underwent three sessions on topics: Rickets, Osteosarcoma, and Osteomyelitis. Pre-tests and post-tests (MCQs) were used to assess knowledge gain and a Likert scale evaluated student perception. Data was analyzed using paired and unpaired t-tests with SPSS v26. A p-value < 0.05 was considered significant. Results: Pre-test scores were comparable between groups except for Osteomyelitis, where SGD scored higher (p=0.012). Both groups showed statistically significant improvements from pre- to post-test scores across all topics (p<0.001). Post-test comparisons between PBL and SGD revealed no significant differences between these two groups indicating both methods were equally effective. More than 90% of students reported improved understanding, engagement, critical thinking, and overall satisfaction with both methods. Conclusion: Both PBL and SGD are effective teaching-learning methods for clinical subjects in undergraduate medical education, promoting knowledge application to real-time clinical scenarios, and enhancing collaborative and problem-solving skills. Keywords: Problem Based Learning, Small Group Discussion, Medical education, Undergraduate teaching, Learning outcomes

Background: The aim is to establish the diagnostic usefulness of Delta Neutrophil Index as an early marker of disease severity in patients with acute pancreatitis. Materials and Methods: Single centre, non-interventional, prospective observational study in department of medicine for a period of 2 years in acute pancreatitis cases admitted diagnosed through clinical, laboratory and radiological parameters. Results: Mean heart rate was lesser in mild cases (79.20±9.7 bpm) compared to total population (85.05±12.1 bpm). This suggests that heart rate increases with severity of acute pancreatitis. Delta neutrophil index (DNI) had strong positive correlation with CRP, ANC, ATLANTA and BISAP scores , stronger correlation of DNI with severity was seen in mild cases compared to moderate-severe cases. Conclusion: DNI measured at presentation in emergency has the potential to function as an adjunctive marker for prediction of severity of acute pancreatitis. Keywords: Delta neutrophil index, Absolute neutrophil count , High sensitivity C reactive protein.

Background: Candida species have emerged as significant opportunistic pathogens, causing a wide spectrum of infections in hospitalized patients. The increasing prevalence of non-albicans Candida species along with rising antifungal resistance poses substantial challenges in clinical management. Aim and Objective: The present study aimed to determine the distribution of Candida species isolated from various clinical samples and to assess their antifungal susceptibility patterns in a tertiary care hospital setting. Materials and Methods: This observational study was conducted over a period of 18 months in a tertiary care hospital. Clinical samples such as blood, urine, respiratory secretions, vaginal swabs, and pus were collected and processed for fungal culture. Isolated Candida species were identified using conventional and automated identification methods. Antifungal susceptibility testing was performed using the CLSI broth microdilution method for commonly used antifungal agents, including fluconazole, voriconazole, amphotericin B, and caspofungin. Results: A total of 210 Candida isolates were obtained. Candida albicans accounted for 45% of isolates, while non-albicans Candida species constituted 55%, with Candida tropicalis (22%), Candida glabrata (15%), Candida parapsilosis (10%), and Candida krusei (8%) being predominant. Antifungal susceptibility revealed 18% resistance to fluconazole, primarily among non-albicans species. Voriconazole and amphotericin B exhibited high susceptibility rates across all species, while emerging resistance to caspofungin was observed in 6% of isolates. Conclusion: The increasing prevalence of non-albicans Candida species with variable antifungal resistance patterns underscores the need for routine species identification and susceptibility testing to guide effective antifungal therapy and improve patient outcomes. Keywords: Candida species, antifungal susceptibility, non-albicans Candida, fluconazole resistance, tertiary care hospital, candidiasis.

Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and its accurate diagnosis is crucial for effective management. Objective: This study aims to evaluate the semiquantitative expression of CK19 in different thyroid lesions, including PTC, the follicular variant of PTC (FVPTC), follicular adenoma, and multinodular goiter (MNG), and to assess its diagnostic accuracy. Materials and Methods: This cross-sectional study was conducted at tertiary care hospital from June 2020 to June 2023. The sample size for this study comprised 50 thyroid cases. Tissue samples were collected from patients who underwent thyroid lobectomy or total thyroidectomy. The samples were then processed and fixed in formalin, followed by paraffin embedding. Serial tissue sections were prepared for IHC staining. Results: The study revealed that CK19 expression was strongly positive in 80% of usual-type PTC cases (moderate to strong expression). In the FVPTC group, CK19 was moderately expressed in 75% of cases. The follicular adenoma and MNG groups showed minimal to no CK19 expression, with 66.7% and 77.3% of cases, respectively, showing no CK19 staining. The sensitivity of CK19 in diagnosing PTC was 84%, with a specificity of 91%. The positive predictive value (PPV) was 82%, and the negative predictive value (NPV) was 89%. Conclusion: It is concluded that CK19 is a highly sensitive and specific marker for diagnosing papillary thyroid carcinoma, particularly in distinguishing it from benign thyroid lesions such as follicular adenoma and multinodular goiter. The semiquantitative assessment of CK19 expression demonstrated strong, diffuse positivity in usual-type PTC and moderate expression in FVPTC, making CK19 a valuable diagnostic tool. Keywords: Carcinoma, Patients, PTC, FNAC, Metastasis, Diagnosis.

Background: Acute abdomen is a medical emergency with diverse etiologies requiring rapid diagnosis for timely intervention. Imaging plays a pivotal role, with ultrasonography (USG) and plain abdominal radiography (X-ray) being the most accessible first-line modalities in emergency settings. The objective is to evaluate and compare the diagnostic efficacy of ultrasonography and plain radiography in identifying the underlying causes of acute abdomen and to correlate imaging findings with clinical and surgical outcomes. Materials and Methods: A hospital-based cross-sectional study was conducted over one year, including 200 patients aged 18–85 years presenting with features of acute abdomen. All patients underwent USG and plain radiography. Imaging findings were recorded and correlated with final diagnoses. Data were analyzed using SPSS version 23.0, with p < 0.05 considered statistically significant. Results: USG demonstrated high diagnostic accuracy in detecting cholelithiasis (99.9%), appendicitis (90%), pancreatitis (92.8%), and abscesses (99.9%). X-ray was more effective in bowel obstruction (99.9%) and radiopaque calculi (99.9%). Both modalities showed complementary diagnostic value. Conclusion: Ultrasonography and plain radiography serve as valuable complementary tools in evaluating acute abdomen. Integrating both enhances diagnostic precision and supports timely management in emergency care. Keywords: Acute abdomen; Ultrasonography; Radiography; Diagnostic imaging; Abdominal emergencies.

Background: Otomycosis is fungal infection of external ear and middle ear, commonly seen in tropical and subtropical regions. It is common condition encountered in ENT practice. Objective: To study mode of presentation, predisposing factors and types of fungi causing otomycosis. Materials and Methods: This observational study was included 166 patients (90 females and 76 males), 18-60 years of age group who were clinically diagnosed patients of otomycosis, and was carried out in Tertiary Care Hospital & Medical College of India over period of six months from July to December. A detailed history was taken including symptoms and various predisposing factors. Two swab samples were taken from affected ear and were sent to microbiology for identification of fungi causing otomycosis. After that patients were treated by ear cleaning and given antifungal drops/tablets according to presentation. Results: Our study showed maximum patients were of 21-40 years of age (77.71%), female preponderance (54.22%) and unilateral ear involvement (96.98%). Itching (83.13%) was the most common presentation in present study. Most common pre-disposing factor was self-cleaning by unsterile object (83.53%). Aspergillus Niger (79.08%) was found to be the commonest isolated fungus causing otomycosis. Conclusion: Present study highlights the commonest isolation of Aspergillus species in cases of clinically diagnosed otomycosis with common risk factor like self-cleaning to get relief from ear itching. Keywords: Otomycosis, Aspergillus, Candida.

Background: Child malnutrition is a major public health issue worldwide. An estimated 144 million children under age 5 are stunted, 47 million are wasted, and 38.3 million are overweight or obese. Around 45% of deaths among children under 5 years of age are linked to undernutrition. Malnutrition throughout the first five years of life cannot just have a poor effect on a child's physical and mental growth, but can also result in death. While malnutrition is a multifaceted issue, improper feeding habits account for more than two-thirds of cases globally. The present study is an attempt to identify the barriers and facilitators to optimal practices faced by the parents / primary caregivers of these children in the urban slum areas of Delhi. The objective is to study the barriers and enabling factors associated with IYCF practices among children aged 6 – 23 months. Materials and Methods: A community-based cross-sectional study was conducted among 400 children aged 6-23 months residing in the field practice areas of the medical college using simple random sampling. Data was obtained using a semi-structured questionnaire through the researcher-administered interview to parents/caregivers of study participants using good clinical and ethical practices. Data obtained was thus compiled using MS Excel and analysed using SPSS version 26.0. Results: Advice of healthcare workers and family members, as well as prior knowledge of the benefits of good breastfeeding and complementary feeding practices, were the major enablers for appropriate IYCF practices. whereas existing myths, ill-advice given by family members and traditional practices were the barriers identified under study. The study emphasises the pivotal role of healthcare workers. Conclusion: Traditional myths and practices should be addressed to combat inappropriate feeding practices, not just with parents / primary caregivers but also with other members of the family. This can be achieved by community health education programs, as well as one-on-one counselling by local ASHAs, ANMs, AWWs and skilled birth attendants. Keywords: Infant and Young Child Feeding Practices, Enablers and Barriers, Urban Slums.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Early detection and risk stratification are crucial for improving patient outcomes. Among the various biomarkers under investigation, Red Cell Distribution Width (RDW), which measures the variation in red blood cell size, has emerged as a potential indicator for the severity of CAD. This study aimed to explore the relationship between RDW levels and CAD severity, hypothesizing that elevated RDW values correlate with more advanced stages of CAD. Materials and Methods: This prospective observational study was conducted at Government Theni Medical College over 18 months, enrolling 100 patients diagnosed with acute coronary syndrome (ACS) and other CAD-related conditions. Data were collected using clinical history, examination, and laboratory tests, including complete blood count (CBC) with RDW measurements. Statistical analysis was performed using SPSS software, employing the Chi-square test, Spearman’s rank correlation, and Karl Pearson correlation methods. Results: The study cohort had a mean age of 56.04 years, with 65% male patients. RDW scores were significantly higher in patients with STEMI compared to those with Non-STEMI or Unstable Angina (p < 0.001). RDW was also strongly associated with systolic and diastolic blood pressures (p < 0.001). Patients with greater RDW scores exhibited higher blood pressure levels and more severe left ventricular dysfunction (LVEF). A significant correlation was found between RDW scores and the severity of left ventricular dysfunction, with higher RDW values associated with poorer LVEF (p < 0.001). Discussion: RDW levels correlate with the severity of CAD, particularly in patients with STEMI. The findings suggest that RDW could serve as a simple, inexpensive marker to assess CAD severity, particularly when combined with other clinical indicators like LVEF and blood pressure. Conclusion: Elevated RDW levels are significantly associated with more severe forms of coronary artery disease, including STEMI, higher blood pressure, and worse left ventricular function. RDW may be a useful adjunctive biomarker for assessing the severity of CAD, providing valuable prognostic information for clinical decision-making. Keywords: Coronary Artery Disease, Red Cell Distribution Width, Acute Coronary Syndrome, Prognostic Biomarker, Coronary Angiography.

Background: Suicide is a major global health issue, strongly linked to psychiatric disorders. Both common mental disorders (CMD) and severe mental illness (SMI) significantly increase suicide risk. Early detection of high-risk individuals is critical for prevention. Aim: To assess and compare the prevalence of suicidal ideation and attempts among individuals with CMD and SMI, and identify associated sociodemographic and clinical factors. Materials and Methods: A cross-sectional study was conducted on 80 adults with CMD (n = 40) or SMI (n = 40). Depression and anxiety severity were assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale. Obsessive-compulsive symptoms were measured using the Yale-Brown Obsessive Compulsive Scale. General psychiatric symptoms were evaluated with the Brief Psychiatric Rating Scale. Suicidal ideation and intent were assessed using Beck’s Suicidal Ideation Scale and Suicide Intent Scale. Data were analysed using SPSS; p < 0.05 was considered significant. Results: Suicidal ideation was present in 38.6% of patients with CMD and 36.1% of patients with SMI. Suicide attempts were more frequent in the CMD (18.2%) than in the SMI (5.6%) group, although this difference was not significant. Major depressive disorder was most commonly associated with both ideation (60%) and suicide attempts (30%). Females exhibited higher suicidal ideation (55.6%), whereas males had more attempts (66.7%). Suicidal behaviour was more common among younger individuals and those from lower-middle socioeconomic backgrounds. Conclusion: Suicidal ideation and attempts were common and comparable in CMD and SMI. Risk factors such as age, gender, and family history underline the importance of routine suicide risk screening in psychiatric care. Keywords: Suicide, Suicidal Ideation, Suicide Attempt, Common Mental Disorders, Severe Mental Illness, Depression, Risk Factors.

Background: There is an increase in incidence of knee osteoarthritis among middle-aged individuals, leading to pain and functional limitation. Medial Open Wedge High Tibial Osteotomy (MOWHTO) is a joint-preserving surgical procedure designed to realign the mechanical axis and offload the diseased compartment. The usage Tomofix plate offers better biomechanical stability and prevents the loss of correction thus allowing early mobilization and reliable healing. This study aims to evaluate the functional and radiological outcomes of MOWHTO using the Tomofix plate. Materials and Methods: This prospective interventional study was conducted at NRI Institute of Medical Sciences, Visakhapatnam, over a period of 24 months. 20 patients with symptomatic medial compartmental OA were selected based on strict inclusion criteria. Functional outcomes were assessed using the Knee Society Score, Visual Analogue Scale and Range of Motion. Radiological outcomes were evaluated via Hip-Knee-Ankle (HKA) angle measurements pre- and post-operatively. Results: The mean age of population in this study is 54.45 with 60% females and 40% males. The mean BMI is 25.17. The mean HKA angle improved significantly from 170.5° preoperatively to 184.2° postoperatively indicating successful correction of varus deformity. VAS scores decreased from a mean of 6.8 to 2.6. The KSS score improved from 54.1 to 90.6 and Functional KSS scores also showed significant improvement from 50.2 to 85.5. The overall complication rate is 10%. Conclusion: MOWHTO using the Tomofix plate is a safe and effective procedure for selected patients with medial compartmental OA. It significantly improves pain, alignment, and functional outcomes with minimal complications, reinforcing its role as a viable alternative to knee arthroplasty in active, physiologically young individuals. Keywords: High Tibial Osteotomy, Tomofix Plate, Osteoarthritis, KSS score, VAS score.

Background: Brachial plexus blockade is the cornerstone of regional anaesthesia practice of most anaesthesiologists. The supraclavicular approach is one of several techniques used to accomplish anaesthesia of the brachial plexus and is performed at the level of the brachial plexus trunks where almost entire sensory, motor and sympathetic nerve supply of the upper extremity is carried. Consequently, typical features of this block include its rapid onset, predictability and density. the objective is to compare dexmedetomidine and clonidine when added to a local anaesthetic solution for Supraclavicular brachial plexus block for upper limb orthopaedic surgeries with respect to Onset of sensory blockade, Onset of motor blockade, Duration of sensory blockade and Duration of motor blockade Materials and Methods: The present Randomized Controlled Trial was carried out at Anaesthesia department involving patients to be posted for upper extremity orthopaedic surgeries in RK Damani Medical College SRIMS Chhatrapati Sambhajinagar, Maharashtra during the study period from January 2024 to December 2024. Results: Proportion of females in Group C were 40% as compared with 22.2% in Group D. Proportion of males in Group C were 60% as compared with 77.8% in Group D. Sensory blockade onset was earlier in Group D as compared with Group C. Motor blockade onset was earlier in Group D as compared with Group C. Duration of sensory blockade was prolonged in Group D as compared with Group C. Duration of motor blockade was prolonged in Group D as compared with Group C. Conclusion: Sensory and motor blockade onset was earlier in Group D as compared with Group C. Duration of sensory and motor blockade was prolonged in Group D as compared with Group C. Keywords: Dexmedetomidine, clonidine, supraclavicular brachial plexus block for upper limb orthopaedic surgeries.

Background: The histogenesis and progression of cervical carcinoma is well documented. It is possible to prevent the development of invasive carcinoma by identifying and treating pre invasive lesions. This study was a prospective study conducted from 01 July 2014 to 01 July 2016. The objectives of the study were to evaluate and interpret the cases of precancerous and cancerous lesions according to The 2001 Bethesda System and to correlate cytology diagnosis with histopathology diagnosis. Materials and Methods: Pap Smears were received along with their corresponding cervical biopsies or hysterectomy specimens in the Department of Pathology, Raja Rajeswari Medical College and Hospital, Bangalore. The Pap smears were stained with Papanicolaou stain and the corresponding biopsies or hysterectomy sections were stained with H & E stain and examined for microscopic details. Results: The cytological evaluation of 200 pap smears was done and 61.5% of lesions were reported as Negative for intraepithelial lesion or malignancy, 15% as ASCUS, 11% as LSIL, 5.5% each as HSIL and SCC and the remaining 1.5% as positive for malignancy. Majority of the women were from the age group of 41-50 years and the commonest presenting complaint was white discharge per vaginum. Of 200 specimens received for histopathology, 137 (68.5%) were reported as Benign, 37 (18.5%) as Premalignant and 26 (13%) as Malignant. Amongst the 37(18.5%) premalignant lesions encountered on histopathology, 11% cases were reported as koilocytic atypia, 43% cases as CIN 1, 27% cases as CIN 2, 16% cases as CIN 3 and 3% cases as CIS. The total number of malignant lesions were 26 (13%) in number. Out of these, 92% were reported as Squamous cell carcinoma and 4% cases each of microinvasive SCC and Adenocarcinoma. Of these 24 cases of SCC, 58% cases were moderately differentiated SCC, 33% were well differentiated SCC and 9% cases were diagnosed as poorly differentiated SCC. Conclusion: The regular screening of population by Pap smear and reporting as per The 2001 Bethesda System is a cost-effective method for early detection of premalignant and malignant cervical lesions. The procedure is simple, inexpensive and can be performed in the outpatient department which is useful in a country like ours. It also has an important role in the diagnosis of inflammatory lesions including the identification of causative organism and atrophic changes and helps in the definitive management of patients. All lesions on Pap smears should be followed by repeat Pap smear examination and cervical biopsies hysterectomy which will improve the diagnostic accuracy and help in staging of malignant lesions. Keywords: The 2001 Bethesda System, Papanicolaou stain, cervical biopsy.