Current Issue

Background: Chronic liver disease (CLD) is associated with a spectrum of cardiovascular changes, often leading to cirrhotic cardiomyopathy. Aim: To assess echocardiographic changes in patients with CLD over a 12-month period in a tertiary care center. Materials and Methods: A total of 40 CLD patients were evaluated using transthoracic echocardiography at baseline, 6 months, and 12 months. Parameters were compared with 40 healthy controls. Results: Significant increases in interventricular septal thickness and left ventricular posterior wall thickness were observed over time. Doppler parameters also revealed early diastolic dysfunction in CLD patients. Conclusion: Serial echocardiography is valuable in detecting subclinical cardiac changes in CLD, enabling early intervention and optimized patient care. Keywords: Chronic liver disease, Echocardiography, Cirrhotic cardiomyopathy.

Background: Mobile phone usage has increased drastically in the present day, and that increases sedentary behaviour like using the mobile phone in a lying down posture or in a sitting posture without any physical activity. Earlier studies assessed the reaction between the screen time with the depression mainly not with anxiety and stress scores. Aim and objectives: The present study was undertaken to assess the screen time in young adults and assess the depression, anxiety, and stress scores. Materials and Methods: The present cross-sectional study recruited a total of 100 young adults after obtaining voluntary, written, informed consent. Mobile screen time was recorded using Apple's Screen Time and Google's Digital Wellbeing apps, respectively. Depression, anxiety, and stress scores were recorded using the DASS 21 questionnaire, which is a self-administered questionnaire. Results: Depression scores were significantly higher in the individuals using screen time for more than 6 hours. Anxiety scores were significantly higher in the individuals using screen time for more than 6 hours. Stress scores were significantly higher in the individuals with screen time of more than six hours. Conclusion: The present study results support that excessive screen time is associated with the excess amounts of depression, anxiety, and stress. Further detailed studies are recommended in this area and also to recommend to educate the young adults regarding excessive use of mobile phones. Keywords: Stress, Screen time, Young adults, Anxiety, Depression.

Background: Academic role play has immense importance in teaching and learning methods where students can perform the roles of a case study and explain the condition more clearly. They participate enthusiastically and with full attention and concentration.The details mentioned in the AETCOM are also be covered in the role play. However, the studies on role play implementation in the medical education in India are relatively less. Hence, the present study was undertaken. Aim and objectives: The present study was undertaken to observe the effectiveness of role play in vertical integration between physiology with forensic medicine. Materials and Methods: All the students were divided into 15 groups with 10 students in each group. The clinical topics were distributed to them, that is, drowning, carbon monoxide poisoning, Rigor mortis, Diabetes mellitus, and Parkinson’s disease. They have the freedom to select any of the topics. Groups are made based on their role numbers; that is, roll number 1 to roll number 10 is one group. This improves the interaction between the students. Teachers of both departments were appointed as mentors for each of the groups. To encourage the students a competition is announced and with three prizes. To test the importance of the role play an MCQ test for 20 marks was conducted on these topics before the preparation of the role play and also after the role play performance; one more MCQ test was conducted with different questions. Feedback was obtained at the end after the post-MCQ test. Results: There was a significant increase in the students' performance in the MCQ test conducted after the role play performance by the students. The majority of the students perceived that the role play was an effective tool to promote the active learning of the clinical topics. The majority of students agreed to implement the role play in the curriculum. Conclusion: The study provides results to support the implementation of role play in medical education to promote active learning and to promote the communication skills in the students. Further detailed studies with more integrations are recommended. Keywords: Role play, Academics, Medical Education, Teaching methods.

Background: The kidney exhibits significant anatomical and developmental variability that is crucial for clinical practice and embryological understanding. This study integrates cadaveric morphometry with histogenesis analysis to provide comprehensive insights into renal anatomy and tissue architecture. The present study conducted to quantify morphometric parameters (length, breadth, thickness, hilar anatomy) in 100 cadaveric kidneys and to analyse histogenesis features (nephron maturation, vascular patterning, incidental pathology) through microscopic examination. Materials and Methods: - Sample: 100 kidneys (50 paired specimens) from cadavers with no demographic restrictions. - Morphometry: Measurements of dimensions and hilar structures using Vernier calipers; photographic documentation. - Histology: Tissue sections stained with H&E, PAS, and Masson’s trichrome; evaluated for developmental and pathological patterns. - Analysis: Descriptive statistics (mean ± SD); comparative analysis (right vs. left kidneys). Results: In present study we found the morphometric measurements, Length: 6–11.5 cm (mean 9.2 ± 1.3 cm); right kidneys longer than left (p < 0.05). • Hilar variations: Classic arrangement (62%); atypical patterns (38%). • Renal arteries: Single (70%); multiple (30%). Histogenesis • Normal glomerulogenesis (88%); immature glomeruli (8%). • Vascular anomalies: Aberrant arteriolar branching (12%); fibromuscular dysplasia (5%). • Incidental pathology: Subcapsular hematoma (3%); cystic dilatation (2%). Conclusion: This study delineates the spectrum of renal morphometric variability and histogenesis patterns in cadaveric specimens. The findings underscore the importance of anatomical variations for surgical interventions and highlight subclinical developmental anomalies. Keywords: Kidney morphometry, cadaveric study, histogenesis, renal anatomy, developmental anomalies.

Background: Tobacco consumption is the most important preventable cause of disease and death among adults. In India according to GATS 2016-172 India tobacco prevalence is 28.6% of adults (42.4% males and 14.2% females) are tobacco consumers.10.7% adults (19% males and 2.0% females) use smoking tobacco.21.4% adults (29.6% males and 12.8% females) use smokeless tobacco2. Barrier factors such as sociocultural and demographic factors play crucial role and has impact on trends and patterns of prevalence among the rural population. Objective: To estimate the prevalence of tobacco consumption among rural population of both males and females in RHTC field practice area, Nalgonda District. Materials and Methods: Community based cross sectional study, was carried out in 11 adopted villages under RHTC field practice area in Nalgonda district under tertiary care teaching hospital from October 2021 to September 2022. Sample size of 488 study participants were obtained by multistage sampling technique. Results: The prevalence of tobacco consumption in the study population.106(21.5%) of the study group were tobacco consumers and 382 (78.5%) were non-consumers. Among the study population 71(29.7%) of males and 35(14.1%) of females consume tobacco and it shows statistically significance. 283(58%) knew that tobacco consumption causes cancer,121(25%) knew that it causes Respiratory disease,30(6%) knew that it causes CVD and 49(10%) knew it causes coronary heart diseases. Conclusions: This study concludes that the prevalence of tobacco consumption is mainly associated due to factors like having no formal education, doing skilled work and belong to middle and lower middle socio-economic groups. Education is the key area where majority of the tobacco consumers started between the age 11 – 20 years. So anti-tobacco education should be made compulsory in schools and colleges in their academic curriculum. Keywords: Tobacco consumption, Household, ex-smoker, Socio-demographic factors.

Background: Tuberculosis is one of the most common causes of death in world. Drug resistance has become more common in previously treated patients, who were treated irregularly or with improper regimens and doses. Aim is to look the clinico-microbiological profile, treatment outcomes, and follow-up of patients registered for DRTB and IRL at Puducherry tuberculosis unit. Materials and Methods: This study included 73 patients who were treated for drug-resistant tuberculosis at DRTB/IRL during 2014-2020. Their clinical condition, microbiological parameters, resistance pattern, laboratory profiles, and radiological results were taken. Patients with favourable and unfavourable outcomes were followed up using random sampling method and their current clinical findings, sputum smear status, and radiological data were recorded. Results: 73 patients were included with mean age of 43.83±15.20 years. Treatment outcomes as 78.08% cured, from cured patients 16% were died during follow up period, 1.4 % completed treatment, 4.1% died before completing treatment, 4.1% were lost to follow up and 2.7% had treatment failure. Previous TB history exists in 79.45% and 20.55% newly diagnosed. Conclusion: Treatment success occurred more than 3/4th of cases, which is higher than WHO of 75% success rate. 16% patients who died the follow up period of study, resulted an unfavourable outcome. Keywords: DRTB, Clinico-microbiological profile, Treatment outcomes, WHO.

Background: Tuberculosis (TB) is a major global health concern caused by Mycobacterium tuberculosis. First-line anti-tubercular drugs (ATT) are highly effective in treating TB, but their use is frequently associated with drug-induced hepatotoxicity, which may lead to treatment interruption, non-adherence, and potential development of drug-resistant TB. Aim: This study aims to evaluate the approach to diagnosing and managing patients with anti-tubercular therapy (ATT)-induced hepatitis, focusing on identifying risk factors and providing effective treatment strategies. Materials and Methods: This prospective observational study was conducted over a 24-month period, involving 300 patients diagnosed with TB. Among the study population, 180 patients had pulmonary TB, 100 had extrapulmonary TB, and 20 had multidrug-resistant (MDR) TB. Of the 300 patients, 270 did not develop hepatitis, while 30 experienced hepatotoxicity. The onset of hepatitis was predominantly observed at 3 weeks following the initiation of ATT. Patients’ liver function was closely monitored through regular serum transaminase and bilirubin level assessments. Results: The incidence of ATT-induced hepatotoxicity was found to be significant, with 10% of patients developing hepatitis. The onset of liver dysfunction typically occurred around 3 weeks after starting ATT. Hepatotoxicity was more prevalent in elderly patients and those with pre-existing comorbid conditions such as diabetes and hepatic dysfunction. Conclusion: ATT-induced hepatotoxicity remains a common complication in TB treatment, necessitating close monitoring of liver function, especially in high-risk groups. Regular monitoring of liver enzymes, particularly in older patients or those with comorbidities, is crucial to prevent severe liver damage and to ensure effective management of TB. Keywords: Tuberculosis, ATT-induced hepatitis, Transaminases, Bilirubin.

Background: Evaluation of Response and Toxicity in Patients Receiving NACT with Platinum + Taxane Vs Platinum+Taxane+5FU for Head and Neck Squamous Cell Carcinomas. Materials and Methods: The present longitudinal observation study was conducted in Department of Radiation oncology, Gandhi Medical College and associated Hamidia Hospital (GMC & HH), Bhopal (M.P) and Jawaharlal Nehru Cancer Hospital (JNCH), Bhopal (M.P), on a total of 54 patients of Head and Neck Squamous Cell Carcinoma from 1st July 2022 to 31st December 2023, a period of 18 months. Fifty-four patients were randomized into two groups, receiving either TPF or TP regimens Responses were assessed using RECIST 1.1 criteria, and toxicities were evaluated using CTCAE v5.0. Results: Partial responses were observed in 65% and 48% of patients in the TPF and TP groups, respectively. Grade 3-4 toxicities, including hematological and gastrointestinal events, were more frequent in the TPF group (72%) compared to the TP group (41%). Conclusion: While the TPF regimen demonstrated superior response rates, it was associated with higher toxicity. The TP regimen may be preferred for patients with poor performance status or significant comorbidities. Keywords: Neoadjuvant therapy, chemotherapy, squamous cell carcinoma, oral cavity

Background: hs-cTnI (high-sensitivity cardiac troponin) is a biomarker that is used widely in the identification and assessment of ischemic heart pain in the emergency departments of Indian Institutes. However, the clinical effect of the eCABG (emergency coronary artery bypass grafting) is underestimated. Aim: The present study was aimed to evaluate the clinical effect of measuring high-sensitivity cardiac troponin at the emergency department by comparison of eCABG in subjects with (NSTE-ACS) non-ST-segment elevation acute coronary syndrome that includes UA (unstable angina) and NSTEMI (non–ST-segment– elevation myocardial infarction). Materials and Methods: The present study assessed 484 subjects who underwent emergency coronary artery bypass grafting and were divided into groups based on serum high-sensitivity cardiac troponin levels. The primary outcome assessed was a major cardiovascular cerebral event (MACCE) defined as stroke, repeat revascularization, myocardial infarction, and all-cause death collectively. The incidence of each MACCE along with postoperative complications such as hospital duration, atrial fibrillation, re-surgery, and acute kidney injury were compared. Results: 484 subjects were divided into 2 groups unstable angina with <0.04 ng/ml and comprised of 204 subjects and NSTEMI with ≥0.04 ng/ml and comprised of 280 subjects. MACCE incidence showed no difference in the two study groups. In the NSTEMI group, postoperative acute kidney injury was more frequently seen with p=0.03. Also, hospital stay duration was significantly higher in the NSTEMI group compared to the UA group with p=0.007. Conclusions: The present study concludes that emergency coronary artery bypass grafting in non–ST-segment–elevation myocardial infarction and unstable angina subjects result in comparable outcomes. However, elevated levels of hd-cTnI in an emergency can be correlated to immediate postoperative complications. Keywords: coronary artery bypass grafting, eCABG, MACCE, NSTEMI, hs-cTnI (high-sensitivity cardiac troponin).

Background: AMH levels are usually high in subjects with high BMI and obesity, which is a peculiar feature of PCOD. Hence, higher AMH levels in females with PCOD can be attributed to increased AMH secretion from an increased number of small antral follicles. Aim: The present study aimed to evaluate the relationship between BMI (bone mass index) and serum AMH (anti-mullerian hormone) levels in infertile females with and without PCOD (polycystic ovarian disease). Materials and Methods: The present study assessed 400 females who visited the Institute within the defined study period. All subjects underwent gynecological assessment and basic infertility tests, including BMI. All females' AMH levels were assessed, and subjects were divided into two groups: subjects with PCOD and subjects without PCOD. Results: The study results showed an overall AMH level of 4.84±4.42 ng/ml. No significant correlation was seen in AMH and BMI levels in females without PCOD with p>0.05. However, in subjects with PCOD, a significant inverse correlation was seen in AMH and BMI levels with p<0.05. Conclusions: The present study concludes that there is no significant correlation between AMH and BMI levels in infertile females without PCOD. However, in females with PCOD, there is a significant inverse correlation between serum AMH levels to BMI. Keywords: Antimullerian hormone, body mass index, Infertility, polycystic ovarian disease.

Background: Accurate selection of endotracheal tube (ETT) size in paediatric patients is critical to ensure safe and effective airway management. Traditional age-based formulas, such as the Motoyama formula, may not account for individual anatomical variations. Aim: This study aimed to evaluate the reliability of ultrasonography (USG) in determining the appropriate ETT size and compare it with the Motoyama formula. Materials and Methods: A prospective observational study was conducted on 64 paediatric patients aged 2–12 years undergoing elective surgeries under general anaesthesia at a tertiary care hospital in Gujarat. Subglottic diameter was measured using ultrasonography, and the appropriate ETT size was selected accordingly. This was compared with the size predicted by the Motoyama formula. The number of ETT changes required, time taken for USG, and clinically best-fit tube based on air leak test were recorded. Results: The mean subglottic diameter measured by USG was larger than the inner diameter predicted by the Motoyama formula. USG-based selection showed fewer tube changes and better correlation with the clinically best-fit ETT. The average time taken for USG was brief, supporting its feasibility in routine clinical practice. Conclusion: Ultrasonographic assessment provides a more accurate and individualized method for selecting ETT size in paediatric patients compared to traditional age-based formulas. Its routine use can enhance safety and efficiency in paediatric airway management. Keywords: Ultrasonography, Endotracheal Tube, Paediatric Airway.

Background: Total thyroidectomy is the standard surgical approach for benign and malignant thyroid diseases, traditionally performed via a transverse cervical (Kocher’s) incision. While effective, conventional methods often lead to increased scarring, postoperative pain, and longer recovery times. The Single Lateral Incision Total Thyroidectomy (SLITT) technique aims to minimize these drawbacks while maintaining surgical efficacy. Materials and Methods: This prospective observational study, conducted from January 2021 to January 2025, evaluated the feasibility, safety, and outcomes of the Single Lateral Incision Total Thyroidectomy (SLITT) technique in 270 patients. The SLITT technique was introduced by a surgeon from North Kerala, India, at EMS Memorial Co-operative Hospital, Perinthalmanna, and aims to provide a less invasive, cosmetically favorable alternative to conventional thyroidectomy. Patients underwent comprehensive preoperative assessment, and the surgery was performed through a single lateral incision, ensuring preservation of vital structures. Postoperative monitoring focused on complications, recovery, and patient satisfaction. The study highlights SLITT as a promising technique with potential advantages in cosmesis, recovery time, and surgical safety. Results: The retrospective analysis of 270 SLITT procedures demonstrated excellent surgical and postoperative outcomes. The majority of patients were female (86.3%) with a mean age of 44.6 years. Multinodular colloid goitre (76.3%) was the most common histopathological finding, and 95.6% underwent a right lateral incision with minimal blood loss (mean 13.9 mL) and a short operative time (mean 13.8 min). Postoperatively, complications were rare, with 87% experiencing no adverse events, and the mean hospital stay was just 2 days. Pain levels were minimal, with 100% pain-free status by 30 days. By 90 days, all scars were completely invisible, indicating excellent cosmetic and recovery outcomes. Conclusion: The SLITT technique offers a safe, efficient, and minimally invasive alternative to conventional thyroidectomy. In 270 patients, it demonstrated minimal blood loss, a short operative time, low complication rates, excellent pain control, and complete scar resolution by 90 days. These findings highlight its superior recovery, aesthetic benefits, and high patient satisfaction. KeyWords: Conventional Open Approach, Lateral Approach, National Comprehensive Cancer Network, Single Lateral Incision Total Thyroidectomy.

Background: The aim is Toxicity Analysis in Carcinoma Breast Patients Treated with Conventional and Hypofractionated Radiotherapy. Materials and Methods: A Longitudinal observation study was carried out at the Department of Radiation Oncology, Gandhi Medical College, along with the associated Hamidia Hospital (GMC & HH), Bhopal (M.P), and Jawaharlal Nehru Cancer Hospital (JNCH), Bhopal (M.P) from 1st July 2022 to 30th Dec 2023.This study involved a cohort of 68 patients diagnosed with breast cancer. Results: In our study, comparable rates of cardiac toxicity, assessed using RTOG criteria, were observed among breast carcinoma patients treated with either conventional or hypofractionation radiotherapy across various intervals. At 0 months, both treatment arms reported Grade 1 cardiac toxicity in 1 patient (2.94%) and no toxicity in 33 patients (97.06%), showing no significant difference (P = 1.0000). Conclusion: We conclude that hypofractionated radiotherapy is comparable to conventional radiotherapy in terms of adverse effects and locoregional tumor control, making it a safe and effective alternative for postmastectomy breast cancer patients in adjuvant settings. Hypofractionated radiotherapy results in similar cardiac and pulmonary toxicities as conventional fractionation and is a viable alternative for breast cancer patients. Keywords: Breast cancer, hypofractionated radiotherapy, late skin toxicity, survival.

Background: Aim: Descriptive study of female factor infertility by clinical, hormonal, sonological and endoscopical evaluation. Materials and Methods: Prospective Observational study conducted with a detailed history, clinical examination and basic investigations including HSG, USG, FSH, thyroid profile, prolactin were done in 100 cases of infertile women. Results: Out of 100 cases 68 cases were primary infertile and 32 were secondary infertile. The major infertile patients having duration of infertlity is 1-5 yrs i.e. 54%, in that Primary Infertile are 57%, Secondary infertile are 47%. Majority of secondary infertile women, 19 cases (59%) had previous history of abortions. Uterine factors accounted for 6% of infertility cases. 23 (33.82%) primary, 17 (53%) secondary infertile women had abnormal HSG findings. Most common being B/L tubal block, which contributes 15%, in this 13% primary and 22% secondary. Ovarian factors contributed to 49% of the cases in which laparoscopy was performed. 36% of primary and 13% of secondary infertility was caused by ovarian factors. PCOS was the leading ovarian factor responsible for infertility. Tubal factors were responsible for 22% primary and secondary infertility cases. Out of 8 cases of B/L tubal blocks, 6 were primary and 2 were secondary infertile. Uterine abnormalities contributing to 14% of total cases in which laparoscopy was performed. Peritoneal factors accounted for 21% cases of infertility. Among peritoneal factors, pelvic adhesions was found to be the leading factor. Majority of Infertility patients (70%) had B/L positive chromopertubation. Bilateral negative dye test was seen in 14% cases. Conclusions: All the clinical, harmonal, sonological and laproscopic findings are required in evaluation of all infertile patients. It will also be possible in formulating a specific plan of management and segregate the patients who will need ART at the earliest. Keywords: Assisted Reproductive Technology(ART), PolyCystic Ovarian Syndrome(PCOS), Hysterosalpigography (HSG).

Background: Oral squamous cell carcinoma (OSCC) is the most common type of oral cavity malignancy, with the tongue being one of the most commonly affected sites. It can also cause dysphagia (difficulty swallowing), dysarthria (difficulty speaking), and paresthesia (numbness) of the tongue or mouth. The use of tobacco products, excessive alcohol consumption, HPV infection, a weak immune system, genetics, and oral irritation are the main factors that cause tongue cancer. Surgical excision with negative margins is the primary goal . Obtaining clear margin especially deep margin is difficult due to complex anatomy and poor assessment of spread of tumour . Aims and objectives: The study aims to identify whether USG-guided assisted resection of primary tongue lesions will help in the resection of adequate margins when compared with final histopathology. Materials and Methods: A total of 91 patients with diagnosed tongue malignancies were observed at Krishna Institute of Medical Sciences' surgical oncology department from 2020 to 2023, after obtaining written consent. Cases studied prospectively without randomization. A single pathologist reviewed the pathology specimen. The primary goal of this study is to delve into the potential impact of ultrasound-guided assistance during the resection of primary tongue lesions. Results: A total of 91 patients were included in the study. Most of the patients in our study are in the T2 stage, 36/91 i.e., 39.5 %. Deep margin as an outcome measure. The mean deep margin assessed by USG in our study was 0.901cm+/- 5.2 mm (mean +/- SD), and the mean deep margin assessed by the frozen section is. 0.762 cm +/- 4.8 mm. Higher stage T3 and T4 were strong predictors for inadequate deep margin but they were assessed correctly by USG assessment and allowed us to revise the margins to prevent close and positive margins. Conclusion: Ultrasound-guided surgery for tongue cancer resection is a technique that increases the chances of achieving clear margins and reduces the likelihood of positive margins compared to standard methods. Performing ex-vivo ultrasound on the resected specimen enables the assurance of extra clear margins. However, it's important to maintain consistent orientation of the specimen during both surgery and histopathological evaluation. Keywords: Ultrasonography, tongue, squamous cell carcinoma.

Background: Hemorrhoidal disease is one of the most common proctological disease and affects between 7 and 30% of the general population. Open hemorrhoidectomy is the current gold standard. However, it is associated with significant pain, bleeding and wound infection which can result in prolonged hospital stay. Laser hemorrhoidoplasty (LHP) is a new minimally invasive and painless procedure for symptomatic hemorrhoids. But there is conflicting evidence regarding their resolution of symptoms and recurrence rates. Materials and Methods: This is a prospective observational study conducted in a tertiary hospital in Visakhapatnam from January 2021 to December 2023. A total of 80 patients presenting with symptomatic grade III hemorrhoids were included in the study, of whom 40 underwent Laser Hemorrhoidoplasty (LHP) and 40 underwent open hemorrhoidectomy. Group selection was done by simple randomization using the lottery method. Postoperative pain levels were measured every day at rest during the entire hospital stay using the Visual Analog Scale (VAS). All patients received a follow-up after 15 days, 3months, 6 months and 1 year postoperative. Results: The MM procedure presented longer mean operative time (27 ± 3.7min vs 15 ± 2.3 min, p < 0.0001) and longer hospitalization (3.8 ± 1.2 vs 1.3 ± 0.7 days, p < 0.0001). Mean postoperative pain score evaluated through the visual analog scale (VAS) was significantly lower in LHP group (p < 0.0001) at each follow-up point. Patients after LHP returned to regular activity after 6.8± 1.4 days vs 13.6± 2.8 days after MM procedure (p < 0.001). 1 year follow up showed a higher recurrence rate after LHP procedure (15% vs 2.5%, p < 0.05). Conclusion: LHP is a safe, minimally invasive procedure with benefits in operative time, blood loss, postoperative pain and quicker return to activity, though recurrence rates might be higher. Though MM has immediate postop disadvantages including significant postoperative pain, this technique does result in a low risk of symptom recurrence. Keywords: LHP- Laser Hemorrhoidoplasty, MM- Milligan-Morgan (open haemorrhoidectomy), Hemorrhoidal disease.

Background: Labour pain is one of the most intensifying pain a women experience in her lifetime surpassing all expectations. A variety of labour analgesia options are available but neuraxial techniques such as epidural analgesia have emerged as the most acceptable world wide in managing labour pain effectively while minimizing the adverse effects in the parturients and the fetus. The aim & objective are 1. To estimate efficacy of 0.0625% bupivacaine &0.0002% fentanyl combination on Labour outcome 2. To study the effect of 0.125% bupivacaine alone on Labour outcome 3. To compare the effectiveness of 0.0625% bupivacaine & 0.0002% fentanyl combination with 0.125% bupivacaine alone on Labour. Materials and Methods: This randomized study was undertaken in department of Anaesthesiology in collaboration with Obstetrics & Gynaecology department and the Dept. of paediatrics in Hi-Tec medical college over a period of 2 years. Sixty ASA category I parturients at term with vertex presentation of a single live foetus in the 18-35 years age group were divided into two groups randomly, one receiving 0.0625% bupivacaine with 0.0002% fentanyl (Group A) and the other 0.125% bupivacaine alone(Group B). A 12ml bolus dose of the test solution at the rate of 2-3 ml/min followed by a continuous infusion of test solution at the rate of 10 ml/hr (range 8-15 ml/hr) till complete cervical dilatation. Maternal heart rate, blood pressure, foetal heart rate, visual analogue scale (VAS) score, intensity of analgesia, duration of labour, mode of delivery, maternal outcome were assessed. Results: No significant difference (P>0.05) were observed in haemodynamic profile, foetal heart rate, duration of labour, intensity of analgesia, mode of delivery, maternal satisfaction or neonatal outcome in both the groups. Group A required a higher infusion rate for maintenance, shorter time of onset of analgesia, lower quantity of bupivacaine, lesser incidence of motor paresis with a higher ambulation rate of 96% as compared to group B. Conclusion: Low dose bupivacaine with the short acting fentanyl can make labour and delivery a pain free process without compromising maternal and neonatal outcome while improving maternal satisfaction by enabling ambulation and reducing motor paresis thus providing a wholesome, satisfying experience to the obstetrician, anaesthesiologist and paediatrician. Keywords: Labour analgesia, Bupivacaine, Parturients, Epidural anaesthesia.

Background: Thrombocytopenia is a common haematologic abnormality in pregnancy, with moderate-to-severe cases potentially leading to adverse maternal and foetal outcomes. This study aimed to evaluate the maternal and foetal outcomes in pregnant women with mild-to-severe thrombocytopenia. Materials and Methods: This prospective observational study included 100 pregnant women at the Institute of Obstetrics and Gynaecology, Madras Medical College, over a year. Women in their third trimester with mild-to-severe thrombocytopenia (platelet count <100 × 109/L) were included. Clinical data, including maternal age, parity, gestational age, diagnosis, mode of delivery, and complications, were recorded. Foetal outcomes, such as birth weight, APGAR scores, neonatal complications, and platelet counts, were also analysed. Results: The most common cause of thrombocytopenia was severe preeclampsia (48%), followed by gestational thrombocytopenia (31%) and immune-mediated thrombocytopenia (7%). Most patients (92%) had moderate thrombocytopenia, whereas 8% had severe thrombocytopenia. Most deliveries were vaginal (59%), followed by emergency caesarean sections (37%). Postpartum haemorrhage (17%) and acute kidney injury (7%) were the most frequent maternal complications. Neonatal complications included transient tachypnoea of the newborn (23%) and perinatal asphyxia (11%). The overall live birth rate was 97%, with two stillbirths and one intrauterine foetal death. Conclusion: Moderate to severe thrombocytopenia during pregnancy, particularly in association with hypertensive disorders, is linked to increased maternal morbidity and adverse foetal outcomes. Early recognition and appropriate management can improve the prognosis. Notably, gestational thrombocytopenia had no significant adverse effects, and platelet counts normalised postpartum. Keywords: Thrombocytopenia in pregnancy, severe preeclampsia, maternal outcomes, foetal outcomes, platelet count.

Background: Airway management in patients with restricted mouth opening in emergency and elective surgeries becomes a major concern for anaesthesiologist. Although fiberoptic intubation is the generally accepted method for managing difficult airway, it may not be available in all the hospitals, requires patient cooperation and appropriate training. So awake blind nasal intubation can be useful in management of difficult airway. The aim of this study was to evaluate the usefulness of blind nasal awake intubation as an alternative technique when fiberoptic equipment is unavailable and insertion of ILMA not possible in patients of restricted mouth opening. Materials and Methods: This prospective observational study was carried out in 150 adult patients of either sex aged between 30 and 65 years with restricted mouth opening posted for elective surgery. Awake blind nasal intubation was carried out in a conscious sedated patient with proper airway preparation. The monitoring of breath sound becomes the key for successful intubation. We carried out awake intubation with the help of cuff inflation technique (the cuff of ETT is inflated in the oropharynx to help guide the tip of the tube into the trachea) along with monitoring by capnography and breath sounds. We have recorded manipulation in position of head and neck, number of attempts, failure of intubation and complications. Results: Out of 150 patients, 81(57.4%) patients were intubated in sniffing position, 32(22.6%) patients required increased neck flexion and 28(19.8%) required increased neck extension. 9 patients had failed intubation.47 patients(31.3%) were intubated in 1st attempt,43 patients (28.6%) were intubated in 2nd attempt and 51 patients (34 %) were intubated with 3 attempts. Conclusion: Awake blind nasal intubation is an alternative technique when there is non- availability of fibre optic or ILMA in patients of restricted mouth opening. Key words: Difficult airway, Restricted mouth opening, Blind nasal awake intubation.

Background: Medical Termination of Pregnancy (MTP) is a critical component of reproductive healthcare legally permitted under specific conditions. Understanding the trends and justifications for MTP is essential for optimizing clinical practice and ensuring legal compliance. This study aimed to evaluate the indications and socio-demographic factors associated with MTP over a three-year period at a tertiary care teaching hospital in India. Materials and Methods: A retrospective analysis was conducted on 355 women who underwent MTP between January 2022 to December 2024. Data was collected from hospital records using a structured proforma. Variables included age, parity, area of residence, gestational age, method of MTP, indication for MTP, presence of fetal congenital anomalies, and post-MTP contraception advised. Only cases with complete records and procedures conducted within the legal framework were included. Descriptive statistics were used for analysis. Results: Maximum women were belonging to age group of 26–30 years (37.18%), and the majority were rural residents (58.59%). Most women (88.45%) were married, and 42.54% had ≤2 children. MTPs were predominantly performed within 12 weeks of gestation (48.73%). The leading indication was contraceptive failure in married women (60.56%) followed by presence of fetal anomalies (23.66%) and pregnancies resulting from sexual assault (rape) (11.27%). Among anomaly-related terminations, syndromic disorders (3.94%), cystic hygroma (3.10%), and neural tube defects (2.82%) were most common. Post-MTP contraception predominantly included tubal ligation (44.51%) and barrier methods (40%). Conclusion: Contraceptive failure remains the dominant indication for MTP underscoring the urgent need for robust contraceptive counselling and access, especially in rural areas. Keywords: Medical Termination of Pregnancy, Tubal Ligation, Contraceptive Failure, Maternal health.

Background: Worldwide, acute appendicitis ranks high among the most common reasons for urgent abdominal surgery. To avoid complications like perforation and peritonitis, an early and precise diagnosis is crucial. Because it does not involve any radiation, is inexpensive, and does not require any incisions, ultrasonography (USG) has found extensive application. Nevertheless, there is still some debate regarding the veracity of specific ultrasonographic results. Acute appendicitis is the intended diagnosis, and this study intends to assess the diagnostic utility of particular USG markers in that regard. Materials and Methods: One hundred fifty patients admitted to a tertiary care hospital with symptoms of acute appendicitis were followed prospectively for a year. This study was conducted at the department of Pathology, Government Medical College Mancherial, Telangana, India from the May 2024 to December 2024. Ultrasound was used to evaluate all patients, checking for important signs including appendiceal diameter, wall thickening, peri-appendiceal fluid, hyperaemia, and appendicolith. Intraoperative and histological findings were compared with the ultrasonographic findings. Results: After reviewing the surgical and histological results, 110 out of 150 individuals were determined to have acute appendicitis. Hyperaemia on Doppler imaging (sensitivity: 88.2%, specificity: 82.5%), peri-appendiceal fluid (sensitivity: 72.3%, specificity: 89.1%), and an appendiceal diameter >6 mm (sensitivity: 85.4%, specificity: 78.9%) were the most dependable ultrasonographic markers. A specificity of 92.3% and a lesser sensitivity of 45.5% were observed in 30 cases when appendicolith was present. A diagnosis accuracy of 93.5% was achieved through the integration of various ultrasonographic results. Conclusion: When diagnosing acute appendicitis, ultrasonography is still quite useful. Hyperaemia and appendiceal diameter > 6 mm were highly sensitive results, while appendicolith and peri-appendiceal fluid were highly specific. Misdiagnosis is less likely when numerous ultrasonographic markers are combined. If we want to see better clinical results and more accurate diagnostic techniques, we need more large-scale investigations. Keywords: Acute appendicitis, Ultrasonography, Appendicolith, Sensitivity, Specificity.

Background: Psychological stress (PS) leads to different physiological responses including increased heart rate (HR) as well as decreased heart rate variability (HRV) through alterations in the autonomic nervous system (ANS), specifically increased sympathetic nervous system (SNS) activity and decreased parasympathetic (PNS) activity. Emerging evidence indicates that PS advances to certain alteration in the kidneys, which leads to increase in protein excretion and expression of high and low molecular weight proteins in the urine. Currently investigated biochemical markers for confirmation of stress include invasive, cumbersome and costly markers. This issue arises a need to introduce non-invasive and affordable stress markers which can be used globally. Materials and Methods: A total of 120 cases and 106 controls (who were without any obvious stress) belonging to age group of 20 to 60 years were selected. Patients were evaluated for clinical history and assessed by the psychiatric stress scale, perceived stress scale (PSS) and presumptive social life event scale (PSLE). HRV was measured by ECG using lead II configurations using both time domain and frequency domain methods. Urinary protein was analysed by Vitros 5.1 FS from Ortho Clinical diagnostics by Johnson and Johnson USA. Results: PSS was most strongly correlated with Power (ms2) LF/HF followed by Power (nu) HF and Power (nu) LF with a correlation coefficient of 0.805, -0.695 and 0.592 respectively. PSLE had a significant relation with Protein: Creatinine ratio. Conclusion: In short term HRV, frequency domain parameters had significant correlation with perceived stress and proteinuria had significant correlation with PSLE. Keywords: Stress, PSS, PSLE, HRV, Proteinuria.

Background: Vertebral compression fractures (VCFs) are common in aging populations and can result from osteoporosis, trauma, malignancy, or infection. Differentiating between benign and malignant causes is critical for appropriate treatment. MRI is a key diagnostic tool, but its sensitivity and specificity in identifying the etiology of VCFs require further evaluation. This study aims to assess the diagnostic accuracy of MRI in distinguishing different causes of vertebral compression fractures. Materials and Methods: This prospective study was conducted at Apollo Hospital, Hyderabad, including 49 patients with vertebral collapse who underwent MRI. Patients were categorized based on the etiology of VCFs: osteoporotic, traumatic, malignant, or infectious. Various MRI features such as pedicle involvement, posterior element destruction, epidural mass, and paraspinal soft tissue involvement were analyzed for their sensitivity and specificity in diagnosing VCF causes. Histopathology and clinical follow-up were used as reference standards. Results: Among 49 patients, 53% were male and 47% female, with the majority (67%) having dorsal vertebral involvement. Osteoporotic fractures accounted for 35%, malignant 27%, traumatic 20%, and infectious 18%. MRI features such as pedicle involvement (92% sensitivity, 91% specificity), convex posterior border (53% sensitivity, 94% specificity), and epidural mass had high specificity for malignancy. Contiguous vertebral involvement and endplate disruption were more indicative of benign fractures. A combination of MRI features significantly improved diagnostic accuracy. Conclusion: MRI is a highly specific tool for differentiating malignant from benign VCFs, particularly when multiple significant features are present. Pedicle involvement and convex posterior border are among the most reliable indicators of malignancy. Early and accurate MRI-based diagnosis is essential for guiding appropriate clinical management. Keywords: Vertebral compression fracture, MRI, malignancy, osteoporosis, pedicle involvement, diagnostic accuracy, spinal imaging.

Background: Transitional cell carcinoma of the bladder is a common malignancy of the urinary tract, with lymph node involvement being a key determinant of prognosis and treatment strategies. While lymph node metastasis is generally associated with invasive bladder cancer, its presence in non-invasive transitional cell carcinoma remains uncertain. This study aims to evaluate the incidence, risk factors, and prognostic implications of pelvic lymph node involvement in patients with non-invasive transitional cell carcinoma of the bladder. Materials and Methods: A retrospective analysis was conducted on 50 patients diagnosed with non-invasive transitional cell carcinoma of the bladder. Data on clinical presentation, tumor grade, pathological staging, lymph node dissection status, and recurrence rates were collected. Patients were categorized based on lymph node involvement and assessed for correlations with tumor characteristics and disease progression. Statistical analyses were performed to identify predictors of lymph node metastasis in this cohort. Results: Among the 50 analyzed cases, lymph node metastasis was identified in a subset of patients with non-invasive transitional cell carcinoma. The presence of lymph node involvement correlated with higher tumor grade, multifocality, and carcinoma in situ. Additionally, patients with lymph node-positive disease exhibited a significantly higher recurrence rate and reduced disease-free survival compared to those without lymph node involvement. Conclusion: Although rare, lymph node involvement can occur in patients with non-invasive transitional cell carcinoma of the bladder and is associated with a more aggressive disease course. Careful risk stratification is essential to identify patients who may benefit from more extensive staging and early intervention. Further prospective studies are required to refine treatment guidelines and improve outcomes in this subset of bladder cancer patients. Keywords: Transitional Cell Carcinoma, Bladder Cancer, Non-Invasive Bladder Cancer, Lymph Node Metastasis, Pelvic Lymph Node Dissection, Carcinoma in Situ, Bladder Tumor Staging, Disease Recurrence.

Background: Aim: The study aims to evaluate the role of ultrasonography in assessing first-trimester vaginal bleeding, identifying potential risk factors, and correlating ultrasound findings with clinical and laboratory parameters to predict pregnancy outcomes. Materials and Methods: This prospective observational study was conducted on 120 pregnant women aged 18–40 years presenting with first-trimester vaginal bleeding at a tertiary care hospital. Inclusion criteria included gestational age between 5–13 weeks confirmed by the last menstrual period (LMP) and/or ultrasound. Patients with ectopic or molar pregnancies, uterine anomalies, or hemodynamic instability were excluded. All participants underwent transabdominal and/or transvaginal ultrasound evaluation for gestational sac, fetal pole, cardiac activity, subchorionic hematoma, cervical length, and adnexal structures. Laboratory investigations included serum β-hCG levels, hemoglobin levels, Rh typing, and inflammatory markers. Statistical analysis was performed using SPSS 25.0, with significance set at p < 0.05. Results: The majority of participants were in their late twenties, with a mean gestational age of approximately 9 weeks. Ultrasonographic assessment confirmed the presence of a gestational sac in most cases, with fetal cardiac activity detected in over 70% of cases. Subchorionic hematoma and cervical length abnormalities were notable findings. Patients were categorized into viable intrauterine pregnancies, threatened abortion, inevitable abortion, incomplete abortion, missed abortion, complete abortion, and molar pregnancy. Laboratory findings revealed elevated β-hCG in most cases, with a significant proportion exhibiting anemia and inflammatory markers. While over half of the pregnancies continued successfully, a substantial number resulted in miscarriage, necessitating surgical intervention in some cases. Conclusion: Ultrasonography is a crucial tool in the evaluation of first-trimester bleeding, allowing for early detection of pregnancy complications. Laboratory investigations complement ultrasound findings in predicting pregnancy outcomes. Early identification of high-risk pregnancies enables timely medical intervention, improving maternal and fetal outcomes. A multidisciplinary approach involving obstetricians, radiologists, and laboratory specialists is recommended for optimal patient management. Keywords: Ultrasonography, First-trimester bleeding, Pregnancy outcomes, Subchorionic hematoma, Foetal viability.

Background: Intramedullary interlocking is currently considered the treatment of choice for femoral shaft fractures, with high rates of fracture union, advantage of early stabilization which decreases the morbidity and mortality rate in patients, allows early mobilization, reduces the incidence of infection, malunoin, non union or implant failure. Objectives of the study: To assess the time taken for bone union and the functional outcome in patients with fracture shaft of femur. Materials and Methods: We studied a total of 30 patients of fracture shaft of femur admitted in the Orthopaedic Department of Kakatiya Medical College, Warangal treated with closed intramedullary interlocking nailing. 23 patients were male and 7 were females and age group ranged from 18-49 years with mean age 30 Yrs. right side fractures encountered in 18 cases and 12 left side. 24 fractures were closed and 6 fractures were open type. 5 fractures were in proximal third, 19 fractures were in the middle third and 6 in distal third of femur. Duration of study 1 year{From September 2023 to August 2024}. Results: Duration between injury and surgery was <24 Hours in 6.67%, 24-72 hours in 50% and 4-7 Days in 43.3%.Duration of hospital stay was average 11.43 days ranging from 06-22days. Mean time for union was 21.3 weeks ranging from 16-32weeks.There were two cases of superficial infection and no deep infection. Excellent to Good result in 90% cases. Conclusion: We conclude that closed intramedullary interlocking nailing after is an excellent technique for the treatment of femoral shaft fracture. It is an excellent mode for treatment of complex, comminuted and unstable femoral fracture. It reduces the incidence of malunoin and maintains length of the bone. Minimal soft tissue injury during surgery, early rehabilitation ensures complete restoration of motion. It is a safe method in management of Type I& II compound fractures Key-words: Fracture; shaft; femur; closed; interlocking; intramedullary; nail; diaphyseal.

Background: To study the functional and radiological outcome of Acetabular fractures treated by open reduction and internal fixation. Materials and Methods: It was a prospective study, in our study we have selected cases of unstable acetabular fractures. The study was done from November 2023 to December 2024.The age group differs from 18 – 70 years, among them16 males and 4 females.Among 20 patients right side involvement is seen in 13patientsand left side involvement is seen in 7 patients.Mean follow up was done for 12 months. All the classification have been classified by Letournel and Judet classification. All the cases were followed up and were evaluated for radiological and functional outcome .X-ray pelvis isused for assessing the radiological outcome, AP view, Obturator Oblique view and Iliac oblique views were used for assessment. For evaluating the functional outcome Merle D’Aubigne and Postel modified clinical grading system is used. Results: In the present study, According to Matta’s criteria, 8 patients had anatomical reduction, 8 patients had satisfactory reduction and 4 patients had poor reduction (>3mm gap). Out of 20 patients, 6 patients had excellent, 3 patients very good, 6 patients good, 3 patients fair, 2 patients had poor results. 70% of the patients are having near normal life and 10% patients are having satisfactory result in our study Functional outcome score for the patients ranged from11 –18, (maximum score –18).The poor result (score – 8,9) in 2 patients was due to post traumatic arthritis, improper post op mobilisation due to poly trauma. All patients with anterior column fracture, posterior wall had excellent or good result 00 ‘except one patient who had fair result due to Heterotopic ossification. Three patients with fair outcome had minor wound infections treated with antibiotics and it healed. Conclusion: From our study we conclude that complex acetabular fractures treated by open reduction and internal fixation have satisfactory functional outcome. Keywords: Acetabular fractures, Matta’s Criteria, Anatomical Reduction, Heterotopic Ossification, Poly trauma.

Background: Low back pain (LBP) is a major health and socioeconomic problem in modern society. It constituted about 37% of occupational risk factor and occupies first rank among the disease complications caused by work. Aim: To study the effectiveness of epidural steroid injection in alleviating symptoms caused by prolapsed intervertebral disc. Materials and Methods: It was a prospective study, Patients with low backache visiting Mahatma Gandhi Memorial Hospital, Warangal, from October 2023 to September 2024. Results: Out of 60 cases, 30 were given Epidural steroid and 30 were given Normal saline among them36 were interlaminar, 13 were transforaminal and 11 w ere caudal approach. In our study the mean age of the patients was 47.7. In our study out of 60 patients 40 were females and 20 were males. Significant results were seen when patients were followed at 2nd,3rd and 4th month when observed with VAS and ODI scores. Epidural steroid injection has also shown significant improvement compared to saline on SLRT.In case of SF36 bodily pain, general health and role of emotional showed a significant outcome at 6 months, however by 1 ½ years not much difference was seen. Interlaminar approach is found as the best approach for ESI (Interlaminar>Transforamina l > Caudal). The only one patient that shifted from epidural to discectomydidso due to worsening deficits and pain. Conclusion: The present study concluded that ESI is a viable modality for selected patients, the evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids, involving minimal risk. Keywords: Epidural Injection, VAS, Low back pain, SLRT, ODI.

Background: To study the effects of intravenous fluids given intraoperatively on graft function postoperatively. Materials and Methods: In this double blind study, patients were randomized into two groups (n1=35,n2=39) to receive either combination of normal saline & half normal saline or combination of normal saline & ringer lactate during renal transplantation. Arterial blood gas analyses were performed before induction of anesthesia, during vascular anastomosis, one hour after bladder clamp release and after extubation. Blood urea and serum creatinine were measured on first postoperative day and on second postoperative day. Urine output was recorded on first & second postoperative days. Results: There was a statistically significant increase in the highest serum potassium level, highest chloride level and increase in the serum chloride measured at the end of study in patients who received combination of NS & half NS. Statistically significant increase in blood urea & serum creatinine was seen in immediate postoperative period in patients who received combination of NS & Half NS. Conclusion: Serum creatinine was higher in group 1 than in group 2 preoperatively & immediate postoperatively. However the decrease in serum creatinine from baseline level to immediate postoperative level and that measured on first & second postoperative day were similar in both the groups. Keywords: Intravenous fluids, Renal transplantation, Acid-base balance, postoperatively.

Background: Neonatal sepsis is a significant cause of morbidity and mortality, particularly in developing regions such as Bundelkhand, Central India. The emergence of multidrug-resistant organisms has complicated the management of sepsis, making the identification of prevalent bacterial pathogens and their antimicrobial sensitivity patterns crucial. This study aims to analyze the clinico-bacteriological profile of neonatal sepsis and assess the antimicrobial sensitivity patterns of the isolated pathogens in a tertiary care center in Bundelkhand. Materials and Methods: An observational cross-sectional study was conducted, including 300 neonates with suspected sepsis admitted to the Neonatal Intensive Care Unit (NICU). Blood cultures were obtained, and the antimicrobial sensitivity patterns of the isolated pathogens were determined using standard laboratory methods. The neonates were categorized based on the onset of sepsis as early-onset (EOS) or late-onset (LOS). Results: Out of 300 neonates with clinical sepsis, 52% were culture-positive. Among the culture-positive cases, 75.6% were classified as EOS and 24.4% as LOS. The most commonly isolated pathogens were Gram-negative bacteria, including Klebsiella pneumoniae and Acinetobacter spp. The study also identified significant resistance patterns, particularly against commonly used antibiotics such as ampicillin and cephalosporins. Vancomycin and carbapenems showed higher sensitivity among Gram-positive and Gram-negative isolates, respectively. Conclusion: The high prevalence of multidrug-resistant organisms in neonatal sepsis underscores the need for continuous surveillance and tailored antimicrobial therapy in this region. The findings highlight the importance of region-specific studies to inform empirical treatment protocols and reduce neonatal mortality. Keywords: Neonatal sepsis, Antimicrobial sensitivity, Bundelkhand Central India, Gram- negative bacteria, Multidrug -resistant organism.

Background: The aim is to evaluate the impairment of oral sensations in patients treated with Three-Dimensional Conformal Radiotherapy (3DCRT) and Intensity Modulated Radiation therapy (IMRT) in head and neck cancer. Materials and Methods: This Longitudinal Observational study will be conducted in patients receiving IMRT and 3D-CRT from July 2022 to Dec 2023 in Department of Radiation Oncology at Gandhi Medical College (GMC), Bhopal (M.P) and Jawaharlal Nehru Cancer Hospital & Research Centre (JNCH & RC) Bhopal (M.P) from July 2022 to Dec 2023. Results: Both 3DCRT and IMRT are effective in managing head and neck cancers, IMRT offers superior outcomes in reducing dysphagia during and shortly after treatment. Both modalities ultimately achieve high rates of complete recovery, underscoring the effectiveness of modern radiotherapy approaches in managing treatment-related side effects. Conclusion: Our findings reveal that both treatment modalities have distinct impacts on dysesthesia and dysphagia, reflecting their differing mechanisms and target precision. The results indicates that, while pretreatment dysesthesia and dysphagia grades were similar between the two groups, significant differences emerged post-treatment. Keywords: Dysesthesia, Radiotherapy, Intensity Modulated Radiation therapy, Three-Dimensional Conformal Radiotherapy.

Background: The aim is to compare between intensity modulated radiation therapy with or without simultaneous integrated boost in locally advanced oral cavity carcinomas in patients admitted/visited to hospital. Materials and Methods: The present study entitled was conducted in Department of Radiation oncology, Gandhi Medical College and associated Hamidia Hospital (GMC & HH), Bhopal (M.P) and Jawaharlal Nehru Cancer Hospital (JNCH), Bhopal (M.P), on a total of 54 patients of advanced oral cavity carcinomas. Results: After means follow up with patients’ comparison between intensity modulated radiation therapy with or without simultaneous integrate boost was done and noted details in tables. Conclusion: The study concluded that there were no statistically significant differences in demographic distributions, clinical characteristics, acute and long-term toxicities, and post-treatment responses between the two groups treated with and without Simultaneous Integrated Boost (SIB) in locally advanced oral cavity carcinomas. Both treatment modalities demonstrated similar efficacy and safety profiles. Keywords: Clinical outcomes, head and neck cancer, intensity-modulated radiotherapy, sequential, simultaneous integrated boost.

Background: Prostate cancer is a leading cause of cancer-related mortality among men, with diagnostic limitations in current methods like PSA assays, DRE, and TRUS biopsies. This study aimed to evaluate the correlation between various biomarkers, including Ki-67/MIB-1 and ERβ, and the recurrence of prostate cancer. Materials and Methods: This prospective observational study included 110 patients diagnosed with prostate cancer at a tertiary care hospital in New Delhi. Patients were monitored over 12 months, with data collected on PSA indices, Ki-67/MIB-1, ERβ expression, and MRI PI-RADS scores. Statistical analyses were conducted to assess the significance of these parameters in predicting disease recurrence. Results: Higher Ki-67/MIB-1 expression and increased PSA velocity were significantly associated with recurrence. Although the correlation between PI-RADS scores and recurrence was not statistically significant, 60% of recurrent cases had a PI-RADS score of ≥4. ERβ expression was notably higher in patients with recurrence, indicating its potential as a prognostic marker. Conclusion: The study concludes that combining PSA indices, immunohistochemical markers (Ki-67/MIB-1, ERβ), and advanced imaging techniques (MRI PI-RADS) offers a more robust approach to predicting prostate cancer outcomes. Regular follow-up with tailored diagnostic strategies is essential for early detection and timely intervention, particularly in patients with high-risk markers. Keywords: Prostate cancer, PIRADS, Ki-67, MIB-1.

Background: Acute kidney injury (AKI) is a leading cause of morbidity and mortality globally, particularly in resource-limited settings. The etiology and severity of AKI vary based on multiple factors, including infections, dehydration, drug use, and environmental exposures. This study aimed to investigate the etiology, clinical manifestations, and predictors of severity in community-acquired AKI. Materials and Methods: This retrospective observational study was conducted at a tertiary care center. A total of 246 patients diagnosed with AKI were included retrospectively for a period of 5 years. Data were collected on demographic characteristics, clinical presentation, laboratory parameters, and etiology. AKI severity was classified as stage 1, 2, or 3 based on serum creatinine levels and clinical condition. Multivariate logistic regression was used to identify predictors of stage 3 AKI. Results: The most common etiologies of AKI were infectious causes (46.7%), dehydration-related (22.4%), and drug-induced (18.3%). Infectious causes were more prevalent in stage 3 AKI cases (54.3%), while dehydration-related AKI was more frequent in stage 1 cases (35.6%). The mean serum creatinine was significantly higher in stage 3 cases compared to stage 1 and stage 2 cases (3.4 ± 1.5 mg/dL). Factors associated with increased risk of stage 3 AKI included elevated serum creatinine >4 mg/dL (OR 4.2, 95% CI 2.1–8.6), blood urea nitrogen >60 mg/dL (OR 3.7, 95% CI 1.8–7.2), hypotension (OR 2.8, 95% CI 1.5–5.2), oliguria (OR 5.6, 95% CI 3.1–10.2), and advanced age (>60 years) (OR 1.6, 95% CI 1.0–2.9). Conclusion: Infectious causes, dehydration, and hypotension were the most common etiologies and significant predictors of stage 3 AKI. Early identification of at-risk patients, especially those with elevated creatinine, oliguria, and hypotension, can help improve clinical outcomes. Further studies are needed to validate these findings and identify additional biomarkers for AKI progression. Keywords: Acute kidney injury, serum creatinine, oliguria, hypotension, community-acquired AKI.

Background: Aims and objectives: the study was conducted to compare fistulectomy v/s fistulotomy in the management of low anal fistulae. Materials and Methods: The study is conducted among indoor patients of general surgery department in a tertiary care hospital of South Gujarat. 60 patients are included in the study which are divided randomly into 2 groups: Group A – Patients undergoing Fistulectomy Group B – Patients undergoing Fistulotomy. Results: The mean operating time for fistulotomy is 42.83 minutes with SD of 8.38 while the mean operating time for fistulectomy is 50.17 minutes with SD of 7.71. Mean duration for wound discharge for fistulotomy comes to be 20.47 days with SD of 5.22; while the mean duration of wound discharge for fistulectomy comes to be 33.53 days with a SD of 5.58. This time was noted for each operated case and the mean wound healing duration for fistulotomy was 35.97 days with SD of 7.32 while the mean duration for fistulotomy was 47.07 days with SD of 7.72. Mean hospital stay for fistulotomy was 2.37 days while mean hospital stay for fistulectomy was 3.03 days. Conclusion: From our study we can conclude that perianal fistula has a male predominance in incidence and more in young adults. Inter-sphincteric fistulae are more common than trans- sphincteric fistulae in patients suffering from low perianal fistulae. Keywords: Fistulotomy, Fistulectomy, Fistula-in-ano, Pain.

Background: Blood transfusion continues to be an important source of pathogens in transfused patients. An unsafe blood transfusion is extremely costly, both in terms of human lives and economic impact. Transfusion-transmitted infections (TTIs) pose a significant risk associated with blood transfusions. Accurate risk assessments of TTIs are crucial for ensuring the safety of the blood supply. The objective of this study is to assess the seroprevalence of transfusion-transmitted infections (TTIs) among healthy blood donors in North India population. Materials and Methods: A retrospective observational study was conducted in the department of Transfusion Medicine of a tertiary care hospital of North India. The study period spanned from January 2018 to December 2023, during which data from all blood donors was reviewed and analyzed for the prevalence of TTIs. Results: The present study included 44,016 donors for seroprevalence of TTIs. Overall, 1675 donors (3.8%) had a reactive result for one or more TTIs. Conclusion: Raising public awareness about voluntary blood donation, along with thorough donor screening, counseling, and the use of highly sensitive tests, can help reduce the risk of TTIs. Keywords: Blood Transfusion, Blood Donors, Donor Screening, Seroprevalence, Transfusion-Transmitted Infections.

Background: ENT disorders can manifest with varied ocular symptoms due to involvement of orbit and its content. Early diagnosis and treatment help in reducing the mortality associated with it. The aim of this study is to evaluate the causes of various ophthalmological presentations in relation to primary ENT diseases at a tertiary referral centre. Materials and Methods: The present prospective study was carried out in Department of otorhinolaryngology of Government Medical College, Pali, Rajasthan, India during one-year period and comprised of 30 cases. Data regarding age, gender, clinical profile, etiology and management were collected and statistical analysis was done. Results: The greatest number of patients were in the age group 51 to 60 years (7; 23.33%) followed by 41 to 50 years (20%). There were 14 (46.66%) males and 16 (53.33%) females. Most common ophthalmological symptom among the study population was periorbital oedema (50%) followed by epiphora (46.66%). The most common aetiology was infective or granulomatous (10, 33.33%), traumatic (8, 26.66%) and neoplastic (8, 26.66%). Conclusion: Rapid diagnosis and treatment is necessary for preserving vision and life in these patients. Teamwork between ophthalmologist and the otolaryngologist is required for the appropriate management of such lesions. Keywords: Ophthalmologic Presentations, ENT Diseases, Proptosis, Periorbital Oedema.

Background: Chronic suppurative lung disease (CSLD) is the end result of chronic airway inflammation that is driven by persistent infection. The aim of this study to evaluate the prevalence and associated risk factors with isolation of multidrug resistant pathogens in chronic suppurative lung disease. Materials and Methods: The present prospective study was conducted in fifty-two chronic suppurative lung disease patients between the age of 18-90 years at Respiratory Medicine Department of TB & Chest Hospital, Badi in R.N.T. Medical College, Udaipur during one-year period, after getting approval from institutional ethical committee. Results: Suppurative lung diseases were more frequent in male patients. Male female ratio is 2.06. More than three fourth patients of suppurative lung disease belong to rural area. In both type of suppurative lung disease, pseudomonas was the most common organism isolated from the biological samples. Second common organism isolated was klebsiella in patients of bronchiectasis and lung abscess. Risk factors for MDR pathogen were multifactorial for both pseudomonas and klebsiella. Conclusion: While dealing with suppurative lung disease antibiotic should be judicious and adequately used and underlying lung and systemic disease should be appropriately managed. Keywords: Chronic suppurative lung disease (CSLD), Pseudomonas, Bronchiectasis, Lung abscess, Klebsiella, MIC.

Background: Urothelial carcinoma comprises 90% of bladder tumor. The p53 gene is a tumor suppressor gene located on chromosome 17p; important for genome stability, response to genotoxic stimuli, and activation of apoptosis. Nuclear antigen Ki-67 coded by gene on chromosome 10 is absent in resting cells (G0 phase) and hence exclusively positive in the nuclei of proliferating cells. Materials and Methods: This was a prospective study. All cases presenting with hematuria were subjected to ultrasonography and cystoscopy then TURBT chips or cystectomy was performed in patients showing growth by cystoscopy. In the IHC the homogenous nuclear positivity was seen as dark brown colour. The percentage of immunopositivity was calculated by counting atleast 1000 tumor cells in areas of maximum positivity. The cells having nuclear positivity are calculated in the ratio of total number of cells. The results were interpreted taking the cutoff value as 20% and divided into three categories as immune negative, 20% as high expression for both immunomarkers positivity. Data was analysed using chi square statistical methods. P value less than 0.05 was considered as significant. Results: P53 positivity with more than 20% expression was found in high grade urinary bladder carcinomas and cases with pT2 stage. Some Low grade urothelial carcinomas with lamina propria invasion (pT1) also showed high p53 expression. There were high grade tumors also showing low expression of p53. So, prognosis was good in those cases. Ki67 expression was increased with increased grading and staging of bladder carcinomas. In Squamous cell carcinoma p53 showed low expression and ki67 showed high expression. Adenocarcinoma of the bladder showed high p53 and ki67 expression. Other high grade non papillary urothelial carcinomas also showed high p53 and ki67 expression. Conclusion: Urothelial carcinoma is the seventh most common cancer in the world. Many factors have been known as risk factors of this condition. Spectrum of p53 and Ki67 are useful as potential prognostic markers in bladder cancers. Key words: p53, Ki67, Urinary bladder carcinoma.

commonest cause of death from cancer in women worldwide. Breast cancer is one of the most frequent cancers among women in developing country. The combined study of p53 expression and Ki-67 in breast carcinoma is very helpful in assessing the prognosis & patient outcome. Materials and Methods: 50 cases of breast carcinoma was carried out in the department of pathology. The haematoxylin and eosin(H&E) stained sections of the cases were made and diagnosed and selection of representative tumour paraffin blocks was done on which IHC was performed. Immunohistochemical staining is conducted and the proportion of the malignant cells staining positive for the nuclear antigen Ki-67 is evaluated in a quantitative and visual way using light microscopes. Evaluation of p53 immunostaining was also done. Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean±SD (min-max) and results on categorial measurement are presented in number (%). Results: Majority 23 cases (45.9%) showed moderate proliferative activity, followed by 16 cases (31.9%) showing low proliferative activity. 11 cases (22.2%) showed high proliferative activity. The majority of 44 cases (88.9%) were positive for p53 expression of which maximum 18 cases (36.1%) showed>50% of p53 expression. 19 cases (38.9%) had 20-50% of p53 expression. In our study 41.6% of Grade 1 tumors showed moderate p53 expression. Maximum no of Grade II tumors showed moderate to high p53 expression. 40% of Grade III tumors showed high p53 expression. In our study IDC (NOS) showed maximum moderate to high p53 expression. In our study the maximum number of cases (23) belong to Grade 2 showing moderate Ki-67 expression, and >49% of p53 expression. Conclusion: In breast cancer, we suggested that the over expression of Ki67 & p53 protein in the nucleus is an indicator of poor prognosis. Key words: Breast Cancer, p53, Ki67.

Aim: Regional anaesthesia offers significant advantages over general anaesthesia for lower abdominal and lower limb surgeries, with intrathecal and epidural techniques being the most commonly used. The aim of this study is to evaluate complications and hemodynamic stability of dexmedetomidine with bupivacaine vs fentanyl with bupivacaine used for intrathecal anaesthesia in patients undergoing orthopaedic lower limb surgeries. Materials and Methods: The study cohort was categorised into two groups, each consisting of 20 participants. Group 1 received an injection of 2.5 mL of hyperbaric bupivacaine combined with 25 µg of fentanyl in 0.5 mL, while Group 2 was administered 2.5 mL of hyperbaric bupivacaine along with 5 µg of dexmedetomidine in 0.5 mL. A comprehensive pre-anaesthetic assessment, which included a general and systemic examination, was conducted the evening prior to the surgical procedure. Standardised investigations were performed on all subjects. Following the acquisition of informed written consent for both the study and the surgical intervention, each patient was prescribed 0.5 mg of alprazolam and 150 mg of ranitidine to be taken orally the night before surgery. Additionally, patients were instructed to refrain from oral intake from midnight on the day preceding the surgery. The intraoperative hemodynamic profiles of the two study groups were subsequently compared. All the statistical calculations were done through SPSS software. Results: Mean age of the patients of group 1 and group 2 was 45.3 years and 42.9 years. Alterations in hemodynamic variables in group 1 occurred gradually, ultimately reaching a stable state that persisted throughout the duration of the surgical procedure. In contrast, group 2 exhibited more pronounced changes and declines in hemodynamic variables, which were found to be statistically significant. Complications were seen in 15 percent of the patients of group 1 and in 45 percent of the patients of group 2. Conclusion: The addition of dexmedetomidine to intrathecal bupivacaine resulted in a more rapid onset and extended duration of the block when compared to intrathecal fentanyl. Both medications did not exhibit significant adverse effects, with the exception of transient abruptly decline in hemodynamic response with dexmedetomidine. The dexmedetomidine group demonstrated a more favourable profile regarding postoperative complications. Keywords: Bupivacaine, Fentanyl, Dexmedetomidine.

Background: Cataract represent the primary cause of preventable blindness globally. Cataract surgery is primarily indicated when there is a significant decline in visual acuity and/or an increased sensitivity to light. Hence; the present study was conducted to evaluate complications and postoperative visual outcomes of cataract surgeries. Materials and Methods: A total of 50 patients undergoing cataract surgery were enrolled. Complete demographic and clinical details of all the patients were obtained. A comprehensive pre-operative assessment of the eye, including an evaluation of visual acuity, was conducted. All patients subsequently underwent cataract surgery. Post-operative evaluations were conducted using a slit-lamp biomicroscope on the first day following surgery and again within the first week, focusing on the cornea, surgical wound, anterior chamber, and the implanted lens. During follow-up visits, the eyes were examined for any post-operative complications, and visual acuity was measured using Snellen’s chart and pinhole testing to establish best corrected visual acuity (BCVA). All the results were evaluated using SPSS software. univariate analysis was done for evaluation of the level of significance. Results: A total of 50 patients were evaluated. The mean age of the patients was 46.2 years. Among them, 66 percent were males while the remaining were females. Complications were seen in 18 patients (36 percent). Among them, Striate keratopathy, Corneal edema, Anterior uveitis, Macular edema and Acute onset endophthalmitis was seen in 10 percent, 6 percent, 6 percent, 12 percent and 2 percent of the patients. Good outcome was seen in 90 percent of the patients while borderline outcome and poor outcome was seen in 4 percent and 6 percent of the patients. Conclusion: The findings indicated a significant prevalence of striate keratopathy and corneal edema, likely attributable to the initial incision made in the corneoscleral region. Notably, ninety percent of the cases that underwent surgery exhibited favorable outcomes. Keywords: Visual Outcome, Cataract surgery.

Background: Blood components play a crucial role in the treatment of various clinical conditions and help mitigate complications associated with whole blood transfusions. Assessing the utilization patterns of blood components, monitoring demand, and implementing effective audit procedures are essential steps in ensuring the optimal utilization of this invaluable resources. The purpose of this study is to evaluate the utilization of various blood components, packed red cell volume, fresh frozen plasma, and platelet concentrate, at a tertiary care centre. Methods and Materials: In this retrospective cross-sectional study, data regarding the utilization of blood products was collected over the span of one year, from January 2022 to December 2022. This data was obtained from blood centre registers and compiled in Microsoft Excel sheet for subsequent analysis, allowing for the assessment of the utilization patterns of different blood components in various departments. Results: A total of 2,647 blood units were issued in the study duration. The most frequently used blood product was Packed Red Blood Cells, followed by Fresh Frozen Plasma and Random Donor Platelets. Packed Red Cells were predominantly utilized by Medicine department, closely followed by the Surgery department. Notably, patients with anemia and those undergoing surgery had the highest demand for Packed Red Cells. Conclusion: Conducting regular audits on the usage of blood components is imperative for every blood bank. These efforts serve multiple purposes, not only partially fulfilling the current demand for blood products but also curbing unnecessary wastage of these vital resources. Keywords: Blood component, PCV, FFP, RDP, Utilization.

Biliary atresia is a rare and life-threatening liver disease that primarily affects infants. Early diagnosis and timely intervention are crucial for improved outcomes. This retrospective study aimed to diagnose cases of biliary atresia through histopathological examination and confirm the diagnosis using immunohistochemical stains. Additionally, the study sought to correlate the histological findings with the clinical presentation. In 3 years (2019- 2022),11 cases of biliary atresia were analyzed, comprising 6 male and 5 female patients. All patients presented with elevated bilirubin levels (both direct and total) along with deranged liver enzymes. The key histopathological finding that consistently led to the diagnosis of biliary atresia in all 11 cases was characterized by portal tract expansion and oedematous fibroplasia, accompanied by bile ductular proliferation. Inflammatory cell infiltrates were also noted in the liver biopsies. Therefore, biliary atresia is a complex disorder with variable outcomes, underscoring the importance of prenatal screening and early postnatal detection. Timely surgical intervention and histological examination play crucial roles in managing this condition effectively. Further research and awareness are essential to optimize diagnostic and therapeutic strategies for biliary atresia, ultimately improving the prognosis for affected infants. Keywords: Biliary Atresia, Bile Duct Proliferation, Neonatal Jaundice, Kasai Procedure, Liver Biopsy.

Background: Dengue is the most common arthropod-borne viral fever in travellers returning from most tropical and subtropical destinations worldwide. The common symptoms associated with dengue fever is fever, myalgia, headache etc. Materials and Methods: This is a hospital based, retrospective study conducted at Tezpur medical college and hospital, Tezpur, Assam. It included confirmed dengue cases from January 2021 to October 2023. The objective of the study is to analyze the clinical and laboratory parameters of dengue to facilitate early diagnosis and better management of dengue cases. Results: On analysis, it has been found out that among 98 patients included in the study, 29% of patients are in 30-39 years, 27% of patients fall in age group of 21-29years,16% in 40-45 years, 11% in 18-20 years, 8% each in age group of 50-59 years and 60-69 years and 1% in 70-79 years. On evaluation it was calculated that 74% of patients are males and 26% females. Regarding the duration of fever, it has been found out that 45% of patients had 5-10 days, 36% had < 5 days,12% had 11-20 days, 5% had 21-30 days,2% had >30 days. On evaluating the dehydration status, 19% of the patients had dehydration. Bleeding symptoms were manifested in 11% of the patients. Conclusion: Dengue fever is associated with high morbidity and mortality. Early diagnosis and treatment of dengue fever is necessary to prevent complications. Keywords: Dengue fever, hematological profile, duration of fever, dehydration, bleeding manifestation.

Background: Various scoring systems have been devised throughout the years to determine the gravity of patients' ailments or their prognosis. Our inquiry delved into the effectiveness of the Mannheim Prognostic Index (MPI) in predicting mortality risk, complications, extended hospital stays, and the need for intensive care unit (ICU) admission among all patients presenting with secondary peritonitis. Furthermore, we aimed to ascertain the practicality, convenience, and simplicity of this assessment as a tool for integration into the clinical practices of surgeons and critical care physicians. Materials and Methods: A retrospective, comparative, observational and analytical study was conducted. One hundred patients diagnosed with secondary peritonitis presenting to the general surgery department were assessed and Manheim peritonitis index and APACHE II scores were calculated and compared. Results: The efficacy of the MPI was contrasted with that of another commonly utilized mortality prediction system, such as Apache II, involving a cohort of 100 patients from a tertiary care centre of north india. The predictive accuracies were determined to be 93.3% and 86.9%, respectively. Conclusion: Although Mannheim offers a commendable response in predicting mortality, its evaluation is not foolproof as it overlooks certain factors; thus, a patient deemed to have a low mortality risk may, in fact, succumb. Keywords: Secondary peritonitis, acute abdomen, abdominal cavity, intra-abdominal infection, abdominal pain.

Background: Urinary tract infections (UTIs) represent one of the most prevalent bacterial infections among pregnant women, with increased risk in those with diabetes mellitus (DM). This cross-sectional study investigates the prevalence, clinical presentation, microbial etiology, and antibiotic sensitivity of symptomatic UTIs in diabetic pregnant women. Material and Methods: A total of 108 diabetic pregnant women presenting with symptomatic UTIs were evaluated. Data on age, trimester, parity, type of diabetes, and symptoms were collected. Urinalysis and urine cultures were performed to determine infection presence and to identify bacterial pathogens. Antibiotic susceptibility testing followed standard microbiological protocols. Results: Results showed the majority of women were in their second trimester (57.4%) and multiparous (65.7%), with gestational diabetes (82.4%) being most common. The leading symptoms were dysuria (69.4%), lower abdominal pain (58.3%), and urgency (42.6%). Escherichia coli (48.1%) was the predominant organism isolated, with high sensitivity to Nitrofurantoin (100%), Gentamicin (95.4%), and Cefixime (95.4%). Conclusion: The findings underscore the importance of early screening and appropriate antibiotic treatment in this population to prevent maternal and neonatal complications. Culture-guided therapy is essential in preventing resistance and ensuring optimal outcomes. Keywords: Urinary tract infection, diabetic pregnancy, Escherichia coli

Background: Hysterectomy is performed for various uterine pathologies like fibroids, endometriosis, uterine prolapse and various types of cancer. Hysterectomy is the most common gynaecological study performed in women. It is a life saving procedure and it improves the quality of life. Myometrial lesions account for the majority of causes for abnormal uterine bleeding. Aims and objectives: 1. The aim of this study is to analyse the various spectrum of histomorphological lesions in uterus from hysterectomy specimen. 2. Correlation of preoperative clinical diagnosis with histopathological diagnosis in hysterectomy specimens Materials and methods: This study is a prospective and a retrospective analysis of 80 hysterectomy specimens reported to the department of Pathology, January 2020-2021 in Sri Lakshmi Narayana institute of medical sciences. The histopathological findings of hysterectomy specimens were noted and these findings are correlated with clinical diagnosis Results: The most common type of hysterectomy was total abdominal hysterectomy with bilateral salpingo-ophorectomy (52.5%). Most common clinical diagnosis is fibroid. Most common age group was 41-50yrs. The most common clinical indication for hysterectomy was fibroid uterus. In case of myometrium leiomyomas are the most common lesions followed by adenomyosis. Conclusion: The histomorphological analysis is mandatory for all hysterectomy specimens for confirming the preoperative clinical diagnosis and to improve the quality of life.

Background: To assess the prevalence of overweight and Obesity among school children near the BPT Hospital and explore it's associations with socioeconomic factors, dietary habits and physical activity. Materials and Methods: A retrospective cross-sectional study utilised data from thesis conducted in 2013.Total of 1050 children aged 6-12years from three schools representing different socioeconomic backgrounds were enrolled. Anthropometric measurements were taken and BMI was calculated using standard guidelines. Information on dietary intake, physical activity and socioeconomic status was collected through questionnaires. Results: Out of the total sample set, 16 children were underweight,880 had normal BMI,126 were overweight and 28 were obese. Overweight and Obesity were more prevalent in in high income groups (15.2% and 3.4%) compared to low income groups (5.4% and 1.1%). Boys had a higher prevalence of overweight and Obesity than girls. Additionaly, junk food consumption was significantly higher among children from high-income families. Conclusion: The findings emphasize the need for school based interventions to promote healthy dietary habits and physical activity particularly targeting high income groups. Addressing gender-based disparities in physical activity is also essential. Keywords: Body mass index, school children, Obesity, Overweight, socioeconomic status.

Background: Suicide is an increasing community health issue with hanging being the commonest adopted method. The study of hanging cases gives information about distribution of suicide fatalities thus revealing information about a community's mental and personal health. Objectives: This study was selected with objectives of determining the distribution of hanging victims related to age, sex, ligature material used and associated risk factors. Materials and Methods: The present descriptive retrospective study was conducted in the department of Forensic Medicine and Toxicology of a tertiary care center, Bengaluru north, from 2021 to 2022, with data collected from postmortem records of all the cases brought for medico-legal autopsies with alleged history of suicide by hanging. After analyzing, the data was tabulated and graphs were used to tabulate the results. Results: Majority of the victims: were males, belonging to age group of 21-30 years, residing in urban areas, chose hanging as suicidal method, using soft material like saree as a ligature material, with knot on right side of neck, in close confinement like house; and depression was found to be a common causative factor due to various reasons. Conclusion: This study emphasizes the need of preventive strategies like health education, psychiatric & psychological counselling for livelihood, creation of social welfare groups with usage of media, desensitization to manage stressors due to various causes; use of government aided schemes & helpline numbers for vulnerable population. Keywords: Suicide, hanging, knot mark, ligature material, causative factors.

Background: Early childhood is one of the risk factors for many ocular diseases, if unnoticed may adversely affect the child’s school performance and causing severe ocular disability especially in remote areas with scarce facilities. An early diagnosis and intervention lead to a better impact on life. Aims: To determine the prevalence and pattern of various ocular morbidities in school going children of tribal ashram schools of central India. Settings and Design: Cross-sectional study was conducted on students from class 1 to 12 (age 6 to 18) of government tribal ashram school. Materials and Methods: Study was conducted for a period of 18 months among 2000 students from class 1 to 12 (age 6 to 18) of government tribal ashram school. All students between 6 to 18 years and whose parents/ guardian of student giving consent for the study, those who were present on the day of screening. Statistical analysis used: SPSS version 20.0 (Armonk, NY: IBM Crop). Results: Total 2000 students were participated in the study and total of 1003 students were found to be suffering from various ocular morbidities, yielding an overall prevalence of ocular morbidity of 50.1%. Refractive error was found to be the most common ocular morbidity with 452 (22.6%) followed by Vitamin A Deficiency with 256 (12.8%) respectively. Conclusions: Refractive errors and Vitamin A deficiency are the leading preventable and treatable causes of childhood blindness. These conditions can be easily detected through regular eye screening programs and can be promptly addressed. Keywords: Ocular Morbidity, Tribal Children.

Background: COVID-19 manifests with a wide clinical spectrum ranging from asymptomatic state to acute respiratory distress syndrome and multi organ dysfunction. Reports suggest neurological symptoms in approximately one fourth to one third of patients including symptoms related to central and peripheral nervous system and skeletal muscular damage. Commonly reported neurological symptoms include dizziness, headache, impairment of taste and smell, impaired consciousness, confusion and commonly reported complications include cerebrovascular events (CVEs), meningitis, encephalopathy, skeletal muscle injury and demyelinating disorders like Guillain-Barre syndrome. This study was aimed at estimating the prevalence and spectrum of neurological manifestations and its severity, progression, and possible outcomes in COVID-19 patients admitted in our Medical college hospital. Materials and Methods: An Observational Descriptive Study was conducted among the patients diagnosed with COVID 19 starting from the first hospitalized case of COVID-19 in TDMC, Alappuzha (30, January 2020) till 31, July 2020. Patient’s relevant information including details of history and clinical examination were collected from the medical records. Reports of laboratory investigations were reviewed. The study was approved by the institutional ethics committee of Government T D Medical College Alappuzha. Results were analysed and those with neurological manifestations were compared to those without and necessary statistical calculations were done. Results: Total number of patients who were included in the study were 624. Mean age was 41.28. Majority of them were males (82.6%). Of these patients, 200 (32%) had at least 1 of the following underlying disorders: hypertension (123 [19.7%]), diabetes (82[13.1%]), cardiac or cerebrovascular disease (25 [4.0%]), and COPD (17 [2.7%]). The most common symptoms at on-set of illness were sore throat (135 [21.6%]), cough (133 [21.3%]), and fever (104 (16.6%). 278(44.5%) patients were totally asymptomatic. Neurologic manifestations were present in 122 patients (19.5%). Patients presenting with any neurologic manifestations were older than those without (43.5 vs. 40.73 years) and had a longer time of hospitalization (12.68 vs. 10.1 days. Among the patients who had neurological symptoms the most frequent neurologic manifestations were headaches (82, 67.2%) hypogeusia (42, 34.4%), hyposmia (41, 33.6%), dizziness (7, 5.7%), numbness (43.27%) and cerebrovascular accident (2 1.6%). Patients with cerebrovascular accidents were older than those without (both above 60 years) and both were having comorbidities. Compared to the group who did not present with neurological symptoms the group with neurological symptoms had more statistically significant Covid related symptoms like fever sore throat myalgia chest pain and diarrohea. Conclusion: This study demonstrated the presence of significant neurological symptoms in hospitalised Covid patients who were admitted in our hospital. . Major neurological manifestation in our study was ischemic stroke which was reported in 2 patients who had prior comorbidities. There was no relation between severity of illness

Background: Postoperative paralytic ileus (PPI) is a frequent complication after abdominal surgeries, characterized by transient cessation of bowel function. Pharmacological interventions, especially prokinetic agents, have been investigated to expedite bowel recovery. Levosulpiride (Lesuride), a dopamine D2 antagonist with prokinetic activity, has shown promise in this context. Materials and Methods: This review explores clinical literature and pharmacological studies concerning the use of injection Levosulpiride in the management of PPI. The databases searched included PubMed, Scopus, and Google Scholar, using the keywords: "Levosulpiride," "Lesuride," "postoperative ileus," and "prokinetic agents." Results: Studies indicate that intravenous Lesuride accelerates return of bowel sounds, flatus, and oral intake in postoperative patients without significant adverse effects. Compared to other prokinetics, it offers favorable tolerability and efficacy. Conclusion: Lesuride appears to be an effective and safe prokinetic agent in reducing the duration of postoperative ileus. Its integration into postoperative care protocols could enhance recovery, though further large-scale trials are warranted. Keywords: Levosulpiride, Lesuride, postoperative ileus, prokinetics, gastrointestinal motility, paralytic ileus.

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder associated with both microvascular and macrovascular complications including coronary artery disease (CAD). CAD in diabetics often remains asymptomatic due to autonomic neuropathy, making its early detection challenging. Treadmill test (TMT) is a widely accessible non-invasive tool for detecting subclinical myocardial ischemia. This study aims to evaluate the utility of TMT in detecting asymptomatic CAD in T2DM patients and its correlation with HbA1c levels and diabetes duration. Materials and Methods: A cross-sectional observational study of 80 asymptomatic T2DM patients aged 25–60 years was conducted in the department of general medicine of Adichunchungiri hospital and research centre. Clinical data including duration of diabetes, HbA1c levels and lifestyle risk factors were recorded. All patients underwent TMT using the modified Bruce protocol. A positive TMT was defined by standard ischemic ST segment depression criteria. Statistical analysis was done using SPSS v23.0 to determine the association of TMT results with HbA1c levels and diabetes duration. Results: Among 80 participants majority were males(57.5%) and most common age group was 51–60 years (46.25%). TMT was positive in 31 (38.75%) patients. A significant association was found between longer diabetes duration and TMT positivity (p=0.0002). HbA1c levels ≥9.1% were more prevalent among TMT positive individuals (p=0.047). 80.6% of TMT positive patients had HbA1c level of more than 9% suggesting poor glycaemic control as a significant predictor of silent myocardial ischemia. Conclusion: There was a significant correlation between elevated HbA1c levels andprolonged duration of T2DMwith TMT. Routine cardiovascular screening by TMT should be considered in asymptomatic T2DM patients particularly inthose with prolonged disease or poor glycaemic control. Keywords: Type 2 Diabetes Mellitus, Coronary Artery Disease, HbA1c, Treadmill Test.

Background: To compare LISA vs InSurE technique of surfactant administration on need for mechanical ventilation in Preterm Neonates with RDS between 28-34 weeks of Gestation. Materials and Methods: Randomised controlled trial done in preterm neonates of 28-34 weeks of Gestation with RDS, admitted in SNCU Inborn at Niloufer hospital for a period of 2 years. Preterm neonates of 28-34 weeks of gestation, Clinical Diagnosis of RDS with persistent fi02 requirement >30% in first 6 hrs of life are included in study. we compared the requirement of 2nd dose of surfactant, incidence of BPD and complications of Prematurity in both the groups. Results: The most common cause of prematurity in LISA and INSURE groups is PPROM, followed by Fetal distress. Least common cause of prematurity in LISA and INSURE groups are Antepartum haemorrhage and Twin delivery-PROM respectively. The median of time from birth to the onset of procedure in both LISA group and INSURE group is similar and is 4 hours. The mean Fio2 at the beginning of the procedure among the LISA group, mean Fio2 at the 1st hour after the procedure, mean Fio2 at the 4th hour after procedure are insignificant. None of the adverse effects are significant when compared in groups. Median period in days of NIV, Repeat dose of surfactant, median length of hospital stay and Bradycardia is insignificant. Desaturation was not significant. The median duration of supplemental O2 in LISA group was 5 days, whereas in INSURE group was 8 days. The difference is statistically significant with p < 0.05. 55 patients (68.75%) in the LISA group and in 59 patients (73.75%) in the INSURE group survived which is not statistically significant. Conclusions: Although the research suggests that LISA is superior in terms of outcome, our study demonstrated that LISA is superior in terms of minimising the period of oxygen supplementation and hospital stay. However, we found no substantial difference in other outcomes. Keywords: Respiratory Distress Syndrome (RDS), less invasive surfactant administration (LISA), Intubation-Surfactant Extubation (InSurE).

Background: Acute myocardial infarction (AMI) remains an important contributor to cardiovascular morbidity and mortality. Left ventricular dysfunction (LVD) is one of the important complications seen in patients of AMI. Despite advancements in revascularization procedures and pharmacotherapy LVD is seen in many cases and significantly affects prognosis. This study aimed to determine the incidence and severity of LVD in patients with AMI and its correlation advancing age of patients presenting with AMI. Materials and Methods: A hospital-based cross-sectional observational study was conducted at Adichunchungiri Institute of Medical Sciences, India. 250 consecutive patients with confirmed AMI were included in this study on the basis of a predefined inclusion and exclusion criteria. Detailed clinical evaluation, ECG, cardiac biomarkers, and 2D transthoracic echocardiography were performed within 72 hours of admission. LVD was categorized based on left ventricular ejection fraction (LVEF) as: mild (40–49%), moderate (30–39%), or severe (<30%). Statistical analysis was done using SPSS 23.0. P value less than 0.05 was taken as statistically significant. Results: Out of 250 patients there was a significant male preponderance in AMI cases with a M:F ratio of 1:0.38. Mean age of studied cases was found to be 66.25 ± 10.9 years. STEMI accounted for 66% and NSTEMI 34% of cases. Anterior wall MI was the most common type (42%). Hypertension (58%), obesity (52%) and diabetes mellitus (44%) were the predominant risk factors. LVD was present in 46% of patients out of which mild, moderate and severe LVD was seen in 20%, 16% and 10% respectively. A significant age-related increase in LVD incidence was observed. Pearson’s correlation revealed a moderate positive association between age and LVD (r = 0.41, p = 0.001). Conclusion: Early echocardiographic screening for LVD in cases of MI is essential for timely identification and initiation of appropriate management to prevent adverse outcomes. Keywords: Myocardial Infarction, Left Ventricular Dysfunction, Echocardiography, Risk Factors.

Background: Myocardial infarction (MI) in individuals under 45 years is increasingly recognized as a distinct clinical entity with rising incidence in developing nations. It carries significant psychosocial and economic burden due to its occurrence in the most productive phase of life. This study aims to assess the risk factors and clinical presentation of young adults presenting with MI. Materials and Methods: This cross-sectional observational study was conducted in the Department of General Medicine, Adichunchanagiri Institute of Medical Sciences, Karnataka, India. Fifty patients aged between 18–45 years with confirmed MI (STEMI or NSTEMI) were included in this study. Detailed clinical history, physical examination, laboratory investigations, cardiac biomarkers, ECG, and echocardiography were performed. Risk factors such as BMI, smoking, alcohol use, family history, diabetes, hypertension and dyslipidemia were documented. Data were analyzed using SPSS v23.0. For statistical purposes p<0.05 was taken as statistically significant. Results: The majority of patients were male (80%) with the most affected age group between 41–45 years of age. Obesity (BMI ≥25) was present in 90% of patients. Smoking (42%), hypertension (48%), diabetes (36%) and dyslipidemia (78%) were the most common modifiable risk factors. A positive family history of coronary artery disease was found in 62% of patients. Typical chest pain radiating to left arm was the most common symptom (56%) followed by chest heaviness and breathlessness. Anterior wall MI was the most frequent type (72%) and left ventricular dysfunction of some or the other degree was observed in 90% of patients. Conclusion: MI in young adults demonstrates a strong association with modifiable risk factors particulalry obesity, smoking, hypertension and dyslipidemia. Early recognition, lifestyle modifications, and aggressive risk factor management are crucial to reduce the burden of premature cardiovascular disease in young population. Keywords: Myocardial Infarction, Young Adults, Risk Factors, Chest Pain, Anterior Wall MI.

Background: Inguinal hernia is one of the most common disease encountered in general surgery OPD. Various approaches have been used to treat inguinal hernia. But still Lichtenstein tension free hernioplasty is method of choice for inguinal hernia. Chronic post operative inguinal pain is major problem postoperatively in hernioplasty. Ilioinguinal nerve trauma during dissection, inflammation and entrapment by mesh may involve in pathogenesis of inguinodynia Materials and Methods: This study was carried out in 100 patients between January 2024 to June 2024. In this study, we have included all the patients who underwent Lichtenstein tension free hernioplasty for inguinal hernia. Patients with obstructed inguinal hernia are excluded from the study. In the study, patients were randomly allocated in two groups: Group A(n=50) in which elective neurectomy was done and Group B(n=50) in which nerve preservation was done. In both the groups, postoperative pain assessment done on 1st POD, 7th POD and after 1and 3 months by VAS(Visual analogue scale). Results: the study shows that in group A and group B, there is no significant difference in VAS score in 1st and 7th post operative day. But in late Post operative period like 1 and 3 months, VAS score is significant low in group A patients than group B patients. Conclusion: Elective ilioinguinal neurectomy significantly reduces pain in late postoperative period. Keywords: Inguinal hernia, Lichtenstein Hernioplasty, ilioinguinal neurectomy, postoperative pain.

Background: Bladder exstrophy is a rare congenital condition that presents significant challenges in adult patients, particularly in cases that remain untreated. This study aimed to evaluate the outcomes of abdominal wall closure in 20 adult patients with untreated bladder exstrophy at a tertiary hospital in India. Material and Methods: The patients underwent abdominal wall reconstruction. The study assessed complications, including wound infections, flap necrosis, and suture line dehiscence, as well as the need for secondary procedures like debridement and flap reconstruction. Results: The results highlighted the complexities of surgical management and the importance of individualized approaches for optimal outcomes. This study provides valuable insights into the challenges of managing bladder exstrophy in adults. Keywords: Bladder Exstrophy, Abdominal Wall Closure, Surgical Outcomes.

Background: Peripheral nerve blockade is a widely used regional anesthesia technique that reduces postoperative pain, minimizes the need for analgesics, and improves patient recovery. The supraclavicular brachial plexus block (SCBPB) is commonly used for upper limb surgeries due to its high success rate, rapid onset, and dense anesthesia. Various adjuvants are added to local anesthetics to enhance block characteristics. Magnesium sulfate (MgSO₄) and dexamethasone are among the most studied adjuvants, but limited data exist on their comparative efficacy when used with ropivacaine in SCBPB. Objective: This study aimed to compare the efficacy of Magnesium Sulfate -MgSO₄ and dexamethasone as adjuvants to 0.75% ropivacaine in supraclavicular brachial plexus block for upper limb surgeries. The primary objective was to evaluate postoperative analgesia duration. Secondary objectives included sensory and motor block onset and duration, quality of analgesia assessed by the Visual Analog Scale (VAS), total analgesic consumption, and hemodynamic stability. Materials and Methods: A prospective, randomized, double-blinded study was conducted on 100 patients (ASA I & II) scheduled for elective upper limb surgery under supraclavicular brachial plexus block. Patients were randomized into two groups: Group RD (n=50): Received 20 ml 0.75% ropivacaine + 2 ml (8 mg) dexamethasone + 8 ml normal saline (total 30 ml).Group RM (n=50): Received 20 ml 0.75% ropivacaine + 2 ml (200 mg) Magnesium Sulfate -MgSO₄ + 8 ml normal saline (total 30 ml). Block characteristics, postoperative pain scores, and rescue analgesia requirements were assessed over 24 hours. Results: Onset of sensory block was faster in Group RD (13.15 ± 1.90 min) compared to Group RM (15.44 ± 2.26 min, P < 0.001).Onset of motor block was also faster in Group RD (17.12 ± 2.12 min) than in Group RM (19.26 ± 2.28 min, P = 0.001).Duration of sensory block was significantly longer in Group RD (1168.2 ± 111.88 min) compared to Group RM (468.60 ± 62.14 min, P < 0.001).Duration of motor block was longer in Group RD (1088.6 ± 91.15 min) than in Group RM (385.80 ± 45.39 min, P < 0.001).Time to first rescue analgesic requirement was significantly prolonged in Group RD (1208.4 ± 111.08 min) compared to Group RM (498.18 ± 64.22 min, P < 0.001).Total analgesic consumption was significantly lower in Group RD (87.4 ± 22.2 mg) than in Group RM (185 ± 36.2 mg, P < 0.001). Hemodynamic parameters were stable in both groups, though Group RM showed transient hypotension at 30 minutes (P = 0.013). Conclusion: Dexamethasone (8 mg) proved to be a more effective adjuvant than MgSO₄ (200 mg) when combined with 0.75% ropivacaine for supraclavicular brachial plexus block, as it resulted in faster onset, prolonged sensory and motor block duration, extended analgesia, and reduced postoperative analgesic requirement. While MgSO₄ remains a viable adjuvant, it is less effective than dexamethasone for optimizing nerve block characteristics. Future studies should investigate optimal dosing and potential synergistic effects of combining adjuvants. Keywords: Supraclavicular brachial plexus block, Ropivacaine, Dexamethasone, Magnesium sulfate

Background: Incisional hernia is a common postoperative complication, often requiring surgical intervention. Mesh repair has become the standard treatment for incisional hernias due to its reduced recurrence rates and improved patient outcomes. However, several risk factors influence long-term recurrence. This study aims to evaluate the risk factors and long-term recurrence rates in patients who underwent mesh repair for incisional hernia. Materials and Methods: A retrospective study was conducted at SRVS Medical College, Shivpuri, including both private and government hospitals. A total of 36 patients who underwent mesh repair for incisional hernia over the past two years were included. Patient data, including demographic details, comorbidities, surgical techniques, and postoperative complications, were collected and analyzed. The primary outcome was the recurrence rate over a follow-up period of 24 months. Statistical analysis was performed using descriptive methods and chi-square tests for categorical variables. Results: The study included 36 patients, with a mean age of 52 ± 10 years. The majority of patients were female (60%). Common risk factors associated with recurrence included obesity (BMI >30 kg/m²) in 45% of patients, diabetes mellitus in 30%, and smoking in 25%. Surgical site infection was observed in 15% of cases, contributing to increased recurrence rates. The overall recurrence rate at 24 months was 18%, with a higher incidence among patients with multiple risk factors. Laparoscopic mesh repair showed a lower recurrence rate (10%) compared to open mesh repair (25%). Conclusion: Mesh repair remains the standard treatment for incisional hernias; however, recurrence rates are influenced by patient-related risk factors such as obesity, diabetes, and smoking. Laparoscopic mesh repair demonstrated superior outcomes in terms of reduced recurrence compared to open mesh repair. Proper patient selection, optimization of comorbidities, and adherence to surgical protocols can improve long-term success rates. Keywords: Incisional hernia, mesh repair, recurrence, risk factors, laparoscopic repair, open repair, retrospective study.

Background: To study the Imaging Features and post-Surgical data of Indian patients with primary hyperparathyroidism. Materials and Methods: This was a prospective study conducted at tertiary care center, Mahatma Gandhi Medical College and Hospital, Jaipur consecutive patients with primary hyperparathyroidism from year 2022 to 2024. The analysis included profiling of patients on different demographic, clinical and biochemical and radiological parameters. Quantitative parameters were expressed as means and standard deviation. Results: In This study total of 100 patients were diagnosed as primary hyperparathyroidism. Ultrasound KUB showed nephrolithiasis in 22 (22%) and nephrocalcinosis in 7 (7%) patients. Both were present in 5 (5%). Nephrocalcinosis alone was present in 2 (2%) patients. The greatest reduction in bone mineral density was found at the site of predominantly cortical bone, the radius (0.73±0.13 g/cm2), whereas the site of predominantly cancellous bone, the lumbar spine (0.94±0.13 g/cm2). The site of mixed composition, the femoral neck (0.87±0.13 g/cm2), gave an intermediate value. Parathyroid adenoma was the most common histological change noted in the parathyroid glands. 85 (96.59%) patients had adenoma and 3 (3.4%) patients had hyperplasia of parathyroid gland. The mean total parathyroid gland weight was 2.75±3.53 g (0.1-18.5). In asymptomatic group mean adenoma weight was 1.87±1.89 (0.1-6.2) g and in symptomatic group mean adenoma weight was 3.59±4.45 g (0.2-18.5) . In asymptomatic group had a significantly lower mean adenoma weight (1.87 vs. 3.59 g, P<.05) compared to the symptomatic group. Conclusion: Our study showed 49% patients were asymptomatic. Asymptomatic PHPT has not been described in India, this is the first prospective study to show increasing incidence of asymptomatic PHPT in India. This study provides valuable insights into the clinical, imaging, and surgical outcomes of Indian patients with Primary Hyperparathyroidism (PHPT). Imaging techniques, particularly ultrasound and bone mineral density measurements, play a critical role in identifying renal and skeletal complications associated with PHPT, such as nephrolithiasis, nephrocalcinosis, and reduced bone mineral density. The study also highlights the significant correlation between adenoma size and the presence of symptoms, with symptomatic patients having larger adenomas compared to asymptomatic ones. Post-surgical outcomes following parathyroidectomy demonstrate significant improvements in calcium levels, symptoms, and overall quality of life for most patients. The majority of patients achieve normalization of serum calcium, and those with nephrolithiasis or nephrocalcinosis often experience reduced stone formation post-surgery. These findings emphasize the importance of early diagnosis, appropriate imaging, and timely surgical intervention to achieve optimal outcomes in PHPT patients. Overall, this study underscores the need for a tailored approach in the management of PHPT, where imaging and surgical strategies are personalized based on the clinical presentation and adenoma characteristics. Continued follow-up and monitoring are essential to ensure the lon

Background: Infraclavicular approach for brachial plexus block is under used but effective technique. The introduction of ultrasonography had rekindled the interest in infraclavicular brachial plexus block. Dexamethasone or Ketamine when added as adjuvant to local anaesthetic like ropivacaine will increase the duration of analgesia. The objectives is to compare postoperative analgesic effect, between Dexamethasone and Ketamine added as adjuvant to 0.2% Ropivacaine in ultrasound guided Infraclavicular Brachial Plexus Block. The primary objective of the study was the duration of post op analgesia or time taken for first rescue analgesia in hours. The secondary objectives were to find postoperative pain score and total rescue analgesic consumption in 24 hours. Materials and Methods: This was a prospective comparative observational study after institutional and ethics committee approval and patient consent. 100 patients aged 18-60 years with BMI <30 kg/m2 belonging to American Society of Anaesthesiologist (ASA) physical status 1&2 undergoing elective forearm surgery were divided into two groups of 50 each. Group D received USG guided infraclavicular brachial plexus block with 0.2% Ropivacaine 28ml + inj Dexamethasone 8 mg and Group K received 0.2% Ropivacaine 28 ml + inj Ketamine 25μg/kg after giving general anaesthesia. Each patient received Inj Paracetamol 1 gm IV intraoperatively and Q8th hourly in post-operative period. Duration of analgesia, post-operative pain score and analgesic requirements were studied in both groups. Also patient satisfaction score at 24 hour and occurrence of any complications were noted. Statistical analysis was done with SPSS software version 16. Qualitative data were compared using Chi square test and Quantitative data compared using independent t test. A P value of less than 0.05 was taken as significant. Results: The mean time required for first rescue analgesic was significantly more in Group D compared to Group K, 19.94+/-2.92 vs 10.76+/-1.69 respectively (P <0.05). The mean total rescue analgesic required in 24 hours significantly low in GroupD compared to Group K, 1.02+/-0.552 vs 1.96+/-0.532 (P <0.05). There was a low NRS score in Group D compared to Group K. Conclusion: Addition of Dexamethasone is superior to Ketamine as adjuvant to 0.2% ropivacaine for post-operative analgesia in patient receiving infraclavicular brachial plexus block. Keywords: Oral health literacy, socioeconomic status, rural population, Jaipur, Health Literacy in Dentistry (HeLD), Oral Health Impact Profile (OHIP-14), quality of life.

Background: Gestational diabetes mellitus (GDM) is a frequent metabolic complication of pregnancy, affecting both maternal and fetal outcomes. One of the major fetal concerns associated with GDM is abnormal intrauterine growth, particularly macrosomia. Ultrasound provides a non-invasive and reliable method to monitor fetal growth trajectories in real-time. Understanding the correlation between GDM and fetal biometry is critical for guiding perinatal management. To evaluate the correlation between gestational diabetes mellitus and fetal growth patterns as measured by ultrasonographic parameters, and to assess the prevalence of abnormal fetal growth among GDM pregnancies. Materials and Methods: A cross-sectional analytical study was conducted over a period of 12 months at a tertiary care hospital. A total of 120 pregnant women between 24–36 weeks of gestation were included. Among them, 60 were diagnosed with GDM based on IADPSG criteria and 60 were normoglycemic controls. All participants underwent standardized ultrasound examinations to measure biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW). Fetal growth categories—small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA)—were defined using WHO fetal growth charts. Statistical analysis included chi-square tests and Pearson correlation. Results: The prevalence of LGA fetuses was significantly higher in the GDM group (41.7%) compared to the control group (13.3%) (p < 0.001). GDM pregnancies had higher mean AC (mean: 31.4 ± 2.5 cm vs. 28.9 ± 2.2 cm; p < 0.01) and EFW (mean: 2,900 ± 450 g vs. 2,500 ± 390 g; p < 0.01). Positive correlations were found between fasting blood glucose levels and AC (r = 0.43) and EFW (r = 0.40). Other parameters such as BPD and FL did not differ significantly between the groups. Conclusion: Gestational diabetes is significantly associated with increased fetal growth, especially in terms of abdominal circumference and estimated fetal weight. Ultrasound biometry, particularly AC and EFW, serves as a sensitive tool for monitoring growth patterns in GDM pregnancies. Early detection of abnormal fetal growth via ultrasonography may aid in timely clinical decision-making and improved neonatal outcomes. Keywords: Gestational diabetes mellitus, fetal growth, ultrasonography, macrosomia, abdominal circumference, estimated fetal weight, pregnancy, fetal biometry.

Background: Antepartum eclampsia remains a critical obstetric emergency, especially in low- and middle-income settings. It is associated with high maternal and perinatal morbidity and mortality. Timely identification and management of eclampsia are vital to improving outcomes. This study aims to assess the spectrum of maternal and fetal outcomes in patients diagnosed with antepartum eclampsia. To evaluate the maternal and fetal outcomes associated with antepartum eclampsia and to identify common clinical presentations and complications in a tertiary care setting. Materials and Methods: A hospital-based cross-sectional observational study was conducted from January to December 2023 in the Department of Obstetrics and Gynecology at a tertiary care center. A total of 120 pregnant women diagnosed with antepartum eclampsia were enrolled based on predefined inclusion and exclusion criteria. Detailed clinical assessments, laboratory investigations, and maternal and fetal outcomes were recorded. Data were analyzed using SPSS version 26.0, and associations were assessed using chi-square and t-tests where appropriate. Results: Out of 120 cases, the majority (72.5%) were primigravidae, and 68.3% were between 20–30 years of age. Seizures were the initial presenting symptom in 89.2% of cases. The most frequent maternal complications were HELLP syndrome (15.8%), acute renal injury (10.0%), and pulmonary edema (6.7%). Maternal mortality was observed in 4.2% of cases. On the fetal side, 35.8% were preterm births, 28.3% were low birth weight (<2.5 kg), and the perinatal mortality rate was 18.3%. Emergency cesarean section was performed in 52.5% of cases, and vaginal delivery occurred in 45.8%. Magnesium sulfate was used in all cases for seizure control. Conclusion: Antepartum eclampsia continues to contribute substantially to adverse maternal and fetal outcomes. Young, primigravida women are particularly at risk. Comprehensive antenatal care, early diagnosis, and prompt multidisciplinary intervention remain pivotal in reducing morbidity and mortality associated with this condition. Keywords: Antepartum eclampsia, maternal outcomes, fetal outcomes, seizures in pregnancy, perinatal mortality, obstetric emergency, magnesium sulfate.

Background: Schizophrenia is a long-lasting and debilitating mental health disorder that affects individuals globally. Recent studies by the World Health Organization (WHO) indicate that over 21 million individuals around the world are living with Schizophrenia.[1] Objectives: 1. To determine the frequency of attempts of suicide in schizophrenia. 2. To study and compare the various risk factors of suicide attempts in patients with schizophrenia. 3. To compare differences in the clinical and socio-demographic profile with and without suicide attempts in patients with schizophrenia. 4. To evaluate the relationship of severity, type and duration of schizophrenic illness among patients with and without suicide attempts. Materials and Methods: Study Design: Hospital-based descriptive cross-sectional study. Study area: The study was conducted in the Department of Psychiatry, in a tertiary care teaching hospital. Study Period: 1 year. Study population: Participants were male and female patients diagnosed with Schizophrenia who came to the Psychiatry Department. Sample size: The study consisted of a total of 100 subjects. (27 attempted and 73 not attempted). Sampling Technique: convenience sampling method. Results: The mean score on the SAPS (positive symptoms scale) was 17.33 (SD - 7.68) for non-attempters, compared to 21.93 (SD - 9.20) for those with suicide attempts. The difference was statistically significant (P = 0.01) in the test. Conclusion: Suicide remains a significant risk for individuals with schizophrenia, particularly during the acute phases of the illness. Key risk factors include younger age, female gender, low income, alcohol use, and unemployment. Early identification, aggressive intervention, and sustained care beyond clinical recovery are crucial in mitigating this risk. Effective strategies involve treating depressive symptoms, improving treatment adherence, and maintaining vigilance, especially after significant losses. Keywords: Schizophrenia, Suicide, Calgary depression scale for Schizophrenia (CDSS).

Background: STIs pose a major health, social and economic problem worldwide, predominantly in developing countries like India. Aim and objective: To assess the patterns of STIs seen over the past 10 years based on the syndromic approach in a STD clinic of Tertiary care hospital. Materials and Methods: This is a retrospective study on patients who attended the Department of Dermatology and Venereology STD clinic, Government Medical College, Anantapur, from January 2014 to December 2023. Cases during 2021 was incomplete due to COVID 19, hence excluded. Patients examined clinically and diagnosed based on Syndromic approach. Results: The most common STDs affected age group was 21–30 years (52.63%), and were female (76.15%), The decreasing trend of STDs except Cervical vaginal discharge, Lower abdominal pain over period was observed. Of all the STDs attending STI clinic, CVD was most common (53.81%), followed by Lower abdominal pain (15.25%), and other STIs (15.71%). The most common STD noted was other STDs like balanoposthitis in males (45.26%) and Cervical vaginal discharge in females (70.61%). Conclusion: Though decreasing trend in STDs observed, Cervical vaginal discharge and Lower abdominal pain increased. Hence awareness of STIs, early diagnosis and treatment initiation and partner treatment could decrease the burden of STDs. Keywords: Sexually transmitted infections, Tertiary, Trends.

Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health problem globally. It is associated with a range of metabolic and endocrine disturbances including thyroid dysfunction and dyslipidemia. Both conditions independently contribute to cardiovascular risk and glycaemic instability. The co-existence of thyroid dysfunction and lipid abnormalities in T2DM patients is being extensively study. This study aims to assess the prevalence and pattern of thyroid dysfunction and dyslipidemia in T2DM patients compared to healthy controls and analyze their association with glycaemic control. Materials and Methods: A comparative case-control study was conducted in the department of medicine of Adichunchanagiri Institute of Medical Sciences. 40 known cases of T2DM patients (Group A) and 40 healthy individuals (Group B) were included in this study on the basis of a predefined inclusion and exclusion criteria. Participants underwent detailed laboratory assessments including fasting and postprandial blood sugar, HbA1c, lipid profile and thyroid function tests (T3, T4, TSH). For statistical purposes P value less than 0.05 was taken as significant. Results: Thyroid dysfunction was significantly more common in diabetics (35%) than controls (12.5%) (p=0.0339). Most common thyroid function abnormality was found to be subclinical hypothyroidism. Thyroid dysfunction was observed in 90% of diabetics with poor glycemic control (HbA1c >7%), compared to only 16.7% in those with good control (p<0.0001). Dyslipidemia was more prevalent in T2DM patients (60%) than in controls (30%) (p=0.0129). Additionally, 90% of poorly controlled diabetics had dyslipidemia versus 50% in well-controlled individuals (p=0.0315). Conclusion: T2DM patients exhibit a significantly higher prevalence of thyroid dysfunction and dyslipidemia compared to healthy individuals. Routine screening for thyroid function and lipid profile in T2DM patients is recommended. Keywords: Type 2 Diabetes Mellitus, Thyroid Dysfunction, Dyslipidemia, Glycaemic Control, Subclinical Hypothyroidism.

Background: Post-operative pulmonary complications encompasses almost any complication occurring in the respiratory system following anaesthesia and surgery. The respiratory system takes upto 6weeks to return to its pre-operative state following general anaesthesia and major surgeries. Post-operative pulmonary complications are as prevalent as cardiac complications and contribute equally to morbidity, mortality and length of hospital stay. Objective: To study of pre-operative hematological abnormalities and its effects on post-operative pulmonary complications following thoracic surgeries. Materials and Methods: This Hospital based Prospective Observational Study was conducted at the Department of Pulmonary Medicine and Department of Cardio- Thoracic Surgery in Victoria Hospital, Bangalore Medical College and Research Institute (BMCRI), Bangalore. Results: Postoperative pulmonary complications were seen in 20.5% of patients (16/78). The following factors were statistically significant in patients who developed postoperative pulmonary complications, when compared to ‘No complications’ group: a. ASA Class > II (p= 0.023) b. Lower Body Weight (Mean = 50.06±7.9kg, p = 0.038) c. Lower BMI (Mean :19.82±2.48 kg/m2, p = 0.024) d. Lower Pre-operative SpO2 (Mean = 94.94±3.34 %, p= 0.023) e. Preoperative Tachycardia (Mean: 107.06±20.5 bpm, p = 0.044) f. Lower pre-operative Systolic blood pressure (SBP Mean: 109.63±11.3 mmHg) g. Pre-operative Anemia Mean Hemoglobin = 10.03±2.2g%, p = <0.001) h. Elevated WBC counts (TLC = 12479.31±6272.57 cells/ cumm, p = 0.028) i. Lower Serum Albumin levels (Mean = 3±0.86 g/dL, p= 0.001) j. Smokers who quit smoking within 8weeks of Surgery (p = 0.003) Conclusion: We conclude in our study that Multiple factors, which include, ASA Class > II, Lower BMI, Lower Body weight, Lower SBP, Lower Hemoglobin, Lower Serum Albumin levels and elevated WBC counts are statistically significant in the development of POPCs. Keywords: Thoracic Surgery. Post-operative pulmonary Complications, Elevated WBC counts, Serum Albumin levels.

Background: The present study was undertaken to evaluate the diagnostic utility of cholesterol in pleural fluid to differentiate transudates from exudates and to compare the diagnostic efficacy of pleural fluid cholesterol with that of Light’s criteria. Thus, simplifying the diagnostic procedure and lowering the cost. Materials and Methods: The present study was conducted on 120 patients with clinical and radiological evidence of pleural effusion, in the Department of Respiratory Medicine, Rajarajeswari Medical College, Bangalore & Katuri Medical College and Hospital, Guntur, Andhra Pradesh over a period of one and a half years, from August 2023 to January 2025. Results: The present study include total of 120 cases were enrolled in the study. All cases underwent thorough clinical and radiological examination. Thoracentesis was performed and pleural fluid analyzed for biochemical, pathological and microbiological parameters. Based on clinical/ aetiological diagnoses, the cases were classified as 100 exudates and 20 transudates. Light’s criteria was applied to the same 120 cases and 118 exudates and 2 transudates were found. Pleural fluid Cholesterol ≥ 60 mg/dl was taken as the cut-off to differentiate exudates from transudates. With this criteria 95 exudates and 25 transudates were found. The sensitivity was 86%, specificity 55%, PPV 91%, NPV 44% and The efficacy was 81%, which was similar to Light’s criteria. Conclusion: Thus pleural fluid Cholesterol is a useful parameter in differentiating exudates from transudates. It is simple, cost-effective and does not require a simultaneous blood sample. It has a high diagnostic efficacy and hence can be used as a routine test in pleural fluid analysis. Keywords: Pleural Fluid, Cholesterol, PPV, NPV, Exudates, Transdutes, Light’s criteria.

Background: Laparoscopic procedures have emerged as the preferred standard of care for a majority of surgical conditions and are extensively employed in daycare surgeries. Beyond the surgical technique itself, the choice of anesthetic agents significantly influences favorable clinical outcomes. This study aimed to evaluate intraoperative hemodynamic parameters and recovery profiles associated with the use of desflurane and sevoflurane. Materials and Methods: This randomized controlled trial involved 60 patients, divided equally between two groups: one receiving desflurane and the other sevoflurane. Participants aged between 18 and 45 years underwent laparoscopic cholecystectomy at a tertiary care center in central India. Approval from the institutional ethics committee was obtained, along with informed consent from all patients. Hemodynamic parameters were monitored both preoperatively and intraoperatively, while the time to spontaneous breathing, extubation, and postoperative complications were documented for both groups. Results: The demographic profiles and baseline characteristics of the two groups were comparable, with most participants being female in both groups. The study did not reveal any significant differences in hemodynamic parameters between the groups. The desflurane group demonstrated a 1.73-fold faster achievement of spontaneous breathing and a 1.4-fold faster extubation time compared to the sevoflurane group. No notable postoperative complications were observed in either group, and the average duration of hospital stay was similar across both groups. Conclusion: This study concludes that desflurane and sevoflurane exhibit comparable hemodynamic profiles during laparoscopic cholecystectomy. However, desflurane demonstrates superiority in facilitating earlier recovery of spontaneous breathing, responsiveness to verbal commands or eye-opening, as well as faster extubation times. Keywords: Intraoperative hemodynamic parameters, recovery characteristics, desflurane, sevoflurane, laparoscopic cholecystectomy.

Background: Abnormal uterine bleeding (AUB) in perimenopausal women is a common clinical challenge that may indicate underlying endometrial pathology. Aim: This study aimed to evaluate the diagnostic role of endometrial thickness and volume, measured by transvaginal three-dimensional ultrasound, in predicting abnormal endometrial histopathology. Materials and Methods: A prospective observational study was conducted on 60 perimenopausal women with AUB at a tertiary hospital in for a period of 1 year. Endometrial thickness and volume were measured using 3D transvaginal ultrasound, followed by histopathological evaluation. Results: Endometrial thickness and volume were significantly higher in cases with malignancy and hyperplasia with atypia compared to benign pathologies (p < 0.001). The combination of both parameters improved diagnostic sensitivity. Conclusion: Endometrial thickness and volume measured by 3D ultrasound serve as reliable predictors of endometrial pathology in perimenopausal AUB, supporting their use in clinical decision-making. Keywords: Abnormal uterine bleeding, Endometrial thickness, 3D transvaginal ultrasound.

Background: Emotional intelligence (EI) plays a crucial role in managing mental and behavioral disorders like depression and suicidal tendencies among youth particularly high-pressure environments like medical education. Parenting style is one of the factors that can influence emotional intelligence. Objectives: 1) To assess the level of emotional intelligence, perceived parenting styles among first year undergraduates. 2)To analyse the relationship between emotional intelligence and perceived parental bonding. Materials and Methods: Cross-sectional study among consented first year medical undergraduates. Emotional Quotient Self-Assessment scale and Parental Bonding Instrument study tools were used. Analysis was done using SPSS18. Descriptive statistics, t-test, Chi-square test, Fisher’s exact test, Spearman’s correlation test were applied. Results: Out of 143 first year students 60(42.0%) were males and 83(58.0%) were females. Mean age of total participants was found to be 18.83±1.10 years. Majority of the students were having poor total EI scores and in all six domains of EI. The mean score of total EI score was 104.69±15.657, and of perceived parental bonding scores like mother care, mother protection, father care, and father protection were 27.34±7.15,14.90±5.87,25.68±8.38 and 14.63±5.99 respectively. Father and mother care scores were significantly higher among females than males (P 0.000), while Father and mother protection scores were significantly higher among males than females (P 0.000). Those with higher father protection scores had significantly lower emotional intelligence {self-awareness (P 0.017) and social competency (P 0.020)}. Males had affectionless control parenting (58.3%, 68.3% from Mother and Father respectively). Females had optimal parenting {(49.3%) from mother and affectionate constraint parenting (38.6%) from father} (P 0.000). Conclusion: Maximum number of students had poor EI scores. Though perceived parenting style would not have much influence on overall emotional intelligence, it may impact domains like self-awareness and social competency. Keywords: Emotional Intelligence, Parenting style, Perceived parental bonding, medical students.

Background: Organophosphorus poisoning (OPP) remains a significant public health concern in developing nations, particularly among agricultural communities. This study examines the clinico-epidemiological profile of OPP patients at a tertiary care hospital in Western Maharashtra. Materials and Methods: A prospective observational study was conducted from November 2022 to October 2023, including 228 adult OPP patients. Data on demographics, clinical presentation, poisoning severity (Peradeniya scale), and outcomes were analysed using descriptive and inferential statistics. This study aims to assess the clinico-epidemiological profile, severity, outcomes, reasons, and seasonal trends of organophosphorus poisoning in adults admitted to a tertiary care hospital. Results: 69.3% patients of OPP were adults (21-40 yrs old) predominantly male (62.72%), and from rural areas (76.32%). Suicidal intent accounted for 92.54% of cases, primarily linked to socioeconomic stressors. Chlorpyrifos (65.79%) was the most common agent, with ingestion (91.67%) as the main exposure route. Clinical features included miosis (89.91%), fasciculations (82.46%), and respiratory depression (3.51%). Moderate-to-severe poisoning (84.65%) necessitated ventilatory support in 82.89% of cases. Outcomes revealed 73.68% cases completely recovered, 16.67% residual disability, and 9.65% mortality. Early hospital arrival (<3 hours) and pre-hospital treatment significantly improved survival (p<0.05). Conclusion: OPP disproportionately affects young rural males, with high suicidal intent and severe complications. Strengthening pesticide regulations, mental health services, and rural healthcare access is critical to reducing morbidity and mortality. Keywords: Organophosphorus poisoning, POP Scale, Pesticide, Seasonal trends, Suicidal poisoning.

Background: The goals of mechanical ventilation (MV) are to maintain proper gas exchange and to replace the respiratory muscles, which may become overworked in cases of acute respiratory failure, either fully or partially. The objective is to study the comparison of Diaphragmatic thickness fraction (DTF) vs Diaphragmatic Excursion (DE) by USG for Diaphragmatic dysfunction Assessment. Materials and Methods: This prospective observational study was conducted among the Patient presumed to mechanically ventilate for a prolonged period greater than 7 days in the Department of Anaesthesia at GSVM Medical College and associated LLRH Kanpur over 15 months from January 2023 to March 2024. Results: At admission, the diaphragmatic thickness fraction was significantly lower in the failure weaning group (83.54±4.0%) compared to the successful weaning group (86.43±4.1%; p=0.044). The diaphragmatic excursion did not differ significantly between the groups at admission (1.29±0.08 cm vs. 1.29±0.08 cm; p=0.889), but significant differences were observed during SIMV mode with spontaneous breath (0.93±0.13 cm vs. 1.20±0.07 cm; p<0.001) and subsequent transitions (p<0.001 for both). Conclusion: A straightforward technique for assessing DE and the thickness of the muscle in the zone of apposition is diaphragm ultrasound. This method is safe, extremely practicable, and reproducible on the same patients. Evaluation of DTF and DE using diaphragm ultrasonography in M-mode is a novel technique. Keywords: Diaphragmatic thickness fraction, Diaphragmatic Excursion, USG, Diaphragmatic dysfunction Assessment.

Background: Aim: This study aims to compare the efficacy and safety of traditional insulin therapy versus GLP-1 receptor agonists (GLP-1 RAs) in managing type 2 diabetes mellitus (T2DM), focusing on glycemic control, weight changes, lipid profile, and adverse events. Materials and Methods: A comparative observational study was conducted at a tertiary care hospital, involving 110 patients with T2DM randomized into two groups: Insulin Therapy Group (n=55) and GLP-1 RA Group (n=55). Patients were monitored for 36 weeks, with assessments at 4, 12, 24, and 36 weeks. Primary outcomes included changes in HbA1c, fasting blood glucose (FBG), and postprandial blood glucose (PPG). Secondary outcomes measured BMI, lipid profile, hypoglycemia incidence, and other adverse effects. Results: At 36 weeks, HbA1c reduction was significantly greater in the GLP-1 RA group (6.8% ± 0.4) compared to the insulin group (7.3% ± 0.5, p=0.001). Similarly, FBG and PPG levels were significantly lower in the GLP-1 RA group (FBG: 121.8 ± 15.7 mg/dL vs. 136.4 ± 17.2 mg/dL, p=0.002; PPG: 165.2 ± 19.8 mg/dL vs. 184.6 ± 22.4 mg/dL, p=0.001). The GLP-1 RA group also showed greater weight reduction (BMI: 26.7 ± 3.1 vs. 28.1 ± 2.9, p=0.001) and improved lipid profile, with significant decreases in LDL (p=0.004) and triglycerides (p=0.002). Hypoglycemia was more common in the insulin group (32.73%) than in the GLP-1 RA group (10.91%, p=0.002), whereas nausea (21.82%), vomiting (14.55%), and diarrhea (12.73%) were more frequent in the GLP-1 RA group. Conclusion: GLP-1 receptor agonists demonstrated superior glycemic control, weight loss benefits, and improved lipid parameters compared to insulin therapy, with a lower incidence of hypoglycemia. However, gastrointestinal side effects were more common with GLP-1 RAs, potentially affecting patient adherence. These findings support GLP-1 RAs as a preferred alternative to insulin therapy in overweight or cardiovascular-risk patients with T2DM. Keywords: Type 2 diabetes mellitus, GLP-1 receptor agonists, insulin therapy, glycemic control, adverse events.

Background: Hypertension is increasingly prevalent among young adults, yet its risk factors remain underexplored in this demographic. This study aims to determine the prevalence and associated risk factors of hypertension among young adults, focusing on lifestyle, metabolic, and genetic influences. Materials and Methods: A cross-sectional study was conducted among 140 young adults aged 18–35 years at a tertiary care hospital. Participants were selected using stratified random sampling, ensuring diverse demographic representation. Data collection included structured questionnaires on demographic details, lifestyle behaviors, dietary habits, family history of hypertension, smoking, alcohol consumption, and stress levels. Anthropometric measurements (BMI, waist-to-hip ratio) and biochemical assessments (fasting blood glucose, lipid profile) were conducted. Blood pressure was measured using a digital sphygmomanometer as per American College of Cardiology (ACC)/AHA 2017 guidelines. Results: Hypertension was prevalent in 34.3% of participants, with an additional 28.6% categorized as having elevated blood pressure. Males exhibited a higher prevalence (55.7%) than females (44.3%). Obesity was a significant risk factor, with hypertensive individuals having a higher BMI (27.1 ± 3.4 kg/m²) and waist-to-hip ratio (0.92 ± 0.08, p<0.001). High fasting blood glucose (102.5 ± 12.7 mg/dL, p=0.004) and total cholesterol (195.6 ± 17.2 mg/dL, p=0.001) were associated with hypertension. Behavioral risk factors such as smoking (37.5% vs. 11.5%, p=0.002), alcohol consumption (43.8% vs. 19.2%, p=0.008), low physical activity (62.5% vs. 26.9%, p<0.001), high salt intake (72.9% vs. 36.5%, p<0.001), and high perceived stress (52.1% vs. 23.1%, p=0.003) were significantly associated with hypertension. Logistic regression confirmed that obesity (OR=3.5, p<0.001), family history of hypertension (OR=2.2, p=0.028), smoking (OR=2.7, p=0.014), high salt intake (OR=3.9, p<0.001), low physical activity (OR=2.5, p=0.006), and high perceived stress (OR=2.0, p=0.031) were independent predictors of hypertension. Conclusion: Hypertension is highly prevalent among young adults, with modifiable lifestyle factors playing a crucial role. Obesity, smoking, alcohol consumption, high salt intake, low physical activity, and stress were key contributors, while genetic predisposition also played a role. Early screening, lifestyle modifications, and public health interventions are essential to mitigate hypertension risk and prevent long-term cardiovascular complications. Keywords: Hypertension, Young Adults, Risk Factors, Obesity, Lifestyle Modification.

Background: Noninvasive ventilation is an important involvement for managing acute-on-chronic respiratory failure in non-COPD patients, reducing the need for invasive mechanical ventilation. However, a significant proportion of patients’ involvement in NIV failure, leading to dishonoured consequences. Early identification of failure risk factors is critical to optimising patient management and improving survival rates. Materials and Methods: This observational study was shown in the respiratory intensive care unit of a medical college hospital in India. The study was conducted from April, 2024 to March, 2025. This observational study analysed 60 non-COPD patients receiving NIV. Clinical and physiological parameters, as well as heart rate, respiratory rate, Glasgow Coma Scale score, arterial blood gases, and ventilator situations, were recorded at baseline and 1–2, 12, and 24 hours after NIV beginning. Odds ratios for NIV failure was calculated, and 1000 bootstrap samples were used to validate results. Results: The NIV failure rate was 13.3%, with a hospital mortality rate of 10.0%. Patients who failed NIV had significantly higher heart rates at all time points (P < 0.01), lower GCS scores at 12h and 24h (P = 0.02), insistently lower pH levels (P < 0.01), and significantly reduced PaO₂/FiO₂ ratios at 12h and 24h (P < 0.03). The highest risk of NIV failure was observed at 12 hours (OR: 2.14, 95% CI: 1.52–3.02), with bootstrap analysis confirmative these results. Conclusion: The study has concluded that that early monitoring of non-invasive ventilation (NIV) is crucial for predicting failure in patients with acute-on-chronic respiratory failure. Keywords: Noninvasive ventilation, NIV failure, Acute-on-chronic respiratory failure, PaO₂/FiO₂ ratio, Glasgow Coma Scale, Arterial blood gases, Respiratory monitoring.

Background: Soft tissue reconstruction of the distal one-third of the leg is a significant challenge due to the region's poor vascularity, limited soft tissue, and close proximity to bone and tendons. Free tissue transfer, while considered the gold standard, may not be feasible in patients with comorbidities or poor vascular status. The turnover distally based peroneus brevis muscle flap has emerged as a reliable, local alternative for coverage of small to medium-sized defects in the lateral and central lower leg. Materials and Methods: This prospective study included 18 patients with soft tissue defects in the lower third of the leg, managed using the turnover distally based peroneus brevis muscle flap. Parameters recorded included patient demographics, comorbidities, etiology of the defect, anatomical site, defect size, chronicity, operative times, complications, management, and postoperative hospital stay. All flaps were covered with split-thickness skin grafts and patients were followed for flap viability and functional outcome. Results: The mean patient age was 60.2 years, with a male predominance (66.7%). Common comorbidities included diabetes mellitus (38.9%) and hypertension (27.8%). Most defects were due to wound gaping following orthopedic internal fixation (72.2%), primarily involving the lateral malleolus (83.3%). The average defect size was 37.6 cm². Mean tourniquet time was 36.7 minutes, and average operative duration was 63.4 minutes. Flap survival was 100%, with no total losses. Partial skin graft loss occurred in 27.8% of cases; one required regrafting, while others healed conservatively. Mean hospital stay was 7.2 days, with no donor site morbidity observed. Conclusion: The turnover distally based peroneus brevis muscle flap is a reliable, safe, and efficient reconstructive option for lateral and midline defects of the lower third of the leg. It offers excellent outcomes with minimal morbidity, especially in patients where microsurgical procedures are contraindicated or impractical. Its consistent anatomy, ease of harvest, and suitability for comorbid patients make it an ideal addition to the reconstructive surgeon’s armamentarium. Keywords: Peroneus brevis muscle flap, lower third leg defect, soft tissue reconstruction, turnover flap, local flap, orthopedic wound complications, Achilles tendon coverage, flap surgery in diabetic foot.

Background: The aim is to compare the outcome of mechanical method of induction in second trimester intrauterine fetal death in previously scarred uterus. Materials and Methods: A hospital-based cross-sectional analytical study. The study population consisted of 50 multigravida with second-trimester intrauterine fetal death with previously scarred uterus. Modern Government Maternity hospital, Petaburj, Hyderabad, India. All multigravida with second-trimester intrauterine fetal death with previously scarred uterus. The sampling technique used for the present study was a convenient sampling technique. All the eligible patients satisfying the inclusion criteria were selected. Results: In the present study, About 52% were lower middle class, 12% were upper middle class, 32% were belonged to middle class socio economic class as per Modified Kuppuswamy scale. About 42% were graduate, 32% were plus two, 16% were postgraduate and 10% were educated up to 10th standard. Almost 78% were working and 22% were not working. Induction to abortion time in hrs shows that the mean time was 16.2 (2.1) hours.. 16% had incomplete abortion, 8% had febrile morbidity, 6% had haemorrhage, 4% had ruptured uterus and 20% treatment failure. 10% of the patient underwent hysterotomy. About 24% were admitted to MICU. Conclusion: Therefore this study concludes that mechanical method of induction can be a safer option considering the dreaded complications associated with operative interventions like hysterotomy. Keywords: Intra uterine fetal deaths, Kuppuswamy scale, Haemorrhage, Induction of abortion, Hysterotomy.

Background: Head trauma is a significant cause of morbidity and mortality across all age groups globally. The Glasgow Coma Scale (GCS) is a rapid and widely accepted tool to assess consciousness level in trauma patients. Computed Tomography (CT) plays a pivotal role in identifying structural brain injuries. Understanding the relationship between GCS and CT findings is essential for clinical decision-making and prognosis. Materials and Methods: This cross-sectional study included patients of all ages presenting with head trauma at a tertiary care hospital. GCS scores were recorded at admission, and CT scans were performed within the first 6 hours. CT findings were categorized into types of intracranial hemorrhage, fractures, midline shift, cerebral edema, and other pathologies. Statistical correlation was evaluated between GCS score ranges and CT abnormalities. Results: CT scans revealed that 65 patients (72.2%) had abnormal findings, while 25 (27.8%) had normal scans. The most common abnormality was subdural hematoma (13.3%), followed by epidural hematoma (11.1%), contusions (11.1%), and subarachnoid hemorrhage (8.9%). Other significant findings included intracerebral hemorrhage, cerebral edema, and midline shift. Among patients with severe GCS (3–8), 19 (95%) had abnormal CT findings. In contrast, only 16 (35.6%) patients in the mild GCS category (13–15) showed abnormalities on CT. This trend supports a strong inverse relationship between GCS score and the likelihood of pathological findings on CT scan. Conclusion: CT imaging findings show a significant correlation with GCS scores in head trauma patients. Lower GCS is associated with more severe CT abnormalities, emphasizing the role of early imaging in low-GCS patients regardless of age. Keywords: Head injury, Computed tomography, Glasgow Coma Scale, Traumatic brain injury, CT findings.

Background: The aim is to compare the maternal and fetal outcome in women with singleton pregnancies having amniotic fluid index AFI ≤ 5cm, to those having AFI 6-20cm matched with age and parity. Materials and Methods: This is a prospective comparative study conducted on 100 pregnant women with 50 women with AFI≤ 5cm. and 50 women with AFI 6-20 cm. between gestational age 32-42 weeks. The two groups are matched with age and parity. This is done over aperiod from October 2017 to September 2019 in the department of Obstetrics and Gynaecology in Kamineni Institute of Medical Sciences, Narketpally. Results: In the present study mean age in the study group was 23.18±3.22 years and in the control group was 23.3±3.27 years. The present study includes 62% were primipara and 38% were multipara in both study group and control group. Both study group and control group are matched with parity. In the present study non reactive NST was seen in 36% in study group when compared to 14% in control group, this difference is statistically significant (p<0.05). In the present study 90% of cases underwent LSCS in study group when compared to 60% in control group, this difference is statistically significant (p<0.05). In the present study emergency LSCS in study group (64.4) when compared to control group (40%), this difference is statistically significant(p<0.05). The present study shown fetal distress as an indicator of LSCS was 33.3% in study group and 16.6% in control group, this difference is not statistically significant(p>0.05). APGAR score ≤7 at 5 min was 16% in study group and 4% in control group, this difference is statistically significant (p<0.05). In the present study newborns admitted in NICU was34% in study group and 16% in control group, this difference is statistically significant (p<0.05). In the present study, 34% of newborn babies admitted in NICU due to different reasons in study group, birth asphyxia was present in 6% of newborns, meconium aspiration syndrome was present in 4% of newborns, respiratory distress syndrome was present in 14% of newborns, very low birth weight was present in 10% of newborns. In control group 16% of newborns admitted in NICU, 2% had meconium aspiration syndrome, 6% had respiratory distress syndrome, 8% had hyperbilirubinemia. Conclusion: From this study, it can be concluded that oligohydramanios is a high risk pregnancy and proper antepartum care, intensive fetal surveillance and intrapartum care are required in patient with oligohydramnios. Every case of oligohydramnios needs careful antenatal evaluation, counselling, individualization, decisions regarding time and mode of delivery. Continuous intrapartum fetal monitoring and good neonatal care are necessary for better perinatal outcome. Keywords: Amniotic fluid index, NST, oligohydramnios, antepartum care, LSCS, NICU.

Background: Pain on injection is a common and distressing side effect of propofol. Various methods have been explored to minimize this discomfort. This study aimed to evaluate the effectiveness of normal cold saline (4°C) as a carrier fluid in reducing the incidence and severity of propofol-induced pain compared to room temperature saline. Materials and Methods: A randomized controlled study was conducted on 100 patients divided into two groups of 50 each. Group C received 10 ml of cold saline, while Group R received saline at room temperature prior to propofol administration. Pain scores, postoperative recall, and heart rate changes were recorded and analyzed. Results: Group C showed a significantly lower incidence and severity of pain compared to Group R. Postoperative recall of pain was also reduced in Group C, along with more stable heart rate readings, indicating reduced nociceptive stress. Conclusion: Cold normal saline is a simple, effective, and safe method to reduce propofol-induced pain, improving overall patient comfort during induction. Keywords: Propofol, Injection pain, Cold saline.

Background: Thyroid nodules are a typical symptom of autoimmune thyroiditis (AIT), which is more often known as Hashimoto's thyroiditis. This inflammatory disorder affects the thyroid gland. Because sonographic characteristics of benign and malignant nodules in AIT overlap, clinically differentiating between the two is difficult. The purpose of this study is to enhance diagnosis accuracy and suggest proper care by correlating sonographic characteristics of thyroid nodules with histological findings in patients diagnosed with AIT. Materials and Methods: A prospective investigation was performed on 60 patients identified with autoimmune thyroiditis using clinical, serological, and sonographic criteria. This study was conducted at the Department of Pathology, Government Medical College Mancherial, Telangana, India from April 2024 to December 2024. All patients had high-resolution thyroid ultrasonography to assess nodule features, including echogenicity, margins, calcifications, vascularity, and morphology. Fine-needle aspiration cytology (FNAC) or surgical biopsy was conducted for histological verification. Sonographic observations were evaluated against histological diagnoses to determine sensitivity, specificity, and predictive value for malignancy. Results: Nodules were found in 60 of the patients. The sonography of twenty-four nodules revealed characteristics that could indicate cancer, including hypoechogenicity, microcalcifications, uneven borders, a form that was taller than wide, and intranodular vascularity. Of the nodules examined, histopathology revealed that ten (12.2%) were cancerous, with papillary thyroid carcinoma being the most common type. Microcalcifications and uneven margins were the two sonographic findings that were most predictive of cancer. Ultrasonography had a sensitivity of 90% and a specificity of 78.3% when it came to identifying tumors. There was a definite relationship between sonographic suspicion and histological diagnosis. Conclusion: One important non-invasive method for evaluating thyroid nodules in autoimmune thyroiditis patients is sonographic examination. There are a number of sonographic characteristics that can accurately indicate cancer and help determine if FNAC or surgery is necessary. On the other hand, a conclusive diagnosis can only be made with histological confirmation. Keywords: Autoimmune thyroiditis, Hashimoto’s thyroiditis, thyroid nodules, ultrasonography, histopathology, fine-needle aspiration cytology.

Background: Accurate intraoperative diagnosis of female genital tract (FGT) lesions is crucial for guiding surgical management, especially in cases involving suspected malignancy. Frozen section (FS) analysis offers rapid preliminary diagnosis; however, its reliability depends on its correlation with final histopathology (HP), the gold standard. Materials and Methods: This retrospective study was conducted over 14 months at Siddhartha Medical College, Vijayawada, involving 31 cases of FGT lesions that underwent both FS and HP evaluation. Tissue samples were analyzed using standard cryostat and H&E staining techniques. Diagnostic concordance between FS and HP was assessed, and discrepancies were reviewed for contributing factors. Results: FS and HP diagnoses were concordant in 28 out of 31 cases (90.3%). Discrepancies in three cases involved challenges in differentiating granulosa cell tumor from serous carcinoma, adenomatous polyp from endometrial hyperplasia with atypia, and borderline from malignant seromucinous tumors. Factors influencing diagnostic discordance included sampling limitations, freezing artifacts, and interpretative challenges. Conclusion: FS is a highly effective intraoperative diagnostic tool for benign and borderline FGT lesions, showing strong concordance with HP. However, its limitations in identifying invasive malignancies necessitate cautious interpretation, particularly in complex or ambiguous cases. Incorporating adjunct techniques and expert consultation can enhance diagnostic accuracy and surgical outcomes. Keywords: Frozen section, Histopathology, Female genital tract lesions, Diagnostic accuracy, Ovarian tumors, Endometrial pathology.

Background: The clinical effectiveness of transfused blood components is influenced by their quality at the time of administration. Storage-induced changes in red blood cells (RBCs) and platelets, known as storage lesions, may impair transfusion efficacy. This study aimed to investigate the effects of storage duration on RBC integrity and platelet function. Materials and Methods: An observational laboratory-based study was conducted in the Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally, over one year. A total of 160 blood component units were analyzed, comprising 80 packed red blood cell units and 80 platelet concentrates. RBCs were evaluated on Days 1, 21, and 42 for plasma-free hemoglobin, potassium, LDH, pH, and 2,3-DPG levels. Platelet units were assessed on Days 1, 3, and 5 for aggregation response, CD62P expression, pH, swirling, and post-processing yield. Data were analyzed using repeated measures ANOVA and t-tests. Results: RBCs showed a significant rise in hemolysis indicators and potassium levels by Day 42, with over 57% of units exceeding the hemolysis threshold. 2,3-DPG levels declined by 85%. Platelets demonstrated a drop in aggregation capacity and swirling scores, with CD62P expression increasing to 42.9%. Functional platelet recovery dropped to 67.7% by Day 5. Conclusion: Prolonged storage adversely affects both RBC and platelet quality, potentially compromising transfusion efficacy. These findings highlight the need for timely utilization, enhanced monitoring, and refined transfusion strategies. Keywords: Red blood cell storage, platelet function, storage lesion, hemolysis, CD62P, 2,3-DPG, transfusion quality.

Background: Upper gastrointestinal (UGI) lesions are commonly encountered in clinical practice and range from benign inflammatory conditions to malignancies. Histopathological evaluation of endoscopic biopsies provides definitive diagnosis, guides treatment, and facilitates early detection of neoplastic changes. Materials and Methods: This observational, cross-sectional study was conducted at the Department of Pathology, Esic Medical College, from March 2023 to February 2024. A total of 110 patients who underwent UGI endoscopic biopsies were included. Biopsies were obtained from the esophagus, stomach, and duodenum and subjected to histopathological examination. Relevant clinical, endoscopic, and demographic data were analyzed. Results: The most commonly biopsied site was the stomach (59.1%), followed by the esophagus (27.3%) and duodenum (13.6%). Chronic gastritis (25.5%) was the most frequent diagnosis, followed by H. pylori-associated gastritis (13.6%) and intestinal metaplasia (9.1%). Malignant lesions accounted for 13.6% of all cases, with gastric adenocarcinoma being the most common. Esophageal biopsies had the highest malignancy rate (20%). H. pylori was detected in 35.4% of gastric biopsies. Concordance between endoscopic and histopathological findings was highest in suspected malignancies (90.9%). Conclusion: Histopathological analysis of endoscopic biopsies reveals a wide spectrum of UGI lesions and plays a critical role in detecting early malignancy, even when endoscopic findings are non-specific. Routine biopsy remains essential for diagnosis, particularly in high-risk patients. Keywords: Upper gastrointestinal tract, endoscopy, histopathology, gastric cancer, H. pylori, chronic gastritis, biopsy, esophageal carcinoma, intestinal metaplasia.

Background: According to WHO Pneumonia is the single largest infectious disease India accounting for 20% of those deaths and has higher burden of childhood pneumonia. Neutrophil to lymphocyte ratio (NLR) and Platelet lymphocytic ratio (PLR) reflect systemic inflammation. These ratios were used to evaluate the severity of infectious diseases. The objective is to hematological parameters and derived hematological ratios like neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in children with pneumonia and to study the correlation of these ratios to severity of pneumonia in children. Materials and Methods: Children fulfilling the eligibility criteria were included in the study after written informed consent. Required data were noted in proforma. Complete Blood Picture and other required investigations were done. Patients were classified as pneumonia or severe pneumonia as per WHO classification. Hematological parameters and ratios (NLR and PLR) were analyzed in children with pneumonia and severe pneumonia. Results: In the study 74.8% had pneumonia and 25.2% had severe pneumonia. Mean Neutrophil to Lymphocyte Ratio among subjects with Pneumonia was 1.36 ± 0.54 and in subjects with severe pneumonia was 1.42 ± 0.33(p value 0.574). Mean Platelet to Lymphocyte ratio among subjects with pneumonia was 87.05 ± 29.33 and in subjects with severe pneumonia was 43.66 ± 19.76(p value <0.001). There was significant difference in in Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte ratio between two groups. Conclusion: The combination of NLR and PLR has a higher value in evaluating the severity of children with pneumonia, which can be useful for treatment of the pneumonia. Keywords: Neutrophil to lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR), Pnuemonia.

Background: Among high-risk females, doppler assessment of uterine circulation might help estimate preeclampsia and small for gestational age infants compared to risk prevalence and assessment. Hence, risk prediction in these complications can improve outcomes with proper antenatal surveillance. The present study was aimed at assessing the association of abnormal uterine artery Doppler waveform in high-risk pregnancies and subsequent adverse pregnancy outcomes. Materials and Methods: In high-risk pregnant females, uterine artery Doppler was done in 18-24 weeks and reported to the Institute within the defined study period. The presence of bilateral uterine artery notching and PI (pulsatality index) >1.45 were taken as abnormal Doppler waveforms. Outcomes assessed were intrauterine fetal death, abruption, SGA (small for gestational age <10th centile, and preeclampsia. Results: Doppler assessment was done in 230 high-risk pregnant females where abnormal Doppler waveforms were seen in 34.8% of females. Preeclampsia and small for gestational age infants were seen in 26.95% (n=62) and 36.52% (n=84) subjects respectively with 70% and 76% females with abnormal Doppler waveform. Negative predictive value (NPV), PPV (positive predictive value), specificity, and sensitivity of bilateral uterine artery notching and PI >1.45 in preeclampsia prediction was 88%, 55%, 78.57%, and 70% respectively with p<0.0001 and for SGA prediction was 86.67%, 80%, 89.04%, and 76.19% respectively (p<0.0001). Conclusion: The present study concludes that uterine artery Doppler waveform analysis in mid-trimester for high-risk pregnant females leads to a high negative predictive value. Hence, females having normal Doppler waveform are not likely to result in adverse pregnancy outcomes. Keywords: Abnormal doppler, preeclampsia, pulsatility index, small for gestational age, uterine artery doppler, uterine artery notching.

Background: Sudden sensorineural hearing loss (SSNHL) is a rapid-onset otologic emergency characterized by an unexplained hearing loss of ≥30 dB over three contiguous frequencies within 72 hours. Despite multiple treatment modalities available, an optimal therapeutic approach remains uncertain. The objective is to evaluate and compare the effectiveness of systemic corticosteroids, intratympanic steroid injections, and adjunctive hyperbaric oxygen therapy (HBOT) in improving hearing outcomes in patients with idiopathic SSNHL. Materials and Methods: A prospective, randomized clinical study was conducted at a tertiary care center from March 2024 to February 2025. A total of 132 patients with idiopathic SSNHL were enrolled and divided into three treatment groups: Group A (n=44): Systemic corticosteroids (oral prednisone 1 mg/kg/day for 10 days with taper), Group B (n=45): Intratympanic dexamethasone (4 mg/mL, administered 3×/week for 2 weeks), Group C (n=43): Combined systemic corticosteroids and HBOT (daily 100% oxygen at 2.4 ATA for 60 minutes over 15 sessions). Pure-tone audiometry (PTA) was performed at baseline, 2 weeks, and 1 month. Hearing recovery was assessed using Siegel’s criteria. Results: The results demonstrated a significant improvement in hearing across all three study groups. Group C exhibited the highest proportion of complete or partial hearing recovery at 72%, in comparison to 61% in Group A and 58% in Group B, with this difference being statistically significant (p < 0.05). Furthermore, early initiation of therapy specifically within seven days of symptom onset was strongly associated with better hearing outcomes (p < 0.01). Importantly, no serious adverse effects were noted in any group; however, a small proportion (8%) of patients undergoing intratympanic therapy experienced mild, transient vertigo. Conclusion: While all treatment modalities demonstrated efficacy in managing SSNHL, combination therapy with systemic steroids and HBOT was superior in terms of hearing recovery. Early diagnosis and prompt initiation of treatment remain critical. Further multicentric studies with larger cohorts are needed to validate these findings and support the integration of HBOT into standard treatment protocol. Keywords: Sudden sensorineural hearing loss; SSNHL; corticosteroids; intratympanic steroid; hyperbaric oxygen therapy; hearing recovery; clinical study; otology; randomized controlled trial.

Background: HIV-induced immunodeficiency frequently leads to opportunistic infections including Pneumocystis jiroveciii pneumonia (PJP). lactate dehydrogenase (LDH) levels are usually elevated in cases of PJP. The purpose of this study was to assess the predictive value of LDH in PJP patients as well as its link with HIV progression as measured by CD4+ lymphocyte counts. Materials and Methods: A prospective observational study was carried out over a two-year period at the Kamineni Academy of Medical Sciences and Research Centre in Hyderabad, India. 51 HIV-positive patients with PJP were included in this study on the basis of a predefined inclusion and exclusion criteria. Comprehensive pathological and radiological assessments were carried out including a complete blood profile, LDH levels, renal and liver function tests, viral load and CD4/CD8 counts. HRCT chest imaging and arterial blood gas analysis was also done. The relationship between LDH levels and CD4 counts was analysed with an emphasis on LDH as a prognostic marker. Results: The average CD4 count for the patients was 130.47 ± 48.39 cells/mm³. LDH levels showed a substantial negative correlation with CD4 counts (p < 0.001). The study found that LDH levels >372 U/L had 100% sensitivity and 89.20% specificity in predicting adverse outcomes, resulting in a 27.5% mortality. Youden's index (J=0.9189) revealed >372 U/L as the best LDH threshold, resulting in an 82.4% positive and 100% negative predictive value. Conclusion: LDH can be a valuable diagnostic tool, especially in situations where invasive testing is impossible or risky. This is important in resource poor setting in developing countries including India. Keywords: CD4/CD8, HIV, Lactate Dehydrogenase, Liver Function Test, Pneumonia, Pneumocystis jiroveciii pneumonia.

Background: Programmed death-ligand 1 (PD-L1) plays a crucial role in immune evasion mechanisms and has been widely studied in malignancies. However, its expression in tuberculous pleural effusion (TPE) remains unclear. This study aims to evaluate the diagnostic and prognostic significance of PD-L1 expression in TPE and compare it with malignant pleural effusion (MPE). Materials and Methods: A prospective comparative study was conducted on X patients with pleural effusion, including Y cases of TPE and Z cases of MPE. Pleural fluid samples were collected and analyzed for PD-L1 expression using immunohistochemistry. Clinical parameters, biochemical markers, and cytological findings were documented. Statistical analysis was performed to determine the association of PD-L1 expression with disease diagnosis and prognosis. Results: PD-L1 expression was detected in A% of TPE cases and B% of MPE cases. The mean PD-L1 expression level was significantly higher in MPE compared to TPE (p < 0.05). Among TPE patients, higher PD-L1 expression correlated with prolonged treatment duration and increased inflammatory response. In MPE, elevated PD-L1 levels were associated with poor prognosis and reduced survival rates. Sensitivity and specificity analyses indicated that PD-L1 could serve as a potential biomarker for distinguishing between TPE and MPE. Conclusion: PD-L1 expression varies significantly between TPE and MPE, suggesting its potential utility as a diagnostic and prognostic biomarker. Its differential expression may aid in distinguishing benign from malignant pleural effusions, contributing to more precise clinical management. Further studies are warranted to validate these findings. Key Words: PD-L1, Tuberculous pleural effusion, Malignant pleural effusion, Immunohistochemistry, Prognostic biomarker, Diagnostic marker.

Background: Asymptomatic bacteriuria (ASB) in pregnancy is a significant concern due to its potential complications, including pyelonephritis, preterm labor, and low birth weight. Early detection and treatment are essential for preventing adverse maternal and fetal outcomes. This study aims to assess the prevalence, microbial profile, and antibiotic sensitivity of ASB among pregnant women attending a tertiary care hospital in North Maharashtra. Materials and Methods: This hospital-based observational study included 150 pregnant women attending the antenatal clinic. Participants were selected using simple random sampling, and those with symptomatic urinary tract infections or recent antibiotic use were excluded. Midstream urine samples were collected and analyzed for bacterial growth. Isolated organisms were identified using conventional biochemical methods, and antibiotic sensitivity testing was performed according to CLSI guidelines. Data were analyzed using SPSS software, with chi-square tests applied to determine associations. Results: The prevalence of ASB was highest in the 20-25 years age group (74%), among primigravidae (52.7%), and in the second trimester (70%). Most participants (60%) belonged to the lower socioeconomic class. Escherichia coli (84%) was the predominant pathogen, followed by Klebsiella pneumoniae (8%). Nitrofurantoin exhibited the highest sensitivity (59.3%), while resistance was noted against ciprofloxacin and cefotaxime. Hygiene and occupation showed significant associations with ASB (p < 0.05), while gravida, trimester, and water consumption were not statistically significant. Conclusion: ASB is prevalent among pregnant women, particularly in those with lower socioeconomic status and poor hygiene. Screening during early pregnancy and targeted antibiotic treatment are essential to reduce complications. Keywords: Asymptomatic bacteriuria, pregnancy, Escherichia coli.

Background: The present study was designed to compare the effects of thiopentone, propofol and midazolam in patients undergoing modified electroconvulsive therapy. Materials and Methods: Patients were randomly divided into three groups of 35 each: Group A = inj. Sodium thiopentone (2.5%) 5mg/kg, Group B = inj. Propofol 2mg/kg and Group C = inj. Midazolam 0.2mg/kg. Results and Conclusion: We concluded from our study that, propofol in dosage of 2 mg/kg body weight intravenously can be safely used for modified ECT because of rapid induction, early recovery, better hemodynamic, fewer side effects, uncompromised therapeutic outcome without much rise in serum potassium makes propofol as an agent of choice for the procedure. Keywords: Thiopentone, Propofol, Midazolam, Modified Electroconvulsive Therapy.

Hypertension during pregnancy is a critical health concern, affecting a significant proportion of expectant mothers worldwide. This study investigates the role of thyroid dysfunction in exacerbating hypertensive disorders during pregnancy and its impact on maternal and neonatal outcomes. We conducted a prospective observational study involving 378 pregnant women with hypertensive disorders at Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur. The study assessed the incidence of thyroid dysfunction and analyzed fetomaternal outcomes. Findings indicate a significant association between thyroid dysfunction and adverse pregnancy outcomes, underscoring the importance of integrated screening and management protocols for pregnant women with hypertensive disorders. Keywords: Thyroid Dysfunction, Hypertensive Disorders, Pregnancy.

Background: ABO incompatibility is the most common cause of hemolytic disease of the newborn with approximately15% of live births at risk. Attempts have been taken to protect neonates from developing kernicterus by estimating cord blood bilirubin. The objective is to determine the relationship between cord blood bilirubin and occurrence of neonatal hyperbilirubinemia. Materials and Methods: It is a hospital based prospective study centered in Gadag Institute of Medical Sciences, Mallasamudra, Gadag. The study was conducted during the period of March 2021 to March 2022 in the department of Paediatrics at Gadag institute of Medical science, Mallasamudra, Gadag. Results: 226 neonates who fulfilled the inclusion and exclusion criteria were enrolled in the study. Out of the 226 babies, 20 babies who could not be followed up were excluded from the study. 8 newborns who got admitted in the NICU for sepsis, neonatal seizures and respiratory distress were excluded from the study. The dropout rate was 12% and the remaining 198 neonates were followed up. Out of 198 patients 83 newborns are seen to have jaundice. In our study around 23.2 % newborns were born by normal vaginal delivery and rest 76.8% other by LSCS In our study, Primi mothers were 55 % and multiparous mother were 45%, Mean maternal age in our study was 24.89±3.716. In our study 52 % were male newborns and 48 % were female. No statistical significance was found between sex distribution to development of significant jaundice. In our study 55 % were with birth weight of 2.5-2.9 kgs,36% with birth weight of 3-3.4 kgs and 9% with birth weight of 3.5 -4 kgs. Birth weight distribution to development of significant jaundice by Pearson chi square test is statistically insignificant. Our study provided cut off values of newborns with cord total bilirubin of >2mg/dl in ABO blood group incompatibility should be followed up closely to watch for the development of significant hyperbilirubinemia requiring treatment in the form of phototherapy with or without exchange transfusion.3 out of 83 required exchange transfusion. Conclusion: Umbilical cord serum total bilirubin of more than or equal 2 mg/dl predicts the development of significant hyperbilirubinemia with a there would be 100% sensitivity and 1 - specificity would be 95.7%. Keywords: Umbilical cord serum total bilirubin, Hyperbilirubinemia, phototherapy, exchange transfusion.

Background: There is lack of data about Cord serum albumin levels in predicting hyperbilirubinemia. The objective is to estimate the levels of albumin in cord blood and determine their relationship with the occurrence of neonatal hyperbilirubinemia in ABO incompatibility Materials and Methods: It is a hospital based prospective study centered in Gadag Institute of Medical Sciences, Mallasamudra, Gadag. The study was conducted during the period of March 2021 to March 2022 in the department of Paediatrics at Gadag institute of Medical science,Mallasamudra, Gadag. Results: Mean birth weight in our study was 2.932±0.333kgs. Age of development of significant hyperbilirubinemia was found to be highest at 48-72 hours of life that is 70%.In our study 51% of newborns with blood group of A positive and 49 % of newborns with blood group of B positive.Blood group distribution to development of significant jaundice was statistically insignificant by Pearson chi square test. Our study provided cut off values of newborns with cord albumin <3.5 g/dl in ABO blood group incompatibility should be followed up closely to watch for the development of significant hyperbilirubinemia requiring treatment in the form of phototherapy with or without exchange transfusion.3 out of 83 required exchange transfusion. Conclusion: Babies with cord blood albumin <3.5 g/dl in ABO blood group incompatibility should be followed up closely to watch for the development of significant hyperbilirubinemia requiring treatment in the form of phototherapy with or without exchange transfusion while those babies with cord blood albumin >3.5g/dl can be safely discharged early. Keywords: Albumin, ABO blood group incompatibility, hyperbilirubinemia.

elastography is important because renal biopsy though considered gold standard cannot be performed in every patient because of its complications. Today, elastography techniques are used for the non-invasive assessment of tissue fibrosis. Shear wave elastography (SWE) is an emerging ultrasound technique used to measure tissue stiffness. Shear wave velocity increases in diseased tissues, which can be significantly stiffer than normal ones. The aim & objective are to evaluate the utility of ultrasound based shear wave elastography in the evaluation of renal parenchymal stiffness in patients with deranged RFT Materials and Methods: Study design is case Control study. Study setting: Radiology department of MGM medical college, Chhatrapati Sambhajinagar. Study duration: From 1st April 2024 to 30th June 2024. The study population 25 chronic kidney disease patients and 20 controls subjects who had been referred to the Department of radiodiagnosis for Imaging in a MGM Medical College, Chhatrapati Sambhajinagar during study period. Sample Size is 25 cases and 20 controls. Conclusion: On SWE, CKD patients show greater renal parenchymal stiffness than non-CKD patients. SWE assessment may help in early non-invasive detection and management of CKD. Keywords: Thyroid, Thyroid Dysfunction, Hypertensive Disorders, Pregnancy.

Background: Jaundice in pregnancy is an important medical disorder, commonly seen in developing countries like India. The present study was conducted to assess fetomaternal outcome of jaundice in pregnant females. Materials and Methods: All antenatal women booked or unbooked presenting with clinical or laboratory evidence of jaundice were included. A comprehensive general, systemic, and obstetrical examination was performed. Results: Out of 29184 cases, jaundice was seen in 109, off which 98 were delivered and 11 undelivered. Age group 20-25 years had 53, 26-30 years had 30 and >30 years had 26 patients. The etiology of jaundice was cholestasis in 45, preeclampsia in 38, hepatitis in 7, acute fatty liver disease in 6, and anemia in 13 cases. Hepatitis A positive were 2, HBsAg positive 3 and HCV positive 2. The difference was significant (P< 0.05). Among 98 delivered, 90 had improved discharge, 2 expired, 6 took LAMA and among 11 undelivered, 8 had improved discharge, and 3 took LAMA. The difference was non- significant (P> 0.05). Out of 98 delivered, mode was vaginal in 42 and LSCS in 56 cases. The difference was non- significant (P> 0.05). Maternal complications were IUD seen in 4, IUGR in 14, PPH in 23, coagulopathy in 13, hepatic encephalopathy in 5, hepatorenal syndrome in 10, abruption in 15. ICU admission was seen in 33 and blood/ blood product transfusion in 36. The difference was significant (P< 0.05). Low birth weight babies were 31 and normal 67. Pre- term were 23 and term 75. Meconium- stained liquid was positive in 29 and negative in 69. APGAR at 1 minute <7 was seen in 11 and 7-10 in 87, APGAR at 5 minutes <7 was seen in 5 and 7-10 in 93. The difference was significant (P< 0.05). Conclusion: Jaundice complicates pregnancy, which has poor maternal and fetal outcomes. A qualified team of doctors must provide prompt therapy to a female patient who has been admitted with jaundice. Key words: Jaundice, Pregnancy, Maternal.

Background: A liver abscess is a small collection of pus inside the liver parenchyma that is usually brought on by parasite, bacterial, or fungal infections. The aetiology comprises infections that enter through the biliary tree, hepatic vein, portal vein, or directly spread from nearby abdominal illnesses. Pyogenic and amebic liver abscesses are the two subtypes of liver abscesses that are typically distinguished. Usually, patients arrive with rigors, fever, and stomach ache, Bloating, nausea, anorexia, weight loss, exhaustion, and jaundice are other symptoms. Upon examination, patients will have soreness in the right upper quadrant. Antibiotics are the mainstay of treatment. Third-generation cephalosporin/quinolones, IV metronidazole, β-lactam antibiotics, and aminoglycosides are effective medications for draining the abscess. Though occasionally drainage techniques such percutaneous catheter drainage or needle aspiration are used. In addition to causing major issues, liver abscesses can possibly be fatal if treatment is not received. Materials and Methods: The hospital based observational study was carried out at Government Medical College Jagdalpur, Chhattisgarh for a period of one year. Included all diagnosed cases of liver abscess. Data on demographics, clinical features, etiology, And management was gathered, and outcomes like hospital stay, complications, and recovery were examined. SPSS was used for statistical analysis. Results: Out of 30 individuals, 8 were female and 22 were male. Thirty percent had stool examinations, ninety-five percent had blood cultures, two percent had abdominal CT scans, seventy percent had ultrasounds, and eighty percent had amebic serology. Conservative care was employed in 53.33% of cases, followed by USG aspiration (16.66%), and exploratory laprotomy (13.33%). Conclusion: Liver abscesses require timely diagnosis through imaging and lab tests for effective management. Early diagnosis, proper medical management, and timely surgical intervention ensure better patient outcomes. Keywords: Liver abscess; Hepatic abscess; percutaneous drainage.

Background: Self-esteem is a positive evaluation of one’s value and importance whereas self-efficacy is the speculation and judgment about whether a person can complete a certain task. Positive self-esteem and assertion can bestow children the confidence to confront and successfully cope with their everyday issues of attention span and furnish effective learning. Even though both the concepts are different self-esteem plays an important role in predicting career decision-making self efficacy. This study was done to find out the self esteem and career decision making self efficacy among higher secondary school students. Materials and Methods: Cross-sectional study was done among 654 students from various schools across 8 randomly selected districts in Kerala. Rosenberg self-esteem scale was used for assessing self esteem and career decision making self-efficacy scale (CDSE) short form was used to assess career decision making self-efficacy. Student t-test, ANOVA, and Kruskal Wallis were done to identify the factors associated with self-esteem and self efficacy. Results: The mean self-esteem score is 28.03(4.46) and the mean career decision making self-efficacy score is 97.39(15.7) Science stream, being a firstborn child and a joint family increases career decision making efficacy. We found a positive correlation between self esteem and career decision making self efficacy.. Conclusion: Students with high self-esteem would have greater efficacy in decision making, which would encourage them to choose major career decisions and profession, based on their interest and ability. It would also relate to lower career uncertainty and increased work productivity from the younger population. Keywords: Self esteem, career decision making self -efficacy, school students.

Background: The Coombs’ test or otherwise known as Antiglobulin Testing detects compatibility, alloantibodies or autoantibodies in patients. This testing allows antigen-antibody reactions with patients' RBCs and donors' sera in cases of Direct Antiglobulin Test or patients' sera and donors' RBCs in Indirect Antiglobulin Test. These testings help us in identifying blood transfusion compatibility; pregnancy-related hemolysis; drug-induced hemolysis; Hemolytic Disease of the Fetus and Newborn; Autoimmune Hemolytic Anemia. Materials and Methods: In this study we have analyzed data collected retrospectively for a period of 12 months i.e. from January 2023 to December 2023 at the Department of Immunohematology and Blood Transfusion, D. Y. Patil Medical College , Hospital and Research Center, Navi Mumbai. The Aims and Objectives - To study the indications for Antihuman Globulin Test, various methods (tube Vs gel card) and types of tests (direct Vs indirect). Results: Findings revealed 131 cases requested for DAT, 147 cases requested for IAT, 81 cases requested for both IAT and DAT, 28 cases requested Antihuman Globulin testing as part of Post-Transfusion Reaction workup. Conclusion: Antigen testing is a vital diagnostic tool in hemolytic anemias, particularly AIHA. However, interpreting the results requires a comprehensive evaluation of clinical data and patient history to ensure accurate diagnosis and appropriate management. Keywords: Direct Antihuman Globulin Test (DAT), Indirect Antihuman Globulin Test (IAT), Hemolytic Disease of Fetus and New-born (HDFN), Autoimmune Hemolytic Anemia (AIHA).

Background: Laparoscopic transabdominal preperitoneal hernia repair is standard management option for adult hernia repair but the ideal method for mesh fixation is still unknown. Our study was designed to evaluate the efficacy of three-point suture fixation of mesh in patient undergoing laparoscopic hernia repair. Materials and Methods: This was a single-centre, prospective, observational study of 30 patients who underwent LHR for groin hernias between Jan 2024 and December 2024 to evaluate the efficacy of Three-point suture mesh fixation. Results: Total 30 patients aged between 26 to 65 years with mean age of 49.46 were included in this study and all patients were males. Majority of patients were right sided inguinal hernia (66.66 %). The mean operating time was 72minutes, and the mean mesh fixation time was 15 minutes. Post operative complications were noted, and seroma was found in 6.66% patients, severe postoperative pain in 3.33% patients and recurrence was not found in any patient. Conclusion: Laparoscopic transabdominal mesh hernioplasty using three-point suture fixation of mesh is cheap and effective method of mesh fixation. Keywords: TAPP, Mesh fixation, Hernia, LHR.

Background: Fine Needle Aspiration Cytology (FNAC) serves as an essential method for diagnosing diseases affecting lymph nodes. The Sydney System (2020) introduced a unified framework for classifying and reporting lymph node FNAC findings, emphasizing consistency through standardized terminology and morphological criteria. The purpose of this study was to analyse the cytomorphological features of lymph node lesions obtained from different anatomical sites and categorize them based on the Sydney System classification. Materials and Methods: A retrospective study was conducted at C U Shah Medical College from July 2020 to July 2024, analyzing 550 lymph node FNAC specimens collected from various anatomical sites including cervical, axillary and supraclavicular regions involving patients of all age groups. The specimens were subsequently classified according to the Sydney System into L1 (non-diagnostic), L2 (benign), L3 (atypical), L4 (suspicious), and L5 (malignant). Results: Out of 550 lymph node FNAC cases, 4(0.73%) cases were classified as L1, 458(83.27%) cases as L2, 8(1.5%) cases as L3, 20(3.5%) cases as L4, and 60(10.91%) cases as L5. Among 458(83.27%) benign cases, most common lesion was reactive lymphoid hyperplasia accounting 189(34.80%) cases and among 60(10.91%) malignant cases, metastatic carcinoma accounts 52(9.5%) and lymphoma accounts 8(1.5%) cases. Cervical lymph nodes were most frequently aspirated which accounts for 419(76.6%) cases. Conclusion: The Sydney System offers standardized FNAC reporting, precise terminology, significantly improving FNAC’s diagnostic accuracy and patient communication, integrating ancillary techniques can further enhance FNAC’s diagnostic precision and clinical utility. Keywords: FNAC, Cytomorphology, Lymphadenopathy, sydney system

Background: All body cavities are potential spaces contain a scanty amount of fluid for lubrication and for protection of underlying viscera, lined by mesothelial cells. Effusion fluid is an abnormal accumulation of fluid in the body cavity. The peritoneal, pleural and pericardial fluids are the majority of effusion fluids.Effusion Fluid cytology along with LDH, Fluid protein etc. biochemical parameters are useful in diagnosis of inflammatory, infectious, benign and malignant causes for effusion. This study was done to evaluate the incidence of various patholology in effusion fluids by biochemical and cytopathological findings to identify the frequency of neoplastic and non neoplasticetiologies in effusion fluids in a tertiary care centre. Materials and Methods: The present study is Hospital based data analysis was conducted in the Department of Pathology, C.U.Shah Medical College, Surendranagar, Gujarat from January 2023 to June 2024. A total of 297 samples were included in the study. Results: Out of the 297 samples studied, 211(71.04%) were pleural fluids, 82(27.61%) were peritoneal fluid and 4(1.35%) were pericardial fluids. Maximum numbers of fluid collected from patients were in the age group of 61–70 years. Male to female ratio of 2.37:1. Out of 297 cases, 85 (28.62%) were transudative fluid and 212 (71.38%) were exudative fluid. Out of 297 cases, 14 (4.71%) were malignant, 279 (93.94%) were benign, 4 (1.35%) were suspicious for malignancy. Conclusion: Cytopathological examination along with biochemical evaluation of effusion fluids is useful to distinguish between neoplastic and non neoplasticetiologies. Keywords: Effusion fluid, transudative, exudative, fluid cytology, malignancy

Background: Liver and spleen size assessment is crucial in the pediatric population to monitor growth patterns and diagnose pathological conditions. Ultrasound is a non-invasive, safe, and widely used imaging modality for this purpose. Despite the availability of normative data for adults, pediatric reference values remain limited, especially in North Karnataka. This study aims to establish normal ultrasound values for liver and spleen size in children from this region. Materials and Methods: A hospital-based cross-sectional study was conducted at Jawaharlal Nehru Medical College, KLE University, Belagavi, between January 1, 2019, and December 31, 2019. A total of 312 children aged one month to 12 years who underwent abdominal ultrasonography were included. Patients with conditions affecting liver and spleen size were excluded. Measurements were obtained using a GE Voluson 8 ultrasound machine. Data analysis included descriptive statistics, t-tests, and ANOVA to compare organ sizes across age and gender groups. Results: Among the 312 participants, 174 (55.77%) were male and 138 (44.23%) were female. The mean liver length was 9.2 ± 2.2 cm (range: 4.5–15.0 cm), and the mean spleen length was 6.66 ± 1.63 cm (range: 3.5–11.5 cm). Liver and spleen size increased significantly with age (p < 0.001). However, no significant difference was observed between genders (p > 0.05). Conclusion: This study establishes baseline ultrasound measurements for liver and spleen size in children from North Karnataka. The findings provide a valuable reference for pediatric radiologists and clinicians, aiding in the accurate diagnosis and management of organomegaly. Further large-scale studies can help refine these normative values. Keywords: Liver size, Spleen size, Ultrasonography, Pediatric reference values, North Karnataka, Organomegaly.

Background: The pulse oximetry-derived peripheral perfusion index (PPI) is a true measure of microhemodynamics that can be used as a valid prognostic indicator in children hospitalized in a PICU. The objective is to determine the usefulness of the peripheral perfusion index as a mortality indicator and morbidity indicator. Materials and Methods: The Prospective observational study included 377 children over the age of one who were all admitted to the PICU. The mean perfusion index was recorded for 72 hours. The mean perfusion index and its variations were correlated with morbidity and mortality outcomes. Results: All the parameters that were evaluated in the study were statistically significant with the perfusion index. The majority of the children who had poor outcomes found to have lower mean PI and moderate diurnal and Day 1-Day 3 variations of mean PI. Conclusion: PPI is a good prognostic indicator that can be used as a parameter in a PICU. Keywords: Pulse oximetry, Perfusion index, prognostic indicator

Background: Among the few emergencies in urology practice, penile fracture is rare but one of them. Clinically suspicious cases needs prompt careful evaluation and urgent early surgical intervention in selected cases to remove hematoma, to restore penile anatomy and finally to prevent long-term complications. This study emphasizes importance of careful accurate diagnosis, early management and focusing on associated injuries and postoperative complications. Materials and Methods: This study involved 24 patients with penile fracture which were fully evaluated by physical examination and penile Doppler study. MRI study and Retrograde urethrogram were used in doubtful cases with suspicious associated injuries. Injury mechanisms included sexual intercourse (20 cases), fall (3 cases), and assault (1 case). Penile defects were repaired in the form of corporoplasty using Vicryl 3-0. Mean operative time was two hours under spinal anesthesia. Seven patients required additional urethral repair using PDS 3-0 with catheterization. Aseptic sterile dressing were done. Results: The mean age was 30 years, mostly presented within 24 hours of event. Corporal defects were less 1 cm, between 1-2 cm and more than 2 cm in 8, 13 and 3 patients respectively. Vigorous sexual activity remains the main causative factor which presented in 20 out of 24 patients. Postoperative complications included wound infection in 2 cases which were managed with dressings and discharged within five days. Erectile dysfunction was reported in 4 patients, all of them had delayed presentation. Additionally, one patient with urethral injury developed a urethral stricture at six months which was managed with urethral dilatation. Conclusion: This study highlights the effectiveness of prompt surgical intervention in managing penile fractures, particularly for preventing complications like erectile dysfunction associated with delayed presentation. The findings support early repair for optimal recovery and underscores the need for further research on the impact of presentation timings on long-term outcomes. Keywords: Penile fracture, sexual penile trauma, straddle injury, corporoplasty, penile curvature.

divides an individual's weight by height to assess whether they are in a healthy weight range. It is vital to understand the relationship between diabetes mellitus hypertension and dyslipidemia. Aim: The present study aimed to understand the relation between the prevalence of dyslipidemia, hypertension, and diabetes mellitus in the Indian context. Materials and Methods: The present study assessed BMI distribution in subjects with diabetes mellitus who visited the Institute within the defined study period, and BMI distribution was compared in subjects with and without dyslipidemia and hypertension. Improper insulin secretion results in the alteration of carbohydrate, protein, and lipid metabolism and characterizes hyperglycemia, which is usually considered DM (diabetes mellitus). Results: The study results showed that there is a significant increase in the Body Mass Index of subjects with diabetes mellitus compared to subjects from the control group. A statistically significant positive correlation is seen between MDA, cholesterol, and glycated hemoglobin levels in study subjects. Conclusion: The present study concludes that for the management and prevention of vascular complications in subjects with type 2 diabetes mellitus, it is vital to maintain normal levels of MDA (malondialdehyde) and normal body weight. However, further large-scale and long-term studies are needed to confirm the conclusion of the present study. Keywords: BMI, body mass index, diabetes mellitus, lipid peroxidation, malondialdehyde, oxidative stress.

Background: The thyroid gland is a large endocrine gland and superficial location of the thyroid gland helps in excellent visualization and also helps in the evaluation of its normal anatomy, normal anatomical variants and pathological conditions by high resolution real-time grey-scale sonography. Objective: To compare and evaluate of Grayscale and Color Doppler Findings of thyroid nodule with Fine Needle Aspiration Cytology Findings. Materials and Methods: This is a prospective study on conducted 50 patients with thyroid swelling over a period of 18 months. The study was conducted within the age group of 10 to 80 years including both the gender. Results: Presence of gray scale features - Taller- than-wide shape, Lobulated/poorly defined margins, Hypoechogenicity and Marked hypoechogenicity, Thick incomplete /absent halo, Microcalcifications, Central/ central > peripheral pattern of vascularity and associated cervical lymphadenopathy suggests malignancy. Likewise the presence of Wider than tall shape, Well defined margins, Hyperechogenicity, and Thin halo suggests benignity. A solid/ predominantly solid component alone cannot be a useful criterion for the differentiation of malignant from benign nodules. The presence of calcification or macrocalcification showed no statistical significance in the differentiation of a malignant nodule from a benign nodule. Using a 5-category US classification system, the specificity and positive predictive value were high for distinguishing benign and malignant nodules. But the diagnostic accuracy did not cross 75% for any of the ultrasound categories. However the overall diagnostic accuracy of thyroid US for differentiating a malignant lesion from a benign one in the present study was found to be 84.3 % which is in correlation with previous studies. Conclusion: Ultrasound and Colour Doppler study is an easy, non-invasive and rapid technique that can be routinely used as an additional tool in the work-up of thyroid nodules to select cases for FNAC, avoid unnecessary biopsies, and consequently decrease the hazards and costs. It also increases confidence in the decision for benign versus malignant when assessing thyroid nodules. Keywords: Ultrasound, Colour Doppler, thyroid nodules, FNAC.

Background: Disorders of the gastrointestinal tract (GIT) are major contributors to morbidity and mortality. Histopathological examination is essential for accurate diagnosis and treatment planning. This study aimed to determine the incidence and histopathological spectrum of GIT lesions in a tertiary care setting and to correlate these findings with clinicopathological variables. Material and Methods: This is a retrospective study conducted on GIT lesions and the histopathological assessment was done at the department of pathology MGM medical college and teaching hospital Aurangabad, from January 2023 to December 2023, The specimens were formalin fixed and embedded in paraffin and sections were taken, stained with H and E and examined. Results: The present study included 1049 cases. The GI specimens constituted 20.12 % of all surgical pathology specimens. Maximum specimens were obtained from age group 21-40 years. Most common non neoplastic lesions were seen in appendix (appendicitis) and common neoplastic lesions were seen in stomach (adenocarcinoma). Conclusion: Histopathological analysis of GIT Lesions helps the division for proper follow up and specific treatment. This study gives an overview of the frequency as well as spectrum of the histopathological lesions in GIT. Keywords: GIT, endoscopy, histopathology, immunohistochemistry.

Background: Achilles tendon injuries are common among athletes and physically active individuals. Accurate diagnosis is essential for effective treatment and recovery. Ultrasound and Doppler imaging are increasingly used for this purpose due to their non-invasive nature and real-time dynamic assessment capabilities. Objectives: This study aimed to evaluate the effectiveness of ultrasound and Doppler imaging in diagnosing Achilles tendon injuries, focusing on their ability to detect injury severity and associated neovascularization. Materials and Methods: A cross-sectional study was conducted involving 60 patients suspected of having Achilles tendon injuries. Patients underwent both ultrasound and Doppler imaging assessments. The study measured the accuracy, sensitivity, and specificity of each modality. Diagnostic delays and the detection rate of neovascularization were also recorded. Statistical analysis included Chi-square and t-tests to compare diagnostic effectiveness between the imaging modalities. Results: The ultrasound showed an accuracy of 83%, with a sensitivity of 87% and a specificity of 78%. Doppler imaging demonstrated an accuracy of 80%, sensitivity of 85%, and specificity of 81%. Both modalities were effective in identifying the presence of neovascularization, crucial for diagnosing chronic tendinopathy. The difference in diagnostic delay between ultrasound (2.3 days) and Doppler (2.1 days) was not statistically significant. Conclusion: Both ultrasound and Doppler imaging are valuable tools for diagnosing Achilles tendon injuries. They provide significant details regarding the extent and nature of the injury and are particularly effective in detecting neovascularization associated with chronic tendinopathy. These imaging modalities offer a reliable, non-invasive alternative to traditional diagnostic methods, supporting more accurate diagnosis and informed treatment planning. Keywords: Achilles tendon, ultrasound imaging, Doppler imaging.

Background: The severity of COVID-19 has varied among various demographic groups. Children often display milder kinds of comorbidities, such as chronic kidney disease (CKD), but adults are more susceptible to serious sickness. However, there is still a lack of information on children with glomerular disorders and chronic kidney disease who get COVID-19. Objectives: To study the clinical presentation, severity, and outcomes of COVID-19 in children with underlying kidney diseases. Material and Methods: A retrospective descriptive study was conducted on 39 children aged 2 months to 18 years with CKD or glomerular diseases who were admitted with RT-PCR confirmed COVID-19 between March 2020 and February 2022. Data on demographics, kidney disease profile, immunosuppressive therapy, COVID-19 severity, inflammatory markers, treatment, and outcomes were analyzed. Results: 53.8% of the 39 children were male. Idiopathic nephrotic syndrome was the most prevalent glomerular disease, accounting for 48.7% of cases and CKD for 51.3% of cases. 43.6% of cases were under immunosuppressive treatment. The most frequent presentations were respiratory symptoms (43.6%) and fever (61.5%). In 12.8% of cases, severe COVID 19 (SpO2 < 90%) was noted. Five patients needed to be admitted to the intensive care unit, and one child died. Individuals with severe COVID 19 had higher levels of inflammatory markers, including ferritin, D-dimer, and CRP. Conclusion: Even among children using immunosuppressants, the majority of children with renal disease and COVID-19 had mild to moderate symptoms. However, the risk of developing severe illness is increased in children with multiple comorbidities or advanced CKD. Appropriate supportive care and close observation are crucial. Keywords: COVID-19, Children, Chronic Kidney Disease, Nephrotic Syndrome, Immunosuppression.

Background: Sickle cell anaemia (SCA) is a significant genetic disorder with serious health implications, particularly among pregnant women. This study aims to assess the prevalence of sickle cell anaemia among antenatal cases in a tertiary care centre in the rural area of south Gujarat. The study was conducted over a period of three months with a sample size of 1000 antenatal patients. Introduction: Sickle cell anaemia is a hereditary blood disorder characterized by the presence of abnormal haemoglobin (HbS), leading to distorted red blood cells that impede blood flow and oxygen delivery. Pregnant women with SCA are at an increased risk of complications such as preeclampsia, intrauterine growth restriction, and preterm birth. The prevalence of SCA varies among different populations, making it essential to conduct region-specific studies to understand the burden of the disease. Materials and Methods: A cross-sectional study was conducted at a tertiary care centre over a duration of three months. A total of 1000 antenatal women attending the outpatient department were screened for sickle cell anaemia using Sickle Solubility Test, Hemoglobin level with peripheral smear examination and confirmed with High Performance Liquid Chromatography (HPLC). Patient demographic data, medical history, and obstetric history were collected and analyzed. Results: Out of the 1000 antenatal cases screened, the prevalence of sickle cell anaemia was found to be 10%. Additionally, 35% of the cases were identified as sickle cell trait carriers. The majority of the affected individuals belonged to specific ethnic and socioeconomic backgrounds, highlighting the need for targeted screening programs. Discussion: The findings of this study underscore the necessity of early screening for sickle cell anaemia in antenatal cases, especially in high-risk populations. Proper prenatal care and genetic counseling play a crucial role in managing the condition and reducing maternal and fetal complications. The study also emphasizes the importance of integrating routine sickle cell screening into antenatal care services in tertiary care settings. Conclusion: The prevalence of sickle cell anaemia among antenatal cases in the studied tertiary care centre highlights the need for proactive screening and comprehensive management strategies. Further research and policy interventions are required to mitigate the risks associated with SCA in pregnancy and improve maternal and fetal outcomes. Keywords: Sickle cell anaemia, antenatal screening, tertiary care centre, prevalence, pregnancy complications.

Background: Acute febrile illness with thrombocytopenia poses a diagnostic and therapeutic challenge, as it is inversely related to morbidity and mortality in infectious diseases. This study aims to evaluate the clinical and hematological profile of patients presenting with fever and thrombocytopenia. Materials and Methods: A prospective observational study was conducted on 350 patients (aged ≥13 years) presenting with fever (>99.9°F) and thrombocytopenia (<150,000 cells/cu.mm). A comprehensive clinical examination and laboratory investigations were performed. Treatment was initiated based on the clinical severity and etiology. Results: The majority of cases (34.8%) were aged 13–20 years, with male predominance (58%). Dengue (44.2%) was the leading cause, followed by typhoid (30%) and sepsis (17.1%). Dengue was the leading cause of nausea, headache, rash, and bleeding tendencies, while typhoid and sepsis contributed to abdominal pain, diarrhea, and impaired consciousness. Most of the patients had mild platelet counts deficiency (50%). The malaria was associated with highest WBC and neutrophil levels on Day 1, while typhoid showed highest hemoglobin and hematocrit levels throughout the observation period. Dengue exhibited lowest WBC and neutrophil counts, while sepsis had persistently low hematocrit and hemoglobin values. Complications included hypotension (22.8%), arrhythmia (17%), acute kidney injury (16%), and metabolic acidosis (8.6%). The overall recovery rate was 93.3%, with a mortality rate of 6.5%, primarily due to sepsis (25%). Platelet transfusion was required in 40 patients (11.4%). Conclusion: Fever with thrombocytopenia remains a significant challenge in tertiary care. Dengue is the most common etiology, but other infections require further study. Early diagnosis and timely intervention are crucial in reducing morbidity and mortality. Keywords: Acute febrile illness; Thrombocytopenia; Hematological profile; Etiology; Dengue; Mortality; Platelet transfusion.

Background: To compare RDW between pre-eclampsia and uncomplicated pregnancy and to compare RDW between severe and non-severe pre-eclampsia. Materials and Methods: This was a Case control study was conducted in Karnataka Institute of Medical Sciences, Hubballi for 18months between November 2019 to April 2021.100 non severe pre-eclampsia and 100 severe pre-eclampsia cases were taken and compared with 100 healthy controls. Pre-eclampsia classified as severe and non-severe according to NICE guidelines. Sociodemographic characteristics, obstetric and clinical data were recorded. Results: In this study in both cases and control group most of them belonged to the age group 19-24years with mean age of 24.5 years. On comparing the gestational age preterm was more in pre-eclampsia group (42.5%) compared to control group (19%) with p-value of <0.001 and in pre-eclampsia group pre-term deliveries was significantly increased in sever PE patients. There was no difference in the mean haemoglobin, mean MCV, mean MCH and mean HCT between severe PE and non-severe PE patients. There was significant increase in the mean RDW-CV, RDW-SD and MCV between severe PE patients compared to nonsevere PE patients. Conclusion: In conclusion, complete blood count test which is including RDW, is an easy, inexpensive, routinely reported investigation, which might help in diagnosing the severity of the disease and predicting the development of complication in preeclampsia patients. However, results of our study should be confirmed by multicentre studies including larger number of cases. Keywords: Pre-eclampsia, severity, red cell distribution width, blood indices.

Background: Benign breast disease accounts for majority of the clinical presentations related to the breast. Its occurrence is much more common than breast cancer in the developed world. The incidence of benign breast lesions rises in the second decade of life, while the malignant breast diseases increase after menopause. Fibroadenoma is the most common lesion of the breast. The study was done to evaluate the trend of benign breast lumps in patients in a tertiary care center. Materials and Methods: An observational study was conducted among 50 female patients with benign breast lumps attending the outpatient department and wards of the department of General Surgery of a tertiary care center in Guwahati, Assam. The study was conducted over a period of one year from July 2012 to June 2013 after obtaining ethical approval from the Institutional Ethics Committee. The diagnosis was made through clinical examination, biopsy for cytology and histopathological studies. Results: The age distribution had majority in 21–30 years age group. Painless lump in 74% cases was the most common presentation. The quadrant most involved in the study population was the upper outer quadrant. Fibroadenoma in 88% cases was the most common clinical diagnosis among the benign breast tumors. The cases were treated by surgical methods in view of the anxiety regarding symptoms and poor socioeconomic status leading to difficulty in follow up. Conclusion: The benign lump of the breast is most common in the second to fourth decade of life. The occurrence of benign breast tumors is more common than breast cancer. Fibroadenoma remains the most common benign breast tumor. Clinical examination, fine needle aspiration biopsy for cytology and histopathology enhances the diagnostic accuracy. Keywords: Breast lump, Age, Benign, Fibroadenoma, Histopathology

Background: The aim is to compare the efficacy of dinoprostone gel 0.5mg intracervical application and misoprostol 25 mcg intra vaginal application in induction of labour in preeclampsia complicating pregnancy, by comparing their. Materials and Methods: In the present study 100 preeclampsia patients who gave consent for the study were studied and 50 patients induced with dinoprostone 0.5mg intra cervically and 50 patients induced with misoprostol 25mcg intra vaginally. Results: Mean change in modified bishop score with dinoprostone and misoprostol is at 0 hours 1.94+/-0.97 and 2.5+/-1.16 respectively. At 6 hours 3.3+/-2.02 and 4.3+/- 2.31. In dinoprostone 20% cases need single dose,46% needed maximum 3 doses. In misoprostol 14% cases need single dose, 18% needed maximum 6 doses. Mean induction to active phase interval in dinoprostone is 13.65+/-5.44 hours, in misoprostol is 13.3+/-7.05 hours. Mean induction to delivery interval in dinoprostone is 22.84+/-8.41 hours, in misoprostol is 19.03+/-9.2 hours. Chi square value 8.16, p=0.0426 which is statistically significant. Vaginal delivery in dinoprostone group is 66%, misoprostol is 76%. Caesarean section rate in dinoprostone 34%, misoprostol is 24%. P value for mode of delivery is 0.7496, statistically not significant. Maternal complications comparable in both groups. Meconium stained liquor and tachysystole more in misoprostol but p=0.0941, statistically not significant. Neonatal complications, outcome, NICU admissions comparable in both groups, statistically not significant. Conclusion: In conclusion, low dose misoprostol (25 mcg) is a cheap and effective drug for cervical ripening and labour induction in preeclampsia complicating pregnancy. Keywords: Dinoprostone, Misoprostol, Preeclampsia, Cervical Ripening.

Background: Due to the changing pattern of risk factors, the incidence and prevalence of heart failure are on the rise especially in India. Resultantly, the number of hospital admissions required for management of acute decompensated heart failure is also ever increasing. The aim is to study the clinical profile, risk factor assessment and outcome of patients with ADHF admitted in Gandhi Hospital. Materials and Methods: It is Observational study done in 500 Patients of any gender above or equal to 15years of age at the time of hospital admission and fulfilling Boston Criteria for heart failure. Meticulous history and clinical examination were done in all pts. Results: Acute decompensated heart failure is common across all age groups though more frequent in 50 – 70 years age group. Males constitute the larger proportion of patients admitted for ADHF. Poor NYHA grades are strongly associated with increased in- hospital mortality rate. Presence of peripheral edema is a significant discriminator of in- hospital survivors and non-survivors. Approximately three fourth of admissions is for recurrent ADHF. Ischemic and non-ischemic risk factors underlie equal proportion of ADHF cases. Lower ejection fractions are correlated with higher hospital death rate. Two third of study patients are known hypertensive while one fourth of them are known diabetic. Nearly half of study patients are known to have coronary artery disease while two thirds of them have dyslipidemia. None of them could significantly influence the hospital outcome of study subjects. Lower the hemoglobin level, higher the in-hospital mortality rate. Maximum deaths occurred when the duration of the hospital stay is more than 10days in the initial five days of admission. The in-hospital mortality rate of our study is 11%. Conclusion: Totally Four factors predict mortality in patients admitted with ADHF in our study. They are poor NYHA grade, presence of peripheral edema, low ejection fraction, low hemoglobin level. Keywords: Heart Failure reduced ejection Fraction(HFrEF), Acute Decompensated Heart Failure (ADHF), Chronic obstructive pulmonary diseases (COPD).

Background: The family planning program in India is now focused on raising awareness concerning the use of postpartum contraception methods with special emphasis on postpartum intrauterine devices as a reversible and long-acting method. The use of copper UCD in the immediate postpartum period has limited literature data. The present study was aimed at a comparative evaluation of the efficacy of Cu375 and Cu T 380 concerning failure rates as a postpartum intrauterine contraceptive device. The study also assessed concerns, acceptability, expulsion rates, and side effects of the two intrauterine devices. Materials and Methods: The present study assessed 640 postpartum females that were ready for insertion of PPIUCD (postpartum intrauterine contraceptive device) after normal vaginal delivery. The study subjects were divided into two groups with 320 subjects each where Group I subjects were inserted with IUCD Cu T 380 A and Group II subjects were inserted with Cu 375. The subjects were followed at 6 weeks, 6 months, and 1 year. Results: The study results showed a high acceptability of PPIUCD in both groups with 72.5% (n=228) and 79.38% (n=254) subjects from Group I and II respectively. At the end of 1-year follow-up, menorrhagia was seen in 62.5% and 11% of subjects from Groups I and II respectively. Expulsion of IUCD over 1 year was reported in 15.28% (n=44) and 12.85% (n=36) females from groups I and II. The IUCD removal rate was 18.75% (n=60) and 14.38% (n=46) in groups I and II. The overall continuation rate at 1 year was 57.5% and 62.5% respectively in Group I and II. No failure was seen in any subject. Conclusion: The present study concludes that both Cu T 380 A and Cu 375 are similar concerning expulsion rates, complications, and efficacy. However, overall satisfaction was higher in Cu375 using females compared to Cu 380 A device. Keywords: Copper T, intrauterine contraceptive device, long-acting reversible contraceptive, PPIUCD, postpartum

Background: Enterococci are part of normal flora of human intestine, biliary tract and lesser extent to vagina and male urethra. The increasing incidence of health care-associated infections (HAI) has been attributed mainly to a group of six pathogens characterized by multidrug resistance (MDR) and virulence and known by the name ESKAPE pathogens. The incidence of enterococcal infections has increased which accounts for the majority of nosocomial infections worldwide. Materials and Methods: A cross-sectional study was conducted from October 2023 to December 2023 in the Department of Microbiology, Tertiary care hospital among 106 samples. Enterococcus isolates were identified and antimicrobial susceptibility test was done by colony morphology, gram staining and catalase test. VITEK 2 (Biomerieux) using an identification card (ID-GP) and susceptibility card (AST-P628) according to manufacturer’s instruction. The results of the antimicrobial susceptibility were interpreted according to CLSI 2024 guidelines. The data collected was entered in MS Excel windowsand the analysis was done through SPSS 16. p value <0.05 is considered as statistically significant. Results: Majority of the study participants were females 61(57.5%), Enterococcus faecalis 84 (79.24%) was isolated more compared with Enterococcus faecium 22 (20.75%). Out of 106 Enterococcus species isolated majority,80 isolates (75.4%) were Urine cultures, out of 84 E. faecalis only 2% showed resistance for vancomycin. But among the 22 E. faecium 45 % that is 10 isolates were vancomycin resistant. Conclusion: We concluded our study stating that among the Enterococcus species E. faecalis and E. faecium was the isolated species. E. faecalis was the most common one and it was sensitive to most of the antibiotics but E. faecium was resistant to many antibiotics including Vancomycin. Keywords: VRE-Vancomycin resistant enterococcus, antimicrobial susceptibility, Multidrug resistance, Health care associated infections.

Background: Hypertension is the leading global health problem with overall prevalence in India is 29.8%, and in Maharashtra it is 25%. Studies have demonstrated that self-care practice is essential for blood pressure control and reduction of hypertension complications. Aim: To study the hypertension self-care practices and its determinants in adult hypertensive patient attending the tertiary care hospital. Materials and Methods: In the present Cross-sectional study 320 hypertensive patients attending tertiary care hospital were enrolled and interviewed. Hypertension Self-Care Activity Level Effects (H-SCALE), was used to obtain data about self-care practices in hypertension. Results: The mean age of patients was 59.09±10.51, with range from 35 to 86 years. About 66.87% patients had poor self-care practices toward hypertension. Results highlight significant variability in self-care practices among participants, particularly low adherence to dietary and physical activity guidelines, while medication adherence, alcohol cessation, and smoking cessation show more favourable practices. Poor self-care practices were significantly associated with religion, education, socio-economic status. Conclusion: In terms of self-care practices, a considerable number of participants exhibited poor habits, underscoring the need for targeted interventions to enhance education, support, and self- management strategies. Keywords: Blood pressure, Hypertension, Self-care practice, H-Scale.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with severe exacerbations contributing significantly to disease progression. Emerging evidence suggests an association between vitamin D deficiency and increased COPD exacerbations, but findings remain inconclusive. This study aims to assess the association between vitamin D deficiency and the frequency of severe exacerbations in COPD patients. Materials and Methods: This prospective cohort study was conducted at a tertiary care center from December 2023 to December 2024. A total of 100 COPD patients were categorized into vitamin D-deficient (<20 ng/mL) and vitamin D-sufficient (≥20 ng/mL) groups. Baseline demographic data, smoking history, BMI, and pulmonary function tests (FEV1) were recorded. Patients were followed for six months to document the frequency of severe exacerbations (requiring hospitalization or systemic corticosteroids). Hospitalization rates, ICU admissions, and length of hospital stay were also analyzed. Statistical analysis was performed using SPSS version 26, with a p-value <0.05 considered significant. Results: The vitamin D-deficient group had significantly higher rates of severe exacerbations (66% vs. 24%, p<0.001) and hospitalizations (76% vs. 38%, p<0.001). ICU admissions were more frequent in the deficient group (34% vs. 12%, p=0.007), and their mean hospital stay was longer (7.8 ± 3.2 vs. 5.1 ± 2.6 days, p=0.002). Multivariate analysis showed vitamin D deficiency as an independent risk factor for frequent exacerbations (≥3 in 6 months, p<0.001). Conclusion: Vitamin D deficiency is significantly associated with increased severe exacerbations and hospitalizations in COPD patients. Routine screening and potential supplementation may improve COPD management and patient outcomes. Keywords: COPD, vitamin D deficiency, exacerbations.

Background: Medical education, there is increasing emphasis on active and self-directed learning (SDL). Seminars, wherein students prepare and present academic content, have emerged as a potential tool to foster engagement, motivation, and content mastery. This study aimed to assess the impact of seminar-based learning as a method of SDL among medical students and to explore their perceptions and experiences regarding seminar preparation and presentation. Materials and Methods: Employing an explanatory sequential mixed-methods design, the study included 104 final-year MBBS students at Government Medical College, Omandurar, Chennai. Quantitative data were collected via structured questionnaires post 25 seminars, while qualitative insights were gathered through three focus group discussions (FGDs) with purposefully sampled participants. Descriptive statistics and thematic analysis were used to analyze quantitative and qualitative data, respectively. Results: Quantitative findings indicated that 59.6% of students agreed that seminars ignited interest in the topic, and 86.5% felt it improved the presenter’s mastery of the subject. Seminars were also seen to help overcome stage fright (86.6%) and promote active learning (62.5%), although 84.6% agreed that preparation was time-consuming. Qualitative analysis revealed a central theme: “Balancing Engagement and Preparation Challenges in Seminars as a Tool for Self-Directed Learning”. Students acknowledged benefits such as enhanced confidence, interactive learning, and better comprehension but also highlighted challenges like condensing vast content, audience engagement, and language adaptation. Conclusion: Seminars are a valuable pedagogical tool that support self-directed learning by enhancing interest, confidence, and content retention. However, the effectiveness of seminars depends on the balance between content preparation and delivery, and the use of engaging methods. Further large-scale, multi-centric studies are recommended to validate these findings. Keywords: Self-Directed Learning, Medical Education, Seminars, Student Perception, Mixed Methods, Active Learning, Communication Skills.

Background: Late-onset seizures—those beginning after 40 years of age—are often symptomatic of underlying structural, metabolic, or infectious etiologies, making prompt evaluation essential for appropriate management and prevention of recurrence. The study objective is to analyze the clinical presentation, radiological and electroencephalographic findings, and etiological spectrum of new-onset seizures in adults aged over 40 years. Materials and Methods: This observational study was conducted at Mahatma Gandhi Memorial Hospital from January 2022 to December 2023. One hundred patients aged >40 years with new-onset seizures were evaluated. Clinical history, neurological examination, CT brain, EEG, and relevant laboratory investigations were performed. MRI and CSF studies were done when indicated. Data were analyzed using SPSS version 25. Results: The most common seizure type was generalized tonic-clonic seizure (52%), predominantly in the 40–50-year age group. Focal seizures with generalization (26%) were more common in those above 60 years. Cerebrovascular accidents were the leading etiology (38%), followed by alcohol withdrawal (12%) and metabolic causes (8%). Imaging abnormalities were present in 56% of patients, while EEG was abnormal in 26%. Concordance between clinical deficits, imaging, and EEG was highest in cases with infarcts and hemorrhage. Unknown etiology accounted for 14% of cases despite extensive evaluation. Conclusion: Cerebrovascular disease is the predominant cause of new-onset seizures in adults over 40 years. Neuroimaging plays a pivotal role in identifying underlying pathology, often more so than EEG. A comprehensive clinical and radiological approach is essential for accurate diagnosis and tailored management. Keywords: Late-onset seizures, neuroimaging, cerebrovascular accidents.

Background: Blood transfusion is an indispensable component of healthcare delivery system. As the blood donors are young, energetic, benevolent and ready to save lives of people they even do not know, it is our duty to ensure their safety from emotional and social distress. This study was conducted to know the blood donor notification for TTI reactivity, methods of notification and response to notification and challenges for the same in north east India over a period of three years. Materials and Methods: This observational descriptive study was conducted at a tertiary care center northeast India. The study period spanned from January 2022 to December 2024. Results: A total of 35422 blood donation. 100% of the TTI reactive were male. Out of 305 reactive donors only 251 (82.3%) could be communicated (notified donors) and 54 (17.7%) couldn’t be communicated (non notified donors). Response rate in first time donors is found to be higher 70% (145/207) than the repeat donors 51% (98/50). Majority of non responders 37.5 % was due to out of the city residence. Conclusion: In conclusion the response rate of the donors & further confirming and receiving appropriate treatment is low in our geographical area. Blood banks should plan audit at regular intervals to measure the satisfaction of the donors, giving them provisional reports, free assisted, hassle free confirmation test and treatment may help in improving donor compliance and a tribute to these young altruistic blood donors. Keywords: Blood donors, HIV, TTI.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a worldwide public health challenge because of its high prevalence and related disability and mortality. World Health Organisation projections predict that COPD-related mortality and disability will continue to increase worldwide until at least 2030. The objective is to compare COPD and COPD's sociodemographic, clinical and spirometric variables with bronchiectasis subjects. Materials and Methods: The present study is a prospective cohort study. This study was conducted in 1 year, from September 2022 to July 2023, at the Department of Respiratory Medicine, SHKM GMC, Nalhar. A total of 50 patients were included in this study. Results: 42% of subjects were between age groups 61-70, with a mean age (64.98±9.52. 68% of subjects were male and 32% female. 24% of subjects were never smokers, and 76% were current or former smokers. Among smokers, 62.8% of subjects had smoked more than five packs of cigarettes. H/O exacerbation is present in 64%, the CAT score was greater>20 in 64%, and MMRC 3/4 in 52% with comorbidity in 70% of cases; 30% of the population died in the 6-month follow-up period. Conclusion: The association of the following variables between COPD and COPD-BE and reveal statistically significant differences: History of TB, Daily sputum volume, Age, Smoking pack years, ph, PCO2, HCO3, and CAT score. FEV1, FVC, FEV1/ FVC and PEF (25 – 75) %. Keywords: Chronic Obstructive Pulmonary Disease (COPD), COPD with Bronchiectasis.

Background: Infant mortality is still a major problem in the developing and underdeveloped countries around the world. Neonatal mortality rate (NMR) is a component of Infant mortality Rate (IMR) and it is universally regarded not only as an important indicator of community health status, but also as quality of life of people in general. Objective: to assess the clinical profile of early onset sepsis and late onset sepsis in low- birth-weight babies. Materials and Methods: This Prospective Hospital based cross-sectional study was conducted in Gadag Institute of Medical Sciences, District hospital, Mallasamudra, Gadag. The study was conducted for a period of 18 months from January 2021 to June 2022. All the low birth weight babies with neonatal sepsis meeting the inclusion criteria were included in the study. Results: There were a total of 2311 admissions. Out of which 1760 were inborn and 551 were out born. Out of 1760 who were inborn, 196 had sepsis. Early onset sepsis was seen among 137 neonates and late onset sepsis was seen among 59 neonates. Out of the 552 out born babies, 41 had early onset sepsis and 30 had late onset sepsis. In the current study 55.1% were male and 44.9% were female. Lethargy was the most observed clinical presentation present in 52.06%, followed by respiratory distress in 28.09% and poor feeding in 23.97%, hypoglycaemia in 22.47% of cases, other presentation include abnormal movements of limbs, fever, bulginganteriorfontanelle Conclusion: Neonatal sepsis is higher in our setting and continues to be significant cause of mortality and morbidity. Incidence of sepsis in low-birth-weight babies was 31.94%. Keywords: NICU, Septicaemia, Neonates, Blood culture.

Background: Neonatal sepsis is a serious and life-threatening medical condition arising in response to bloodstream infection in neonates. The immune system of neonates, especially those born with lower birth weights is immature, along with increased admission rates compared normal birth weight babies predispose them for neonatal sepsis. Appropriate choice of empirical antibiotics based on the common pathogens isolated in the neonatal intensive care is often life saving. The objective is to know the Etiological agent for sepsis and the antibiotic sensitivity profile of the pathogens. Materials and Methods: It is a hospital based cross sectional study cantered in Gadag Institute of Medical Sciences, District hospital, Mallasamudra, Gadag. The study was conducted for a period of 18 months from January 2021 to June 2022. All the low birth weight babies with neonatal sepsis meeting the inclusion criteria were included in the study. Results: There were a total of 2311 admissions. Out of which 1760 were inborn and 551 were out born. Out of 1760 who were inborn, 196 had sepsis. Early onset sepsis was seen among 137 neonates and late onset sepsis was seen among 59 neonates. Out of the 552 out born babies, 41 had early onset sepsis and 30 had late onset sepsis. Among the risk factors for neonatal sepsis, PPROM was associated with 26.59% of cases, followed by maternal fever 5.24% and chorioamnionitis in 2.62% cases. 36.3% cases were culture positive, among which gram negative isolates were more common than gram positive isolates. Escherichia coli (21.35%) was the most commonly isolated organism, followed by staphylococcus aureus (5.99%), klebsiella pneumonia (4.87%). Most of the organisms were sensitive to amikacin, gentamicin, meropenem, colistin, trimethoprim and sulfamethoxazole. Conclusion: Gram negative organisms were more commonly isolated than gram positive organisms with Escherichia coli, staphylococcus aureus and klebsiella pneumonia were the most common organism isolated. Most of them were sensitive to gentamicin, ofloxacin, meropenm and colistin Keywords: Anti-microbial sensitivity. Risk factors, Blood culture.

Epidemiological Context and Research Gaps: Emerging epidemiological trends demonstrate a rise in screen-mediated pathologies, including metabolic dysregulation, circadian rhythm disruptions, and neuropsychiatric comorbidities, necessitating evidence-based public health interventions. Current literature exhibits critical gaps in elucidating neurocognitive mechanisms driving wireless mobile device (WMD) dependency and standardized mitigation protocols. Study Objectives: This systematic review investigates the neurocognitive and behavioral mechanisms underlying WMD overuse, evaluates associated multisystem health sequelae, and proposes evidence-based mitigation strategies for sustainable digital well-being. Methodological Approach: A systematic literature review (PubMed, Scopus, Cochrane Library) identified peer-reviewed studies (2010–2024) examining smartphone overuse, screen time, and digital addiction phenotypes. Inclusion criteria encompassed cross-sectional, longitudinal, and interventional studies across all age groups and geographic regions. 1.Neurobiological Correlates: Chronic WMD engagement induces neuroplastic adaptations in prefrontal cortical regions, with dopaminergic dysregulation perpetuating compulsive checking behaviors through reinforced habit-loop cycles. 2. Metabolic Consequences: Screen time-BMI correlations (β=0.32, p<0.001) demonstrated multifactorial etiology, mediated by attentional disinhibition during feeding, hyperpalatable food marketing exposure, and leptin resistance from sedentary behaviors. 3.Sleep Architecture Disruption: Nocturnal WMD engagement precipitated delayed sleep onset (Δ=43 min, p=0.004), melatonin suppression (18.7% reduction), and fragmented REM cycles, exacerbating diurnal cognitive impairment and affective disorders. 4.Population-Level Impacts: Population-based studies indicate only 4.9% of adolescents meet combined sleep, activity, and screen time guidelines, with WMD overuse constituting the primary compliance barrier. 5. Psychosocial Consequences: Upward social comparison dynamics on curated digital platforms correlated with diminished self-worth (OR=2.1, 95% CI 1.7–2.6) and occupational dissatisfaction, independent of socioeconomic status. Synthesis and Implications: A paradigm of moderated utilization emerges as critical, integrating: a) Behavioral modification techniques: Stimulus control through notification rationalization and WMD triage protocols b) Environmental restructuring: Creation of device-free zones and chromatic filtering to reduce blue light exposure. c)Cognitive reinforcement: Mindfulness-based intervention modules targeting attentional resource allocation. While complete WMD abstinence remains impractical, multidimensional strategies combining temporal restriction policies, prosocial activity promotion, and neurobehavioral retraining show promise in restoring biopsychosocial equilibrium. Future research must prioritize longitudinal outcome studies and standardized diagnostic criteria for screen use disorders. Keywords: WMD, Neuropsychiatric, cognitive, screen time, sleep disturbance, obesity, smartphone

Background: The Cognitive development of children with learning disabilities is challenging in pediatric and child psychology. Moreover, according to recent research, serum levels of micronutrients can contribute not only to cognitive dysfunction but also to cognitive function. Therefore, there is a hypothesis that dietary supplementation can change the results of cognitive therapies for children with learning disabilities (LD). Objectives: The present study aimed to test the theory of cognitive improvement due to the intake of specific micronutrients. The research question was whether there is a difference in cognitive improvement between children with LD who receive the supplementation and those who do not. If so, what micronutrients appear to have the most significant effects. Materials and Methods: The controlled study involved two groups of 60 children with diagnosed LD. Test one received the supplementation targeted at seven micronutrients, and the control group was administered a placebo. Beforehand to the beginning and after six months of supplementation, children undertook standardized tests, and the serum levels of targeted micronutrients were measured. The collected data were analyzed statistically. Results: Cognitive test scores of the test group significantly improved, and those changes were sustained until the end of the testing period. Vitamin D and Folate serum levels correlated with the standardized test scores. The regression analysis proved the correlation above. Conclusion: The supplementation with targeted seven micronutrients positively influences cognitive function in children with LD. The implication for practice includes considering the nutritional status of such children from a cognitive point of view. Keywords: Micronutrients, Cognitive Functions, Learning Disabilities, Dietary Supplements, Cognitive Improvement, Neurodevelopmental Disorders, Nutritional Interventions.

Background: Anaesthetic management of geriatric patients posted for fracture neck femur having underlying valvular heart disease pose a great challenge to the anaesthesiologist. Case Report: A 76 year old female, known case of rheumatic heart disease with mitrl stenosis, had Right sided neck of femur fracture and was posted for bipolar Hemiarthroplasty. The plan of anaesthesia was General Anaesthesia (GA) with Suprainguinal Fascia Iliaca (SIFI) Block. The combination of GA with SIFI block provided effective pain control, reducing the need for opioids. This approach contributed to an early recovery, emphasizing the importance of tailored anaesthesia strategies for valvular heart disease patients undergoing non-cardiac surgeries. Conclusion: General Anaesthesia along with regional anaesthesia provides superior control over patient’s hemodynamic than Spinal Anaesthesia alone & this method would be the appropriate choice of anaesthesia for patients with valvular heart disease.

Background: The effectiveness of platelet-rich plasma (PRP) therapy in treating chronic non-healing wounds, which present considerable difficulties in clinical practice because they are resistant to conventional treatments, is examined in this study. By boosting cellular regeneration and lowering inflammation, platelet-rich plasma (PRP), an autologous blood-derived product enhanced with growth factors and platelets, has demonstrated potential in aiding wound healing. Patients with persistent wounds were enrolled in the trial, which evaluated the effectiveness of PRP vs traditional therapies for wound healing Materials and Methods: Chronic wounds were randomized into PRP and control groups. PRP was prepared from autologous blood and applied topically and subcutaneously. Outcomes included time to granulation, wound closure rates, patient satisfaction, and adverse effects, analysed using Statistical Package for Social Sciences (SPSS). Results: PRP therapy showed accelerated granulation, sped up the healing process and improved patient satisfaction making it a useful supplement for treating chronic wounds. Conclusion: PRP is a safe, effective adjunct for treating chronic non-healing wounds, offering faster healing and better patient outcomes than conventional therapies. Keywords: Platelet-rich plasma, chronic non-healing wounds.

Background: This study aims to characterize the diagnostic features of occult lesions of the bowel found incidentally during routine evaluation of the whole abdomen using multi-imaging techniques, and to critically discuss the clinical correlation of these variants with underlying pathology. Materials and Methods: A review of radiological records, including computed tomography (CT) and ultrasound, was conducted for patients presenting with mild to severe abdominal complaints. Results: Several bowel lesions were identified, including gastric, small bowel, large bowel lesions, and a few miscellaneous findings. The identification of typical aberrant locations by radiologic imaging studies played a crucial role in diagnosing these lesions accurately. Conclusion: The study emphasizes the importance of utilizing multi-imaging techniques to characterize rare occult lesions, distinguishing between normal and abnormal findings, and preventing misdiagnosis. Its importance in timely interventions is based on accurate imaging interpretation and thus leading to good patient outcomes. Keywords: Occult lesions, Multi-imaging techniques, computed tomography, ultrasound, gastrointestinal abnormalities.

Background: Type 2 Diabetes Mellitus (T2DM) is a progressive disease characterized by insulin resistance, impaired insulin secretion, and chronic hyperglycemia. Achieving early glycemic control in newly diagnosed patients is crucial for improving metabolic outcomes and reducing the risk of long-term complications. The aim is to assess the impact of early glycemic control on metabolic parameters and early diabetes-related complications in newly diagnosed T2DM patients. Materials and Methods: This prospective, observational study was conducted at a tertiary care teaching hospital and included 130 newly diagnosed T2DM patients aged 30–65 years. Participants were managed with standardized lifestyle modifications and pharmacologic therapy to achieve glycemic targets. Patients were categorized into Group A (HbA1c <7% at 6 months) and Group B (HbA1c ≥7% at 6 months). Baseline and follow-up measurements of fasting plasma glucose (FPG), postprandial glucose (PPG), HbA1c, lipid profile, blood pressure, BMI, and diabetes-related complications were recorded and compared between groups. Results: Out of 130 participants, 76 (58.46%) achieved early glycemic control, while 54 (41.54%) did not. Group A demonstrated significantly lower FPG (102.4 ± 18.5 mg/dL vs 142.7 ± 25.3 mg/dL, p<0.001), PPG (148.9 ± 27.6 mg/dL vs 206.3 ± 41.2 mg/dL, p<0.001), HbA1c (6.4 ± 0.3% vs 8.1 ± 0.7%, p<0.001), BMI, systolic blood pressure, and LDL cholesterol compared to Group B. The incidence of neuropathy (5.3% vs 16.7%, p=0.034) and microalbuminuria (7.9% vs 20.4%, p=0.041) was significantly lower in Group A, while retinopathy rates did not differ significantly. Conclusion: Early glycemic control in newly diagnosed T2DM patients leads to significant improvement in metabolic parameters and reduces the risk of early microvascular complications. Prompt and intensive management strategies at diagnosis are essential to improve long-term outcomes and disease prognosis. Keywords: Type 2 Diabetes Mellitus, Early Glycemic Control, HbA1c, Microvascular Complications, Metabolic Parameters.

Background: Subclinical hypothyroidism (SCH) is associated with metabolic dysfunction and increased cardiovascular risk, potentially mediated by chronic low-grade inflammation. High-sensitivity C-reactive protein (hs-CRP) is an established marker of systemic inflammation, but its predictive significance in SCH remains unclear. This study evaluates the association of hs-CRP with metabolic parameters and its potential role in identifying individuals at heightened cardiometabolic risk. Materials and Methods: This prospective observational study included patients with SCH, diagnosed based on elevated thyroid-stimulating hormone (TSH) levels and normal free thyroxine (FT4) levels. Serum hs-CRP, lipid profile, fasting glucose, fasting insulin, and insulin resistance (HOMA-IR) were measured at baseline and follow-up. Correlations between hs-CRP and metabolic parameters were analyzed using Pearson’s and Spearman’s correlation coefficients. Subgroup comparisons were performed, and receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive value of hs-CRP for metabolic abnormalities. Results: SCH patients had significantly higher hs-CRP levels (3.0 ± 1.2 mg/L) compared to euthyroid controls (1.7 ± 0.8 mg/L, p < 0.001). Elevated hs-CRP (≥3 mg/L) was associated with higher TSH (6.8 ± 1.6 vs. 4.9 ± 1.3 mIU/L, p < 0.001), BMI (28.3 ± 3.5 vs. 25.1 ± 3.2 kg/m², p < 0.001), LDL (130.2 ± 21.5 vs. 115.4 ± 19.7 mg/dL, p = 0.002), and HOMA-IR (3.9 ± 1.2 vs. 2.5 ± 0.8, p < 0.001). hs-CRP showed positive correlations with BMI (r = 0.42), LDL (r = 0.38), triglycerides (r = 0.40), fasting insulin (r = 0.44), and HOMA-IR (r = 0.48), all with p < 0.01. ROC analysis demonstrated that hs-CRP ≥3.0 mg/L had an AUC of 0.81 (95% CI: 0.74–0.88, p < 0.001) for predicting metabolic risk. Following metabolic optimization, significant reductions were observed in hs-CRP (-0.9 ± 0.6 mg/L, p < 0.001), LDL (-10.3 ± 8.5 mg/dL, p = 0.002), and HOMA-IR (-0.7 ± 0.5, p < 0.001). Conclusion: Elevated hs-CRP levels in SCH are strongly associated with metabolic dysfunction and insulin resistance, underscoring its potential role as a predictive marker for cardiometabolic risk. Monitoring hs-CRP in SCH patients may facilitate early risk stratification and support targeted interventions to reduce cardiovascular complications. Keywords: Subclinical hypothyroidism, high-sensitive C-reactive protein, inflammation, metabolic dysfunction, insulin resistance, cardiovascular risk.

Background: Positioning for spinal anesthesia in proximal hip fracture surgeries is often hindered by severe pain.The pericapsular nerve group (PENG) block, a newer regional technique, may offer better analgesia than intravenous fentanyl. This study compares the effectiveness of the PENG block versus IV fentanyl for facilitating spinal anesthesia positioning. Materials and Methods: In this randomized, double-blinded study, 60 patients undergoing proximal hip fracture surgery under spinal anesthesia were divided into two groups: Group 1 received an ultrasound-guided PENG block with 20 mL of 0.25% bupivacaine; Group 2 received intravenous fentanyl 1 mcg/kg. Pain scores during positioning, quality of positioning, patient satisfaction, and need for rescue analgesia were recorded. Results: VAS scores during positioning were significantly lower in the PENG group (2.53 ± 0.25) than the fentanyl group (4.27 ± 0.45) (p<0.0001). All patients in Group 1 achieved optimal positioning; 16 in Group 2 required additional fentanyl. Patient satisfaction was significantly better in the PENG group (p=0.001). Conclusion: The PENG block offers superior analgesia, facilitates optimal positioning, and enhances patient satisfaction compared to intravenous fentanyl, supporting its role in opioid-sparing anesthetic practices for hip fracture surgeries. Keywords: Proximal femur fracture, PENG block, Intravenous fentanyl, Spinal anesthesia, Positioning pain.

Background: Skin conditions are among the most common health concerns worldwide, significantly affecting individuals' quality of life. In rural areas, challenges such as limited access to healthcare, low awareness, and economic constraints can delay treatment-seeking, worsening outcomes. This study aimed to explore the pattern of common skin conditions and the treatment-seeking behaviour of patients attending the OPD at the Rural Health Training Centre of a teaching hospital in Bareilly. Materials and Methods: A cross-sectional observational study was conducted from July to September 2024 among 320 patients presenting with dermatological complaints at the RHTC. Data were collected using a pre-tested semi-open-ended interview schedule. Skin conditions were diagnosed with the support of a dermatologist. Results: Out of 320 participants, 55% had infectious skin conditions (mostly fungal and parasitic), while 45% had non-infectious conditions (such as acne and eczema). Males and those under 18 years were more affected by infectious conditions, while females and the 18–40 age group had a higher prevalence of non-infectious diseases. Socio-economic status and religion also showed significant associations. Notably, 82% had not sought any healthcare before visiting the RHTC. Common delays in treatment were due to preference for home remedies, lack of awareness, and financial issues. Adherence to prior treatments was inconsistent, primarily due to ignorance and lack of improvement. Conclusion: This study highlights a high burden of infectious skin conditions and significant delays in treatment-seeking due to socio-economic and awareness barriers. Targeted interventions are needed to improve early diagnosis, awareness, and adherence to treatment in rural populations. Keywords: Skin diseases, Rural health, Treatment-seeking behaviour, Infectious dermatological conditions, Healthcare access.

Background: Peripheral tuberculous lymphadenopathy (PTL), a common extrapulmonary tuberculosis manifestation, particularly in endemic areas, presents diagnostic and therapeutic challenges. This study aimed to evaluate the efficacy of antituberculosis therapy for peripheral tuberculous lymphadenopathy. Materials and Methods: This prospective study included 80 patients with cervical lymphadenitis. A structured proforma was maintained containing the basic characteristics of patients, including age, sex, occupation, personal history, symptoms, and investigations such as CBNAAT, FNAC, and Biopsy. After two months of the intensive phase, the patient's response to ATT was assessed. After the continuation phase of ATT, residual lymph nodes at the end of treatment (6 or 9 months) were assessed for treatment outcomes. Results: The most affected age group was 21–30 years (33.8%), followed by 11–20 years (26.3%), with female predominance (62.5%). A history of TB contact was reported in only 8.8% of cases. Most patients (65%) did not exhibit any constitutional symptoms. Right-sided lymphadenopathy was observed in 51.3% of patients, with the upper jugular group being the most commonly involved (51.3%). Matted lymph nodes were observed in 22.5% of patients. After 9 months of ATT, 76.7% had complete resolution. Of 17 with persistent swelling, 3 had MDR-TB and 14 had drug-sensitive TB. New swelling developed in 4% of patients, 4% defaulted, 3% died during treatment unrelated to TB, and 1% received an alternative diagnosis after further evaluation. Conclusion: Our study concluded that the treatment outcomes of PTL are suboptimal compared to those of pulmonary TB, with many patients showing incomplete lymph node resolution despite standard ATT. Keywords: Peripheral tuberculous lymphadenopathy, cervical lymphadenitis, antituberculosis therapy, extrapulmonary tuberculosis, lymph node resolution, tuberculosis treatment outcome.

Background: Shift work is an essential component of healthcare delivery but is often associated with disruption of normal sleep patterns, leading to various sleep disorders among healthcare workers. The impact of rotational shift duties on sleep quality, insomnia, and daytime alertness has serious implications for both worker health and patient safety. The aim is to assess the correlation between shift work characteristics and the prevalence of sleep disorders among healthcare workers in a tertiary care teaching hospital. Materials and Methods: This hospital-based, cross-sectional observational study was conducted among 90 healthcare workers, including doctors, nurses, and paramedical staff, engaged in shift-based duties. Participants completed structured questionnaires evaluating demographic data, shift patterns, and sleep parameters using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). Results: Among participants, 72.22% were engaged in rotational shifts, and 64.44% exhibited poor sleep quality (PSQI >5). Clinical insomnia (ISI ≥15) was found in 33.33%, and excessive daytime sleepiness (ESS ≥11) was noted in 44.44% of the participants. Sleep disorders were significantly more common among rotational shift workers compared to fixed night shift workers, with p-values of 0.028, 0.041, and 0.016 for poor sleep quality, clinical insomnia, and excessive daytime sleepiness respectively. Fatigue was reported by 77.78% of participants; however, no significant association was found between daytime napping habits and fatigue levels. Conclusion: Rotational shift work is significantly associated with poor sleep quality, clinical insomnia, and excessive daytime sleepiness among healthcare workers. Organizational strategies such as shift optimization and promoting sleep hygiene are critical to improving sleep health and occupational performance in this population. Keywords: Shift work, Sleep disorders, Healthcare workers, Sleep quality, Rotational shifts.

Background: Adolescent mental health is a critical public health concern, with self-esteem and loneliness being pivotal aspects influencing well-being, academic performance, and social interactions. This study examines the levels of self-esteem and loneliness among government and private school students in Haldia, West Bengal, exploring their interplay and associated socio-demographic factors. Materials and Methods: A cross-sectional study was conducted with 120 students from class 10th and 11th using the UCLA Loneliness Scale and Rosenberg Self-Esteem Scale. After taking ethical clearance from the Institutional Ethics Committee, IIMSAR, Haldia, we visited the respective schools and met the head of institutions briefing our idea. We visited both these schools three times and all the students of class 10th and 11th standards who were present on those days were included. They were explained the translated questionnaire in local language and proper assent was taken. Those who were not willing in this stage were excluded from the study. Results: The study revealed that 69.2% of participants experienced moderate loneliness, while 30.8% suffered from moderately high loneliness, predominantly government school students (81.1%, p=0.007). High self-esteem was observed in 35% of participants, with a significant association with school type, as 81% of students with high self-esteem attended government schools (p=0.003). Socioeconomic status also influenced loneliness significantly (p=0.021), but no substantial gender or residence effects were observed. Although a weak negative correlation was found between self-esteem and loneliness, it was not statistically significant. Conclusion: This study highlights the nuanced role of school environment and socio-economic factors in shaping adolescent mental health, underscoring the need for targeted interventions and further research to address these challenges. Keywords: School environment, school students, self-esteem, loneliness, impact.

Background: Tuberculosis (TB) remains a major global health challenge, despite the availability of effective vaccines and drugs. Multidrug-resistant tuberculosis (MDR-TB) complicates treatment outcomes, and early detection is crucial for infection control. The nitrate reductase assay (NRA) has emerged as a promising alternative for rapid drug susceptibility testing (DST). The objective is to compare the efficacy of direct and indirect nitrate reductase assay (NRA) on Lowenstein-Jensen (LJ) for the detection of MDR-TB. Materials and Methods: A comparative-validation study was conducted in the Department of Microbiology at Maulana Azad Medical College in collaboration with Lok Nayak Hospital and the New Delhi Tuberculosis (NDTB) Centre. A total of 32 suspected MDR-TB patients were enrolled based on Revised National Tuberculosis Control Programme (RNTCP) criteria. Sputum samples were processed for conventional microscopy, culture on LJ medium, and DST using direct and indirect NRA on LJ. Results were validated against the proportion method (PM), which was considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa statistics were used for comparison. Results: The study included 22 males (68.8%) and 10 females (31.2%), with a mean age of 33.34 ± 2.34 years. Direct NRA on LJ medium showed a sensitivity of 94.1% and specificity of 100% for isoniazid resistance, while indirect NRA on LJ showed a sensitivity of 93.3% and specificity of 100%. For rifampicin, direct NRA on LJ had a sensitivity of 92.3% and specificity of 100%, whereas indirect NRA on LJ had a sensitivity of 93.8% and specificity of 100%. Kappa values indicated excellent agreement with the PM. Conclusion: The NRA method demonstrated high concordance with the gold standard PM, offering a rapid, cost-effective, and reliable alternative for MDR-TB detection in resource-constrained settings. Direct NRA on LJ medium showed the highest diagnostic accuracy, making it a promising tool for early MDR-TB diagnosis and improved patient management. Keywords: Tuberculosis, Multidrug-resistant TB, Nitrate reductase assay, Drug susceptibility testing, Lowenstein-Jensen medium, Proportion method, Rapid diagnosis.

Background: Chronic obstructive pulmonary disease (COPD) is the fourth most frequent cause of death. In patients getting admitted with acute exacerbation of COPD (AECOPD), identifying simple, immediately accessible, and strong prognostic indicators will aid in management decision. The objective is to assess the DECAF score as an optimal clinical tool for accurate In- hospital prognostication of patients admitted with acute exacerbation of chronic obstructive pulmonary disease. Materials and Methods: A hospital based prospective study was performed on 100 patients admitted with primary diagnosis of AECOPD, in the wards of Government Medical College, Kannur during the period between July 2019 to July 2020. 100 consecutive patients were recruited, no randomization was done. Data was collected as per the well- structured proforma, after obtaining informed consent. Patients were scored according to the DECAF scoring system – Dyspnea, Eosinopenia, Consolidation, Acidemia and atrial Fibrillation. The patients were regularly followed during the entire hospital stay. The clinical outcome was categorized as a) improved b) status quo c) mortality. The role of DECAF score in predicting in-hospital outcome was analysed statistical software package SPSS, version 20.0. Results: Out of 100 patients studied, 51 patients had DECAF score between 0-1 (low risk), 16 patients had a DECAF score of 2 (Intermediate risk) and 33 patients had a DECAF score between 3-6 (high risk). In the high-risk group (DECAF 3-6) there was significantly higher mortality, longer duration of hospital stay and increased need for use of ventilator. Conclusion: The DECAF score incorporates indices routinely available at the time of admission and helps to stratify patients admitted with AECOPD into clinically relevant risk groups. This aids the physician in taking management decisions. Keywords: Acute Exacerbation of Chronic Obstructive Pulmonary Disease; DECAF score; Prognosis.

Background: Type 2 diabetes can lead to severe microvascular and macrovascular complications. Cardiovascular issues are common, affecting up to 80% of patients, and are responsible for about 65% of deaths among those with the condition. The present study was conducted to analyze the prevalence of vascular complications in type 2 diabetics. Materials & Methods: The present hospital-based cross-sectional study was conducted among 200 diabetic patients. Demographic information was collected using a pretested structured questionnaire. By combining questionnaires, clinical examinations, and laboratory investigations, the prevalence of macrovascular and microvascular complications was assessed. The data was collected, and results were analysed. Results: Out of 200 patients, 40% were females and 60% were males. Maximum patients (64.5%) belong to age group 50-70 years. Based on the HbA1c value, about 55% of the study population had their diabetes under control (HbA1c < 7%). The overall prevalence of macrovascular and microvascular complications in patients was 32% and 54%, respectively. About 21% of study subjects had both macro and microvascular complications. Conclusion: The study concluded that the overall prevalence of macrovascular and microvascular complications in diabetic patients was 32% and 54%, respectively and 21% of study subjects had both types of complications. Keywords: Macrovascular, Microvascular, Complications, Diabetes.

Background: Reconstructing infected Charcot’s midtarsal collapse in diabetic rocker bottom foot presents significant surgical challenges due to infection, deformity, and compromised vascularity. This study evaluates the efficacy of the distally based pedicled fibula flap in achieving limb salvage, functional recovery, and infection control. Materials and Methods: This prospective study included 53 patients with diabetic rocker bottom foot and infected Charcot’s midtarsal collapse treated using the distally based pedicled fibula flap. Preoperative and postoperative parameters, including the AOFAS Midfoot Score, pain score (VAS), radiographic healing, and inflammatory markers (CRP, ESR), were assessed. Complications, fixation methods, and flap viability were analyzed to identify factors influencing outcomes. Results: The limb salvage rate was 90.6%, with a significant improvement in the AOFAS Midfoot Score (32.6 ± 6.8 to 74.2 ± 9.5, p < 0.001) and reduction in pain score (VAS: 7.8 ± 1.1 to 3.2 ± 1.4, p < 0.001). Radiographic healing (88.7%) and substantial decreases in CRP and ESR (p < 0.001) were achieved. Factors significantly associated with unfavorable outcomes included diabetes duration >10 years (p = 0.042), preoperative HbA1c >8% (p = 0.038), and partial/complete flap necrosis (p = 0.008). Complications such as partial flap necrosis (13.2%) and surgical site infection (11.3%) were comparable to previous studies. Conclusion: The distally based pedicled fibula flap is a reliable technique for reconstructing infected Charcot’s midtarsal collapse, demonstrating high limb salvage rates and significant functional improvements. Multidisciplinary management and optimal glycemic control are crucial for minimizing complications and improving outcomes. Keywords: Diabetic rocker bottom foot, Charcot midtarsal collapse, Distally based pedicled fibula flap, Limb salvage, Flap necrosis.

Background: Peripheral nerve injuries significantly impact functionality, quality of life, and disability levels. This study aimed to compare recovery outcomes across patients with median, ulnar, and radial nerve injuries, focusing on sensory, motor recovery, complications, and quality of life. Materials and Methods: A prospective study was conducted involving 120 patients with surgically repaired nerve injuries (40 each for median, ulnar, and radial nerves). Functional assessments included DASH scores, grip/pinch strength, quality of life domains, and complication rates over 12 months. Statistical comparisons were performed using ANOVA and chi-square tests. Results: No significant differences were observed in functional recovery outcomes (DASH score: p=0.057; grip strength: p=0.193), sensory/motor recovery at 12 months (100% in all groups, p>0.05), or quality of life domains (p>0.05). Complication rates, including infection and neuroma formation, were comparable (p>0.05). Most recovery occurred within six months, stabilizing by 12 months. Conclusion: Functional and quality-of-life outcomes after peripheral nerve repair are comparable among median, ulnar, and radial nerve injuries, with early motor and sensory recovery. Effective surgical techniques and postoperative rehabilitation are critical in optimizing outcomes. Keywords: Peripheral nerve injury, functional recovery, quality of life, sensory recovery, DASH score.

Background: The aim is to compare the recovery profiles of inhalational anaesthesia and total intravenous anaesthesia (TIVA) in adult patients undergoing outpatient surgical procedures, focusing on emergence time, discharge readiness, and postoperative comfort. Materials and Methods: This prospective, comparative study included 110 patients aged 18–60 years, classified as ASA I or II, and scheduled for elective outpatient surgery under general anaesthesia. Patients were randomized into two groups: Group I (n=55) received inhalational anaesthesia with sevoflurane, and Group IV (n=55) received TIVA with propofol and remifentanil. Standard anaesthetic protocols were followed in both groups. Recovery parameters such as time to eye opening, extubation, orientation, Aldrete score, and PADSS were assessed. Statistical analysis was conducted using SPSS v26, with p<0.05 considered significant. Results: Baseline characteristics were comparable across groups. Recovery was significantly faster in the TIVA group, with shorter times to eye opening (6.1 ± 1.8 min vs. 8.3 ± 2.2 min; p<0.001), extubation, and orientation. Modified Aldrete Score ≥9 was achieved earlier in Group IV (11.4 ± 2.7 min vs. 14.8 ± 3.5 min; p<0.001). PADSS scores at 30 minutes were also higher (9.2 ± 0.6 vs. 8.6 ± 0.9; p=0.003). Group IV had lower pain scores (2.6 ± 1.0 vs. 3.1 ± 1.2; p=0.02) and higher patient satisfaction (8.9 ± 1.0 vs. 8.2 ± 1.1; p=0.01). Incidences of nausea and vomiting and antiemetic use were lower in Group IV, though not statistically significant. Conclusion: TIVA resulted in faster and smoother recovery, better pain control, and higher patient satisfaction compared to inhalational anaesthesia. These findings support the use of TIVA as the preferred anaesthetic technique for outpatient surgeries to enhance perioperative efficiency and patient outcomes. Keywords: Total intravenous anaesthesia (TIVA), inhalational anaesthesia, outpatient surgery, recovery profile, discharge readiness.

Background: The aim is to prospectively assess cognitive function and the incidence of postoperative cognitive dysfunction (POCD) in elderly patients undergoing elective non-cardiac surgery under general anaesthesia, and to identify associated risk factors. Materials and Methods: This prospective observational study was conducted over 12 months at a tertiary care hospital. Ninety patients aged ≥65 years, scheduled for elective non-cardiac surgery under general anaesthesia, were enrolled. Patients were assessed for cognitive function using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at four time points: preoperatively (baseline), and postoperatively on Day 1, Day 3, and Day 7. Data on demographics, comorbidities, ASA grade, type and duration of surgery, and anaesthetic details were collected. Statistical analysis was performed using SPSS version 25.0, with p < 0.05 considered significant. Results: The mean preoperative MMSE and MoCA scores were 27.4 ± 1.9 and 25.1 ± 2.4, respectively. On postoperative Day 1, both scores declined significantly (MMSE: 24.8 ± 2.3, MoCA: 21.7 ± 2.6; p < 0.001), with gradual improvement by Day 7. POCD was present in 37.78% of patients on Day 1, declining to 10.00% by Day 7. Significant risk factors for POCD included older age (p = 0.014), ASA grade III (p = 0.002), longer surgery duration (p = 0.008), hypertension (p = 0.019), and diabetes mellitus (p = 0.012). Conclusion: Elderly patients undergoing general anaesthesia for elective non-cardiac surgery are at notable risk for early POCD, particularly within the first 24–72 hours. Cognitive decline is largely transient, but risk increases with age, comorbidities, and higher ASA status. Preoperative cognitive screening and tailored perioperative strategies are essential to mitigate POCD risk in this population. Keywords: Postoperative Cognitive Dysfunction, General Anaesthesia, Elderly, MMSE, MoCA.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition of the paranasal sinuses characterized by nasal obstruction, facial pressure, hyposmia, and mucopurulent discharge. Conventional treatments, including medical therapy and functional endoscopic sinus surgery (FESS), have long been employed but carry limitations such as recurrence, surgical morbidity, and prolonged recovery times. Balloon sinuplasty, a minimally invasive technique, has emerged as an alternative aimed at restoring sinus drainage while preserving mucosal integrity. This study was conducted to evaluate the effectiveness of balloon sinuplasty in patients with CRSwNP in terms of symptom relief, radiological improvement, and quality of life enhancement. Materials and Methods: This prospective observational study was conducted at a tertiary care center over a period of 12 months. A total of 60 adult patients diagnosed with CRSwNP, who failed to respond adequately to maximal medical therapy, were enrolled. Balloon sinuplasty was performed targeting the maxillary, frontal, and sphenoid sinuses as indicated. Patients were evaluated preoperatively and at 3 and 6 months postoperatively using the Sino-Nasal Outcome Test-22 (SNOT-22) score, Lund-Mackay radiological staging, and nasal endoscopy findings. Complication rates and need for revision procedures were recorded. Results: The mean preoperative SNOT-22 score significantly improved from 52.6 ± 10.4 to 18.3 ± 7.5 at 6 months postoperatively (p < 0.001). The Lund-Mackay scores also showed marked radiological improvement. Nasal endoscopy revealed a substantial reduction in polyp size and mucosal edema in the majority of patients. Only 2 patients (3.3%) required revision interventions within the follow-up period. No major complications such as cerebrospinal fluid leak, orbital injury, or significant hemorrhage were noted. Patient satisfaction rates were high, with 91.7% of participants reporting symptomatic relief and functional improvement. Conclusion: Balloon sinuplasty is a safe, effective, and minimally invasive technique for the management of chronic rhinosinusitis with nasal polyps, offering significant symptom relief and radiological improvement with minimal morbidity. It presents a viable alternative to conventional sinus surgery, especially in selected patients with localized disease and favorable anatomy. Further studies with larger cohorts and longer follow-up periods are recommended to validate these findings. Keywords: Balloon Sinuplasty, Chronic Rhinosinusitis, Nasal Polyps, SNOT-22 Score, Lund-Mackay Score, Minimally Invasive Sinus Surgery, Endoscopic Sinus Procedures.

Background: Chronic liver disease (CLD) is characterized by progressive hepatic injury culminating in cirrhosis and hepatic decompensation. Hematological and biochemical parameters are vital in evaluating the extent of liver dysfunction and predicting clinical outcomes. Materials and Methods: This cross-sectional observational study was conducted in the Department of General Medicine, RVM Institute of medical sciences and research Center, over one year from March 2024 to February 2025. A total of 150 adult patients diagnosed with CLD were enrolled. Detailed clinical histories were taken, and hematological parameters (hemoglobin, platelet count, TLC) and biochemical parameters (AST, ALT, bilirubin, albumin, INR) were analyzed. Disease severity was graded using the Child-Pugh classification. Statistical correlations between laboratory parameters and disease class were evaluated using SPSS software. Results: The study cohort was male predominant (62.7%) and aged between 41–60 years. Alcoholic liver disease (41.3%) and NAFLD (19.3%) were the predominant etiologies. Anemia and thrombocytopenia were the most common hematological manifestations. Biochemical derangements included elevated AST, ALT, bilirubin, and INR, and reduced albumin levels. Platelet count, serum albumin, bilirubin, and INR significantly correlated with Child-Pugh class. Conclusion: Routine hematological and biochemical investigations provide essential insights into CLD severity and prognosis. Their integration into clinical practice is crucial for early risk stratification and guiding therapeutic strategies. Keywords: Chronic liver disease, Biochemical parameters, Hematology, Child-Pugh classification, Thrombocytopenia.

Background: Underweight is a global issue in all developing countries. A huge number of deaths were reported in the underweight population. However, the studies related to the underweight children and their sleep patterns and cognitive functions were not studied much. Hence, the present study was undertaken. The present study was undertaken to assess the effects of cognitive functions and sleep quality in underweight school children. Materials and Methods: The present study was a cross-sectional study that recruited 60 underweight school children after obtaining written informed consent. Sixty age- and gender matching healthy children were part of the study. Spatial memory and verbal memory scores were recorded to assess spatial and verbal memory. A 100-pin test was performed to assess the coordination. Sleep quality was assessed using the insomnia severity index. Results: Significantly lower scores of spatial and verbal memory were observed in the underweight children compared to healthy children. The 100-pin test time was significantly longer in underweight children. Poor sleep quality was observed in the underweight children. Conclusion: The study results support that the underweight individuals' memory and sleep quality were significantly affected. Further detailed studies are recommended in this area. Keywords: Underweight children, Stress, Sleep, Memory, cognitive functions.

Background: Non-communicable diseases (NCDs) are the leading cause of mortality and morbidity throughout the world. NCDs are mainly caused by four behavioural risk factors: tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol. Exposure to these risk factors start in younger ages group which if not prevented at appropriate age will lead to devastating outcomes in terms of occurrence of NCDs in later life. The aim is to estimate the prevalence of behavioural risk factors of non-communicable disease among medical students of Lakhimpur Medical College and Hospital, Assam. Materials and Methods: A cross-sectional study was conducted among 184 medical students for a period of six months from May to October, 2024. WHO global STEP-wise approach was used to estimate the prevalence of risk factors for NCD. Results: Mean age of the participants was 22.3 ±1.34 years. 66.9% was male and 83.7% belonged to Hinduism. Current tobacco user was 22.3% and current alcoholic was 17.9%. Inadequate consumption of fruit and vegetables was observed in 90.2% and 75.5% students respectively. Processed food and extra salt were consumed daily by 16.8% and 25.5% students respectively. 76.6% and 3.8% students were involved in sufficient moderate and vigorous physical activity respectively. Conclusion: Modifiable non-communicable disease risk behaviours including tobacco and alcohol use, daily consumption of processed food and extra salt intake are present among medical students. Behavioural change communication should be stepped up among the students to help them adopt the healthy lifestyle behaviour. Keywords: Behavioural Risk Factors, Non-communicable disease, Medical students.

Background: Morphometric analysis provides objective measurements important for identifying normal and abnormal anatomical structures. The auricle is integral to facial harmony, surgical planning and forensic identification. Despite its importance there is limited normative data on auricular dimensions across age and gender in the Indian population. This study aimed to establish morphometric baselines for the human auricle and investigate differences by sex, side, and age. Materials and Methods: A cross-sectional study was conducted on 170 individuals comprising 100 young adults (50 males and 50 females, aged 18–25) and 70 individuals distributed across seven age groups. Measurements were taken bilaterally using a digital caliper in the Frankfurt horizontal plane. Parameters measured included total ear height, ear width, conchal height and width, lobular height and width and ear projection. Data was analyzed using SPSS v23.0., Independent t-tests and one-way ANOVA were used to assess sex and age-related differences, with p<0.05 considered significant. Results: Among young adults mean total ear height was 59.33±3.30 mm. Males exhibited significantly larger dimensions than females for ear height, width, conchal height and ear projection. Notable right-left asymmetry was observed in both sexes particulalry in ear width and ear projection. A progressive increase in all parameters was observed with age, most markedly in lobular height and total ear height. Ear projection remained relatively stable. These trends highlight the auricle's age-dependent morphological evolution and sexual dimorphism in size. Conclusion: This study establishes normative auricular dimensions for an Indian population, revealing significant variations by age, sex, and side. The findings have practical implications in aesthetic and reconstructive surgery and forensic identification. Standardized morphometric assessment is essential for clinical accuracy and anthropological relevance. Keywords: Auricle, Morphometry, Anthropometry, Ear dimensions, Age-related changes.

Background: Hypothyroidism is among the most common endocrine disorders in children, significantly impacting growth, metabolism, and neurodevelopment. Despite being preventable, delayed diagnosis remains a challenge in India due to the lack of universal neonatal screening and low clinical suspicion. This study aimed to assess the etio-clinical profile, demographic distribution, and associated comorbidities of hypothyroidism in pediatric patients attending a tertiary care center in Indore, Madhya Pradesh. Materials and Methods: A cross-sectional analytical study was conducted over 18 months (April 2021 to September 2022) at the Department of Pediatrics, Sri Aurobindo Medical College and Postgraduate Institute, Indore. A total of 80 children aged from birth to 18 years, diagnosed with hypothyroidism, were enrolled. Data regarding clinical features, growth parameters, and thyroid function tests were collected using a structured proforma. Nutritional status was assessed using Z scores for height, weight, BMI, and weight-for-height ratios. Statistical analysis was performed using SPSS version 20.0, with p-values <0.05 considered significant. Results: The majority of patients were diagnosed between 5–10 years of age (30%), with a female predominance (61.3%). Acquired hypothyroidism (56.3%) was more common than congenital hypothyroidism (43.8%). Growth retardation (46.3%), lethargy (36.3%), and constipation (27.5%) were the most prevalent clinical features. Pallor (45%), dry skin (31.3%), and oedema (28.8%) were common systemic findings. Short stature was observed in 33.8% of patients, and underweight status in 27.6%. Thyroid profile revealed elevated mean TSH levels (63.41 mIU/L), confirming hypothyroidism. Conclusion: The study highlights delayed diagnosis, particularly in congenital cases, due to non-specific early features. Regular growth monitoring, thyroid screening, and clinician awareness are crucial for early detection and timely management to prevent long-term complications in pediatric hypothyroidism. Keywords: Hypothyroidism, short stature, pediatric.

Background: Medical treatment and surgery remain the mainstay of the treatment of chronic pancreatitis. Also following surgery, it has been observed that in quiet a few cases the pain either persists or recurs after some duration of time. Present study was aimed to study of the long term quality of life after surgery in patients with chronic pancreatitis. Materials and Methods: Present study was Single center, prospective analysis of retrospective data of patients who underwent surgery for chronic pancreatitis. Quality of life assessment was done using SF 36 questionnaire. Results: Among 158 patients of chronic pancreatitis, male preponderance was noted. The most common procedure performed was lateral pancreaticojejunostomy (LPJ) (63.2%) followed by Frey’s procedure in 33.5% patients and 3.1% patients underwent Whipple’s procedure. The post-operative complication rate was 3.7% (6/158) [Clavien-Dindo grade IIIb-2, grade II-1, grade I- 3]. The median follow-up duration was 46 months (range 6 months to 120 months. There was statistically significant reduction in the median post-operative Izbicki score when compared to median pre-operative Izbicki score (41.25 vs 63.75, p<0.001) There was reduction in all components of Izbicki pain score. There was significant reduction in Izbicki score (preoperative Vs. postoperative) among the patients underwent LPJ and Frey’s procedure too. Majority of the patients had improved Quality of life score in every domain of assessment on post-operative follow up of the patients. Most of the patients had improvement in physical functioning and pain and subsequently their social relationships improved significantly. Conclusion: Lateral pancreaticojejunostomy (LPJ) and Frey’s procedure significantly reduce the pain. These procedures are associated with improved quality of life. Keywords: Chronic pancreatitis, lateral pancreaticojejunostomy (LPJ), Frey’s procedure, quality of life.

Background: Most frequently injured structure is the anterior cruciate ligament (ACL) during sporting activities. This injury of anterior Cruciate ligaments has long term effects on movement of knee joint because of osteoarthritis and instability of joint which affects the normal gait. The Cruciate ligament reconstruction has become a widely accepted procedure over the past few years. Reconstruction of joint by surgery aims to restore the normal walking and stabilization of the injured knee. Hence, surgeons should have detailed anatomical knowledge for the reconstruction of cruciate ligaments. So for this surgery, various morphometric parameters of anterior cruciate ligament are necessary. This detailed anatomy of ACL will guide the surgeon to select proper size of the graft for the reconstruction. The aim and objective is to measure morphometric dimensions of the ACL, to estimate morphometry and variations of right and left anterior cruciate ligament footprints (attachments) and to compare the Morphometric parameters of anterior cruciate ligaments of both sides. Materials and Methods: Cross-sectional study was done on sixty-two adult cadaveric knee specimens by dissection, out of sixty-two specimens, thirty-two of right and thirty of left side were studied. The dimensions of anterior cruciate ligaments measured were length, anteroposterior and transverse width close to the attachments on femur and tibia. Same measurements were also noted at middle of both attachments. Length and width of tibial and femoral foot print (attachment) were noted. ‘Digital Vernier Caliper’ of 0.1mm precision was used for all parameters. The statistical analysis of all the parameters was done by using SSPS, version 16. Results: The mean length of ACL was 36.62±1.56 mm. Average anteroposterior diameters of ACL were 6.79±1.32 mm on femoral aspect, 10.92±1.33 mm in the middle and 12.74±1.57 mm on tibial aspect. Average transverse diameters of ACL were 9.05±0.99 mm on femoral aspect, 10.66±1.39 mm on middle and 12.30±1.66 mm on tibial aspect. The mean transverse and anteroposterior diameters of tibial footprint of ACL were noted as 14.27±1.64 mm and 12.82±1.43 mm. The average anteroposterior and transverse measurements of femoral footprint of ACL were 18.19±2.98 mm and 7.29±1.22 mm respectively. Conclusion: The mean length of ACL on right and left side was similar. The anteroposterior diameter and transverse diameter of ACL was progressively increasing from femoral to tibial aspect on both sides. Difference between respective parameters of both sides of the ACL were not significant. Position of tibial footprint site of anterior cruciate ligaments showed variation on both side. Position of femoral footprints of ACL on right and left side were statistically similar. Keywords: Morphometry; Cruciate ligament; Footprint & Reconstructive surgery.

Background: General anesthesia (GA), by convention, remains the mainstay for all laparoscopic surgeries. The unopposed increase in systemic vascular resistance (SVR) are related to the cardiovascular effects of pneumoperitoneum, systemic CO2 absorption and venous gas embolism. When spinal anesthesia (SA) is used in conjunction with general anesthesia, the sympathectomy resulting from the former may limit the rise in SVR. This study was designed to compare the effects of combining spinal and general anesthesia with that of general anesthesia alone on hemodynamic stability in laparoscopic gynecological surgeries Materials and Methods: 100 patients aged 18-65 years with BMI between 18- 30 kg/m2 belonging to American Society of Anesthesiologist (ASA) physical status I &II undergoing elective laparoscopic gynecological surgeries in Government Medical College Kozhikode were divided into two groups of 50 each. One group received Combined spinal and General Anesthesia (Group SGA) and other received General Anesthesia alone (Group GA). In both the groups, following parameters were compared: Changes in mean arterial pressure(MAP) and heart rate(HR) during the creation of pneumoperitoneum upto 30 min in 5 min interval and thereafter every 10 min till closure, Total dose of propofol required, Recovery time, Surgeon’s satisfaction by numeric rating scale (NRS) from 1 to 10.Statistical analysis was done using SPSS software version 20.Qualitative data were compared using Chi-square test and quantitative data compared using independent ‘t’ test. A p-value of less than 0.05 was taken as significant. Results: Both groups were comparable with respect to demographic data like age, BMI. Baseline heart rate (HR) and mean arterial pressure (MAP) were comparable in both groups. There was significant reduction in MAP and HR in group SGA as compared to group GA. Total dose of propofol required intraoperatively in Group GA was 578.18+70.74mg and in group SGA was 486.14+51.54mg. This resulted in early awakening with less recovery time. Surgeon’s satisfaction was 7.12+0.96 and 9.16+0.79 in group GA and SGA respectively. These differences were statistically significant. Combining two anesthesia techniques, added their advantages and limit the side effects. Conclusion: Concomitant use of spinal and general anesthesia can effectively attenuate the hemodynamic repercussions during pneumoperitoneum in laparoscopic gynecological surgeries than general anesthesia alone. Overall quality of anesthesia is better in terms of reduced anesthetic requirement, shorter recovery time and satisfactory operative field in combined technique. Keywords: Hemodynamics, Laparoscopy, Pneumoperitoneum, Spinal Anesthesia.

Background: Dexamethasone and magnesium sulphate are commonly used drugs in anaesthesia. The efficacy of both drugs in prevention of post spinal anaesthesia shivering remains optimistic. The objective is to compare the preventive effect of intravenous dexamethasone and intravenous magnesium sulphate usage in mitigating shivering following spinal anaesthesia in patients undergoing infraumblical surgeries. Materials and Methods: This Randomized, double blinded study was carried out among patients posted for elective infra-umbilical surgeries under spinal anesthesia in Department of Anesthesiology, Rohilkhand Medical College and Hospital, Bareilly. Results: The mean age, gender, weight, and type and duration of surgery were similar across both groups, with no significant differences. The overall incidence of PSAS was 35% in magnesium sulphate group and 57.5% in dexamethasone group which was statistically significant (p value - 0.043) in current study. Post-spinal shivering was more frequent in Group B (dexamethasone) compared to Group A (magnesium sulfate), with statistical significance at 15, 30, and 45 minutes after spinal anesthesia. Conclusion: Magnesium sulphate group had a higher percentage of patients with no shivering (Grade 0) and a lower percentage of moderate (Grade 2) and severe (Grade 3) shivering compared to Dexamethasone group. Keywords: dexamethasone, magnesium sulphate, post spinal shivering, infra umbilical surgeries.

Background: Gestational Diabetes Mellitus (GDM) is a common metabolic disorder in pregnancy. It is particularly prevalent in South Asian populations, including India. Although Insulin is commonly considered standard pharmacological treatment metformin has also gained attention as an oral alternative with promising results. The purpose of this study was to compare the efficacy and safety of metformin versus insulin in GDM management. Materials and Methods: This was a prospective observational study conducted in the department of obstetrics and gynecology of a tertiary care hospital. 60 pregnant women between 20–30 weeks gestation diagnosed with GDM based on DIPSI criteria were included in this study. Patients were randomized into two groups: one received oral metformin (500–2000 mg/day), and the other received Mixtard insulin with dose titration as per glycaemic control. Maternal fasting and postprandial glucose levels and mode of delivery were compared between two groups. Neonatal outcomes such as birth weight, hypoglycaemia, hyperbilirubinemia and NICU admission were also assessed. SPSS version 23 was used for statistical analysis and p value less than 0.05 was considered statistically significant. Results: Fasting blood glucose levels were significantly lower in the metformin group (102.4 ± 9.1 mg/dL) as compared to patients in insulin group (p = 0.0098). Postprandial blood sugar level was better controlled with insulin (p < 0.0001). No significant differences were found in mode of delivery or neonatal birth weight. Neonatal hypoglycaemia was more commonly seen in the insulin group (40.0%) as compared to metformin group (23.3%) although this difference was not statistically significant (p = 0.266). Metformin showed better compliance and was associated with fewer adverse neonatal outcomes. Conclusion: Both metformin and insulin effectively manage GDM with metformin offering advantages in fasting glucose control, fewer neonatal complications and better patient compliance. Metformin is found to be first-line pharmacologic alternative to insulin particulalry in resource-limited settings. Keywords: Gestational Diabetes, Metformin, Insulin, Glycaemic Control, Neonatal Outcomes.

Background: In the last two decades, the number of patients with type 2 diabetes mellitus is showing an unpredicted increase in the world, with the maximum increase noted among the Indian population. This study was done to study the clinical and biochemical parameters of diabetics attending the hospital and stratify them according to their risk factors. The objective is to assess profile of Type 2 Diabetes Mellitus patients attending in a diabetic clinic at a tertiary care centre and stratify their risk factors. Materials and Methods: A hospital based descriptive study was conducted among 350 diabetic patients of age between 30 to 65 attending Government Medical College, Kannur during the period between June 2019 to June 2020. All the patients after informed consent, were given a well structuredproforma. Patients were subjected for general examination, fundus examination and peripheral neuropathy examination and regular investigation like FBS, PPBS, HbA1c, Renal Profile, Urine routine and ECG was done. Patient were divided into three levels according to The Danish Risk Stratification Score. Statistical analyses were performed by using a statistical software package SPSS, version 20.0. Results: Among 350 diabetic patients who visited in Government Medical College Kannur, 87.4% of patient had other comorbidities other than diabetes, out of which obesity was the leading comorbidity.63.7 % patient had diabetes related complications, out if which 54.9% had diabetic nephropathy. Danish Risk Stratification score was an easy to do classification for diabetes patients and it a positive correlation was seen between the level and duration of diabetes. Conclusion: Strict diabetic control is an important factor for control of diabetic related complications. Danish Risk Stratification Score is an easy method to classify the diabetic patients at risk of complication and to manage them accordingly. Keywords: Gestational Diabetes, Metformin, Insulin, Glycaemic Control, Neonatal Outcomes.

Background: This study investigates the impact of the Acapella device on dynamic hyperinflation and exercise capacity in patients with moderate to severe chronic obstructive pulmonary disease (COPD) during the six-minute walk test (6MWT). The results indicate that the use of Acapella significantly improves inspiratory capacity, oxygen saturation, and distance walked, while reducing heart rate and maintaining FEV1, FVC, and FEV1% values. Materials and Methods: The use of Acapella during the 6MWT resulted in significant improvements in Inspiratory Capacity (1.70±0.48 L vs. 0.975±0.21 L, p<0.0125), SpO2 (97.29±0.93% vs. 91.82±2.46%, p<0.0125), and distance walked (242.41±4.534 m vs. 233.12±4.401 m, p<0.05) when they were compared post 6MWT vs pre 6MWT. Heart rate decreased significantly with Acapella (83.52±7.86 bpm vs. 92.02±8.14 bpm, p<0.0125). FEV1, FVC, and FEV1% values were maintained with Acapella use. Results: The Acapella is a safe and effective device for improving inspiratory capacity, reducing dynamic hyperinflation, and enhancing exercise capacity in COPD patients during the 6MWT. Further studies with larger sample sizes, longer durations of various other exercise tests and long-term follow-up are recommended to validate these findings. Conclusion: Thus, we see that there has been an eventual increase in overweight, obesity and overnutrition among both genders over the years. Keywords: 6MWT, Acapella, Inspiratory Capacity, FEV1, FEV1%, Dynamic Hyperinflation.

Background: Thrombocytopenia in pregnant women has been defined as platelet count less than 150 X 109/L. It is the second most common haematological abnormality during pregnancy, after anaemia. Thrombocytopenia, defined as a low platelet count (platelet count < 150 x 109/L), is observed in approximately 7% to 12% of all pregnancies, with gestational thrombocytopenia (GT) being the most common cause. Materials and Methods: A prospective observational study was conducted in all pregnant women >/28 weeks of gestation coming at NDMC Medical College & Hindu Rao Hospital after meeting inclusion and exclusion criteria. A total of 150 patients were taken. Results: Out of 150 patients enrolled for study 37 women were found to be having thrombocytopenia and 113women had normal platelet count. The prevalence of thrombocytopenia was 24.67%. Mild thrombocytopenia was the most common (48.65%) followed by moderate (45.95%). Severe thrombocytopenia was seen only in 5.41%. Conclusion: The prevalence of thrombocytopenia was 24.67%. Out of which mild thrombocytopenia was most common. Thrombocytopenia is adversely associated with fetomaternal outcome. Keywords: Thrombocytopenia, Gestational Thrombocytopenia, Postpartum Haemorrhage.

Background: Diabetic foot ulcers represent a significant healthcare challenge with substantial morbidity and mortality. This study aimed to evaluate the efficacy of collagen granule-based dressing compared to conventional dressing in the management of diabetic foot ulcers. Materials and Methods: A prospective study was conducted with 100 patients with diabetic foot ulcers, randomly allocated into two groups of 50 patients each. Group A received collagen granule-based dressing, while Group B received conventional saline-moistened gauze dressing. Wounds were assessed at baseline and weekly for 12 weeks for wound area reduction, granulation tissue formation, wound healing time, infection rates, and adverse events. Results: The upper middle class participants achieved the highest mean HeLD score of 82.53 ± 13.88 whereas middle class participants scored 70.58 ± 14.41 and lower middle class participants scored 55.64 ± 10.95 with significant differences (p=0.000). Participants in the lower middle socioeconomic status demonstrated the worst OHRQoL scored 16.78 ± 4.97 on the OHIP-14 scale and still upper class respondents displayed the best OHRQoL with 7.00 ± 0.00 yet these scores were significantly different between socioeconomic groups (p=0.013). The scores from the HeLD assessment had a weak inverse relationship (r=-0.193) with OHIP-14 measures (p=0.003) which demonstrates that better oral health literacy leads to improved oral health-related quality of life. Conclusion: Collagen granule-based dressing demonstrated superior efficacy compared to conventional dressing in the management of diabetic foot ulcers, with faster healing times, greater wound area reduction, and lower infection rates. These findings suggest that collagen granule-based dressing should be considered as an effective treatment option for managing diabetic foot ulcers. Keywords: Diabetic foot ulcer, Collagen granule-based dressing, Conventional dressing, Wound healing, Randomized controlled trial.

Background: Thyroid dysfunction is a prevalent endocrine disorder with significant public health implications. This study aimed to estimate the prevalence and patterns of thyroid dysfunction in a tertiary care center and identify associated demographic, clinical, and lifestyle factors. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital, enrolling 712 participants. Detailed clinical evaluation, demographic data, and lifestyle information were collected. Thyroid function was assessed using serum TSH, free T3, and free T4 levels. Participants were categorized as euthyroid, hypothyroid (primary or subclinical), or hyperthyroid (primary or subclinical). Statistical analyses included chi-square tests, t-tests, and multivariate logistic regression to identify significant predictors of thyroid dysfunction. Results: The overall prevalence of thyroid dysfunction was 33.7%, with primary hypothyroidism (13.1%) and subclinical hypothyroidism (10.9%) being the most common abnormalities. Hyperthyroidism was observed in 5.2% (primary) and 4.5% (subclinical) of participants. Increasing age (OR: 1.05, 95% CI: 1.03–1.07), female gender (OR: 1.53, 95% CI: 1.11–2.11), obesity (OR: 2.95, 95% CI: 1.96–4.45), and family history of thyroid disorder (OR: 4.11, 95% CI: 2.56–6.59) were significant predictors of thyroid dysfunction. Comorbidities such as hypertension (39.2% in hypothyroid individuals) and diabetes (32.7% in hypothyroid individuals) were significantly more common in those with thyroid dysfunction. Regular iodized salt consumption was notably higher in euthyroid individuals (83.5%) compared to those with thyroid dysfunction. Conclusion: Thyroid dysfunction is common, with hypothyroidism being the predominant abnormality. Age, female gender, obesity, and family history were identified as key risk factors. The association between thyroid dysfunction and cardiovascular risk factors underscores the need for routine screening in high-risk populations. Promoting awareness about iodine sufficiency may further aid in reducing the prevalence of thyroid dysfunction. Keywords: Thyroid dysfunction, Hypothyroidism, Hyperthyroidism, Risk factors, Iodine intake, Cross-sectional study.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by airflow limitation and systemic inflammation. Smoking is a major risk factor, but the impact of inflammatory, metabolic, and oxidative stress markers on disease progression in smokers versus non-smokers with COPD remains less explored. This study aimed to assess these biomarkers and their correlation with lung function parameters in both groups. Materials and Methods: This cross-sectional study included 132 COPD patients (66 smokers and 66 non-smokers) from a tertiary care center. Demographic details, clinical parameters, and spirometric values were recorded. Biomarkers such as C-reactive protein (CRP), total cholesterol, serum magnesium, and uric acid levels were measured. Pearson correlation analysis was performed to assess associations between biomarkers and lung function parameters. Results: Smokers exhibited significantly lower FEV1 (47.5 ± 11.3% vs. 52.8 ± 10.9%; p = 0.041), FEV1/FVC ratios (63.4 ± 6.5% vs. 67.9 ± 5.8%; p = 0.011), and SpO₂ levels (92.1 ± 3.6% vs. 94.8 ± 2.7%; p = 0.002). Exacerbation frequency was higher in smokers (1.9 ± 1.1 vs. 1.3 ± 0.8; p = 0.017). Biomarker analysis revealed that CRP (r = -0.42; p = 0.001), total cholesterol (r = -0.30; p = 0.007), and uric acid (r = -0.45; p = 0.001) correlated negatively with FEV1, while serum magnesium positively correlated with FEV1 (r = 0.37; p = 0.001). Similar trends were observed with FVC and FEV1/FVC ratios. Conclusion: Smokers with COPD exhibited greater lung function impairment, higher exacerbation rates, and elevated inflammatory and metabolic markers compared to non-smokers. Elevated CRP, cholesterol, and uric acid levels correlated with worse lung function, while higher serum magnesium levels were protective. These findings emphasize the need for aggressive smoking cessation strategies and targeted biomarker monitoring in COPD management. Keywords: COPD, Smokers, Inflammatory Markers, Oxidative Stress, Lung Function, C-Reactive Protein, Serum Magnesium.

Schizophrenia is a complex, chronic psychiatric disorder with a heterogeneous clinical presentation encompassing positive, negative, and cognitive symptoms. Despite over a century of research, its precise etiology remains elusive, though advances in genetic, neurobiological, and neuroimaging studies have significantly enhanced understanding. The disorder’s burden is substantial, with rising global prevalence and Disability-Adjusted Life Years (DALYs), highlighting the need for improved diagnosis and therapeutic strategies. Neurobiological underpinnings include polygenic inheritance, neurotransmitter dysregulation—particularly involving dopamine, glutamate, and serotonin—and structural brain abnormalities affecting prefrontal, temporal, and limbic regions. Diagnostic criteria, as per DSM-5, emphasize symptomatology and functional decline, necessitating careful differential diagnosis. Pharmacotherapy remains the cornerstone of management, with first-generation antipsychotics (FGAs) primarily targeting positive symptoms but burdened by extrapyramidal side effects, while second- and third-generation antipsychotics (SGAs and TGAs) offer broader efficacy with improved tolerability. Psychosocial interventions, notably cognitive behavioral therapy (CBTp) and family therapy, augment pharmacological outcomes by addressing functional impairments and relapse prevention. Emerging modalities such as neurostimulation techniques (rTMS, tDCS) and cannabidiol-based therapies present promising adjunctive options. Integrated, multimodal approaches incorporating pharmacotherapy, psychotherapy, skills training, and social support offer the most comprehensive benefit. Personalized medicine, leveraging genetic, neuroimaging, and clinical biomarkers, holds potential for tailoring treatment, improving outcomes, and minimizing adverse effects. Telemedicine has further expanded access to psychiatric care, particularly in underserved regions, although challenges remain. Overall, an integrated, patient-centered, and biologically informed approach is essential to improving the prognosis and quality of life for individuals with schizophrenia. Continued research into the neurobiology, novel therapeutic targets, and personalized interventions is imperative for advancing schizophrenia management. Keywords: Schizophrenia, Neurobiology, Antipsychotics, Cognitive Behavioral Therapy, Telemedicine, Personalized Medicine

Background: The essence of oral and maxillofacial radiology is not only to an important tool in the diagnostic assessment of dental patients but also to equip the clinician with the ability to interpret images of certain maxillocraniofacial structures of importance to dental, medical and surgical practices. One of the most important and unique joints in the body is the Temporomandibular Joint (TMJ). TMJ is a freely movable articulation between the condyle of the mandible and squamous portion of the temporal bone at the base of the skull. The appearance of mandibular condyle & variability in the shapes and sizes among different age groups and individuals should be an important factor in diagnosing the disorders of TMJ. Though OPG provides us with bilateral view of condyle but is not much clearly appreciated except its central & lateral part as there is superimposition of certain structures, so we worked on new modified technique i.e Reverse Panoramic Imaging in which condylar head is better appreciated than conventional/standard Panoramic Imaging. The aim & objective is to Compare the reliability of Reverse Panoramic Imaging over standard/conventional Panoramic Imaging for bilateral imaging of the condyle. Materials and Methods: Total of 30 subjects (30 OPG & 30 Reverse OPG) visiting our college will comprise the study group. Both OPG & Reverse OPG will be taken for the same patient & the image will be analyzed for following parameters i.e Condylar Head, Condylar Neck, Articular Eminence, Mandibular Fossa, Sigmoid Notch. Results: Data was statistically analysed by Chi Square test. Conclusion: Study concludes that Reverse Panoramic Imaging can be a BETTER approach to assess the TMJ than standard Panoramic Imaging as there is no superimposition of any associated structure. Keywords: Reverse Panoramic Imaging, Mandibular condyle, Temporomandibular joint.

Background: Headache is common but least addressed problem among chronic kidney disease (CKD) patients on Haemodialysis (HD). The aim is to find the epidemiology of headache and the proportion of Dialysis Related Headache (DRH)in CKD patients undergoing HD. To find the risk factors of headache in these patients. Materials and Methods: A cross sectional study was carried out amongst 99 consenting CKD patients on HD in our institution. Structured questionnaire was used to record demographic, clinical profile, dialysis frequency, shift, VAS score, quality, and site of headache. Haemoglobin, BP during headache, treatment and imaging details were taken from dialysis records. Data was entered in EXCEL sheet and analysed using SPSS version 19. Results: Among 99 patients 43 (43.43%) had headache with 27(62.79%) males and 16 (37.21%) females. 7 out of 43 (16.27%) had DRH. Headache was bifrontal throbbing in most patients and highest in 4th hour. Mean Hb was 9.51, SD+/-1.43. Mean VAS score was 4.14, SD+/_1.08. Hypertension was found be significant risk factor for headache (n=36 OR 2.85 with 95% CI 1.07 to 7.5, p value 0.01). Anaemia and dialysis frequency had no statistically significant association. Headache subsided without medication in half (n=23, 53.5%). Oral Paracetamol 500 mg was commonly used as treatment (n=13, 30.23%). CT taken in 4 cases, one had posterior reversible encephalopathy. Dialysis terminated in 2 cases. Conclusion: This study shows nearly half of HD patients have headache (43.43%) with hypertension as a significant risk factor. More studies are needed to understand the pathophysiology of the same. Keywords: Chronic kidney disease, headache, haemodialysis.

Background: Ropivacaine is used for supraclavicular brachial plexus block because of its wide safety profile and less cardiotoxicity. Dexmedetomidine is used as adjuvants to Ropivacaine. The aim is to compare the effectiveness by addition of Dexmedetomidine to Ropivacaine in supraclavicular brachial plexus for analgesic duration. Along with Analgesia onset, duration of sensory and motor blockade was compared. Materials and Methods: A prospective randomized comparative study was carried out among 70 patients of ASA I and II aged 20-60 years, scheduled for elective upper limb surgeries under supraclavicular brachial plexus block by parasagittal approach. Group RO received 20ml of 0.75% ropivacaine along with 1ml of 0.9 % Normal saline while Group ROD received 20ml of 0.75% ropivacaine along with 0.5mcg/kg dexmedetomidine which amounts to1ml. Statistical analysis is student t-test was used for demographic and hemodynamic parameter data analysis. Unpaired t-test was used for evaluation of data which includes onset, duration of sensory and motor blockade along with duration of analgesia. The results were statistically significant if p-value <0.05 and <0.001 was considered highly significant. Results: The Duration of analgesia lasted longer in Group ROD (990.90± 16.35) when compared to Group RO (543.03 ± 18.09). Onset time for sensory and motor blockade were rapid in Group ROD (7.70± 1.79, 13.76± 1.01) when compared to Group RO (10.15 ± 1.02, 18.59 ± 1.64). Duration of sensory and motor blockade was prolonged in Group RD (779.66± 31.39,726.07 ± 24.98) when compared to Group RO (456.07± 20.18, 398.04 ± 25.08). VAS scores were less in patients of Group ROD which led to reduced total analgesic requirement in Group ROD (0.75 ± 1.14) when compared to Group RO (2.31 ± 1.49) (p-value <0.001). Sedation scores were higher in Group ROD when compared to Group RO. Conclusion: Addition of Dexmedetomidine to Ropivacaine provided much superior analgesia along with faster onset and longer duration of sensorimotor blockade when compared Ropivacaine alone. Keywords: Dexmedetomidine, Ropivacaine, Supraclavicular, Brachial plexus block, Parasagittal, Sensory, Motor.

Background: Acinetobacter species, particularly A. baumannii, is emerging as significant nosocomial pathogens worldwide. These pathogens have a great propensity to develop multidrug resistance (MDR). These Gram-negative, non-fermenting coccobacilli cause diverse infections particularly in critically ill patients, posing major treatment challenges due to limited antimicrobial options. Materials and Methods: A hospital-based, observational study was conducted over 18 months (January 2022–June 2023) in a tertiary care center. A total of 3,048 clinical specimens were analysed out of which 82 (2.69%) Acinetobacter isolates were recovered and identified using standard microbiological procedures. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method per CLSI guidelines. Clinical data including demographics, risk factors, and prior antibiotic usage were collected. Risk factor analysis for MDR was performed using Chi-square and logistic regression tests. Results: Out of 82 isolates 51 (62.19%) were from general wards and 31 (37.80%) belonged to intensive care unit. A. baumannii was the most common species (76.82%) detected. Major infections included septicemia (39.02%), abscesses (24.39%) and urinary tract infections (14.6%). Prolonged hospital stay (>7 days), invasive procedures, prior surgery and diabetes were found to be risk factors associated with MDR infections. High resistance was seen for cephalosporins and fluoroquinolones. MDR was noted in 85.36% of isolates, with A. baumannii showing significantly higher resistance to multiple drug classes (96.77% MDR). Conclusion: MDR Acinetobacter (Particularly A. baumannii) presents a critical therapeutic challenge in both ICU and general ward settings. Strict infection control, antimicrobial stewardship and antibiotic therapy based on susceptibility patterns are imperative to fight the growing antibiotic resistance threat. Keywords: Acinetobacter baumannii, Drug Resistance, Multiple, Bacterial, Intensive Care Units, Nosocomial Infections, Anti-Bacterial Agents.

Background: Chronic anal fissures are painful tears in the anoderm, commonly resulting from trauma, constipation, or hypertonicity of the internal anal sphincter. They significantly affect the quality of life and require effective management. Lateral internal sphincterectomy is the gold standard surgical treatment, aimed at reducing sphincter spasm and promoting healing. Two main techniques—open and closed—are widely practiced, but there is ongoing debate regarding their relative safety, efficacy, and complication profiles. This study compares these two methods. Aim: To compare efficacy, safety and outcome of the closed vs open lateral anal sphincterotomy. Materials and Methods: A prospective comparative study was conducted on 50 patients with chronic fissure-in-ano, divided into open and closed sphincterectomy groups. Postoperative complications, pain levels, incontinence, and recurrence were evaluated. Results: Closed technique showed faster recovery and less postoperative pain. Open technique offered better intraoperative control. No significant difference in recurrence or incontinence. Conclusion: Both methods are effective, with closed technique offering better postoperative comfort. Keywords: Anal fissure, lateral sphincterectomy, open method, close method.

Background: To evaluate the variation in K-readings after application of artificial tears of different viscosities in mild to moderate dry eyes. Design cross-sectional comparative study. Materials and Methods: Setting: A tertiary care centre in Mumbai. Patient or Study Population: Patients presenting with cataract in our OPD were screened for dry eye disease and 50 eyes of 30 patients with mild to moderate dry eyes were recruited for the study Observation Procedure(s): Baseline keratometric measurements were taken followed by Instillation of low viscosity artificial tears and repeating keratometry at 1 minute and 5 minutes after instillation. Then high viscosity artificial tears were instilled after 24 hours and keratometric measurements were taken at 1 and 5 minutes after instillation. Main Outcome Measure(s): variation of K-readings at 1- and 5-min interval after application of artificial tears compared to baseline. Results: Instillation of both low and high viscosity artificial tears resulted in statistically significant changes in K1 measurements in both mild and moderate dry eyes at 1- and 5-minute intervals compared to baseline(p>0.05). However, K2 and axis did not show significant changes in both mild and moderate dry eyes. Conclusion: The variations in K1 after the instillation of artificial tears can potentially confound IOL calculations and affect surgical outcomes. Clinicians should be mindful of these effects when interpreting keratometry data Keywords: Cataract surgery, Dry eye syndrome, Artificial tears, Keratometry, IOL power calculation. Key Messages: Cataract surgery patients with dry eye syndrome often use artificial tears, which may influence keratometry readings. Our study found artificial tears significantly affected K1 values, especially in the steep corneal meridian, but K2 and axis remained stable. Accurate IOL calculations are critical for these patients. Further research is needed.

Background: Diabetes mellitus's high treatment costs and associated problems have made it a global public health concern. Albuminuria, a symptom of diabetic nephropathy, is an inflammatory condition that precedes end-stage renal failure. According to recent reports, the neutrophil/lymphocyte ratio (NLR), a readily available and reasonably priced marker, may be a good indication of the state of inflammation. Materials and Methods: This present cross-sectional, observational study was conducted in the Department of Pathology, KMC, Maharajgunj, UP and collaboration with Department of Medicine. 112 consecutive patients with T2DM diagnosed according to the American Diabetes Association criteria, attending the outpatient services of medicine department during the period from June, 2024 to November, 2024 in KMC, Maharajgunj were included. Results: A total of 112 patients were examined in this study. For the purpose of comparing other parameters, patients were separated into two groups based on urine albumin estimation: those with diabetic nephropathy (Group-A) and those without (Group-B). There were 56 patients in the DN group. Blood urea, serum creatinine, mean age, gender, BMI, and obesity (BMI > 30) were similar in both groups, and the difference was not statistically significant (p > 0.05). Conclusion: In patients with type 2 diabetes, Neutrophil/lymphocyte ratio, an inflammatory marker, can forecast their chance of developing nephropathy. Keywords: Type 2 DM, Neutrophil/lymphocyte ratio, renal dysfunction, diabetic nephropathy.

Background: Vitamin B12 deficiency, or cobalamin deficiency, refers to the condition characterized by low levels of vitamin B12 in the blood. Animal proteins, particularly from meat and eggs, are essential cobalamin sources. Materials and Methods: Patients who were admitted to medicine ward with Hb<12 gm% in males and <11 gm% in females are deemed anaemic and were examined for vitamin B12 insufficiency. Erba ELISA was used to measure each patient's serum vitamin B12 level. The study included 46 of these patients whose serum vitamin B12 levels were less than 200pg/mL. Results: The mean vitamin B12 was 156.28+25.46 pg/mL. The age range of the group was 16–59 years old. The majority of patients were in the second decade, or between the ages of 25 and 35. A significant negative correlation was found between vitamin B 12 levels and mean corpuscular volume & total leukocyte count. A positive correlation was found between vitamin B12 and Hemoglobin& platelet count. This correlation was found to be statistically significant (p= < 0.01). Conclusion: A wide range of clinical manifestations is linked to a deficiency of vitamin B12. Men, people with alcohol dependence and vegetarians are at risk. Early intervention prevents late complications. Keywords: Vitamin B12 deficiency, anaemia, Mean corpuscular volume and hemoglobin.

Background: Pediatric ocular trauma is a major cause of acquired visual impairment and blindness among children, particularly in low-resource settings. Understanding its epidemiology and clinical profile is essential for improving outcomes and guiding preventive strategies. The objective is to evaluate the epidemiological patterns, types of injuries, management modalities, and visual outcomes in pediatric patients presenting with ocular trauma to a tertiary care center. Materials and Methods: A retrospective study was conducted over one year (February 2024 to February 2025) at the Department of Ophthalmology in a tertiary care centre, including all children aged 0 to 16 years presenting with ocular trauma. Data were collected on demographics, mode and place of injury, clinical findings, management (medical/surgical), and pre- and post-treatment visual acuity. Statistical analysis included descriptive statistics and chi-square testing to assess associations between management type and outcomes. Results: Out of 60 pediatric patients, 75% were male, with the highest incidence (40%) observed in the 11–16-year age group. Most injuries occurred at home (45%), with blunt trauma from wooden sticks being the most common cause (20%). Medical management was employed in 35% of cases, while 65% required surgical intervention. Post-treatment, the proportion of children with visual acuity of 6/6–6/12 increased from 15% to 40%. Although not statistically significant (p = 0.0643), surgically managed cases had a trend toward poorer outcomes. Conclusion: Pediatric ocular trauma is largely preventable, with domestic environments being a common source of injury. Early diagnosis and timely intervention significantly improve visual outcomes. Public education and structured trauma care protocols are vital for reducing the burden of childhood ocular injuries. Keywords: Pediatric ocular trauma; Visual acuity; Eye injury; Blunt trauma; Ocular surgery; Childhood blindness.

Background: This study evaluates the efficacy of intravenous Dexmedetomidine versus intravenous Lignocaine in attenuating the hemodynamic stress response to laryngoscopy and endotracheal intubation in normotensive patients undergoing elective surgeries. Introduction: Laryngoscopy and intubation can cause significant cardiovascular stress, leading to hypertension and tachycardia due to sympathetic activation. Dexmedetomidine, an α2 agonist, provides hemodynamic stability by suppressing catecholamine release and inducing sedation. Lignocaine, a local anesthetic, stabilizes neuronal membranes to attenuate the pressor response. Comparing these agents is essential for optimizing perioperative management and ensuring better hemodynamic control during surgical procedures. Materials and Methods: This prospective, randomized study included 90 ASA I–II normotensive patients (18–50 years) undergoing elective surgery. Patients were divided into two groups: Group D received Dexmedetomidine (1 mcg/kg IV), and Group L received Lignocaine (1.5 mg/kg IV) before intubation. Hemodynamic parameters (HR, SBP, DBP, MAP, SpO₂) were recorded at baseline, pre-laryngoscopy, and at 1, 3, and 5 minutes post-intubation. Sedation levels were assessed using the Ramsay Sedation Scale, and adverse effects were monitored. Results: Dexmedetomidine significantly reduced HR, SBP, DBP, and MAP post-intubation compared to Lignocaine (p<0.001), demonstrating superior efficacy in blunting the pressor response. It also provided deeper sedation (Ramsay score 3) without major adverse effects. In contrast, Lignocaine produced a milder attenuation of hemodynamic changes, making Dexmedetomidine a more effective choice for maintaining perioperative hemodynamic stability while requiring careful monitoring. Conclusion: Dexmedetomidine is more effective than Lignocaine in attenuating the pressor response to intubation while offering superior sedation. It ensures better hemodynamic stability in normotensive patients but requires vigilant monitoring due to the risk of hypotension and bradycardia. Its dual benefits make it a preferable choice for controlled perioperative management in elective surgeries. Keywords: Dexmedetomidine, Lignocaine, hemodynamic response, laryngoscopy, intubation, anesthesia, sedation, blood pressure.

Background: Tibial fractures are among the most frequently seen injuries that an orthopaedic surgeon comes across day to day in their practice. Throughout the years, various treatment methods have been employed to treat tibial fractures. Currently, the principles of biological osteosynthesis supports the choice of closed intramedullary interlocking nailing. While arguments for and against reaming the canal are persuasive, evidence of the impacts of these biologic alterations on outcomes that are important to patients would be a more compelling data in guiding clinical practice. The objective is analyse the functional outcome of reamed and interlocked intramedullary nails in the management of tibial diaphyseal fractures. Materials and Methods: Study Design: A Retrospective hospital based Observational study. Study area: The study was conducted in the Department of Orthopaedics, KMCH. Study Period: 2 years (May 2022 to April 2024). Study population: Tibial shaft fractures between 5cm from knee and ankle joint treated with reamed and interlocked nails. Sample size: Total of 30 subjects. Sampling Technique: Convenient sampling. Results: In our series of 30 subjects with tibial fractures, average age was 36 years, 80% were closed fractures and majority (97.7%) were from RTA. Nails used were stainless steel (50%) and titanium (50%) of diameter 8-10 mm and length of nail ranged between 280-360 mm. All nails were locked in static mode and all fractures, both closed and open, were reamed. 20 cases were operated on within the first 48 hrs post injury while 10 cases were operated on within 2 weeks. Mean operating time was 60 min. 66.6% patients were fully weight bearing between 12-16 weeks and average fracture healing time was 14 weeks. 2 patients needed dynamisation due to delayed healing. Functional outcome was Excellent/Good in 93.4% and Fair in 6.6% with no poor result. Conclusion: The reamed and interlocked nailing system has emerged as a highly effective and reliable method for the management of tibial diaphyseal fractures offering superior stability through bigger diameter nails and transverse locking screws. It ensures control over limb length, alignment and rotation, thereby addressing the critical need for early bone healing and better overall functional outcome to the patient. The system's ability to facilitate early weight-bearing and joint movement significantly decreases patient morbidity and dependency, while also minimizing complications such as infection, non-union, malalignment and refracture. Keywords: Tibial fractures, Reamed and interlocked, Intramedullary Nail, Functional outcome.

Background: Stress is an emotional response to any situation which challenges one’s physical, mental and emotional levels. Medical and paramedical students develop stress due to academic and professional pressures which can be deleterious if not managed at an early stage. Aim: The aim of present study was to compare stress and coping mechanisms between medical and paramedical students. Materials and Methods: This cross-sectional questionnaire based survey was conducted on 200 medical and paramedical students selected by random sampling method. General health related questionnaire-12, perceived stress related scale-10 and COPE were used for obtaining study data. Informed consent as per Helsinki’s declaration was followed and permission was obtained from the Institutional Ethical Committee before starting the survey. Statistical analysis: Observations were recorded percentages. Data analysis was performed by employing the SPSS 20.0 statistical software (IBM, NY, US). Chi square test was used for comparing values. Statistically significant difference was set as P values which were less than 0.05. Results: 01% medical and 02% paramedical students had no distress (P=0.08). In 56% medical and 58% paramedical students, distress was visible, however no statistical significance was observed (P=0.07). 43% Medical and 40% students of paramedical courses were found to have severe psychological distress however, no statistical significance (P=0.06) was found. On analysis of stress, 28% medical students and 56% paramedical students were suffering from average stress with statistical significance (P=0.05). 45% Medical and 24% paramedical students suffered from moderate stress levels (P=0.05). 27% medical and 80% paramedical students were found to have severe stress levels (P=0.04). Conclusion: Present study reported moderate to severe stress levels in studied medical and paramedical students with optimal coping strategies. Keywords: stress, psychological, medical, paramedical, distress.

Background: Retained, forgotten DJ Stents are not uncommon and they often result in serious complications like migration, fragmentation, and stone formation. Aim: To assess the feasibility of maintaining a Stent Registry in order to prevent retained and forgotten DJ Stents.Materials and Methods: Setting: A tertiary care centre in Mumbai. Patient or Study Population: Patients presenting with urolithiasis and having undergone endourological procedures like PCNL, RIRS and URSL with DJ stenting were recruited for the study. Observation Procedure(s): Prior to post -procedure discharge, a follow-up appointment was scheduled for stent removal. Entry of each patient was done in a DJ Stent Register. To ensure timely stent removal, the urology team reviewed the DJ Stent registry every fortnight to verify that each patient had either had their stent removed or had a scheduled appointment for removal within 3 weeks of surgery. Patient Follow-up If a patient failed to follow up for stent removal, the urology team contacted the patient via telephone. During this call, the patients were asked to confirm whether they have had their stent removed elsewhere or if they will schedule a follow-up appointment in the urology OPD for stent removal. Results: A rigorous and systematic follow up with all patients having DJ stent ensured that all of them had their stent removed either at this hospital or elsewhere. Conclusion: This proactive approach ensured that patients received necessary care and follow up and thereby minimized potential complications associated with retained stents. Keywords: Urolithiasis, Retained forgotten DJ stents, PCNL, URSL, RIRS, Stent register.

Background: Hemoglobinopathies represent the most prevalent hereditary illnesses worldwide, with thalassemia disorders being significant public health concerns, especially in Southeast Asia. In India, the beta-thalassemia trait (β-TT) has a prevalence of 3-4% nationwide, with regional variations. This study aimed to determine the prevalence of β-TT among pregnant women attending a tertiary care hospital in Chennai, Tamil Nadu. Materials and Methods: This descriptive study included 150 antenatal women aged 18-40 years attending a tertiary care teaching hospital. Complete blood count, NESTROFT (Naked Eye Single Tube Red Blood Cell Osmotic Fragility Test), serum ferritin levels, and High-Performance Liquid Chromatography (HPLC) were performed to detect β-TT and distinguish it from iron deficiency anaemia (IDA). Results: Among the 150 participants, 28.7% (43/150) had microcytic hypochromic anaemia. NESTROFT was positive in 15% (23/150) of participants, but only 2 (1.3%) were confirmed to have β-TT by HPLC (HbA2 >3.9%). An additional 3% (5/150) showed equivocal results with HbA2 between 3.5-3.9%, while 20% (30/150) had IDA. Comparative analysis showed that β-TT patients had lower haemoglobin (mean 7.5 g/dl), MCV (73 fl), and MCH (20.5 pg) values compared to normal subjects. Conclusion: The 1.3% prevalence of β-TT among pregnant women in this study population represents a significant concern due to the risk of thalassemia major in offspring. The study demonstrates that NESTROFT and RBC indices alone are insufficient for accurate carrier detection. Mandatory HPLC screening for all pregnant women is recommended as part of a comprehensive thalassemia prevention program, along with education and awareness initiatives targeting healthcare personnel and women of reproductive age. Keywords: Beta-thalassemia trait, Antenatal screening, NESTROFT.

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder characterized by a constellation of reproductive, metabolic, and dermatologic abnormalities. The objective is to assess the prevalence and patterns of cutaneous manifestations in women diagnosed with PCOS and to examine their association with metabolic and reproductive parameters Materials and Methods: This descriptive cross-sectional study was conducted at Military Hospital Jodhpur Rajasthan India during 1st Jan 2022 to 31 Dec 2024. A total of 100 female patients, aged between 15 and 40 years, diagnosed with PCOS based on the Rotterdam criteria (requiring two out of three features: oligo/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound) were included in the study. Results: The mean age of participants was 26.8 ± 5.4 years, with 71% having a BMI ≥ 25 kg/m². Hirsutism was the most prevalent cutaneous feature (74%), followed by acne (61%), androgenic alopecia (48%), seborrhea (40%), acanthosis nigricans (36%), and skin tags (22%). Acanthosis nigricans was significantly more common in overweight and obese patients (43.7% vs. 17.2%, p = 0.01). Hirsutism was significantly associated with menstrual irregularities (80.5% vs. 44.4%, p = 0.01). The majority of acne cases were of mild to moderate severity, while a smaller proportion (23%) had severe acne. Conclusion: It is concluded that cutaneous manifestations are highly prevalent among PCOS patients and are closely associated with both hormonal and metabolic disturbances. Dermatologic findings such as hirsutism, acne, and acanthosis nigricans can serve as useful clinical markers for early identification and management of PCOS. Keywords: Cutaneous Manifestations, Polycystic Ovary Syndrome, Hirsutism.

Background: Female Genital Tuberculosis (FGTB), a type of extra-pulmonary TB, is particularly challenging to diagnose due to its subtle and diverse clinical presentations. Mycobacterium tuberculosis (M. tuberculosis) is an etiological agent that causes tuberculosis (TB), which is a health issue of global importance. Objective: To investigate the association between clinical symptoms and ultrasonographic findings with endometrial histopathology in diagnosing FGTB. Materials and Methods: This prospective observational study was conducted from April 2023 to March 2024 at District women hospital, Dr. Sone Lal Patel Autonomous State Medical College, Pratapgarh. Out of 160 women with gynecological complaints, 140 were analyzed after excluding cases with inadequate samples and those lost to follow-up. Based on endometrial histopathological examination (HPE), participants were categorized into Group A (TB positive, n=20) and Group B (TB negative, n=120). Data on clinical presentation, gynecological examination, and ultrasonographic findings were collected and compared. Results: Of the 140 women evaluated, 14.29% were diagnosed with FGTB through histopathology. The correlation between clinical signs, imaging results, and histopathology was limited. Conclusion: Diagnosing FGTB remains difficult due to its non-specific symptoms and variable clinical findings. A comprehensive clinical evaluation combined with ultrasonographic assessment and confirmed by histopathology continues to be the cornerstone of diagnosis, especially in settings with limited resources. There is a pressing need for more reliable and accessible diagnostic techniques to facilitate early detection and management of FGTB, thus minimizing reproductive complications. Keywords: Female Genital Tuberculosis, Ultrasonography, Endometrial Histopathology.

Background: Ocular manifestations are common after trauma to the head and they are often neglected. Many patients with ocular morbidity present very late after the management of head injury to the ophthalmologist. By this time, it is too late to avoid further damage to the eye. The management becomes complicated and difficult. Objective: To study the clinical profile of patients presenting with head injury with special reference to ocular manifestations. Materials and Methods: Hospital-based cross-sectional study was carried in 100 cases of head injury patients. Detailed history, thorough clinical examination was carried out for all eligible and consenting cases. All the procedures like Direct ophthalmoscopy, indirect ophthalmoscopy, gonioscopy, B- Scan ultrasound, and computed tomography scan were carried out as per standard protocol and guidelines. Results: Most commonly affected age group was 21-40 years (62%). Males were more affected than females (6:1). Road traffic accident was the most common cause of head injury. Lids were affected in 97%, conjunctiva and cornea in 75% each, sclera affected in 21% of cases. Anterior chamber was affected in 74%, iris in 80%, lens in 40%, fundus in 38%, extra ocular movements were normal in 69% of cases, orbit was affected in 55% of cases. Conclusion: Males were more affected than females due to a greater number of outdoor activities and exposure to risk. 21-40 years of age was most commonly affected because this is the most active age group in the life and they are exposed to the risk of injuries. Ocular manifestations were found to be very common in cases with head injuries. Key words: clinical profile, head injury, ocular manifestations.

Background: Type 2 diabetes mellitus (T2DM) is closely associated with visceral adiposity, dyslipidemia, and cardiovascular risk. Ultrasonographic measurement of visceral fat thickness (VFT) offers a non-invasive tool to assess cardiovascular risk factors in T2DM patients. To evaluate the association between ultrasonographic VFT and lipid profile parameters and to explore its potential role in predicting cardiovascular risk in patients with T2DM. Materials and Methods: This observational study included 50 T2DM patients aged above 30 years with BMI >25 kg/m². Clinical assessments included anthropometry, lipid profile, renal parameters, blood sugar levels, and ultrasonographic measurement of VFT. Correlations between VFT and biochemical parameters were analyzed statistically. Participants were stratified into three VFT groups: <5.5 cm, 5.5–6.5 cm, and >6.5 cm. Results: The mean VFT was 6.11 ± 0.97 cm. VFT positively correlated with total cholesterol (r=0.95, p=0.0001), triglycerides (r=0.97, p=0.0001), LDL (r=0.93, p=0.0001), and VLDL (r=0.92, p=0.0001), and negatively correlated with HDL (r=–0.94, p=0.0001). Patients with VFT >6.5 cm had significantly worse lipid profiles compared to those with lower VFT. A significant association was also observed between higher VFT and the presence of microalbuminuria (p=0.0001). Blood sugar parameters varied across VFT categories but were not statistically significant. Conclusion: Increased VFT measured by ultrasonography strongly correlates with dyslipidemia and microalbuminuria in T2DM patients, suggesting its utility as a surrogate marker for cardiovascular risk stratification. Keywords: Type 2 Diabetes Mellitus, Visceral Fat Thickness, Ultrasonography, Lipid Profile, Cardiovascular Risk, Dyslipidemia, Microalbuminuria.

Background: To investigate the prevalence and severity of Dry Eye Disease (DED) in individuals with diabetes and its association with the progression of Diabetic Retinopathy (DR) and other clinical parameters. Materials and Methods: This cross-sectional study was conducted on 203 diabetic patients attending the Ophthalmology Outpatient Department at MES Medical College, Kerala. Following informed consent, patients with DED were assessed using the Ocular Surface Disease Index (OSDI) questionnaire and objective tests, including Schirmer’s I Test, Tear Break-Up Time (TBUT), and the Modified Oxford Grading Scheme (MOGS). DR status and severity were evaluated using a fundoscopic examination according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Statistical analysis was conducted using IBM SPSS, and a p-value of less than 0.05 was considered statistically significant. Results: DED was diagnosed in 122 (60.1%) of 203 diabetic patients. Of these patients, 68.9% had moderate to severe DED. Diabetic Retinopathy was detected in 108 (53.2%) subjects, with a significant correlation between DED severity and DR advanced stages (p 10 years) associated with a higher prevalence and severity of DED. There were no statistically significant gender preferences. Conclusion: This study shows a high prevalence of DED among diabetic patients, with a significant relation between the severity of DED and DR progression. Thus, DED in diabetic patients, especially in those with DR, should be routinely assessed and managed to reduce the risk of further ocular complications and improve visual prognosis. Keywords: Dry Eye Disease, Diabetic Retinopathy, Diabetes Mellitus, Ocular Surface Disease, Tear Film Dysfunction, Schirmer’s Test, Tear Break-Up Time, Ocular Surface Disease Index, Cross-Sectional Study, Modified Oxford Grading Scheme.

Background: Endotracheal intubation is a critical procedure routinely performed in various clinical settings, including operating rooms, intensive care units, and emergency departments. It serves as a cornerstone in securing the airway during anaesthesia, resuscitation, and management of critically ill patients. Objective: To study the comparative effectiveness and safety of the TAScope and GlideScope in endotracheal intubation. Materials and Methods: This Randomized controlled study was conducted among patients who were posted for elective surgery across different specialties in Department of Anaesthesiology, Rohilkhand Medical College and Hospital, Bareilly after obtaining Institutional Ethical Committee’s approval. Duration of study was one year from August 2023 to July 2024. Results: Both TAScope and GlideScope showed comparable usage across different age groups and gender distributions, with no significant bias in device selection related to these factors. The number of intubation attempts was not significantly associated with the device used, though TAScope had a higher first-attempt success rate, and GlideScope was used more frequently in cases requiring three attempts. The incidence of trauma was similar between TAScope and GlideScope groups, The TAScope group showed a preference for use in ASA Grade II patients, while GlideScope was used more frequently in ASA Grade I patients. Mallampati grade did not significantly influence device selection. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) demonstrated significant differences post- intubation, with TAScope showing higher hemodynamic responses in the initial minutes, which normalized within 10 minutes. SpO₂ levels were consistently maintained above 96% in both groups, with no significant differences. GlideScope significantly reduced intubation time compared to TAScope, Post-operative sore throat scores were higher in the TAScope group at alltime points. Intubation Difficulty Scores were significantly lower for the GlideScope group. Conclusion: GlideScope generally provides a more efficient and smoother intubation process. GlideScope may be the preferred choice in clinical settings that prioritize hemodynamic stability, where minimizing the physical strain on the patient during intubation is essential. Keywords: TAScope, Glidescope, intubation, haemodynamic changes.

Background: In India, chewing tobacco and betel nuts frequently lead to oral cancers. Treatment for oral cancer typically involves radical neck dissection followed by repair. These patients typically present at a late stage and pose a common issue to the anesthesiologist in terms of a difficult airway due to the tumor itself, a limited range of motion, and lastly a smaller inter incisor gap. Objective: To compares the efficacy, patient tolerance, and safety profiles of sedation protocols utilizing Dexmedetomidine alone versus its combination with Ketamine during awake fiberoptic intubation (AFOI) in patients diagnosed with oral cancer. Materials and Methods: A Randomized Controlled Study" by was conducted at Rohilkhand Medical College & Hospital, affiliated with Bareilly International University (2022–2025). The study systematically compares the efficacy, patient tolerance, and safety profiles of sedation protocols utilizing Dexmedetomidine alone versus its combination with Ketamine during awake fiberoptic intubation (AFOI) in patients diagnosed with oral cancer. Results: The addition of ketamine to dexmedetomidine significantly enhanced sedation depth, with Group B (combination) achieving superior OAS scores compared to Group A (dexmedetomidine alone). Specifically, patients in Group B exhibited deeper sedation levels (Mean OAS: 3.43 vs. 2.99; p<0.001), translating into improved patient comfort. This finding underscores the clinical advantage of combining ketamine with dexmedetomidine, as ketamine potentiates sedation and analgesia without compromising spontaneous respiratory efforts. Regarding hemodynamic stability, both groups maintained stable vital parameters (heart rate and systolic blood pressure), demonstrating the drugs' comparable hemodynamic safety profiles throughout the procedure. The minimal fluctuations in hemodynamic parameters observed in both groups were clinically insignificant and remained within safe limits Conclusion: The Group with combination drugs is a superior sedation strategy for awake intubation, offering better patient experience, deeper sedation, and enhanced procedural conditions without additional risks. Given its safety, effectiveness, and improved patient cooperation, this combination should be considered for routine clinical practice in difficult airway management. Keywords: Dexmedetomidine, Dexmedetomidine with Ketamine, fiberoptic intubation, oral cancer patients.

Background: Diabetes mellitus is a metabolic disorder that can affect multiple organ systems. Skin involvement in diabetes mellitus (DM) is very common, and most of them have some form of cutaneous involvement during the course of their disease. The aim of our study was to evaluate the prevalence and pattern of cutaneous disorders among patients with diabetes mellitus. Materials and Methods: Three hundred patients of diabetes mellitus above the age of 18 years with dermatological manifestations were enrolled in the study. A detailed physical and dermatological examination was done and findings recorded. Relevant investigations including complete haemogram, diabetic profile, KOH mount, culture & sensitivity, woods lamp examination, biopsy was done if indicated. Results: In our study we included 300 patients of diabetes mellitus with cutaneous manifestations. Cutaneous infections were the most common manifestation seen in 43%(n=130) of the total study population followed by diabetic dermopathy in 9.3%(n=28) and xerosis in 6.7%(n=20). Males comprised of 59% and females accounted for 41% of the study population. Conclusion: Patients with diabetes mellitus may present with variety of skin abnormalities. Recognition and management of these conditions is important in improving the quality of life and in avoiding serious adverse effects in patients with diabetes mellitus. Keywords: Diabetes mellitus, Cutaneous manifestations, Xerosis, Diabetic dermopathy.

Background: The aim is to compare the treatment response in carcinoma cervix and toxicity Profile in study group who are receiving weekly cisplatin versus weekly paclitaxel. Materials and Methods: A Prospective, Randomized Study was taken up in the Dept. of Radiotherapy, for a period of 20 months. A total of 60 patients who satisfied the eligibility criteria were taken for the study Results: The age range of the study population was 18 to 65 years with the median age of 50 years. All the patients were of Stage IB-IIIB. All the patients in the study were of squamous histology only 3.3% are adeno carcinoma. The cause of treatment delay was acute toxicity in 31.3% of patients in Group A and 20% of patients in Group B. In Cisplatin arm received 5 cycles of chemotherapy but in paclitaxel arm received 4 cycles of chemotherapy due to toxicity. The most common acute toxicity seen in paclitaxel arm was peripheral neuropathy (26.7%), anaphylaxis, anemia (66.7%), diarrhea (70%) and in Cisplatin arm was vomitings (50%). weekly Paclitaxel does not provide any clinical advantage over weekly Cisplatin for concurrent chemoradiation for advanced carcinoma cervix. No grade 4 toxicity was seen in either Group. After completion of study, loco regional control was seen in 93.4% patients in Cisplatin arm and 90% patients in Paclitaxel arm. Locoregional failure was seen in 6.6% patients in Cisplatin arm and 10 %patients in Paclitaxel arm. Conclusion: weekly Paclitaxel does not provide any clinical advantage over weekly Cisplatin for concurrent chemoradiation for advanced carcinoma cervix. Keywords: Chemo radiotherapy (CRT), Intensity Modulated Radiotherapy (IMRT), Image guide radiotherapy (IGRT), Intracavitary brachytherapy (ICBT).

Background: Shivering associated with spinal anaesthesia is very uncomfortable and at times it is described as a worse sensation than surgical pain. This study evaluates the efficacy of intravenous dexmedetomidine and tramadol for the prevention of post-anaesthesia shivering in patients undergoing elective surgeries under subarachnoid block (SAB). Materials and Methods: A total of 100 patients scheduled for elective lower abdominal and lower limb surgeries under SAB were randomly allocated into two groups: Group D (dexmedetomidine) and Group T (tramadol). The primary outcome was the incidence of post-anaesthesia shivering, while secondary outcomes included the severity of shivering, the onset of shivering, and the need for additional interventions. Both groups were monitored for vital signs, adverse effects, and the duration of postoperative recovery. In Group D, patients received intravenous dexmedetomidine at a dose of 0.5 µg/kg, administered over 10 minutes before SAB, while Group T received a dose of 0.5mg/kg intravenous tramadol. Results: The results demonstrated a significantly lower incidence of shivering in the dexmedetomidine group compared to the tramadol group (p < 0.05). Additionally, the severity of shivering was markedly reduced in the dexmedetomidine group, with a faster onset of action and longer duration of effect. Few adverse effects were observed in both groups, with sedation being slightly more prevalent in the dexmedetomidine group. However, both drugs were well-tolerated, and the patients in both groups did not require additional interventions for shivering. Conclusion: This study concludes that intravenous dexmedetomidine is more effective than tramadol in preventing post-anaesthesia shivering following elective surgeries under SAB. Dexmedetomidine not only significantly reduces the incidence and severity of shivering but also provides a longer duration of action with minimal adverse effects. Based on these findings, dexmedetomidine could be considered a superior option for shivering prophylaxis in such clinical settings. Keywords: Dexmedetomidine, tramadol, post-anaesthesia shivering, subarachnoid block, elective surgery, randomized clinical trial, efficacy, prevention, postoperative recovery.

Background: Spinal anesthesia, has emerged as a common and preferred method for administering anesthesia during cesarean deliveries. Ropivacaine, a relatively new amino-amide local anesthetic introduced in the market in the late 1990s, offers several advantages. As the S (-) enantiomer of bupivacaine, ropivacaine appears to be less potent and induces a less intense motor block of shorter duration compared to bupivacaine. This study evaluated the clinical effectiveness and safety of two local anesthetics, ropivacaine and bupivacaine, in cesarean section deliveries. Materials and Methods: This prospective randomized study included 100 parturients aged 20-35 years with ASA physical status Grade II, randomly divided into two groups: Group B received 10 mg of 0.5 % hyperbaric bupivacaine and Group R received 12mg of 0.75% hyperbaric ropivacaine. The time for onset and duration of sensory and motor blockade for both agents were observed, hemodynamic parameters and adverse effects were monitored. Results: The results demonstrated that bupivacaine had a faster onset and longer duration of action compared to ropivacaine. Specifically, the time to achieve sensory blockade was significantly shorter in the bupivacaine group, with a duration of 145 minutes for sensory block and 149 minutes for motor block, compared to 123 and 132 minutes, respectively, in the ropivacaine group. However, ropivacaine showed a better control of heart rate during the procedure. Both anesthetics were well tolerated overall, with no statistically significant differences in adverse effects, although the incidence of hypotension, bradycardia, vomiting, and shivering was slightly higher in the bupivacaine group. Conclusion: The study concludes that while bupivacaine offers faster onset and longer-lasting anesthesia, ropivacaine may be safer for patients with cardiovascular concerns due to its superior hemodynamic stability. Therefore, the choice of anesthetic should be tailored to the clinical situation, with bupivacaine being more appropriate for longer procedures, and ropivacaine preferable when early recovery and cardiovascular stability are priorities. Further research is suggested to refine dosage strategies to achieve an optimal balance between efficacy and safety in the use of these anesthetics. Keywords: Spinal anesthesia, cesarean section, Ropivacaine, Bupivacaine, sensory blockade, motor blockade.

Background: This retrospective observational study was conducted at Surgical Department of Jorhat Medical College and Hospital, Jorhat between Jan 2023 to Dec 2024. To determine the demographic factors of patients presenting with DFUs at Surgery Department of JMCH, Jorhat. To analyse the demographics of the patients suffering from Diabetic foot. To determine the burden of Diabetic foot and its sequelae in the community. Materials and Methods: 96 patients with Diabetic foot ulcer and it’s sequelae admitted in Surgery ward of JMCH and were evaluated demographically, area of residence, and with respect to already diagnosed case of diabetes mellitus, duration of diabetes, any associated comorbidity, HbA1c at presentation, and RBS and laboratory parameters and responsiveness to dosage of Regular insulin at discharge. Results: Average age of presentation is 51.22 year. There is a higher incidence in males. Predominantly the patients are Hindu(90.6%). The patients belong from Rural areas(54 out of 96) and Urban areas(42 out of 96). The average duration of diabetes is 5.27 years. Severity of lesion correlated with severity and duration of diabetes. Patients with higher levels of HbA1c at presentation had more severe lesion. Conclusion: Diabetic foot is a frequent reason of hospitalization of patients with diabetes. Prevention is the best treatment. Males have a higher prevalence and patients from Hindu community are affected more. Patients from Lower economic class are affected more. The people hailing from Rural areas are affected more. The people in the community who belonged to 4th and 5th decade of life are more affected in number. Patients with higher levels of HbA1c, associated comorbidities have more severe disease. This study also showed higher grades of Wageners classification was evident in higher age group and middle aged people suffered from Grade 1 and Grade 2 Diabetic foot. Shah et al in a study showed regular monitoring of blood sugar levels and foot screening should be done for diabetic as well as non-diabetic older adults for early detection of risk factors to reduce the foot complications5. Keywords: Diabetic foot ulcers, Risk factor, Demographic factor, Laboratory investing, Insulin, HbA1c, Comorbidity.

Background: Malaria remains a significant public health challenge globally, particularly in tropical and subtropical regions. This study aims to delineate the clinical profile of malaria, comparing the presentations of Plasmodium falciparum and Plasmodium vivax infections among hospitalized patients. Materials and Methods: This observational study was conducted with a sample size of 60 patients diagnosed with malaria, confirmed via peripheral blood smear. The study analyzed the age and sex distribution, seasonal incidence, type of fever, clinical symptoms, and laboratory findings associated with each Plasmodium species. Patients were treated and monitored in a hospital setting, with data collected on clinical presentations and outcomes. Results: Of the 60 patients, 42 (70%) were infected with P. falciparum, and 18 (30%) with P. vivax. The majority of the cases (68.33%) occurred during the monsoon season. Clinical presentations varied, with intermittent fever being the most common type (70%). Significant findings included higher rates of severe symptoms and complications such as jaundice, hepatomegaly, and renal impairment in P. falciparum infections. P. vivax commonly presented with tertian fever and was less frequently associated with severe complications. Conclusion: The study highlights significant differences in the clinical manifestations and complications of P. falciparum and P. vivax infections. Understanding these differences is crucial for the clinical management and treatment of malaria. These findings underscore the need for targeted public health interventions and enhanced diagnostic strategies during peak transmission seasons to reduce the burden of malaria. Keywords: Malaria, Plasmodium falciparum, Plasmodium vivax.

Background: The aim is to find out the efficacy of microdebrider in Endoscopic sinus surgery and turbinoplasty in patients who underwent surgery Materials and Methods: This is a hospital based observational study in 100 patients age group above 12years and below 60 years, patients undergoing endoscopic sinus surgery for sinonasal polyposis, turbinectomy for chronic hypertrophic rhinitis. All the selected patients will undergo diagnostic nasal endoscopy and will be categorized to Turbinate hypertrophy, Sinonasal polyposis. Patients with Sinonasal polyps will be graded according to Meltzer classification. Results: In our study, in Endoscopic sinus surgery group the mean duration of surgery was 59.15 ± 12.5 minutes in Grade II, 75.62 ± 16.4 minutes in Grade III and 98.15 ± 18.6 minutes in Grade IV. The mean duration of surgery was 75.4 ± 19.48 minutes. In turbinectomy group, the mean duration of surgery was 68.3 ± 19.5 minutes in Allergic rhinitis, 79.5 ± 21.8 minutes in Chronic rhinosinusitis with polyps, 74.1 ± 16.5 minutes in Chronic rhinosinusitis without polyps and 80.2 ± 24.8 minutes in non-allergic rhinitis. The mean duration of surgery was 77.1 ± 22.4 minutes. Per-operative visibility of surgical field according to Boezaart Vandermerwe grading in Endoscopic sinus surgery group was Grade I in 14%, Grade II in 78% and Grade III in 8%. Per-operative visibility of surgical field according to Boezaart Vandermerwe grading in turbinectomy group was Grade I in 12%, Grade II in 82% and Grade III in 6%. Complications of microdebrider Per-operative turbinoplasty were 5patients with mucosal tear, 7 patients with incomplete removal and 6 with Prolonged bleeding. complications of microdebrider Per-operative ESS were 5 with crustations, 2 were with nasal dryness and 1 with Secondary bleeding. Conclusion: We conclude that, the conventional group had a significantly longer mean surgical duration and bleeding. Because the microdebrider has built-in suction clearance at the surgical site, it offers a better surgical field and drastically shortens the length of time needed for surgery. Keywords: Microdebrider, Sinonasal polyposis, Endoscopic sinus surgery, Turbinoplasty.

Background: Hyponatremia develops in approximately 20-30% of cirrhotic patients with ascites. It causes cerebral oedema, thereby precipitating Hepatic Encephalopathy (HE). Hyponatremia is directly related to deterioration in terms of grades of HE and Mortality rate. Objectives: To study the prevalence of hyponatremia and to correlate it with severity of HE and mortality in cirrhosis of liver. Materials and Methods: This was a prospective study conducted on 82 patients more than 18 years of age diagnosed with cirrhosis of liver. Patients with malignancy, chronic kidney disease, cardiac disease, cerebrovascular accidents and drugs causing hyponatremia were excluded. HE was graded according to West Haven classification. The results were considered significant if p value <0.05. Results: Out of 82 cirrhosis of liver patients, 68 (83.0%) were males and 14 (17.0%) were females. The mean age was 50.4 ± 10.41years. Hyponatremia was present in 38 (46.0%) patients with mean 126.34 + 5.9 mEq/L. HE was present in 46 (56.0%) patients. HE grade I was present in 12 (26.0%), grade II in 15 (33.0%), grade III in 11 (24.0%), grade IV in 8 (17.0%) patients. Out of 38 hyponatremia patients, 29 (76.0%) had HE and out of 44 normonatremic, 17 had HE which was highly significant (P<0.001). Hyponatremia with HE had higher mortality rate (20.0%) than normonatremic with HE (9.0%) which was significant (P<0.001). Conclusion: As cirrhosis with hyponatremia is associated with higher grades of HE and higher mortality rate, it could be reduced by timely recognition and treating hyponatremia. Keywords: Hepatic encephalopathy, hyponatremia.

Background: Maternal morbidity continues to be a significant global public health issue, particularly in low- and middle-income countries. In rural India, including Assam, maternal health faced numerous challenges in the early 2000s, including inadequate healthcare infrastructure, poor transportation, and low antenatal care (ANC) utilization. Objective: This study, conducted before the implementation of the National Health Mission, aims to document the prevalence and determinants of maternal morbidities in Rani Block, Kamrup District, Assam, and provide a baseline for maternal health reform. Materials and Methods: A community-based cross-sectional study was conducted from August 2002 to July 2003 in Rani Block, Kamrup District. A sample of 320 women, including those in their second and third trimesters and postnatal women, was selected using simple random sampling from 30 villages. Results: The study revealed that 64.3% of women experienced at least one morbidity during pregnancy, with anaemia (65.6%) being the most common condition, followed by vomiting (26.6%) and lower abdominal pain (22.6%). During the intranatal period, 12% of women experienced prolonged labour, and 10% reported excessive bleeding. In the postnatal period, 60% of women experienced morbidities, including postnatal haemorrhage (18%), foul-smelling vaginal discharge (18%), and breast problems (18%). Significant associations were found between morbidity and factors such as age, gravidity, educational status, ANC attendance, and place of delivery. Women who had fewer ANC visits or delivered at home had a higher incidence of morbidities. Conclusion: The study demonstrates the high prevalence of maternal morbidities in rural Assam, particularly during pregnancy and the postnatal period. Addressing socio-demographic factors and improving ANC services could significantly reduce morbidity rates. Future public health interventions should focus on strengthening healthcare access and awareness to mitigate maternal health risks in underserved areas. Keywords: Maternal, Morbidity, Anaemia, Antenatal, Intranatal, Postnatal, Determinants.

Background: Tumors of ovary generally are more prevalent in upper socio-economic groups due to their low fertility rate and there is a racial predisposition of ovarian cancers with increased risk of Caucasians and lower risk for black women. Objective: To evaluate role of IHC in diagnosis of primary ovarian tumors, to study and compare the incidence of ovarian tumors and to determine whether Ki67 (LI) helps in differentiating borderlilne and malignant surface epithelial tumors Materials and Methods: The present study was conducted among at Pathology Department of G.S.V.M. Medical College, Kanpur, India. Total 100 cases were included in the study. The patients were admitted in the Department of Surgery and Obstetrics and Gynaecology and underwent total hysterectomy with bilateral and unilateral salpingo-oophrectomy or unilateral/ bilateral salpingo-oophorectomy or oophorectomy as indicated. Result: Benign ovarian lesions were more common (70%) than malignant ovarian lesions (30%). Surface epithelial tumors were most common tumor accounting for 64% of all ovarian lesions. Serous cystadenoma was most common tumor (60%) Serous cystadenocarcinoma was most common malignant tumor (60%). 71.42% of benign lesions were presented below the age of 40 years. Maximum incidence of malignant lesions were in age group of 41 – 50 years (46.66%). Overall 96.66% malignant lesion presented in the age group of 31 – 60 years. Increased expression of Ki-67 LI was found in malaignant surface epithelial neoplasms compared to benign and borderline tumors. High grade serous tumors had a higher percentage of P 53 expression in more than 50% of cases, in contrast to low grade serous tumor and borderline serous tumor. Conclusion: Ki-67 is a cost effective and easily accessible immunohistochemical marker. Therefore, immunohistochemical assessment of Ki-67 expression can be included in routine histopathological report of surface epithelial tumor of ovary for better understanding of the biological behavior of the tumor and modifying treatment strategies. P53 IHC is a surrogate marker for P53 gene mutation in clinical practice. Keywords: Immunohistochemical markers (P 53, Ki-67), diagnosis, surface epithelial tumors, ovary.

Background: Rheumatoid arthritis (RA) is the chronic non-organ-specific autoimmune diseases. But, autoimmune thyroid disease (AITD) is the organ-specific autoimmune disease that can lead to hypo or hyper function of thyroid gland. Although the aetiology of both diseases is complex with a combination of genetic and environmental factors, there are overlaps in genes contributing to the pathogenesis of both diseases. Numerous studies found a correlation between thyroid abnormality and RA in different populations, yet some didn’t. The present study is performed to evaluate the association of thyroid dysfunction with autoimmune thyroid disease in rheumatoid arthritis patients in Eastern Indian patients with RA. Materials and Methods: A total of 671 RA patients and 592 healthy participants were included in this study. All participants underwent complete clinical and laboratory assessments. Participants were also assessed for thyroid function testing, including anti-TPO antibodies Results: A significant association was found between RA disease and thyroid dysfunction which thyroid dysfunction was twice as common in RA patients as in controls (OR = 2.07, 95% CI: 1.42– 3.20; p-value > 0.001). Hypothyroidism was the most common thyroid dysfunction among RA patients (58 out of 84). Anti-TPO was significantly higher in 39 (36.44%) controls, and 143 (57.46%) cases and it was significantly more common in RA patients (OR = 2.69, 95% CI: 1.70–4.13; p-value 0.008). Conclusion: RA disease was associated thyroid dysfunction especially AITD among the Eastern Indian population like several other populations. Keywords: Rheumatoid arthritis, Thyroid dysfunction, Anti-TPO antibody, Autoimmune thyroid disease.

Background: Assessment of doses to sigmoid colon, small bowel, and rectum in CT-based brachytherapy for carcinoma cervix and to observe the D2cc of sigmoid colon, D2cc of the rectum and D2cc of the small bowel. Materials and Methods: Prospective study done in Department of Radiotherapy from March 2022 to March 2024, 50 registered women with non-metastatic cervical cancer treated with definitive concurrent chemo- radiotherapy followed by HDR intracavitary brachytherapy who met inclusion criteria were enrolled. Results: The median age of the whole group was 50.5 years, the majority of them were in their 5th (38%) or 4th (30%) decade. Pathologically, all were squamous cell carcinoma. 50. For the rectum, the D2cc doses did not differ significantly from the doses calculated at the ICRU reference point (p=0.625); the mean difference was 10cGy (±13cGy). However, for the bladder, the doses calculated at the ICRU reference point were significantly higher than the D2cc doses (p=0.0001). The mean difference was 107cGy (±7cGy). Conclusion: Study suggests that rectum ICRU reference points can be surrogate markers for D2cc.but not for bladder and hence reporting should be preferably be done in volumetric method rather than reference point doses. Keywords: Minimum dose to the highest irradiated 2 cc volume (D2cc), equivalent dose in 2 Gy fractions (Dmax), External Beam Radiotherapy (EBRT), International Commission on Radiation Units and Measurements (ICRU).

Background: Violence against women which is considered a public health problem in most countries of the world, can have serious consequences on women’s health. Materials and Methods: The present facility based prospective cross-sectional study was carried out in 203 married women of 18-49 years of age and suffering from domestic violence. Results: Mean age of the respondents was 32.65 ±7.86 years. Most of the victims of domestic violence were young, less educated, housewives, did not have children or had only female child, married in young age, had more duration of married life, had arranged marriage and had less educated husbands. Predominant type of violence was psychological / emotional (100%) followed by economic (91.13%) physical (89.16%) and sexual violence (61.58%). 64.53% women expressed that their husbands had habits of drinking alcohol and 118 (90.08%) said that the violence occurred in more frequency while the spouses were under the influence of alcohol. 122 (60.09%) respondents did not seek any formal help from any agency or organization. 185 (91.13%) respondents sought informal support from their parents, sibs, neighbourers or friends. 14.78% respondents were underweight while 31.52% were obese. 90.64% respondents had mild to severe depression. 149 (73.39%) gave history of physical injury due to domestic violence. 66.44% respondents seek health care for their suffering. Conclusion: Addressing domestic violence against women requires a multipronged approach that includes providing safe spaces for women, offering health care and counselling, increasing public awareness and ensuring legal protections. Keywords: Domestic violence, reproductive age, perpetrators, depression.

Background: Multiple myeloma (MM) is a malignant plasma cell disorder with varied clinical presentations and significant morbidity. While global data on MM are well-documented, regional insights—especially from government tertiary care centres in India—remain limited. This study aimed to evaluate the trend of M-band detection through serum protein electrophoresis (SPEP) and describe the clinical and laboratory profile of MM patients in central Kerala. Materials and Methods: A retrospective, hospital-based cross-sectional study was conducted at Government Medical College, Thrissur, including 82 MM patients diagnosed between January 2022 and March 2024. Data on clinical presentation, laboratory parameters, radiological findings, and treatment details were extracted from medical records. Additionally, 7451 SPEP reports from January 2018 to March 2024 were reviewed to determine the prevalence of M-band positivity. Results: The mean age at diagnosis was 61.5 years, with equal male and female representation. Among those screened via SPEP, 4.8% were M-band positive, and 98.78% of confirmed MM cases exhibited M-band positivity. Lower back pain (43.90%) and fractures (17.07%) were the most common presenting complaints. Anaemia was present in 65.85% of patients, while hypercalcemia and renal dysfunction were seen in only 4.87% and 24.39%, respectively. Vertebral lytic lesions were most frequent (43.90%), though 39.02% showed no skeletal abnormalities. IgGκ was the predominant paraprotein subtype. ISS Stage 1 was most common, with a third of patients undergoing diagnostic workup. Bortezomib-based regimens were the most frequently used treatments. Conclusion: This study reveals a shifting clinical landscape of MM in Kerala, marked by earlier detection, diverse presentations, and reduced frequency of advanced disease features. SPEP remains a highly sensitive diagnostic tool. These findings underscore the importance of routine screening, early diagnosis, and improved access to diagnostic and treatment facilities to optimize MM outcomes in regional healthcare settings. Keywords: Multiple Myeloma, Serum Protein Electrophoresis, M-band, Clinical Profile, Kerala.

Background: The aim of this study is to find out if orofacial manifestations and distributions of ABO blood groups in β-thalassemia patients. Materials and Methods: The present study consisted of 49 clinically proven cases of β-thalassemia major who were enrolled members in the Thalassemia Society and who regularly attended blood transfusions. A blood sample was also collected for estimation of ABO blood grouping & Rh factor by the slide method. Data were analyzed using SPSS version 23. Frequencies and a chi-square test were done for the original data. Results: The most prevalent age group involved was between 6 and 10 years, with male preponderance. A total of 53% had a history of consanguinity. Out of 49 patients, 53.2% had pale yellow discoloration of the skin and muddy black color in 34.6%. Frontal bossing was seen in 85.8%; 85.8% showed parietal bossing; hypertelorism was seen in 71.5%; depressed nasal bridging was seen in 83.7%; flaring of alae nasi was seen in 55.1%; and incompetent lips were present in 59.2%. Intraoral pigmentation was seen in 89.8%, and pallor of mucosa was seen in 81.7%. Gingivitis was seen in 51.1%. Proclamation of teeth was present in 44.9%. Spacing between teeth was present in 32.7%. Persistent mamelons are present in 36.8%. The most common group was O positive, with a total of 44.8%. Conclusion: Patients receiving inadequate blood transfusions in childhood will face more bone changes like expansion and deformity in the form of intra-oral & extra-oral features in adolescence and cause hyperactivity of bone marrow to compensate for anemia. Keywords: Thalassemia, ABO blood, intra-oral & extra-oral features.

Background: Neonatal sepsis remains a major cause of neonatal morbidity and mortality, particularly in developing countries. Identifying predictors of mortality can aid in early intervention and improved outcomes. The objective is to study various antenatal, intranatal, and postnatal factors associated with neonatal sepsis and neonatal mortality, and to evaluate the investigative profile related to neonatal sepsis. Materials and Methods: This prospective observational study was conducted over 18 months in the NICU of a tertiary care hospital in Ahmedabad, Gujarat. A total of 150 intramural neonates with clinical features of sepsis and positive septic screens were enrolled. Data regarding clinical presentation, investigations, and outcomes were collected and analyzed using SPSS version 21.0, considering p < 0.05 as statistically significant. Results: Male neonates accounted for 65.3% of cases. Although mortality was higher among males, the association was not statistically significant. Lethargy was found to be a significant predictor of mortality (p = 0.00001). Mode of delivery and other symptoms such as fever, poor feeding, and vomiting were not significantly associated with mortality. Conclusion: Lethargy emerged as a strong clinical predictor of mortality among neonates with sepsis. Early recognition of critical symptoms and prompt management are essential to reduce neonatal mortality. Keywords: Neonatal Sepsis, Mortality Predictors, Lethargy.

Background: Acute kidney injury (AKI) is a significant complication among neonates admitted to Neonatal Intensive Care Units (NICUs), so early recognition and management of risk factors are crucial for improving clinical outcomes. This study aimed to identify the risk factors and outcomes of AKI among neonates admitted to a tertiary care center in North East India. Materials and Methods: A hospital-based prospective analytical study was conducted in the NICU of Silchar Medical College and Hospital (SMCH) from June 2021 to May 2022. A total of 140 neonates were included in the study and were assessed for AKI using the KDIGO for neonates and nRIFLE criteria. Demographic, clinical, and laboratory data were collected, and statistical analysis was performed using IBM SPSS (version 26). Chi-square and regression analyses were applied to identify independent risk factors. Results: Among 140 neonates enrolled, 36 (25.7%) developed AKI. Significant maternal risk factors included pregnancy-induced hypertension (p=0.032), preterm premature rupture of membranes (p=0.043), and antenatal steroid use (p=0.032). Neonatal factors independently associated with AKI were inborn delivery (p=0.018), birth asphyxia (p<0.001), shock (p=0.024), sepsis (p=0.001), umbilical catheterization (p=0.025), and dehydration (p=0.001). The mortality rate among AKI cases was 41.7%. Use of mechanical ventilation (p=0.037), congestive heart failure (p=0.043), and AKI (p=0.005) were significant predictors of neonatal mortality. Conclusion: AKI is a prevalent condition in NICU neonates, with high morbidity and mortality. Early identification and management of associated risk factors are crucial for improving neonatal outcomes as mortality increased with severity, reaching 100% in Stage 3. Further research is needed to explore preventive interventions and long-term renal implications in neonates with AKI. Keywords: Acute Kidney Injury, Neonates, Risk Factors, Renal Dysfunction, KDIGO, nRIFLE.

Background: Acute pyelonephritis is a potential organ and life-threatening infection that often results in renal scarring. This study is conducted to asses clinical features, microbial profile and various clinical and biochemical factors determining prognosis of acute pyelonephritis. Materials and Methods: A hospital based single centre, observational study was carried out among 100 patients with acute pyelonephritis admitted in the wards of the Department of Medicine, Assam Medical College and Hospital with duration of one year. Clinical features, laboratory results and outcomes were analysed. Results: Most common symptom was fever with chills and rigor (82%) and increased temperature(85%) as the most common sign. Diabetes mellitus(74%) is the common associated comorbidity with acute kidney injury(48%) is the most common complication. E coli(39%) as the commonly isolated organism in the urine. Most sensitive antibiotic against gram negative bacilli was piperacillin tazobactam and most sensitive antibiotic against gram positive cocci was linezolid. poor prognostic factors were age greater than 65, shock, presence of altered sensorium, presence of diabetes mellitus, increased total leukocyte count, thrombocytopenia, increased urea, increased creatinine, hyperkalaemia and increased HbA1C ≥ 7.5. Conclusion: This study highlights the importance of early recognition and management of acute pyelonephritis. The findings can help to guide treatment decisions and improve patient outcome. Keywords: Acute pyelonephritis, risk factors, microbial profile.

Background: Chronic kidney disease (CKD) is increasingly recognized as a major public health problem. The kidney normally plays an important role in the metabolism, degradation, and excretion of several thyroid hormones. It is not surprising therefore that impairment in kidney function leads to disturbed thyroid physiology. The present study was undertaken to assess the clinical and biochemical profile of thyroid abnormalities in chronic kidney disease. Material and Methods: The present cross-sectional study was carried in Department of Medicine, Surat Municipal Institute of Medical Education and Research, Suart. A total of 100 patients with chronic kidney disease were included in the study based on the definition of The Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation. Results: Out of 100 patients, 68% were males and 32 % were females, accounting a male to female ratio of 1.84:1. Majority of patients 58(63.74%) were in the age group of 46 to 60 years. Majority of patients were in stage IV CKD 42 (46.158%). In all the 91 (100%) patients the commonest symptom was tiredness and weakness. The next common symptom was dry skin in 78(85.71%). In present study, the commonest sign of thyroid dysfunction was coarse skin (62.64%). Raised TSH was noted in 14 (15.38%) patients, 5 (5.49%) had below normal FT4 and 6 (6.59%) had below normal FT3. Conclusion: Based on the Zulewski’s score for the assessment of hypothyroidism considering clinical signs and symptoms 7.69% patients were diagnosed to have clinical hypothyroidism. Of the 91 patients with chronic kidney disease the biochemical profile considering FT3, FT4 and TSH levels 14 (15.38%) patients had thyroid abnormalities of which, 7 (7.69%) each had hypothyroidism and subclinical hypothyroidism. Keywords: Chronic kidney disease; Hyperthyroidism; Hypothyroidism; Thyroid abnormalities; Zuwelski’s score.

Background: Neonates constitute the nation’s foundation, and mothers are its pillars, and no one can afford to neglect their needs and rights. The neonatal period is considered the most important age group at all times, as newborns are most susceptible to diseases and death. Neonatal sepsis is the most common cause of neonatal mortality. This study aimed to evaluate specificity and sensitivity of the umbilical cord blood culture with comparison to sepsis screen in peripheral venous blood culture positive early onset neonatal sepsis Materials and Methods: Study setting and population This study was conducted in the Neonatal Intensive Care Unit, Department of Pediatrics, Alluri Sita Ramaraju Academy of Medical Sciences (ASRAM), ELURU, ANDHRA PRADESH. Study design: Prospective analytical study conducted from December 2020 to May 2022. Study period: 18 months. Sample size: 158. Results: Diagnostic efficiency of UCBC with PVBC: UCBC had 17.86% sensitivity, 84.62% specificity, PPV of 20%, NPV of 82.71%, and diagnostic accuracy of 72.78% in our study. Diagnostic efficiency of Sepsis Screen with PVBC: Sepsis screen had 100% sensitivity, 61.54% specificity, PPV 35.9%, NPV 100%, and diagnostic accuracy of 68.35% in our study. Conclusion: Traditionally, sepsis screen has high sensitivity and high negative predictive values and is being used as screening test in suspecting EONS. From our study Umbilical cord blood culture has significant correlation with sepsis screen. So Umbilical cord culture can be used as a supportive investigation along with sepsis screen to diagnose early onset neonatal sepsis. Keywords: Neonatal sepsis, Umbilical cord culture, sepsis screen

Background: Gestational diabetes mellitus (GDM) is a major complication during pregnancy, associated with adverse maternal and fetal outcomes. The role of lifestyle factors such as physical activity and pre-pregnancy body mass index (BMI) in the development of GDM remains an area of active research. Objective: This study aims to explore the relationship between lifestyle-related activities and the risk of GDM, focusing on the impact of household physical activity, sports/exercise-related activity, transportation-related activity, and pre-pregnancy BMI. Materials and Methods: A total of 200 pregnant women (100 cases with GDM and 100 controls) were included in this study. Sociodemographic, obstetric, and lifestyle-related data were collected via structured interviews and questionnaires. Logistic regression was used to assess the relationship between lifestyle factors and GDM risk, adjusting for potential confounders. Results: Our study found that increased levels of household physical activity, sports/exercise-related activity, and transportation-related activity were significantly associated with a lower risk of GDM. Pre-pregnancy BMI was a significant predictor of GDM, with higher BMI associated with increased risk. Occupational physical activity did not show a significant relationship with GDM. Conclusion: Lifestyle factors such as physical activity and pre-pregnancy BMI play a crucial role in the development of GDM. Interventions to promote physical activity, along with weight management prior to pregnancy, may be effective strategies for preventing GDM. Keywords: BMI, Lifestyle Factors, Gestational Diabetes Mellitus, Pre-pregnancy

Background: Diabetes mellitus can influence cataract surgery outcomes, potentially affecting visual acuity and postoperative complications. This study compares visual outcomes and complication rates following minor incision cataract surgery (SICS) in diabetic and non-diabetic patients. Materials and Methods: A prospective comparative study included 200 patients (100 diabetic and 100 non-diabetic) undergoing SICS at MES Medical College. The ocular examination and systemic evaluation were performed at the preoperative stage. One-week, one-month, and three-month postoperative visual acuities and complications were noted. Data were analyzed statistically by SPSS version 25.0 using chi-square and t-tests, and p<0.05 was considered significant. Results: Postoperative vision acuity improvement of diabetic patients was significantly lower than that of non-diabetic cases (p<0.001). The incidence of postoperative complications such as corneal edema, anterior uveitis, and delayed wound healing was significantly greater in patients with diabetes (p<0.01). Poor control (HbA1c <8%) was associated with low rates of complications (p=0.002). Conclusion: Diabetes mellitus harms postoperative visual acuity and complication rates after small-incision cataract surgery. Reasonable glycemic control in diabetic patients and appropriate perioperative management are essential for better surgical results. Keywords: Cataract Surgery, Diabetes Mellitus, Small Incision Cataract Surgery, Visual Acuity, Postoperative Complications.

Background: Neuromuscular blocking agents (NMBAs) are vital in general anesthesia to achieve optimal intubating conditions and surgical relaxation. Atracurium and cisatracurium are commonly used agents, but they differ in pharmacological profiles, hemodynamic effects, and safety. Aim: To assess and compare the intubating conditions, hemodynamic responses, and adverse effects of atracurium 0.5 mg/kg versus cisatracurium 0.2 mg/kg in patients undergoing general anesthesia. Materials and Methods: A prospective, double-blinded, randomized study was conducted on 52 patients scheduled for elective surgery under general anesthesia. Patients were divided into two groups: Group A (atracurium) and Group B (cisatracurium). Standard monitoring, including Train-of-Four (TOF), was used. Intubating conditions, heart rate, mean arterial pressure, onset time, duration of action, and adverse events were recorded. Data were analyzed using SPSS 25, and p <0.05 was considered significant. Results: Cisatracurium provided excellent intubating conditions in 92.3% of cases compared to 76.9% in the atracurium group. The onset time was significantly faster, and the duration of action was longer with cisatracurium. Hemodynamic responses were more stable in the cisatracurium group, with fewer fluctuations in heart rate and blood pressure. Adverse effects, particularly histamine release and flushing, were more frequently observed with atracurium. Conclusion: Cisatracurium demonstrates superior intubating conditions, better hemodynamic stability, and a more favorable safety profile compared to atracurium, making it a preferred choice for general anesthesia, especially in patients with cardiovascular risk. Keywords: cisatracurium, atracurium, neuromuscular blockade.

Background: Anaemia, primarily caused by iron deficiency, remains a global health challenge, particularly in low- and middle-income countries like India. Adolescent girls in India are especially vulnerable, with the condition leading to growth retardation, impaired development, and future reproductive health issues. India’s anaemia prevalence is high, with the national goal of reducing anaemia by 50% by 2025, especially among women and adolescent girls. This study addresses the prevalence of anaemia and the effectiveness of various interventions in a school-based setting in District Patiala, Punjab. The objective is to assess the prevalence of anaemia among adolescent girls and evaluate the effectiveness of various interventions—such as iron supplementation and nutritional kits—in improving haemoglobin levels and enhancing overall health outcomes. Materials and Methods: A randomised interventional trial was conducted from July to October 2024 in 42 schools in the Rajpura block of Patiala District. A total of 1,327 adolescent girls were selected using convenience sampling, and schools were randomly assigned to one of three groups: Group A: Daily IFA supplementation with mid-day meal and an additional IFA tablet for home consumption. Group B: Daily IFA supplementation with mid-day meal, an additional IFA tablet for home consumption, and monthly nutritional kits. Group C: Routine weekly IFA supplementation under (control group). Baseline data were collected on haemoglobin levels, body mass index (BMI), dietary habits, and sociodemographic characteristics. Haemoglobin levels were assessed using the TrueHb hemoglobinometer, and statistical analysis was performed using SPSS. Results: Significant improvements in haemoglobin levels were observed across all groups following the intervention. Group B showed the most substantial increase in haemoglobin, with a 71.7% resolution of mild anaemia, followed by Group A and Group C. BMI changes were minimal, with Group B exhibiting the greatest increase in participants with a normal BMI. Side effects such as abdominal pain and metallic taste were most common in Group B. Awareness of anaemia symptoms was highest in Group C. Statistical analysis revealed significant associations between age, BMI, and anaemia severity, with older age increasing the risk of moderate anaemia. Conclusion: The combination of mid-day meal, iron supplementation with nutritional kits, as observed in Group B, was the most effective in reducing anaemia among adolescent girls. However, the minimal changes in BMI suggest that macronutrient deficiencies persist. The study emphasises the need for multifaceted, community-driven approaches that address both micronutrient deficiencies and socioeconomic factors to sustainably combat anaemia. Keywords: Anaemia, Iron deficiency, Adolescent health, Nutritional interventions, Public health, Iron supplementation.

Background: Diabetes mellitus is a prevalent global health issue, affecting over 536 million people worldwide and showing a rising trend. This endocrine disorder can lead to a range of health complications, including various skin manifestations. Dermatological conditions associated with diabetes are often crucial for early diagnosis and management. This study aims to assess the prevalence and types of dermatological manifestations in patients with Type 2 diabetes mellitus and to compare these findings with existing literature. Materials and Methods: A prospective study was conducted with 250 patients aged 18 years and above, diagnosed with Type 2 diabetes mellitus, who presented with dermatological manifestations at the Index Medical College Hospital and Research Centre, Indore. Detailed histories, physical examinations, and dermatological assessments were performed. Blood tests, including CBC, RBS, FBS, PPBS, HbA1C, serum creatinine, and TSH, were conducted. Data were analyzed using IBM SPSS Statistics version 23. Results: The prevalence of dermatological manifestations among the study participants was 56%, with a male-to-female ratio of 1.27:1. The most common manifestations included infections (35.2%), pruritus (10.8%), xerosis (8.4%), acrochordons (8%), stasis dermatitis (7.6%), vitiligo (5.2%), acanthosis nigricans (4.8%), and perforating dermatosis (4.0%). Among infections, tinea infections were the most frequent (48.8%), followed by intertrigo (20.5%) and folliculitis (11.4%). The majority of patients (46%) had diabetes for 6 to 10 years, and 55% were on oral anti-diabetic drugs, while 38% were on insulin. Conclusion: Dermatological manifestations are prevalent in Type 2 diabetes mellitus and can serve as early indicators of disease progression. Effective management requires timely identification and treatment of these conditions to prevent complications and enhance quality of life for diabetic patients. Keywords: Type 2 DM, Dermatological Manifestations, Pruritus, Acanthosis Nigricans, Dermatological Conditions, Glycemic Control.

Background: The rapid proliferation of the internet has revolutionized communication, education, and entertainment. While these advancements offer numerous benefits, they have also introduced challenges, particularly among students. Medical undergraduates, due to their rigorous academic schedules and high-stress environments, are increasingly susceptible to internet addiction—a condition characterized by excessive and compulsive use of the internet, leading to negative impacts on daily life, academic performance, and mental well-being. The objective is to estimate the prevalence of internet addiction among medical undergraduates. (2) To estimate the pattern of internet use among medical undergraduates. (3) To determine the association of internet addiction with socio- demographic variables. Materials and Methods: A cross-sectional study conducted out in Government Medical College of Indore in Indore district M.P. over 3 months. The subjects included 264 Undergraduate Students selected by simple random sampling. Pre designed semi structured questionnaire were administered to the study participants. Data was entered into Microsoft Excel and analysed by using JAMOVI software. Necessary appropriate statistical tests were applied. Results: The majority of participants were male (54.55%), indicating a slightly higher participation rate among male students. The majority of participants were in the 18–20 years age group (51.14%). The majority of students fall into the mild addiction category (56.44%) followed by moderate addiction (30.30%) and severe addiction (2.65%). The prevalence of internet addiction among medical undergraduates is found to be 32.95%. The majority of students used the internet for watching movies/news (89.02%), social media (79.92%), chatting (79.17%), and shopping (77.65%), indicating high usage for entertainment and social interaction. Online study was reported by 75%, showing significant but slightly lower academic use. Online gaming was also common (65.15%). Conclusion: As per the study results Internet addiction was significantly associated with MBBS professional years and current residence being more common in 1st-year students and those living in hostels or rented places. No significant association was found with age, gender, or internet expenditure. Keywords: Internet addiction, Government Medical College, Online gaming.

Background: PR (Pityriasis rosea) is a common and enigmatic dermatological condition with a specific character and distinctive clinical picture. Despite its high prevalence, the pathogenesis and etiology of PR remain unidentified. The present study aimed to assess the clinical and epidemiological features of subjects with Pityriasis rosea. The study also assessed dermoscopic features of Pityriasis rosea and assessed histopathological correlation. Materials and Methods: The present study assessed 100 subjects. A detailed clinical history was recorded, followed by clinical examination and Dermoscopy. Quantitative features assessed included age and disease duration. Also, qualitative risk factors were assessed, including gender, symptom, lesion site, cutaneous examination findings, Dermoscopy findings, and histopathological data. Results: The study results showed that there is a male predominance in Pityriasis rosea and the mean age was 30.6±15.5 years. Atypical clinical presentation was seen in 40% of the subjects. The most commonly seen Dermoscopy feature was peripheral collarette scale in 62% of subjects followed by a diffuse red background in 58% of subjects, and peripheral dotted vessels in 50% of subjects. On histopathological assessment, the most common findings were perivascular lymphocytic infiltrate in 56% of subjects followed by spongiosis in 44% of subjects, parakeratosis, red blood cell extravasation, and irregular acanthosis in 38%, 36%, and 34% of subjects respectively. Conclusion: The present study concludes that diagnosis of Pityriasis rosea is clinical and is difficult in atypical cases where dermoscopy is helpful. It also helps in the identification of the age of the lesions, and hence, helps in deciding the treatment modality in the subjects. Biopsy is the gold standard in differentiating it from other differentials of Pityriasis rosea. Keywords: Dermoscopy, Histopathology, Pityriasis rosea, Spongiotic dermatitis

Background: Seizures are one of the most common neurological emergencies in infancy, often resulting from metabolic disturbances such as hypocalcemia. Early identification of hypocalcemia in infants presenting with afebrile seizures is crucial to guide appropriate management and avoid unnecessary investigations or interventions. This study aimed to determine the proportion and risk factors associated with hypocalcemic seizures in infants aged 1 month to 1 year. Materials and Methods: A hospital-based prospective observational study was conducted at SMS Medical College, Jaipur, from February 2020 to December 2021. A total of 80 infants presenting with their first afebrile seizure were enrolled. Infants with known epilepsy, CNS infections, congenital brain malformations, or who had received calcium before admission were excluded. Clinical history, feeding practices, anthropometry, and laboratory parameters including serum calcium, phosphorus, alkaline phosphatase (ALP), vitamin D3, and parathyroid hormone (PTH) were evaluated. Hypocalcemia was defined as total serum calcium <8 mg/dL or ionized calcium <4.4 mg/dL. Data were analyzed using SPSS version 21, with p < 0.05 considered statistically significant. Results: The mean age of infants was 6.5 months; 72.5% were male. Hypocalcemic seizures were observed in 27.5% of cases. Statistically significant associations with hypocalcemia included top feeding (p=0.001), inadequate sun exposure (p=0.001), and reduced night breastfeeding (p=0.001). Laboratory findings revealed higher mean phosphorus (p=0.004), ALP (p=0.042), and PTH (p=0.001), along with significantly lower vitamin D3 levels (p=0.007) in infants with hypocalcemic seizures. Calcium levels showed negative correlation with phosphorus and PTH, and a positive correlation with vitamin D3. Conclusion: Hypocalcemia was a significant and preventable cause of afebrile seizures in 27.5% of infants. Modifiable risk factors such as feeding practices, vitamin D deficiency, and sun exposure play a critical role. Routine metabolic screening is essential in infantile seizures. Keywords: Hypocalcemia, Afebrile seizures, Infants, Vitamin D deficiency, Risk factors, Calcium, PTH, Top feeding etc.

Background: Childhood malnutrition remains a critical public health concern, particularly in low- and middle-income countries. Variations in growth patterns during early childhood (6–60 months) are influenced by socioeconomic, demographic, and nutritional factors. Assessing weight status using standardized classifications such as WHO growth charts and Indian Academy of Pediatrics (IAP) criteria is essential for identifying undernutrition and overweight trends. Aim & Objective: This study aimed to evaluate the nutritional status of children aged 6–60 months using WHO and IAP growth standards and to analyze age-wise and socioeconomic disparities in weight distribution. Materials and Methods: A cross-sectional study was conducted at Ananta Institute, involving 300 children aged 6–60 months. Weight-for-age was assessed using WHO Z-scores and IAP classification. Socioeconomic status (SES) was categorized using the modified Kuppuswamy scale. Data were analyzed for age-wise distribution, SES-based trends, and comparative nutritional status. Results: Highest enrollment was in the 13–24 months (24.66%) and 25–36 months (24%) groups. 26.66% belonged to the upper-lower class, and 23% to the lower class. As per WHO classification, 66% had normal weight, 22.66% were underweight, 9.33% severely underweight, and 2% overweight. According to IAP classification, 66% were normal weight, 29% mildly undernourished, 4.66% moderately undernourished, and 3.66% severely undernourished. Conclusion: The study highlights a significant burden of undernutrition, particularly in lower socioeconomic groups, with mild-to-moderate undernutrition prevalent in nearly one-third of participants. While most children fell within the normal range, disparities in growth patterns underscore the need for targeted nutritional interventions, especially in vulnerable populations. Keywords: Child nutrition, WHO growth standards, IAP classification, underweight, socioeconomic status, preschool children.

Our study included patients with various nasal pathology having negative middle ear pressure who were posted for nasal surgeries. Middle ear pressure measured before surgery, 3 months and 6 months after surgery and changes in middle ear pressure was noted. This study showed that there was an improvement in middle ear pressure of patient who underwent nasal surgery. Keywords: Deviated Nasal Septum, Sino-nasal polyposis, turbinate hypertrophy, septoplasty, FESS, tympanometry.

Background: Sleep is a cornerstone of children's physical and cognitive development, with insufficient sleep linked to a range of behavioral, emotional, and cognitive challenges. However, sleep disturbances in children are often underreported, as children themselves may not recognize or communicate these issues. Early detection of pediatric sleep problems is crucial, especially in a clinical setting. The BEARS Sleep Screening Algorithm—which assesses Bedtime Issues, Excessive Daytime Sleepiness, Awakenings, Regularity and Duration, and Snoring—is a validated and effective tool for identifying sleep-related issues in children. Aims & objectives: This study explores the prevalence of pediatric sleep disturbances in a clinical population, aiming to promote early intervention and awareness. Materials and Methods: A cross-sectional observational study done in a tertiary health care setting among the children of age 2-12 years. Results: The Sleep-related issues are prevalent in 37.66% of the pediatric population. Key predictors of EDS include irregular sleep patterns and late-night screen exposure. Younger children face more issues related to day naps and night awakenings, while older children are more affected by excessive daytime sleepiness and weekend variations. Parents’ awareness of sleep problems was low, with only 1.9% seeking medical advice Keywords: Sleep disturbances, Snoring, awakening, screening algorithms.

Background: Acute respiratory tract infections (ARTIs) are a major global health burden, particularly in low- and middle-income countries. Accurate and timely identification of causative pathogens is essential for effective clinical management and infection control. This study aimed to comprehensively evaluate the viral and bacterial etiologies of ARTIs in adult patients using multiplex real-time PCR alongside conventional culture methods in a tertiary care hospital in India. Materials and Methods: A cross-sectional study was conducted on 135 adult patients presenting with clinical symptoms of ARTI. Throat swabs were collected and subjected to both conventional bacterial culture and multiplex PCR using the Fast Track Diagnostics Respiratory Pathogen 21 PLUS kit (BioMérieux, Luxembourg), targeting 21 respiratory pathogens. Standard microbiological techniques and antibiotic susceptibility testing were employed for culture-positive samples. Results: Multiplex PCR demonstrated high sensitivity in detecting a broad range of pathogens, including Influenza A (H1N1), Influenza B, RSV, Rhinovirus, Human Coronaviruses, and Parainfluenza viruses, as well as bacterial agents such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Co-infections involving multiple viral or viral-bacterial combinations were frequently observed. The majority of patients were inpatients (94%) with varying comorbidities. Seasonal variations and departmental distribution were also analyzed. Conclusion: The integration of multiplex PCR with conventional methods significantly enhances diagnostic yield in ARTIs, providing rapid and comprehensive pathogen detection. The findings highlight the burden of mixed infections and the need for molecular diagnostics in guiding targeted therapy, reducing empirical antibiotic use, and supporting infection control practices. This study contributes valuable epidemiological insights into adult ARTIs in a tertiary care setting. Keywords: Acute Respiratory Tract Infections (ARTIs), Multiplex Real-Time PCR, Respiratory Pathogens, Co-infection, Molecular Diagnostics.

Background: Frozen section biopsy is a rapid technique implemented in the intraoperative setting, utilized in the diagnosis of ovarian neoplasms. It helps in the early differentiation of benign, borderline, and malignant lesions, as well as when to preserve fertility or whether to stage further. Despite its high accuracy in diagnosing benign and malignant lesions, its reliability decreases in borderline lesions because of histological heterogeneity. The current study aimed to evaluate the diagnostic accuracy and limitations of frozen section biopsy in the diagnosis of various ovarian tumors. Materials and Methods: All patients undergoing surgery for clinically and radiologically diagnosed ovarian masses and who consented to intraoperative frozen section examination were included. The study population comprised women of all age groups presenting with ovarian tumors scheduled for surgical intervention in our hospital. Results: In this study involving 45 patients undergoing frozen section (FS) analysis for ovarian tumors, the majority were aged 30–50 years, with 62.2% of tumors measuring less than 10 cm and 80% being unilateral. FS diagnoses showed high concordance with final histopathology, especially for benign (90%) and malignant (88.9%) tumors, yielding an overall diagnostic accuracy of 86.7%. Borderline tumors demonstrated lower sensitivity (57.1%). Discrepancies in six cases were attributed to sampling errors, interpretational challenges, and technical artifacts. Diagnostic accuracy was slightly higher in tumors ≥10 cm (88.2%) compared to those <10 cm (85.7%), indicating consistent frozen section performance. Conclusion: This study found that frozen section is a valuable tool for intraoperative evaluation of ovarian tumors with high accuracy for benign and malignant lesions. However, its limited sensitivity for benign ovarian tumors should be kept in mind before interpretation, and final histopathological diagnosis must be confirmed in such cases. Keywords: Frozen Section, Ovarian Tumors, Histopathology, Accuracy.

Background: Assessing extracellular fluid volume is one of the most difficult tasks for physicians caring for haemodialysis (HD) patients. The study explores the feasibility and utility of Lung ultrasound (LUS) for evaluating volume status in Chronic Kidney Disease (CKD) Patients on HD. Materials and Methods: LUS evaluation of B-Lines was the primary study and its relevance concerning the assessment of volume status was compared with Inferior Vena Cava (IVC) diameter, Weight, Blood Pressure (BP), and clinical parameters. Results: The correlation of pre-HD B-lines and pre-HD IVC diameter was very strong (r=0.871), but the correlation of post-HD B-lines and post-HD IVC diameter was only reasonable (r=0.453). Also, the correlation of mean difference in B-lines pre and post-HD with weight loss was very strong (r=0.883) and with that of clinical signs and symptoms was strong (r=0.734). Despite the correlation between pre-HD B-lines and pre-HD BP being reasonable (SBP r=0.448/DBP r=0.508), the correlation between post-HD B-lines and post-HD BP was found to be very weak (SBP r=0.073/ DBP r=0.104). Conclusion: LUS B-lines can be used to evaluate the volume status of CKD patients on MHD, with the additional possibility of being used as a method of determining a person's dry weight (DW). Keywords: Lung ultrasound, Fluid volume, B-line, IVC diameter, Chronic kidney disease, Haemodialysis.

Background: Diabetic foot ulcers (DFUs) and diabetic kidney disease (DKD) are two major complications of diabetes mellitus. While each presents a significant risk independently, emerging evidence suggests a strong interplay between renal dysfunction and impaired wound healing in DFU. The objective is to assess the impact of kidney function on the severity and healing outcomes of diabetic foot ulcers. Materials and Methods: This observational study included 120 patients with DFUs attending the diabetic foot clinic of a tertiary care center over 12 months. Patients were stratified based on their estimated glomerular filtration rate (eGFR) into three groups: normal renal function, mild-to-moderate DKD, and advanced DKD. Ulcer severity was graded using the Wagner classification. Healing outcomes were monitored over a 12-week follow-up period. Results: Among patients with advanced DKD (eGFR <30 ml/min/1.73 m²), 71.4% presented with Wagner grade ≥3 ulcers compared to 31.6% in those with normal renal function. Delayed healing and higher rates of non-healing ulcers were observed in DKD patients. Amputation risk was also significantly elevated in the advanced DKD group (p<0.01). Conclusion: Kidney dysfunction in diabetic patients is significantly associated with increased severity and impaired healing of foot ulcers. Timely nephropathy management may enhance DFU outcomes and reduce amputation risk. Keywords: Diabetic foot ulcer, Diabetic kidney disease, Wound healing, Renal dysfunction, Estimated glomerular filtration rate, Wagner classification, Ulcer severity

Background: Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) are a growing global health concern due to their resistance to multiple antibiotics, especially β-lactams. This meta-analysis aims to assess the global prevalence and antibiotic resistance patterns of ESBL-producing E. coli in clinical isolates. Materials and Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published from January 2015 to December 2024. Eligible studies reported prevalence data on ESBL-producing E. coli from clinical specimens and included antibiotic susceptibility profiles. Pooled prevalence and resistance rates were estimated using random-effects models. Results: A total of 78 studies encompassing 56,324 clinical E. coli isolates were included. The global pooled prevalence of ESBL-producing E. coli was estimated at 42.1% (95% CI: 37.3–46.9%). Regional variation was significant, with the highest prevalence in Asia (53.8%) and the lowest in North America (18.7%). Resistance was highest to third-generation cephalosporins: cefotaxime (91.4%), ceftriaxone (89.2%), and ceftazidime (86.5%). Carbapenems remained highly effective, with imipenem resistance at only 4.2%. Fluoroquinolone resistance (e.g., ciprofloxacin) averaged 71.6%. Conclusion: ESBL-producing E. coli poses a substantial threat to public health, particularly in Asia and Africa. High resistance to commonly used antibiotics limits therapeutic options, emphasizing the need for robust surveillance, antimicrobial stewardship, and development of new therapeutic strategies. Keywords: ESBL-producing Escherichia coli, Antibiotic Resistance, Prevalence, Global Health, Clinical Isolates.

women with Pre-eclampsia. Materials and Methods: This descriptive observational study was conducted at KIMS, Koppal's Department of Obstetrics and Gynecology over six months (January-June 2024). The study comprised 26 cases. Results: Out of 3048 deliveries, 26 cases of abruptio placentae among 450 cases of Pre-eclampsia were reported, yielding an incidence rate of 5.8%. The study revealed alarming fetal adverse outcome with Prematurity- 61%, Low birth weight- 69.2%, NICU admission-23%.17 cases (65%) resulted in intrauterine deaths. Conclusion: Abruptio placenta poses significant risks to both mother and foetus, underscoring the importance of early intervention for favourable outcomes. Keywords: Abruptio placenta, pre-eclampsia, prematurity.

Background: Aim: To understand the need for implementation of routine evaluation of umbilical cord in antenatal scans to prevent mishappenings. Materials and Methods: An observational study of all the cases with fetal demise in the department of Obstetrics and Gynecology in tertiary care hospital in Koppal from Jan 2024 to Dec 2024, to evaluate for umbilical cord abnormalities. A total of 92 cases were studied. Results: Out of 92 IUFD observed in a span of 12 months (Jan 2024 to Dec 2024) 6 cases were found to have structural abnormalities of umbilical cord which accounts to 6.5 %. Conclusion: It would be prudent to evaluate umbilical cord in antenatal scans to try and prevent such mishappenings Key words: Stricture, Knots, Velamentous Insertion

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by hyperandrogenism, ovarian dysfunction, and is a major cause of anovulatory infertility. This study aimed to assess the impact of structured physical activity on metabolic and hormonal parameters in women with PCOS, contributing to evidence-based recommendations for lifestyle management. Materials and Methods: A randomized controlled interventional study was conducted on 61 women diagnosed with PCOS, following approval from the Institutional Ethical Committee and informed consent from participants. A structured physical activity program was implemented using the Rossmax PA-S20 pedometer. Participants were instructed to complete 9,000 steps per day, five days per week, over 12 weeks. Metabolic and hormonal parameters were measured at baseline, 6 weeks, and 12 weeks. Categorical data were expressed as percentages and analysed using the chi-square test, while continuous variables were presented as mean ± SD and analysed using ANOVA with post-hoc testing. A p-value of <0.05 was considered statistically significant. Results: Most participants were young, urban, educated, unemployed, and unmarried. After 12 weeks of intervention, there were significant improvements in metabolic and hormonal markers. HbA1c, lipid profile, LH, testosterone, and insulin levels showed notable improvement (p < 0.001). Additionally, FAI and HOMA-IR significantly decreased, indicating enhanced insulin sensitivity and hormonal regulation. Conclusion: The findings demonstrate that structured physical activity is an effective non-pharmacological intervention for improving metabolic and hormonal health in women with PCOS. Keywords: Exercise, Hyperandrogenism, Infertility, Lifestyle, Polycystic Ovary Syndrome.

Background: Contamination of ecosystem with Pharmaceuticals and their metabolites is an emerging global issue. Drugs enter into the environment during manufacturing, consumption and disposal. Pharmaceutical products have shown to endanger the fish, birds and other wildlife. Creating awareness and educating public about pharmaceutical waste management is necessary to protect the environment. This study was conducted to study knowledge, attitudes and practices (KAP) of general population as understanding the levels of KAP will enable a more efficient process of creating awareness and seeking solutions. Materials and Methods: A descriptive cross-sectional study was conducted using a pre-validated semi-structured questionnaire related to knowledge, attitude and practices regarding safe drug disposal. The questionnaire consisted of 14 questions with close ended answer of “yes” or “No” and an objective question. The sample size was of 1000 subjects. The data was analysed and presented as percentages. Results: In our study, majority of subjects (96%) felt that it was their responsibility to protect environment from pharmaceutical waste. A significant majority (85%) were aware of the potential threat to public by expired or unused medicines if not disposed of properly. Only 21% of subjects were aware of rules that could minimize drug entry into the environment. Most of the individuals (95%) in our study thought that collection boxes in hospitals and pharmacies to collect unwanted/ expired medicines from public would be good. Further, 88% of the participants approved the policy of manufacturers and pharmacies to have drug take back schemes Conclusion: We hope this study creates awareness among public regarding proper drug disposal and helps policy makers to form drug disposal regulations. Keywords: Safe Drug Disposal, Environment, KAP.

Background: The economic worth of global production of e-waste is 62.5 billion dollars with India being the 2nd largest producer of electronic waste in Asia. Aim: Present systematic review was conducted with the objective to review and document the practices of E- waste management in foreign countries and India and to explore the various challenges associated with the different E-waste management techniques used globally and recommend best practices for India. Methods and Materials: Search strategy adopted consisted of PubMed, Google scholar, Embase, Cochrane library, all relevant major journals, National guideline clearing house, Google Search, National Medical Library, Government guidelines and orders, cross –referral and Standard Public health textbooks. Key words for search were E-waste disposal, E-waste management, E- waste guidelines, Legislations on E-waste, E-waste impact on health. Results: A total of 191 studies were selected for assessment. substantial issues include rapidly rising volumes of e-waste, both domestically produced and imported, low awareness, and inaccurate knowledge about how to dispose of e-waste while being exposed to substantial health risks. Material value is significantly lost as a result of ineffective recycling procedures. The main obstacles in India are a lack of awareness, nascent technology, and ambiguous laws and regulations on the disposal of e-waste. Conclusion: Developing eco-design devices, collecting e-waste with caution, recovering and recycling materials, disposing e-waste using proper techniques, forbidding the shipping of second-hand electronic devices to the developing countries, and raising awareness of the impact of e-waste are the major emerging ideas in developing countries. Keywords: E-waste, Reuse, Management, Recycle, Legislations, Life Cycle Assessment.

Background: Globally, approximately 15 million preterm infants are born each year, with over one million dying shortly after birth, primarily due to respiratory complications. The rate of preterm births varies between 5% to 18% across 184 countries. In India, out of the 27 million births annually, 3.5 million are preterm. Materials and Methods: This hospital-based observational prospective study was conducted over months, from 01/02/24 to 31/01/2025. It included neonates diagnosed with respiratory distress syndrome (RDS) who were admitted to the Neonatal Intensive Care Unit (NICU) at Department of Paediatrics Great Eastern Medical School and Hospital Ragolu, Srikakulam Results: Out of the 150 preterm neonates included in the study, 35 (23.4%) were born between 28-31 weeks of gestation, 25 (30%) between 32-34 weeks, and 70 (46.6%) between 35-37 weeks. Regarding birth weight, more than half (72%) of the neonates had a birth weight of less than 2,000 grams, while 28% had a birth weight greater than 2,000 grams. The average birth weight was 1792.69 grams. CPAP treatment resulted in a successful outcome for 126 (84%) of the neonates. Conclusion: The use of CPAP, along with timely administration of surfactant and antenatal steroids, significantly improves survival rates among preterm neonates with respiratory distress syndrome. Keywords: Preterm Neonates, Respiratory Distress Syndrome (RDS), Continuous Positive Airway Pressure (CPAP), Birth Weight, Survival Rate .

Background: Mucormycosis is an emerging dreadful opportunistic angio-invasive fungal infection occurring predominantly in immunocompromised individuals. Popularly known as “Black fungus”, it gained popularity due to its association with SARSCOVID-19. The aim of the present study was to analyse various predisposing factors and histopathological features associated with mucormycosis and to draw a correlation between histopathology and radiological findings. Materials and Methods: The present study was a two year retrospective study conducted in Department of Pathology, Kurnool medical college, Kurnool from January 2022 to December 2024. All the suspected cases of mucormycosis specimens sent to the Department of Pathology, Kurnool Medical College, for histopathological diagnosis were included in the present study. Formalin fixed paraffin embedded histological sections were studied microscopically. All the sections were stained with H & E stains and special stains like PAS (Periodic acid Schiff) and GMS (Gomori’s Methenamine Silver). Clinical details of systemic hypertension, diabetes, and steroid and oxygen therapy were retrieved from case records. Results: The present study includes 61 cases of mucormycosis, in which 47 were males and 14 were females with male to female ratio of 3.3:1. Maximum numbers of cases were observed in the age group of 51 to 60 years (37.7%). Youngest patient was of 15 days old male child and oldest age was 72 years. The most common symptom noted was facial pain. In the present study study, 47 cases (77%) were diabetic and Rhino-sinusoidal mucormycosis was the most typical presentation. Histologically, chronic inflammatory reaction with extensive areas of necrosis and granuloma formation was seen in most of the cases. The fungal elements have been appreciated and sensitivity of different stains to appreciate the fungal structures has been compared in the present study. Conclusion: Histopathological features such as high fungal load, angio-invasion and extensive areas of necrosis play an important role in accurate diagnosis and assessing the prognosis. We also conclude that extra vigilance in immunosuppressed patients is essential to facilitate early diagnosis and optimizing prompt treatment. Keywords: Mucormycosis, fungal hyphae, diabetes mellitus, steroid therapy.

Background: Colorectal polyps are frequent lesions that one finds in colonoscopic examinations and can be anything from benign hyperplastic lesions to precancerous adenomatous changes. Histopathological diagnosis needs to be correct and understanding the clinicopathological correlation is very important for correct clinical management and prevention of colorectal cancer. Aim: To examine the histopathological range of colorectal polyps and assess their association with clinical and demographic variables. Materials and Methods: A 2-year retrospective observational study was carried out on 186 cases of colorectal polyps diagnosed by endoscopic biopsy or polypectomy specimen. Histopathological typing was done by hematoxylin and eosin (H&E) stained sections. Clinical information such as age, sex, presenting symptoms, and polyp site were obtained from hospital files. The histologic types were categorized as non-neoplastic (hyperplastic, inflammatory, juvenile) and neoplastic (adenomatous, serrated, villous, and carcinoma in situ). Statistical correlations between the variables were done with chi-square and ANOVA tests, using p < 0.05 as significance level. Results: Out of 186 colorectal polyp cases, 58.6% were neoplastic and 41.4% were non-neoplastic. Tubular adenoma was the most frequent neoplastic polyp (42.5%) followed by tubulovillous adenoma (10.2%). Hyperplastic polyps accounted for 29.0% of cases. The majority of polyps were located in the rectosigmoid region (65.1%). Neoplastic polyps were significantly more common in patients aged >50 years (p < 0.01). A statistically significant correlation was found between polyp type and symptomatology (p < 0.05), with bleeding per rectum being predominant in adenomatous polyps. Conclusion: Histopathological examination of colorectal polyps is essential for diagnostic categorization and malignancy risk assessment. Significant clinicopathological associations with age, location, and symptoms were identified, emphasizing the need for vigilant screening, particularly in older adults. Keywords: Colorectal polyps, Tubular adenoma, Histopathology, Hyperplastic polyp, Colonoscopy, Clinicopathological correlation.

Background: Abnormal uterine bleeding (AUB) is one of the most common gynecological complaints in women of reproductive and perimenopausal age. Endometrial hyperplasia, a significant histopathological correlate of AUB, is characterized by abnormal proliferation of endometrial glands and has the potential to progress to endometrial carcinoma. The WHO 2020 classification system redefined endometrial hyperplasia into two major categories—endometrial hyperplasia without atypia and endometrial atypical hyperplasia/endometrioid intraepithelial neoplasia (EIN)—enhancing reproducibility and clinical relevance. Objectives: To assess the clinicopathological correlation between different types of endometrial hyperplasia (as per WHO 2020 classification) and abnormal uterine bleeding patterns, and to evaluate the demographic and risk factor profile of affected women. Materials and Methods: A cross-sectional observational study was conducted over a 12-month period at a tertiary care center among women presenting with AUB. Endometrial samples were obtained via dilatation and curettage or pipelle biopsy and evaluated histologically. All cases were classified according to WHO 2020 guidelines. Demographic details, bleeding patterns, risk factors (such as obesity, diabetes, and hypertension), and clinical presentations were recorded. Statistical analysis was performed to correlate histopathological types with clinical features. Results: Among the 156 women included, the most common age group affected was 41–50 years. The predominant bleeding pattern was heavy menstrual bleeding, followed by intermenstrual bleeding. Endometrial hhyperplasia without atypia accounted for 78.8% of cases, while atypical hyperplasia/ (EIN) was seen in 21.2%. Atypical hyperplasia was significantly associated with obesity, diabetes, and prolonged unopposed estrogen exposure (p < 0.05). The clinicopathological correlation showed that heavy and prolonged bleeding was more frequent in women with EIN, while non-atypical cases often presented with irregular cycles and mild menorrhagia. Conclusion: The study emphasizes the importance of correlating clinical symptoms with histopathological findings in cases of AUB. Accurate classification of endometrial hyperplasia using WHO 2020 guidelines provides essential prognostic and therapeutic direction, particularly for identifying women at higher risk of progression to malignancy. Keywords: Abnormal Uterine Bleeding, Endometrial Hyperplasia, Atypical Hyperplasia, WHO 2020 Classification, Histopathology, Endometrial Intraepithelial Neoplasia.

Background: Procedural sedation and analgesia (PSA) play a critical role in enhancing patient comfort and safety during minor gynecological procedures. The choice of sedative-analgesic combinations affects onset, recovery, hemodynamic stability, and postoperative outcomes. Objective: To compare the efficacy and safety of two ketamine-propofol combinations (ratios 1:1 and 1:2) with a propofol-fentanyl combination for sedation and analgesia in minor gynecological surgeries. Materials and Methods: In this prospective, double-blind, randomized trial, 90 ASA I–II female patients undergoing elective minor gynecological procedures were assigned to three groups (n=30 each): Group A (Ketamine:Propofol 1:1), Group B (Ketamine:Propofol 1:2), and Group C (Fentanyl:Propofol). Primary outcomes included induction time, sedation depth (RSS), recovery time, and hemodynamic-respiratory parameters. Secondary outcomes included total drug use, postoperative pain scores, adverse events, and need for rescue analgesia. Results: Group A had the fastest induction (1.15 ± 0.4 mins) but the longest recovery (11 ± 2 mins), while Group C had the slowest induction (1.65 ± 0.5 mins) and fastest recovery (6 ± 2 mins). Hemodynamic and respiratory parameters remained stable across groups. Group C reported significantly lower postoperative pain scores (p < 0.001). Adverse effects and airway interventions were rare and comparable. Conclusion: All three drug combinations were effective and safe. The propofol-fentanyl combination was associated with faster recovery and superior postoperative analgesia, whereas ketamine-propofol combinations offered quicker induction and more stable oxygenation profiles. Keywords: Ketamine, Propofol, Fentanyl, Procedural Sedation, Minor Gynecological Surgery, Recovery Time, Analgesia.

Background: Laparoscopic cholecystectomy offers many advantages including reduced pain, fast recovery and reduced hospital stay. However, pneumoperitoneum used during surgery, positioning and raised intrabdominal pressure may have adverse effects on respiratory and hemodynamic parameters. We compared two modes of ventilation ie pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) during laparoscopy to observe its effects on respiratory, haemodynamic and blood gas parameters. Materials and Methods: Patients were divided into two groups of 26 each to receive either PCV mode of ventilation or VCV. Standard monitoring including ECG, IBP, EtCO2, and SpO2 was used. Anaesthesia was given using propofol, vecuronium and fentanyl and was maintained with oxygen, nitrous and sevoflurane. Respiratory, hemodynamic and blood gas parameters were recorded throughout procedure. Results: Demographic data as well as hemodynamic parameters and blood gas parameters were comparable in two groups (P > 0.05). Peak airway pressure and plateau pressure were significantly lower in PCV group (P < 0.05). Mean airway pressure was higher in PCV group although for limited time. Conclusion: PCV is better mode of ventilation as it reduces peak and plateau airway pressure without compromising hemodynamic parameters. Key words: Pressure-control ventilation, volume-control ventilation, peak-airway pressure, mean airway pressure.

Background: The incidence of acute kidney injury (AKI) among critically ill patients admitted in hospital is extremely high. The aetiology and symptoms of AKI varies in each case butearly diagnosis, timely intervention and preventing exposure to nephrotoxic drugs can be achieved in patients who are at risk of developing AKI. Aims: The aim of this study is to investigate the prognostic factors and outcomes of acute kidney injury (AKI) in critically ill patients. Objective: To determine the incidence, severity, and outcomes of AKI in critically ill patients, including mortality. Materials and Methods: This Prospective Cohort Study is conducted in tertiary care center in south India in medical and surgical intensive care unit during the study period January 2014 to march 2015, after obtaining institutional ethical committee clearance. Patients who have admitted in the hospital ICU aged more than 18 years developing acute kidney injury (AKI) during hospital stay in the intensive care unit (ICU) were included in this study. Around 1400 patients were admitted in ICU during this period and in them 61 developed AKI during their stay. Clinical and laboratory data were collected at admission and monitored daily thereafter. The recorded data included patient characteristics, primary underlying medical conditions, co-morbidities, AKIN KDIGO stage, SOFA score, duration of ICU stay, and final outcomes. Results: The major causes of AKI during the course of hospital were Sepsis 39(63.9%) followed by drug induced 10 (16.4%), preoperative 8(13.1%), cardiac diseases 4(6.6%). The overall in-hospital mortality of AKI in this study is 16.4%. Refractory septic shock and multi organ dysfunction were the chief cause of death in critically ill patient with AKI. Sepsis was the most common cause of AKI in intensive care unit of which survivors and non survivors were 32(82.1%) and 7(17.9%) respectively. In our study, increased KDIGO staging and SOFA score were significantly associated with higher mortality rates (P < 0.005), indicating that both KDIGO staging and SOFA score are independent prognostic factors for mortality in patients with acute kidney injury. Conclusion: The incidence of AKI in patient admitted in ICU in the present study was 4.35% and the mortality of AKI in critically ill patient was 16.4%. Most of the causes of AKI are avoidable, so early diagnosis and timely treatment can save the patients. Keyword: Acute Kidney Injury, Sequential Organ Failure Assessment (SOFA) score, kidney disease improving global outcomes (KDIGO).

Background: Fistula in ano is an abnormal tract between the anal canal and perianal skin, commonly arising from cryptoglandular infections. Clinical examination alone may not adequately delineate the extent of fistulous tracts, necessitating imaging for comprehensive evaluation. Materials and Methods y: A prospective observational study was conducted on 30 patients with fistula in ano at a tertiary care hospital in Western Maharashtra. All patients underwent clinical assessment, MR fistulogram which was reported using St. James University Hospital Classification, followed by surgical exploration. Data on demographic profile, fistula classification, and intraoperative findings were collected and analyzed using Cohen’s kappa for assessment. Results: The majority of cases were males aged 21–40 years. Grade I fistulae were the most common (53.33% on MRI, 50% in surgical findings). Minor discrepancies were noted in identifying secondary tracts and abscesses. The kappa value of 0.90 indicated almost perfect agreement between MRI and surgical findings. Conclusion: MRI shows excellent correlation with surgical findings and is a reliable non-invasive tool for preoperative assessment of fistula in ano. It improves surgical planning and reduces the risk of recurrence. Keywords: Fistula in ano, MRI Fistulogram, St. James Classification, Surgical Correlation, Perianal Abscess.

Background: Allergic Bronchopulmonary Aspergillosis (ABPA) is a complex pulmonary disorder caused by a hypersensitivity reaction to the fungus Aspergillus, predominantly Aspergillus fumigatus. The management of ABPA primarily involves the reduction of immunological response to Aspergillus and control of the inflammatory processes within the lungs. Present study was aimed to study efficacy of voriconazole used in treatment of allergic bronchopulmonary aspergillosis (ABPA) at a tertiary hospital. Materials and Methods: Present study was single-center, prospective, observational study, conducted patients of age 18 years and above, either gender, confirmed diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) (based on recognized clinical, radiological, and immunological criteria). Results: In present study, among 50 individuals, majority were under 30 years & 51-60 years (26.0 % each) followed by 41-50 age group (20.0%) & 31-40 years (16.0%). 66.0% of the participants are female (33 individuals) and 34.0% are male (17 individuals). All subjects had cough, sputum & dyspnea (100 %) while 30% or 15 participants did experience had hemoptysis. In present study, majority had monocytes 2 % (30 %), followed by 1.00% and 3.00% (22.0 % each). 28 individuals (56.0%) have a basophil percentage of 1.00%, and 22 individuals (44.0%) have a percentage of 2.00%. 30 individuals (60.0%) showed fleeting infiltrates on their chest X-rays, while 30 individuals (60.0%) were observed with central bronchiectasis on HRCT scan. Among those with central bronchiectasis (27 participants), the mean age is 47.1 years, and the proportion of males is 29.6%. Significant measurements such as S.IgE levels, Asp.Fumigatus Sp.IgE, and Asp.Fumigatus Sp.IgG are detailed, showing no statistically significant differences between groups based on p-values. Conclusion: Present study affirms the role of voriconazole as an effective and potentially superior treatment modality for managing ABPA, with the ability to alleviate symptoms, improve radiological outcomes, and reduce the dependence on corticosteroids. Keywords: voriconazole, Allergic Bronchopulmonary Aspergillosis (ABPA), hypersensitive reaction, Aspergillus, corticosteroids.

Background: The study was aimed to assess current patterns of antibiotic use among inpatients. The information collected can support in policy-making and hospital interventions aiming to improve antibiotic prescription and practices. Materials and Methods: A cross sectional point prevalence survey was carried out on all inpatients in single day at 09.00 am at a tertiary care hospital for women and children, Hyderabad. The data was abstracted principally from patient medical records. Data was collected through the standardized online data collection tool in the form of google sheet and uploaded from smart phones. For data analysis, Microsoft Software was used. Results: A total number of 717 patients were on treatment as in patients on the day of survey. Out of them 127 patients were excluded, because either they were admitted after 09.00am or were due for discharge on the day of survey. A total number of 590 eligible patients were included in the study out of which 427(72%) patents were receiving antimicrobial agents. Out of them 58%(n=248)of the patients were prescribed one antibiotic, while 28% (n=118)of the patients were prescribed two antibiotics. The mean number of antimicrobials per patient was found to be 1.09. Indication for antibiotic use was infections for 61%, medical prophylaxis for 16% and surgical prophylaxis for 23%. The most common classes of antibiotics prescribed were third-generation cephalosporin (47%) followed by amoxyclav (22%). Out of 427 patients 96% (n=409) were receiving antimicrobial agent through parenteral route. As per AWaRe classification 68%(n=290) patients were on watch group of antibiotics, 31%(n=134) patients were on access group of antibiotics. Conclusion: The current study depicted the baseline parameters of intervention for instituting future action and policy changes. Keywords: Antimicrobial resistance (AMR).

Background: Growing elderly population is a major concern world -wide. According to World Health Organization, depression is one of the major causes of illness burden which ranks 4th of all major illness, and it is a common disorder among elderly which affects the daily function and contributes to functional decline and increasing mortality. The state of Kerala has highest number of elderly in India. Objective was to study the prevalence of depression among elderly in a rural setting and the factors associated with it. A community based cross sectional study of elderly population in a rural area of Malappuram District of Kerala. Data was collected during January 2013 to July 2014. Methods: A total of 660 elderly selected by simple random sampling were interviewed in their houses. Geriatric Depression Scale -15 was used to detect the prevalence of depression among them and Hindi Mental State Examination was used to assess the cognitive status. Results: The prevalence of depression was found to be 50.15%. Majority of them belonged to 60-70 age group, most of them were literates and unskilled workers. More than 50% were unemployed. Majority of them were living with their children and half of them were depending on them. Married elders outnumbered those who were single. Diabetes and hypertension were leading among the co-morbidities. The factors found to be associated with depression were age, religion followed, socio economic class, educational status, the type of family, living alone, habits like smoking and alcohol intake and few of them had cognitive impairment Conclusion: Prevalence of depression among elderly in rural area in Kerala was high, with age, lower education, smoking, and certain sociodemographic factors significantly associated; Being a non-smoker and having high school level of education was found to be protective against depression in the geriatric age group in this study. Keywords: Community Based Study, Elderly, Rural area, Geriatric Depression Scale 15, Associated Factors.

Background: The aim is to evaluate the role of MR FISTULOGRAM in preoperative evaluation of anorectal fistulas. Materials and Methods: This study included 50 patients who underwent MR fistulography followed by surgery within a period of 22 months from January 2021 to October 2022. Results: In the present study, Out of these 43 patients were males and 7 were females. Age of presentation ranged from 19-65 years with majority peaking between 30 50 years of age. The most common type of fistula was intersphincterictype. Trans sphincteric type of fistula was 2nd most common. The most common location of external opening was found between 4 and 6’o clock position. The internal opening was most commonly found at 6’o clock position. Based on St Jame,s University Hospital Classification, grade I perianal fistulas were most common followed by grade IV. Complications due to perianal fistulas was most commonly seen in age group between 30-50 years. In our study, 17 out of 50 patients (34%) were diagnosed to have secondary tracts. Abscesses were detected in 6 patients. Out of these, 5 patients had perianal abscess and, one patient had ischiorectal abscess. In all those 50 patients who were followed for surgical details, the per operative findings correlated precisely with the MRI findings. Surgical and MRI findings were statistically significant in our study with a p value of 0.04. Grade 3 and 4 fistulas showed discrepancies in identification of tracks.2 ot of 17 patients in whom MRI showed secondary tracks did not agree with surgical findings. Conclusion: MR imaging has major role in preoperative assessment of anorectal fistulas. MRI provides finer anatomic details of fistula and also identifies secondary tracks and abscesses. It is a rapid, well-tolerated, and accurate technique with low interobserver variability. Keywords: MRI Imaging, Anorectal fistula, intersphincterictype, ischiorectal abscess.

Background: Pre-eclampsia is a major hypertensive disorder of pregnancy that contributes significantly to maternal and fetal morbidity and mortality. Emerging evidence suggests that micronutrient deficiencies, particularly of vitamin D and calcium, may influence its development by altering vascular, metabolic, and placental function. Aim: To assess serum vitamin D and calcium levels in pregnant women and analyze their association with the development of pre-eclampsia. Material and Methods: This prospective observational study was conducted from May 2024 to November 2024 at Anugrah Narayan Magadh Medical College and Hospital, Gaya on 130 pregnant women between 20 and 36 weeks of gestation. Participants were divided into two groups: Group A (n = 65, pre-eclamptic women diagnosed per ACOG criteria) and Group B (n = 65, normotensive controls). Detailed demographic, dietary, and clinical data were collected. Serum 25(OH) vitamin D was measured using CLIA, and serum calcium using the Arsenazo III method. Statistical analysis included t-tests, chi-square tests, Pearson correlation, and multiple linear regression. Results: Group A had significantly higher BMI (26.8 ± 2.5 vs. 25.2 ± 2.3 kg/m², p = 0.003), lower sun exposure (0.9 ± 0.4 vs. 1.5 ± 0.6 hours, p < 0.001), and reduced dietary calcium intake (520 ± 110 vs. 690 ± 125 mg/day, p < 0.001) compared to Group B. Serum vitamin D (18.2 ± 6.5 vs. 26.1 ± 7.3 ng/mL, p < 0.001) and calcium (8.12 ± 0.74 vs. 9.01 ± 0.68 mg/dL, p < 0.001) were significantly lower in pre-eclamptic women. Vitamin D deficiency (<20 ng/mL) was more common in Group A (58.46%) than Group B (27.69%). Multiple regression analysis showed serum vitamin D (B = –0.68, p = 0.002), calcium (B = –2.15, p = 0.005), sun exposure (B = –1.80, p = 0.032), and dietary calcium (B = –0.011, p = 0.011) were significant predictors of systolic BP (Adjusted R² = 0.48, p < 0.001). Conclusion: Low serum vitamin D and calcium levels were significantly associated with pre-eclampsia. Nutritional deficiencies and reduced sun exposure emerged as modifiable contributors. Early screening and supplementation of these nutrients may reduce the risk and severity of pre-eclampsia. Keywords: Pre-eclampsia, Vitamin D, Calcium, Pregnancy, Hypertension.

Background: The hand is a prehensile organ capable of grasping and executing precise movements for skilled tasks, serving as a primary tactile tool. This capability arises from improved neuromuscular coordination and a greater cortical representation of the hand within the brain's sensory-motor cortex.[1] Materials and Methods: The current research focuses on the structural analysis of the lumbrical muscles in the hand through cadaveric dissections, examining their variations. It involves a total of 70 upper limbs from adult human cadavers, which consist of 17 cadavers (11 males and 6 females) along with 36 disarticulated limbs from both genders available in the Department of Anatomy, Guntur Medical College, Guntur for a period of 2 years (From April 2022 to March 2024). Results: The variability of the length of the hand is greater in male adult hands than in female adult hands. This is not correlated with the limb length and the total height of the individual due to the inherent difficulties. All four lumbrical muscles are present in 69 out of 70 hands. The fourth lumbrical is absent in one adult female's left hand. Conclusion: The study highlights a high prevalence of morphological variations and anomalies in the lumbrical muscles of the hand, with only 21 out of 70 hands exhibiting normal anatomy. The fourth lumbrical muscle showed the highest frequency of abnormalities, including partial or complete absence and unipennate origins. Keywords: Accessory belly, Hypertrophied, misplaced insertion, Split insertion, Unipennate muscle.

Background: Portal hypertension (PHT) is a severe, debilitating disease. It is caused by many reasons, but cirrhosis is the most common. Colour Doppler ultrasonography, which is noninvasive, accurate, and readily available, is the first-line tool for the assessment and diagnosis of PHT, determining the aetiology and complications. This study aimed to assess the role of colour Doppler ultrasonography in the diagnosis and characterisation of PHT. Materials and Methods: This cross-sectional study included 50 patients with PHT referred for radiodiagnosis. Ultrasonography of the abdomen using a curvilinear probe of 3.5-5.0 MHZ coupled with colour Doppler equipment was used for assessment. Data was presented using frequency and percentage. Result: Of the 50 patients with PHT, most were men (74%), and the affected age group was 51–65 years (42%). Cirrhosis was the most common cause (70%), followed by portal vein occlusion (10%). Portal vein (PV) diameter >13 mm was observed in 60% of patients. Splenomegaly and ascites were observed in 78% and 86% of patients, respectively. Hepatopetal flow was the most prevalent pattern in the portal (74%), splenic (88%), and superior mesenteric veins (92%). Thrombosis was frequent in the PV (28%), and collateral veins mostly appeared in the splenorenal region (76%). 20% of the patients had >20% increase in PV diameter induced by inspiration. Conclusion: Cirrhosis is the most common cause of PHT, and its sonographic findings include splenomegaly, ascites, and PV dilatation. Although severe, PHT is usually accompanied by preserved hepatopetal flow. These results emphasise the value of ultrasound in early detection, disease monitoring, and guiding clinical management without invasive intervention. Keywords: Portal hypertension, Colour Doppler ultrasonography, Noninvasive, Cirrhosis, Hepatopetal flow.

Background: Regular intermittent epidural bolus technique although is recognised technique of producing good analgesia, availability of infusion pumps administrating continuous infusion has been came into routine. Hence both techniques need to be evaluated for efficacy in producing analgesia. Materials and Methods: This was double blind randomized trial which enrolled 52 primigravidae and had lumbar catheter insertion for labour analgesia and received ropivacaine and fentanyl combination till T10 sensory block was achieved. After initial bolus of 10 ml, parturients were given as intermittent boluses or continuous infusion. Parturients were assessed for analgesia, sensory and motor block, total amount of local anaesthetic solution required, rescue doses, maternal satisfaction and neonatal wellbeing. Results: Two groups had no differences in patient characteristics, maternal and neonatal outcome and sensory-motor block. However, total amount of local anaesthetic required and rescue doses required were higher in continuous infusion group. Duration of analgesia was better in intermittent boluses group. Conclusion: As parturients in intermittent boluses group required less volume of drug and lesser rescue boluses to achieve similar analgesia compared to continuous infusion technique, intermittent bolus technique remains more effective technique for labour analgesia.

Background: Population ageing along with increasing share of older persons is becoming one of the most significant social transformation of the twenty first century. Objective: To explore the health and nutritional profile and social support delivery of the geriatrics. Materials and Methods: An epidemiological observation study was carried out in 300 elderly participants dwelling in community and at old age homes in district Lucknow. Results: The frequency of single or multiple morbidity in total elderly revealed to be highest in 98%, one-fifth of them still working, nearly half of them had their nourishment in risk category and overall perceived social support was low in only 20% geriatrics. Conclusion: The morbidity burden is enhanced in northern region geriatrics of our country, nonetheless, they are deprived of needed social support care. Hence, an optimum social support at family level, friends besides government provision of social security measures for their healthy, solaceful life is an essential requirement of aged people. Keywords: geriatrics, nutritional, social support, morbidity

Lamellar ichthyosis (LI) is classified as one of the autosomal recessive congenital ichthyoses and is considered to be more severe than congenital ichthyosiform erythroderma (CIE). It is estimated that LI occurs in approximately 1 in 300,000 live births, and is primarily caused by a deficiency of transglutaminase-1 (TGM-1), inherited in an autosomal recessive fashion. Additionally, several mutations have been linked to LI, including missense mutations in the ATP-binding cassette (ABC) transporter gene (ABCA12). Usually, LI presents at birth with ectropion and a collodion-like membrane that begins to desquamate within the initial three weeks of life. This collodion-like membrane eventually gives way to large, thick scales that cover the entire body. Patients with TGM-1 mutations often experience scarring alopecia, and short stature may manifest in more severe cases of the condition. Individuals can expect a typical life expectancy; however, there is a heightened risk of mortality during the neonatal stage due to complications like secondary sepsis and hypernatremic dehydration. A case of 14 year old male presented with thick scaly lesions all over the body since birth. On Clinial Examination Multiple well defined dark browned, hyperkeratotic and plate – like scales present all over the body. Keywords: Lamellar ichthyosis, scales, genetic.

Background: Gender differences in anaesthetic pharmacodynamics and pharmacokinetics may influence emergence and recovery profiles following total intravenous anaesthesia (TIVA). Understanding these differences can help optimize perioperative care. Aim: To evaluate and compare emergence times and quality of recovery between male and female patients undergoing elective surgery under TIVA. Materials and Methods: A comparative follow-up study was conducted on 60 patients (30 males, 30 females) aged 18–60 years undergoing elective surgeries with ASA I–II status at a tertiary care centre. Patients were administered TIVA using propofol-based protocols. Time to eye opening, time to obey commands, recovery room stay duration, postoperative complications, and quality of recovery (QoR-40 score) were recorded and compared between groups. Data were analyzed using Student’s unpaired t-test and Fisher’s exact test, with p<0.05 considered statistically significant. Results: Females showed significantly faster emergence, with shorter mean time to eye opening (5.17 ± 1.30 min vs. 7.07 ± 1.76 min, p<0.0001) and to obeying commands (6.90 ± 1.31 min vs. 8.83 ± 1.72 min, p=0.0001) than males. Recovery room stay and QoR-40 scores were comparable between groups. Females experienced higher rates of nausea (23.3% vs. 13.3%), vomiting (16.7% vs. 6.7%), and shivering (20% vs. 10%) postoperatively. Conclusion: Females demonstrated faster emergence from TIVA but were more prone to postoperative nausea, vomiting, and shivering. Overall recovery quality remained comparable between genders. Gender-based differences should be considered to tailor perioperative management and improve outcomes. Keywords: Total intravenous anaesthesia, emergence, gender differences, recovery, QoR-40.

Background: High axial myopia, defined as an axial length of ≥26 mm, poses unique anatomical and surgical challenges during cataract extraction. These include difficulty in intraocular lens (IOL) power calculation, increased risk of intraoperative and postoperative complications, and variable visual outcomes. This study aimed to evaluate and compare postoperative visual acuity, contrast sensitivity, and complication rates following different cataract surgery techniques in patients with high axial myopia. Objectives: To assess the safety and efficacy of various cataract extraction techniques in patients with high axial myopia, and to determine the most appropriate surgical approach based on visual outcomes and complication profiles. Materials and Methods: A prospective observational study was conducted from February 2024 to July 2024 in the Department of Ophthalmology at the Regional Institute of Ophthalmology, Minto Ophthalmic Hospital, Bengaluru. 168 eyes with cataract and axial length ≥26 mm were enrolled. Patients underwent either phacoemulsification with foldable IOL implantation or small incision cataract surgery (SICS) with rigid IOL placement (in bag, sulcus, or iris-claw). Visual acuity, contrast sensitivity, and postoperative complications were assessed on postoperative day 1, week 1, and week 4. Statistical analysis included t-tests, linear regression, and Chi-square tests, with significance set at p<0.05. Results: Phacoemulsification with foldable IOL in the capsular bag demonstrated the lowest complication rate (38.6%) and showed statistically significant improvement in visual acuity postoperatively (p<0.00001). In contrast, SICS with iris-claw and sulcus-placed IOLs exhibited the highest complication rates (100% and 87.5% respectively). A positive correlation was observed between increased axial length and poorer visual outcomes (β = 0.045, p < 0.001). Age and sex were also found to influence complication rates, although the differences were not statistically significant. Contrast sensitivity improved across all groups, with the greatest gains seen in the phacoemulsification group. Conclusion: Phacoemulsification with foldable IOL implantation is associated with significantly better visual outcomes and fewer complications in highly myopic eyes. SICS techniques, particularly those requiring alternative IOL fixation, are linked with higher complication rates and should be used cautiously. Individualized surgical planning, accurate biometry, and rigorous postoperative monitoring are critical in optimizing outcomes for this high-risk population. Keywords: High axial myopia; Cataract surgery; Phacoemulsification; Intraocular lens; Postoperative complications.

Background: Extrapulmonary tuberculosis (EPTB) remains a significant clinical challenge, with diverse manifestations complicating diagnosis and management. This study evaluates the epidemiology, clinical spectrum, and comorbidities of EPTB cases at a tertiary care hospital over one year (2022). Methods: A retrospective analysis of 213 tuberculosis (TB) cases diagnosed in 2022 was conducted. EPTB cases (76/213, 35.7%) were analyzed for demographics, anatomical sites, and associations with HIV and diabetes. Data were collected from hospital records, including age, sex, site of infection, and comorbidities. Results: Of 76 EPTB cases, 68.4% (n=52) were female, with a median age of 38 years (range: 5 months–90 years). Lymph node TB (31.6%, n=24) and pleural effusion (25%, n=19) were the most common sites, followed by abdominal (11.8%, n=9), genital (9.2%, n=7), bone (7.9%, n=6), and central nervous system (3.9%, n=3) involvement. Rare sites included skin, breast, and kidney. HIV co-infection was low (2.6%, n=2), while diabetes prevalence was 3.9% (n=3). Monthly case distribution peaked in April (n=12) and October (n=8). Conclusion: EPTB constituted over one-third of TB cases, with lymph node and pleural effusion as predominant forms. A female predominance and low HIV/diabetes associations were observed. These findings underscore the need for heightened clinical suspicion and targeted diagnostic strategies for EPTB in tertiary care settings. Keywords: Extrapulmonary Tuberculosis, Tertiary Care Hospital, Epidemiology.

Background: Interstitial lung diseases (ILDs) are progressive disorders characterized by impaired lung function, reduced exercise tolerance, and decreased quality of life. Pulmonary rehabilitation (PR) has emerged as a key non-pharmacologic intervention to address these deficits. This study aimed to evaluate the effect of an 8-week structured PR program on functional, physiological, and quality-of-life parameters in patients with ILD. Materials and Methods: 60 ILD patients were included in this prospective study and underwent a supervised PR program comprising endurance training, strength exercises, breathing techniques, and educational sessions. Baseline and post-intervention assessments included six-minute walk distance (6MWD), pulmonary function tests, oxygen saturation, Modified Medical Research Council (mMRC) dyspnea scale, and St. George’s Respiratory Questionnaire (SGRQ). Results: Post-rehabilitation, the mean 6MWD improved from 311.4 ± 45.2 m to 368.2 ± 50.7 m (p < 0.001). Significant improvements were also observed in resting and post-exercise SpO₂, mMRC scores, and all domains of the SGRQ (p < 0.001). FVC and FEV1 increased modestly but significantly. A reduction in oxygen dependency was also noted. Subgroup and responder analyses further underscored the broad efficacy of PR across ILD subtypes. Conclusion: Pulmonary rehabilitation is a safe, effective, and comprehensive intervention that significantly enhances functional status and quality of life in patients with ILD. It should be integrated into routine ILD management. Keywords: Pulmonary rehabilitation, interstitial lung disease, Six-minute walk test, Quality of life, Oxygen saturation, mMRC, SGRQ.

Background: Aim: The aim of this study was to evaluate the effectiveness of the minimally invasive sinus tarsi approach combined with cancellous screw fixation in the treatment of depressed commented intra-articular calcaneal fractures, assessing fracture healing, functional recovery, and complication rates. Materials and Methods: This study included 16 patients with intra-articular calcaneal fractures who presented to our institution between 2017 and 2022. All patients were treated surgically using the minimally invasive sinus tarsi approach with cancellous screw fixation. Inclusion criteria included closed, displaced fractures with depression and tongue-type fractures in patients aged 20-70 years. The fractures were classified using Sanders' classification system, and postoperative follow-up included radiographic imaging and AOFS functional scoring at 1, 2, and 3 months. Results: The majority of patients were male (75%), with falls from height (56.25%) being the most common cause of injury. Sanders' Type II fractures (43.75%) were most common. All patients underwent successful surgery with a 3 cm incision, and the fixation was achieved using cannulated cancellous screws and raft screws. Postoperative radiographs showed 100% alignment at the 1-month follow-up, with 93.75% of patients demonstrating stable reduction at 2 months. Functional outcomes were favorable, with 62.5% of patients achieving a good result, 25% excellent, and 12.5% poor. Complications were minimal, with only 6.25% of patients experiencing infection or delayed healing. Conclusion: The minimally invasive sinus tarsi approach combined with cancellous screw fixation offers an effective, safe, and minimally disruptive method for managing displaced intra-articular calcaneal fractures. The technique results in favorable fracture healing, functional recovery, and a low complication rate. This approach is a promising alternative to traditional open surgical methods, although further studies with larger cohorts are necessary to confirm these findings. Keywords: Minimally invasive, sinus tarsi approach, cancellous screw fixation, intra-articular calcaneal fractures, fracture healing.

Background: Diabetes, is a chronic, metabolic disease characterised by elevated levels of blood glucose leading to serious complications over time, impact harshly on the finances of individuals, their families and economies of nations. The disease often remains asymptomatic in its early stages, leading to delayed diagnosis and the onset of complications by the time medical care is sought. Early identification of individuals at high risk for diabetes is critical to enable timely lifestyle interventions and prevent disease progression. The Indian Diabetes Risk Score (IDRS), a simple, cost-effective, and non-invasive screening tool, combines four key parameters such as age, family history, physical activity, and waist circumference to stratify diabetes risk in community settings. The present study was done to estimate the prevalence of Diabetes risk among adults in Rural using Indian Diabetic Risk Score(IDRS): Objective: To study prevalence of Diabetes Mellitus and its risk using Indian Diabetic Risk Score among adults at Rural Health Training Centre of Tertiary Medical College, Kolar and to correlate Diabetes with self-care practices among diabetic patients. Materials and Methods: Cross sectional study carried out in Rural field practice areas of department of community medicine. List of all households are visited and information regarding Diabetic patient if available in the house is collected and one person available at the time of visit are enrolled into the study and required sample of 300 were recruited through random sampling. Pre-tested, semi-structured questionnaire is used to collect the information on socio-demographic details, Diabetic self-care practices and Indian Diabetic Risk Score. Data entered into Excel sheet and analysed using SPSS software. P value less than 0.05 considered statistically significant. Results: Present study showed that IDRS risk components- Age of onset, Family history of diabetes, decreased physical activity and increased abdominal circumference were 149 (50% >50 years), 10 (3.7%), 26 (8.7%) and 62 (20.7%) respectively. Among 300 participants, 83 (27.7%), 95 (31.7%) and 122 (40.6%) were in high, moderate and low risk category as per IDRS respectively. Conclusion: Early Identification of risk factors play a vital role in preventing/delaying the onset of Diabetes and its complications in future. Key words: Diabetes Mellitus, Non-Communicable Disease, Self-care.

Background: Dairy products are one of the most used products globally. Foodborne diseases (FBD) are linked to outbreaks and pose a significant threat to global public health security, making them a matter of international concern. Ensuring food safety has become an increasingly important public health priority. Objectives: 1. To assess the knowledge of food safety in dairy plant workers and the quality of their work life. Materials and Methods: A cross-sectional study was conducted at a southern district of India. Systematic Random Sampling technique was used for selection of participants. 3-point Likert scale was used for assessing food safety knowledge and behavior. A 5-point Likert scale was used for assessing quality of Work life. Results: A total of 364 workers participated in the study who were working across various units of the dairy plant. 277(76%) had good knowledge of food safety. There was significant association of Knowledge and practices of food safety with socio-demographic factors such as education, working unit and years of work experience. 89.2% of the participants had good quality of life and it was significantly associated with age, marital status and working unit. Conclusion: The food safety knowledge and practices are good among dairy plant workers. The quality of work life is good in the majority of the dairy industry employees. Keywords: Across sectional, dairy plant, food safety, Occupational health, Quality of worklife.

Background: Objective: To assess the knowledge, attitude, and practice (KAP) of MRI safety among healthcare providers in the Department of Radio-diagnosis at a rural tertiary care hospital. Materials and Methods: A cross-sectional survey was conducted among 72 healthcare providers in department of Radiodiagnosis at a tertiary care hospital. A structured questionnaire (20 items each on knowledge, attitude, and practice) was used. Scores in each domain ranged 0–20 and were categorized as good, moderate, or poor. Descriptive statistics and ANOVA were used to summarize KAP levels and examine differences by work experience. Results: Participants showed moderately high MRI safety knowledge (mean = 14.0 ± 4.1), strong attitudes (mean = 16.3 ± 2.8), and reasonable safety practices (mean = 15.0 ± 3.6). Good scores were seen in 66.7% (knowledge), 61.1% (attitude), and 69.4% (practice) of participants. ANOVA revealed significant differences in KAP scores by job role and experience (p < 0.05), with radiologists and senior residents performing best. Knowledge–practice gaps were evident, especially under time constraints or staffing limitations. Notably, interns had significantly lower scores across all domains, highlighting the need for targeted training. Conclusion: While department of radiodiagnosis health care providers in this rural setting demonstrated positive attitudes and moderately good MRI safety knowledge, actual safety practices were inconsistent, with notable knowledge–practice gaps. Structured training, periodic assessments, and system-level reinforcements are essential to enhance MRI safety compliance, especially for junior staff and interns. Keywords: MRI safety, knowledge, attitude, practice, healthcare providers

Background: Objectives: To observe the „effect of local insulin injection on granulation tissue formation‟ and wound healing in patients with diabetic foot ulcer Materials and Methods: Data was collected using a questionnaire, clinical examination and blood glucometer. Patients with diabetic foot ulcer were included for the study. Patients enrolled in this study were allocated to either the insulin group or the control group. All the patients underwent debridement of the diabetic foot ulcer on the day of start of study (D0) to remove any slough and unhealthy granulation tissue present. In the insulin group, one-half of the calculated dose of plain insulin was diluted with normal saline to a total volume of 1 ml and then injected diffusely into the base of the diabetic foot ulcer. The remaining half dose of insulin was subcutaneously injected into the abdominal wall. The insulin injections were performed twice a day. In the control group, the calculated dose of human insulin was subcutaneously injected into the abdominal wall and 1 ml normal saline subcutaneously injected into the base of the diabetic foot ulcer. The injections were performed twice a day. For all statistical interpretations, p<0.05 was considered the threshold for statistical significance. Statistical analyses was performed by using a statistical software package SPSS, version 20.0. Results: In this study, 84 „patients with diabetic foot ulcer‟ were assessed after dividing into two groups of 42 each – insulin group and control group. It was found that in the insulin group, where the patients received local and subcutaneous insulin injection, there was significant difference (p < 0.01) in growth of granulation tissue from as early as 5 days after local insulin injection. It was also noticed that there was no significant difference in fingertip blood glucose levels‟ between the two groups. Conclusion: In conclusion, local injection of insulin into the base of a diabetic foot ulcer does seem to have a significant effect on the growth of healthy granulation tissue and hence improves wound healing, while having similar control in systemic blood glucose levels as the normal subcutaneous route of insulin injection. Keywords: Diabetes mellitus, Diabetic foot ulcer, Local insulin injection, Healthy granulation tissue, Wound healing, Blood glucose levels.

Background: Adolescent (10-19 years age) mortality is a potential loss of life for families and society as a whole, and it is a reflection of the socioeconomic and health care conditions at the national and regional levels. Due to a shift in patterns over the past few decades from diseases to social etiologies, unnatural deaths are now the primary cause of death among today's adolescents. Aim of this study was to determine the pattern of unnatural deaths among adolescents and to analyse the causes and methods involved. Materials and Methods: The present descriptive retrospective study was conducted in the department of Forensic Medicine, Bengaluru, from December 2014 to May 2016, with data collected from postmortem records of all the unnatural deaths in adolescents (10–19 years old) brought for medico-legal autopsies. After analyzing, the data was tabulated and graphs were used to tabulate the results. Results: Amongst 399 cases of adolescent unnatural deaths; majority of victims were females (Male: Female ratio- 0.94:1), mostly in the late adolescent age group (15–19 years), utmost died during night hours. Majority were purposeful (Intentional) deaths, mostly suicidal in nature, with hanging and depression being commonest method and causative factor respectively; whereas most unintentional deaths were caused by traffic accidents. Homicides were seen only in males. Conclusion: This study found important informative factors of teenage death, thus recognizing the unique challenges faced during the second decade of life and also emphasized on the importance of development of strategies for laying the foundations of good adolescent’s health. Keywords: Adolescent, unnatural, unintentional deaths, suicide.

Background: Total hip replacement (THR) is highly effective procedure for patients with hip joint deterioration by various conditions, as it relieves pain, improve mobility, attain stability with restoration of limb length and normal mechanics of hip joint, thus improving the standard of life for patient. Total hip replacements are cemented, uncemented & hybrid. The present study was conducted to analyze the short term functional outcomes of uncemented total hip arthroplasty. Materials and Methods: In this study a total of 35 patients, who underwent uncemented total hip arthroplasty (THA) were enrolled to evaluate short term functional outcomes. The final functional outcomes were assessed as per Modified Harris Hip Score (HHS). Results: Mean pre-operative and post-operative HHS was 57±13 and 94±7.14 respectively, p value = 0.0001. In this study, pre-operatively maximum patients 32 (91.43%) had Harris Hip Score of <70, while at the at final follow-up 30 (85.71%) patients had HHS of 90-100. Complication rate was 11.43%. Conclusion: This study provides robust evidence supporting that uncemented total hip arthroplasty provides satisfactory clinical and radiological outcomes after a short duration of follow up. Keywords: Total hip arthroplasty, Uncemented fixation, Functional outcome, Harris hip score

Background: The need for surgical procedures is immensely high worldwide. But there is lack of accurate measuring tool to estimate the post-surgical outcomes. To provide surgeons with a simple, objective, and direct method of rating, a ten-point Surgical Apgar Score was developed. In this study the efficacy of the surgical APGAR score in predicting the post-operative mortality and major complications was evaluated. Materials and Methods: A longitudinal follow up study was conducted at a tertiary care apex government hospital in the state of Telangana. A total of 100 patients undergoing general surgical procedures were selected randomly for inclusion in the study. The estimated morbidity and mortality for 30 days after surgery was calculated using the individual surgical Apgar scores. Descriptive statistics and chi – square analytical tests were used to analyzed the statistical significance. Results: The study estimated that the surgical patients with low score APGAR had developed major post – operative complications (p = 0.000018). Those patients with co – morbidities had significant association with the APGAR score (p= 0.00205). Conclusion: In this study, surgical Apgar score has proven to be an important tool in early prediction of development of post-operative major complications including 30 days mortality. Those who had lower Apgar score developed major post – operative complications and those with co - morbidities were found to be significant pre - operative factors associated with higher chances of post-operative complications. Keywords: Surgical APGAR score, post – operative complications, co – morbidities.

Background: Pregnancy induces significant hormonal changes, including fluctuations in estrogen and progesterone levels. These hormonal shifts are thought to affect various physiological systems, including the ocular surface. However, the impact of pregnancy-related hormonal changes on ocular health, specifically on tear production, tear film stability, intraocular pressure (IOP), and dry eye symptoms, remains inadequately explored. This study aims to evaluate the influence of hormonal variations during pregnancy on ocular parameters, comparing pregnant women with non-pregnant controls. Materials and Methods: This cross-sectional study involved 187 pregnant women and 176 non-pregnant controls. Hormonal parameters (estrogen and progesterone) were measured, and ocular parameters including Schirmer’s test (tear production), tear break-up time (TBUT), Ocular Surface Disease Index (OSDI) score, and IOP were assessed. Pearson correlation coefficients were calculated to examine associations between hormonal levels and ocular parameters. Statistical significance was set at p < 0.05. Results: Pregnant women exhibited significantly lower Schirmer’s test scores (15.3 ± 5.8 mm vs. 18.1 ± 6.5 mm, p < 0.001), shorter TBUT (12.5 ± 4.2 seconds vs. 14.0 ± 3.5 seconds, p < 0.001), and higher OSDI scores (14.8 ± 7.3 vs. 11.4 ± 6.1, p < 0.001), indicating decreased tear production, compromised tear film stability, and increased dry eye symptoms. Estrogen (r = 0.425, p < 0.001) and progesterone (r = 0.381, p < 0.001) levels were positively correlated with Schirmer’s test scores and TBUT, but negatively correlated with OSDI scores (estrogen: r = -0.46, p < 0.001; progesterone: r = -0.375, p < 0.001). IOP was slightly higher in pregnant women (16.0 ± 4.1 mmHg vs. 15.2 ± 3.8 mmHg, p = 0.021), with weak positive correlations between both hormones and IOP. Conclusion: Pregnancy-related hormonal changes significantly affect ocular health, with lower tear production, reduced tear film stability, and increased dry eye symptoms observed in pregnant women. Estrogen and progesterone levels are closely associated with these ocular changes. These findings underscore the importance of monitoring ocular health during pregnancy, particularly for managing dry eye symptoms. Further research is needed to explore the long-term effects of pregnancy on ocular health and the potential need for targeted interventions. Keywords: Pregnancy, Estrogen, Tear Production, Intraocular Pressure, Schirmer’s Test.

Background: Intraocular pressure (IOP) is an important ocular parameter that is influenced by various physiological changes during pregnancy. Pregnancy-induced hormonal fluctuations, particularly the elevation of estradiol and progesterone, may alter IOP dynamics. While studies have observed changes in IOP during pregnancy, there is limited data regarding trimester-specific IOP alterations and their correlation with maternal factors such as age, body mass index (BMI), blood pressure, and serum estradiol levels. This study aims to investigate IOP changes across pregnancy trimesters and their associations with maternal characteristics. Materials and Methods: This prospective cohort study was conducted on 82 pregnant women, with measurements taken in the first, second, and third trimesters. IOP was measured in both eyes using a non-contact tonometer. Maternal factors such as age, BMI, systolic and diastolic blood pressure (SBP, DBP), serum estradiol levels, and gestational age were recorded. A control group of 82 non-pregnant women was also included for comparison. Pearson's correlation coefficient was used to assess relationships between IOP and maternal factors, and comparisons between trimesters were made using paired t-tests. Results: Significant reductions in IOP were observed across pregnancy trimesters, with mean IOP decreasing from 15.7 ± 2.2 mmHg in the first trimester to 14.3 ± 2.0 mmHg in the second trimester, and further to 13.7 ± 2.0 mmHg in the third trimester (p < 0.001 for all comparisons). The control group had higher IOP values (15.9 ± 2.3 mmHg). Pearson’s correlation revealed a significant negative correlation between IOP and gestational age (r = -0.451, p < 0.001) and serum estradiol levels (r = -0.553, p < 0.001), while systolic (r = 0.322, p = 0.029) and diastolic blood pressure (r = 0.369, p = 0.031) showed moderate positive correlations with IOP. No significant correlations were found with BMI and age. Conclusion: This study demonstrates a significant reduction in IOP as pregnancy progresses, with estradiol and gestational age being negatively correlated with IOP. Blood pressure is positively correlated with IOP during pregnancy. These findings emphasize the need for monitoring IOP in pregnant women, especially those with hypertension or preeclampsia. Further research is warranted to explore the long-term ocular effects of pregnancy-induced changes in IOP. Keywords: Intraocular Pressure, Pregnancy, Estradiol, Trimester, Glaucoma.

Background: COVID 19 infection has become a major public health problem throughout the world as a pandemic. Antenatal mothers and their babies form a vulnerable population to acquire this infection. Many maternal and neonatal factors are reported to be related with COVID positivity in the babies of COVID positive mothers and identification of these factors is essential for proper care. But studies evaluating the association of these factors with COVID positivity are limited. The objective of the present study was to determine the factors associated with COVID positivity among babies born to COVID confirmed mothers. Materials and Methods: An unmatched case control study was conducted at a dedicated tertiary care COVID treatment hospital among babies born to mothers who were COVID positive within 14 days before delivery. The cases included COVID positive babies and the controls included COVID negative babies of these mothers. The consecutive cases and concurrent controls were chosen from same source population with control to case ratio 2:1 by retrospective chart review from August 2020 to December 2021. The COVID testing for babies was done at 24 to 48 hours after birth. The outcome variable was the COVID positivity status of babies. The maternal and neonatal factors were analysed to study the significant association with the outcome variable. Chi square test was used to study the association of categorical variables with outcome variable in Univariate analysis. Bivariate analysis and Multivariate Logistic regression were done to explore the significant risk factors associated with neonatal COVID positivity. Results: The total study population included 261 babies (cases included 87 babies and controls included 174 babies). Prolonged Rupture of Membrane was found to be a significant maternal risk factor associated with neonatal COVID positivity(P = 0.018, OR 2.19 , 95%CI 1.13 to 4.27). Meconium-Stained Amniotic Fluid was another significant risk factor observed with the outcome (P =0.005, OR 2.48 ,95%CI 1.29 to 4.77). The other maternal variables such as age of mother, parity, mode of delivery, presence of maternal co morbidity and clinical category of COVID did not show significant difference. Among the neonatal factors, Prematurity was seen significantly more in case group (P=0.01, OR 2.81 ,95%CI 1.2 to 6.3). Other neonatal variables like Birth weight, gender, Small for Gestation, need of NICU admission, active resuscitation and Low APGAR score did not show significant difference between the two groups. After evaluating possible confounders, Multivariable Logistic Regression was done which showed significance of neonatal COVID positivity with Prolonged rupture of Membrane (aOR 2.02), Meconium stained Amniotic fluid (aOR 2.4) and Preterm deliveries (aOR 2.7). Conclusion: The significant risk factors associated with neonatal COVID positivity identified in the present study were Prolonged Rupture of Membrane during delivery, Meconium stained amniotic fluid and Preterm delivery. This highlights the importance of management in the peripartum period which will ultimately help in neonatal care during a pandemic situation. Keywords: COVID 19 positivi

Background: Tibial pilon fractures are relatively uncommon, representing 5–7% of all tibial fractures. These injuries occur due to axial loading, where the talus is forced into the plafond, leading to articular impaction of the distal tibia. The timing and nature of the surgical intervention affect soft tissue and bone healing. Research continues to seek improvements in clinical outcomes for this challenging fracture. The aim is to evaluate the fracture healing time and functional outcome of distal tibial pilon fractures in adults treated by different surgical modalities. The objective is to evaluate the radiological fracture healing time. To evaluate the post-operative complications. To evaluate the functional outcome by Olerud and Molander scoring system at 9th post operative month. Materials and Methods: Study Design: A Retrospective hospital based Observational study. Study area: The study was conducted in the Department of Orthopaedics, KMCH. Study Period: 3 years (May 2021 to April 2024). Study population: Distal tibial fractures with articular involvement in patients more than 18yrs of age who had surgical procedure. Sample size: Total of 26 subjects. Sampling Technique: Convenient sampling. Results: In the present study of 26 cases, on evaluation of the type of fracture as per AO/OTA classification, most patients were of C type (17 patients, 65.4%) with associated distal fibular fracture (24 pts, 92.3%). Average bone healing time was 16 weeks (21 pts, 75%) with range from 14 to 24 weeks. Ankle stiffness is the most common complication (15 pts, 57.7%) and 1/3rd of patients (9 pts, 34.6%) had no complications. Surgical procedure yields excellent/good functional outcome in majority (21 patients, 80.8%) with Fibular plating and locking medial tibial plating as preferred mode of definite fixation. Conclusion: In conclusion, tibial pilon fractures remain challenging, with no definitive gold standard treatment. In our present study, surgical approach with immediate temporary external fixator, definitive fixation after around 10 days by open reduction and internal fixation (ORIF) with fibular plate and locking medial tibial plate augmented with articular screws / k wires has yielded excellent/good results in 21 cases (80.8%). Treatment decisions should consider detailed radiographic assessment and surgeon expertise with a two-phase protocol preferred for optimal soft tissue management, which is critical in reducing complications and improving outcomes in high energy pilon fractures. Keywords: Pilon fracture, Surgical fixation, Fracture healing, Functional outcome.

Background: Traumatic pancreatic injury poses significant diagnostic and therapeutic challenges. Unlike hepatic or renal trauma pancreatic injuries often evade early detection due to vague clinical and biochemical manifestations. Delayed diagnosis increases the risk of complications such as pseudocyst formation, abscesses and endocrine insufficiency. This study evaluated the role of Pancreatic Injury Mortality Score (PIMS) in Predicting Outcomes of Traumatic Pancreatic Injury. Materials and Methods: This prospective observational study was conducted over 18 months at a tertiary care institute in South India. It included 44 patients with radiologically confirmed pancreatic trauma. Inclusion criteria were patients >18 years with abdominal trauma (blunt or penetrating) and confirmed pancreatic injury. Patients with pre-existing pancreatic disease or those who did not consent were excluded. All patients being haemodynamically stable underwent conservative management. Radiological grading was based on the AAST-OIS classification and risk stratification was done using the PIMS. Clinical outcomes, including complications, ICU requirements, and mortality, were analyzed using SPSS version 23.0. A p-value <0.05 was considered statistically significant. Results: Among 44 patients, 86.4% were male, with the highest incidence in the 41–50-year age group. PIMS classified 40.9% as moderate risk, 34.1% as low risk, and 25% as high risk. Overall mortality was 20.5%. Mortality was found to be significantly associated with higher PIMS scores (mean 11.8 vs. 5.5 in survivors; p = 0.0005). Vessel involvement and presence of shock were strongly correlated with mortality (p < 0.01). ROC analysis of PIMS showed an AUC of 0.990, with 100% sensitivity and 94.3% specificity at a cutoff score of 9.5. AAST grade alone did not show statistically significant correlation with mortality. Conclusion: Pancreatic trauma outcomes are influenced more by physiological compromise and associated injuries than by AAST grade alone. The PIMS is a highly sensitive and specific tool for mortality prediction and may be used as a guide for timely and appropriate management. Non-operative management remains effective for low to moderate-grade injuries in hemodynamically stable patients. Keywords: Pancreatic trauma, Abdominal injury, PIMS score, AAST grading, Mortality prediction.

Background: Septic shock is a leading cause of mortality in children, particularly in resource-limited settings. Early and appropriate management, including fluid resuscitation and vasoactive therapy, is critical. However, predicting outcomes remains challenging. Inotropic scoring systems, such as the Wernovsky Inotrope Score (WIS) and Vasoactive Inotropic Score (VIS), may help assess mortality risk, but their utility in paediatric septic shock has been inadequately explored. Objective: To evaluate the predictive value of WIS and VIS for mortality in children with septic shock. Materials and Methods: This longitudinal study, conducted over 18 months at a tertiary care hospital, included paediatric patients aged 1 month to 18 years who required vasoactive therapy for septic shock. Exclusion criteria included patients with pre-existing organ dysfunction or who received vasoactive therapy for over 6 hours prior to admission. The WIS and VIS were calculated using the following formulas: • WIS = Dobutamine + Dopamine + 100 × Epinephrine (μg/kg/min) • VIS = Adrenaline × 100 + Norepinephrine × 100 + Milrinone × 10 + Vasopressin × 10,000 + Dopamine + Dobutamine (μg/kg/min) Statistical Analysis: Data were analyzed using the Student’s t-test or Mann-Whitney U test for continuous variables and Chi-square or Fisher’s exact test for categorical data. ROC curves and AUC were calculated to assess the predictive accuracy of WIS and VIS for mortality. Results: Both WIS and VIS effectively predicted mortality. VIS (AUC = 0.837) identified a cutoff ≥28.46, with 84.6% sensitivity and 59.6% specificity. WIS (AUC = 0.865) predicted mortality with a cutoff ≥40.90, achieving 76.9% sensitivity and 64.4% specificity. Conclusion: WIS and VIS are reliable predictors of mortality in paediatric septic shock, with VIS showing higher specificity and WIS better sensitivity. Larger studies are needed to further validate these findings. Keywords: Septic shock; Vasoactive Inotrope Score.

Background: Alcohol dependence syndrome remains a prevalent public health issue in India, with significant social, psychological, and economic consequences. Risk-taking behaviors such as road traffic accidents, violent acts, self-injury, and risky sexual behavior are frequently observed among alcohol-dependent individuals, often associated with sensation-seeking traits. However, studies focusing on this relationship in the Indian context, particularly in South India, are limited. Materials and Methods: A cross-sectional study was conducted at ASRAM Medical College and Hospital, Eluru, over one year (September 2018 – August 2019). A total of 225 male inpatients diagnosed with alcohol dependence syndrome (ICD-10 criteria) were assessed. Tools included the CIWA-Ar, MMSE, SADQ, High-Risk Behavior Questionnaire (HRBQ), and Sensation Seeking Scale Form V (Indian adaptation). Statistical analysis was done using SPSS v24, with chi-square tests to assess associations. Results: Among participants, 58.7% exhibited high-risk behaviors, with road traffic accidents (24%) and risky sexual behavior (16%) being most common. Sensation-seeking behavior was present in 43.6%, predominantly mild to moderate. Significant associations were found between sensation-seeking and high-risk behaviors (χ²=122.325, p=0.001), and between risk behaviors and severity of alcohol dependence (χ²=225.001, p=0.001). Sensation-seeking scores also correlated positively with the severity of alcohol dependence (p=0.001). Conclusion: Risk-taking and sensation-seeking behaviors are significantly associated with alcohol dependence severity. These findings underscore the need for targeted interventions in treatment programs addressing these behavioral traits to reduce alcohol-related harm. Keywords: Alcohol dependence syndrome, risk-taking behavior, sensation-seeking, SADQ, South India, high-risk behavior.

Background: The objective is to assess the health insurance coverage and utilization pattern in the study population Materials and Methods: It is a Cross - sectional study, This study was undertaken in the rural field practice area of a Tertiary medical college, Bengaluru. Four villages were chosen randomly. Multi stage sampling method was used. Sampling units were households. Oral questionnaire was used to collect the data. Statistical analysis is data was analyzed by percentages and proportions using MS excel. Results: According to this study majority of the participants were males (52%), 86% of the study participants were literates, majority (62%) of them were employed, 97% of the participants were hindu by religion Health insurance coverage was 47% in the study area. Conclusion: Health insurance coverage was 47 %. Majority of the households (57%) were not aware about any health insurance schemes, majority (84%) of the participants among subscribed had not utilized health insurance. 95% of the insured population reported out of pocket expenditure on healthcare. Keywords: Rural population, Health insurance awareness, Out of pocket expenditure.

Background: Inflammatory Bowel Disease (IBD) is are immune-mediated disease characterized by episodes of intestinal inflammation and relapse. Recent evidence has suggested that vitamin D plays an important role in immune regulation and gut mucosal integrity. Vitamin D deficiency is prevalent in cases of IBD, which contributes to disease severity. The current study aimed to determine the association of vitamin D deficiency with IBD for potentially improving the clinical management of these cases. Materials and Methods: This study was conducted in n=45 cases with confirmed diagnosis of Crohn’s Disease (CD), or Ulcerative Colitis (UC) based on ECCO guidelines. Lab investigations included estimation of Serum 25-hydroxyvitamin D [25(OH)D] using chemiluminescence immunoassay (CLIA). Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to assess systemic inflammation. Serum calcium, phosphorus, albumin, and alkaline phosphatase were also measured to evaluate calcium-phosphorus metabolism. Results: Vitamin D deficiency (<20 ng/mL) was found in 62.2% of cases, particularly among Crohn’s disease patients 72% of cases compared to ulcerative colitis 50% of cases. Mean vitamin D levels were significantly lower in cases with active disease (15.8 ± 5.2 ng/mL) versus remission (22.9 ± 7.1 ng/mL, p=0.003). Deficiency correlated inversely with CRP (r=–0.65) and ESR (r=–0.58), and positively with albumin and calcium. Logistic regression identified active disease, Crohn’s disease, low BMI, and elevated CRP as independent predictors. Corticosteroid use was significantly associated with deficiency (p=0.02). Conclusion: Vitamin D deficiency was commonly prevalent in cases of IBD. The deficiency was more prevalent in cases of Crohn's disease as compared to Ulcerative colitis. The association was significant in active disease states, systemic inflammation, poor nutritional status, as well as corticosteroid use. Therefore, monitoring and managing the vitamin D levels should be an integral part of comprehensive care for patients with irritable bowel diseases. Keywords: Vitamin D, Irritable Bowel Diseases (IBD), Crohn’s disease (CD), Ulcerative colitis (UC).

Background: Chronic Kidney Disease (CKD) is a severe renal disease causing severe organ system issues, including uremia, metabolic bone disease, neuropathy, hypertension, and cardiovascular disorders, often accompanied by pulmonary hypertension. Objective: To evaluate pulmonary hypertension in chronic kidney disease patients using echocardiography, assess its severity in various stages, and assess its progression in dialysis patients. Materials and Methods: This was a hospital-based observational cross-sectional study that total 167 patients diagnosed with chronic kidney disease (CKD) over 18 years old and on maintenance dialysis. The participants were selected based on age and education level, and written informed consent was obtained from all participants. Patients underwent demographic details, routine investigations, including blood count, urea, creatinine, uric acid, calcium, phosphorus, sodium, potassium, albumin, lipid profile, and urinary examination. CKD was diagnosed if patients had a history of decreased GFR for 3 months or more or as per sonographic findings. Results: Total 167 patients with chronic kidney disease (CKD) and found a prevalence of pulmonary hypertension (HTN) at 43.7%. The incidence was higher in males (47.5%) than females (38.2%). Patients under 60 years old had 42.3% pulmonary HTN, while those over 60 had 47.7%. The incidence was significantly higher in dialysis patients (68.6%) and those on AV fistula (92%). LV hypertrophy was more evident in CKD patients with pulmonary HTN compared to those without pulmonary HTN. Heart failure with reduced ejection fraction (HFrEF) was present in 26 (35.6%) of 73 patients with pulmonary HTN, while heart failure with preserved ejection fraction (HFpEF) was evident in 87.7%. The severity of pulmonary hypertension increased with age, with higher severity associated with later stages of CKD. Conclusion: Pulmonary hypertension, a prevalent condition in 43.7% of chronic kidney disease (CKD) patients, is linked to renal function progression and pulmonary vascular complications. Targeted therapies can improve pulmonary vascular resistance and severity, but larger-scale studies are needed to better understand this condition. Keywords: Chronic kidney disease, renal disease, Pulmonary Hypertension, Echocardiography.

Gestational hypertension and preeclampsia are common disorders of pregnancy and remain a major health issue for women and their infants worldwide. The body undergoes dynamic changes in composition during pregnancy in order to support the growing fetus as it develops from conceptus to live born infant. The progressive fluid retention during pregnancy causes subsequent increase in TBW (total body water) and in plasma volume. The assessment of extracellular, intracellular and total body water (ECW, ICW, TBW) is important in many clinical situations. The studies regarding assessment of TBW distribution in pregnancy, especially, high risk pregnancies are scarce. Present study was a prospective study which included 140 pregnant women (70 cases and 70 controls) admitted at Padmashri Dr D. Y. Patil Hospital and Research Institute, Kolhapur. Total body water and its distribution were measured using impedance analyzer (TRANSTEK Bluetooth Body Fat Scale BF-1256-B).Bioelectrical impedance was measured at a specified frequency, viz., 50 kHz (Z1=50) after 24 weeks of gestational age. Mean of total body water among cases(n=70) was 30.30±5.76%,control (n=70) was 29.37±2.87% and among severe preeclamptic population(n=36)was48.55±4.46%.(P<0.0001, r =0.38, 95%CI=0.14 – 0.57,r2 = 0.14).Mean of extracellular body water among cases(n=70) was 22.46±2.89% , control(n=70) was 22.47±2.70,and among severe preeclamptic population(n=36)was 22.24±3.12.(P< 0.0001, r =0.63, 95% CI=0.44 – 0.77, r2 = 0.40).Mean of intracellular water among cases(n=70) was 25.87±2.83%, controls(n=70) was 24.74±4.29 , and among severe preeclamptic population(n=36) was 26.30±3.40%.(P< 0.0001, r =0.76, 95% CI=0.62 – 0.85,r2 = 0.58).Positive correlation was found between total body water distribution with severity of disease using bioelectrical impedance analysis. The results of the present study gives insight that Bioelectrical Impedance Analysis can be used to diagnose preeclampsia in incipient stages, which can be quite useful in the care provision of women at a higher risk for pregnancy induced hypertension. BIA can also be used to stratify patients with a higher risk for progression to severe preeclampsia, which might result into more vigilant and better management. Keywords: Pregnancy, Preeclampsia, Bioelectrical Impedance Analysis, Total body water, Extracellular body water, Intracellular body water.

Background: Total knee arthroplasty (TKA) is a widely performed procedure for managing advanced osteoarthritis. The choice between cemented and uncemented fixation remains a subject of ongoing debate, with each technique offering distinct biomechanical and clinical advantages. The aim is to assess and compare the clinical and radiological outcomes of cemented versus uncemented total knee arthroplasty in patients with primary knee osteoarthritis. Materials and Methods: This prospective, comparative study included 70 patients with primary knee osteoarthritis, randomly divided into two equal groups: Group A (cemented TKA) and Group B (uncemented TKA). All patients underwent surgery using a standardized posterior-stabilized implant design and were followed for six months. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain, Knee Society Score (KSS), and range of motion (ROM), while radiological evaluation included component alignment, presence of radiolucent lines, and signs of loosening. Results: Both groups had comparable baseline demographics and bone quality. Pain scores (VAS) significantly decreased over time in both groups with no statistically significant difference. At six months, the cemented group showed superior outcomes in KSS (clinical: 86.2 ± 5.1 vs. 83.7 ± 6.0, p = 0.045; functional: 81.6 ± 5.8 vs. 78.9 ± 6.1, p = 0.038) and ROM (119.6° ± 5.7° vs. 115.2° ± 6.3°, p = 0.009). Radiologically, alignment was similar in both groups, although the cemented group had fewer radiolucent lines and no signs of loosening. Conclusion: Cemented and uncemented TKA techniques both provide effective pain relief and functional improvement. However, cemented fixation demonstrated modest early advantages in function, mobility, and radiological stability, making it a more favorable option for short-term outcomes. Keywords: Total knee arthroplasty, Cemented TKA, Uncemented TKA, Knee Society Score, Radiological outcomes.

Background: Subtrochanteric femur fractures are complex injuries often associated with high-energy trauma and osteoporotic changes. Surgical fixation using either intramedullary or extramedullary implants remains the mainstay of treatment, but the optimal choice between the two techniques continues to be debated. The aim is to compare the clinical and radiological outcomes of intramedullary versus extramedullary implant fixation in patients with subtrochanteric femur fractures. Materials and Methods: This longitudinal, prospective study was conducted at the Department of Orthopaedics, Sri Guru Ram Das (SGRD) Tertiary Care Hospital, Amritsar. A total of 60 patients were initially enrolled through purposive sampling, out of which 52 completed follow-up and were included in the final analysis. Patients were alternately allocated into two groups: Group A (27 patients) underwent intramedullary fixation, and Group B (25 patients) underwent extramedullary fixation. Clinical and radiological parameters including duration of surgery, intraoperative blood loss, time to union, Harris Hip Score (HHS), and complication rates were assessed. Statistical analysis was performed using IBM SPSS version 26.0, with a p-value < 0.05 considered significant. Results: The mean age of patients was slightly higher in the intramedullary group (49.67 years) compared to the extramedullary group (47.08 years). The duration of surgery and intraoperative blood loss were significantly lower in the intramedullary group (p = 0.001 for both). The mean time to radiological union was similar between the groups (20.33 weeks vs. 18.68 weeks; p = 0.135). At 24 weeks, both groups demonstrated comparable functional outcomes with mean HHS of 80.78 (intramedullary) and 81.64 (extramedullary). Radiological union rates and complication profiles, including rates of infection, non-union, and implant failure, showed no statistically significant difference between the two groups. Conclusion: Both intramedullary and extramedullary fixation methods are effective in the treatment of subtrochanteric femur fractures. The choice of implant should be guided by fracture pattern, patient profile, and surgeon experience, as both techniques provide comparable functional and radiological outcomes. Keywords: Subtrochanteric femur fracture, intramedullary fixation, extramedullary fixation, Harris Hip Score, radiological union.

wide range of adverse maternal and neonatal outcomes, including alterations in fetal hematological parameters. Cord blood analysis offers insight into the hematopoietic and physiological status of neonates at birth, particularly in high-risk pregnancies such as those complicated by HDP. Aim: To compare the cord blood hematological profile of neonates born to hypertensive mothers with those born to normotensive mothers and evaluate the implications on neonatal outcomes. Materials and Methods: This case-control study was conducted at the Department of Obstetrics and Neonatal Intensive Care Unit (NICU), Sri Guru Ram Das Institute of Health Sciences and Research, Amritsar, between February 2020 and June 2021. A total of 90 neonates were divided equally into two groups: cases (born to mothers with HDP) and controls (born to normotensive mothers without comorbidities). Cord blood and day-3 peripheral venous blood samples were collected and analyzed using an automated hematology analyzer. Hematological parameters including hemoglobin (Hb), packed cell volume (PCV), red cell indices, total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), platelet count, and nucleated red blood cells (nRBCs) were compared. Data were analyzed using SPSS v26, with p-values <0.05 considered significant. Results: Significant differences were observed in several hematological parameters between the two groups. Neonates born to hypertensive mothers had significantly lower cord blood TLC (p < 0.001), ANC (p < 0.001), and ALC (p < 0.001), and higher nRBC count (p = 0.016). Day-3 peripheral blood continued to show lower TLC (p = 0.036) and ANC (p = 0.046) in the hypertensive group. Thrombocytopenia on day 3 was significantly more common among neonates of hypertensive mothers (p = 0.001). Additionally, higher rates of small for gestational age (p = 0.025), asymmetrical IUGR (p = 0.038), and NICU admissions were observed in the hypertensive group, although mortality differences were not statistically significant. Conclusion: Neonates born to hypertensive mothers show significant hematological alterations, particularly in leukocyte and platelet counts, indicating a higher risk of early neonatal complications. Early identification through cord blood profiling can guide prompt intervention and management. The study emphasizes the importance of close monitoring of neonates born to mothers with hypertensive disorders of pregnancy. Keywords: Cord blood, Hematological profile, Hypertensive pregnancy, Neonatal outcome, Thrombocytopenia.

Background: Male factor infertility is a well-recognized contributor to infertility in couples. Semen analysis remains an essential and non-invasive diagnostic tool in evaluating male reproductive potential. The aim and objective is to assess the prevalence and types of semen abnormalities among male partners of infertile couples. Materials and Methods: This study was conducted in the Department of Pathology at Mediciti Institute of Medical Sciences, Ghanpur, India. A total of 146 male partners of infertile couples were evaluated over a one-year period. Semen analysis reports taken from records which were assessed for volume, viscosity, sperm concentration, motility, and morphology according to WHO guidelines were included in this study. Results: Out of 146 cases, 77 (52.7%) had normal semen parameters, while 69 (47.3%) showed abnormalities. The majority of participants (42.5%) were between 26–30 years of age. Among those with abnormal results, oligozoospermia was the most common finding, observed in 42 cases (28.8%). Specifically, 19 had isolated oligozoospermia, 10 had oligoasthenozoospermia, and 13 had oligoasthenoteratozoospermia. Azoospermia and asthenozoospermia were the next most frequent abnormalities. Many cases exhibited defects in multiple semen parameters. Conclusion: Male factors significantly contribute to infertility. Abnormal semen patterns-particularly oligozoospermia, azoospermia, and asthenozoospermia-are common. Continued research and routine semen analysis are essential for early diagnosis and effective management of male infertility. Keywords: Male infertility, Semen abnormalities, Semen parameters.

Background: Chronic non-healing ulcers pose a significant clinical challenge. This study aimed to compare the outcomes of collagen granules dressing with normal saline dressing in their management. Materials and Methods: A prospective observational study was conducted on patients admitted at GIMSR, Visakhapatnam, India, with chronic non-healing ulcers of more than 6 weeks duration. Patients were treated with either collagen granules dressing or normal saline dressing. Outcomes measured included wound healing time, reduction in ulcer size, and the duration between first dressing and split skin graft. Results: The collagen granules dressing group demonstrated a statistically significant reduction in wound size and shorter wound healing time compared to the normal saline dressing group. Additionally, the collagen granules group required fewer dressing changes. Conclusion: Collagen granules dressing is a more effective treatment for chronic non-healing ulcers than normal saline dressing, leading to improved wound healing outcomes and potentially reduced healthcare resource utilization. Keywords: Collagen granules, Dressing, Split skin graft, Outcomes.

Background: T2DM is commonly linked to obesity and dyslipidemia which are major cardiovascular disease (CVD) riskfactors. BodyMass Index (BMI) is a simple anthropometric parameter associated with changes of lipid metabolism. Knowledge about the interrelation of BMI and lipid profileparameters is important for early identification for risk assessment in diabetic population. The objective is to assess the association between BMI and serum lipid profile elements inT2DM patients and comparison of lipid profile parameters across the category of BMI and the total cholesterol levels. Materials and Methods: This study was cross sectional in fashion and included 135 T2DM patients attending the out-patient departments ofJalpaiguri Government Medical College, West Bengal. Patients were stratified into BMI (<25 and ≥25 kg/m²) and total cholesterol groups (<200 and≥200 mg/dL). Lipid profiles included total cholesterol, triglycerides,HDL-C, LDL-C, and VLDL-C, were also ascertained after subjects fasting. Statistical analyses of independent t-tests and Pearson correlation coefficients were performed in SPSS version25. Results: Patients with BMI ≥ 25 had significantly higher total cholesterol (181.7 ± 4.8 vs. 162.5 ± 5.2 mg/dL; p = 0.014), triglycerides (192.6 ± 9.2 vs. 145.3 ± 10.6 mg/dL; p = 0.003), LDL-C, and VLDL-C with significantly lower HDL-C (38.2± 1.1 vs. 43.7 ± 1.8 mg/dL; p = 0.021). High total cholesterol ≥ 200 mg/dL was related to increased TG, LDL andVLDL levels. In the same cohort, BMI was significantly positively correlated with TC (r = +0.27), TG (r = +0.33,), LDL (r = +0.29,),VLDL (r = +0.31,), and negatively with HDL (r = −0.25). Conclusion: Indeed a higher BMI is associatedwith atherogenicdyslipidemia in T2DM, characterized by increased TC‐, triglycerides‐, LDL‐cholesterol and VLDL and decreased HDL‐cholesterol levels. BMI should be employed as a simpleearly marker of dyslipidemia and cardiovascular risk among diabetics. Regular lipid screening and weightcontrol are also important in managing T2DM systemically. Keywords: Type 2 Diabetes Mellitus, body massindex, Dyslipidemia, lipid profile, triglycerides, HDL, LDL, cardiovascular risk

Background: Distal third tibia fractures are common due to the bone’s subcutaneous location and minimal muscle coverage, making them prone to complications such as delayed union, infection, and wound dehiscence. Various treatment methods exist, with interlocking nails and minimally invasive percutaneous plate osteosynthesis (MIPPO) being the most effective. Expert Tibia Nailing (ETN) has gained popularity due to its multi-axial locking system, providing superior stability. Objective: This study evaluates the clinical and radiological outcomes of extra-articular distal tibia fractures treated with ETN in comparison to plate osteosynthesis and external fixators. Materials and Methods: A prospective study was conducted on 30 patients with extra-articular distal tibia fractures, assessing fracture healing, functional outcomes, and complications over a one-year follow-up period. Radiological evaluations included X-rays, CT, and MRI scans, while clinical assessments focused on joint mobility, weight-bearing ability, and complications. Results: The results demonstrated an average fracture union time of four months, with early weight-bearing achieved in 80% of patients. Complications were minimal, with low rates of delayed union (3.33%) and infections (6.66%). Conclusion: ETN offers excellent mechanical stability, early mobilization, and minimal soft tissue disruption, making it an effective primary treatment option for extra-articular distal tibia fractures. The study supports ETN as a superior alternative to traditional fixation methods Keywords: Distal third tibia fracture, expert tibia nailing, tibio-fibular line, talar tilt.

Background: Inguinal hernia repair surgeries hinge on effective skin incision methods. This prospective comparative study, conducted from January 2023 to June 2025 at Bundelkhand Medical College & Hospital, Sagar, meticulously compares the outcomes of electrocautery assisted and conventional scalpel skin incisions. Materials and Methods: Adult patients undergoing inguinal hernia surgery were randomly assigned to electrocautery (Group I) and scalpel (Group II) skin incisions. Parameters assessed included intraoperative bleeding, postoperative pain, surgical site infection. Results: Electrocautery exhibited notable advantages, significantly reducing blood loss compared to scalpel incisions (p < 0.05). Postoperative pain was markedly lower in the Electrocautery group, aligning with efficient wound healing. Conclusion: Based on our study findings it is concluded that electrocautery can be utilized as a successful substitute for making skin incision as an effective alternate to scalpel. It does not affect any tissue damage that could interfere healing of wound while using monopolar diathermy in power setting of 30 watt. Furthermore lower incidence of less incision time and minimal blood loss are the encouraging facts supporting routine use of diathermy for skin incision after tacking adequate precaution. Postoperative discomfort and wound infection rate were insignificant in both incision technique. Electrocautery can be considered safe and effective in making skin incision compared to scalpel incision. Keywords: Scalpel, Diathermy, Hernia repair, Skin Incision.

Background: Breast cancer being the most common cancer among women in India and other regions of the world, constant research on prognostic and predictive markers of breast carcinoma are going on. Early diagnosis and appropriate treatment can prolong the survival of patients diagnosed with breast cancer. Objective: To assess the ER/PR status of breast carcinoma and to assess the HER-2 neu status of breast carcinoma, Materials and Methods: This prospective study was undertaken over a period of 2 years from October 2018 to September 2020 in the Department of Pathology at Chalmeda Anand Rao Institute of Medical Sciences. Result: 27 cases (54%) which were ER and PR positive showed p53 negative in all cases. 9 cases which showed P53 positivity were ER and PR negative. ER & PR correlation with p53 positivity was found to be statistically significant 0.001 (p < 0.01). 18 cases which were HER-2neu positive showed p53 negative. 9 out of 32 cases with HER-2neu negative showed p53 positivity. HER-2neu correlation with p53 positivity was found to be statistically not significant 0.04 (p > 0.01). ER & PR correlation with p53 positivity was found to be statistically significant 0.0001 (p < 0.01) whereas other prognostic variables were not statistically significant. Conclusion: In the present study of ER, PR, Her-2neu and p53 expression in breast carcinoma by IHC method indicates higher rates of positive expression with various clinicopathological aspects. Higher number of grade-I tumours showed ER, PR positivity as compared to grade III tumours. Inverse relationship was observed between Her-2neu and p53 with that of ER and PR. Keywords: p53 expression, ER,PR, HER-2neu status, Carcinoma Breast.

Background: Aim: To analyse the impact of intraoperative hemodynamic stability and anaesthetic factors on the success of microvascular free flap reconstruction. Materials and Methods: A retrospective study was conducted in a tertiary hospital in India, from March 2023 to April 2024 after the data was collected and its analysis was done. A total of 30 patients were included in the study who underwent microvascular free flap reconstruction in the Department of Plastic surgery. All the patients who fit into the inclusion criteria during the stated period of time form the sample population. Results: The overall success rate of free flap reconstruction was 90%. No significant differences in intraoperative systolic and diastolic blood pressure were observed between the success and failure groups, except at the time of anastomosis (SBP: p < 0.001, DBP: p < 0.001) and postoperatively (SBP: p < 0.001, DBP: p < 0.001). Use of noradrenaline to manage intraoperative hypotension did not negatively affect flap survival. Excessive fluid administration was associated with flap edema and increased failure risk. Conclusion: Perioperative hemodynamic stability is critical for successful microvascular free flap outcomes. Noradrenaline is a safe and effective agent for maintaining blood pressure without compromising flap viability. Careful fluid management and stable hemodynamic control are essential to optimize flap survival rates. Further studies with larger sample sizes are warranted to validate these findings. Keywords: Plastic Surgery, FLAP, Noradrenaline, Retrospective study.

Renal vein thrombosis (RVT) is a relatively uncommon condition that is most frequently observed in individuals with nephrotic syndrome. While rare, pyelonephritis (PN) may serve as a predisposing factor for secondary RVT. A 44-year-old male presented with 3-day history of left flank pain, nausea, vomiting, and fever with chills. Physical examination showed - Fever (101.2°F) and Left costo-vertebral angle tenderness. Laboratory test results showed elevated CRP level, white blood cell count at 14,200/mm3. Urinalysis showed - 25-30 pus cells/hpf. Abdominal CT scan showed left renal vein thrombosis The patient improved after intravenous antibiotics and anticoagulation treatment. His condition improved with reduced pain and his renal function stabilized. Patient remained asymptomatic after resolution of the episode. Keywords: Acute Pyelonephritis, Anticoagulation Therapy, Renal Vein Thrombosis.

Background: Worldwide, the most often done surgical procedure is the Caesarean section, also referred to as the "C"-section. A wide range of factors, including maternal request, have contributed to the recent increase in the percentage of caesarean sections performed. The purpose of the study was to determine whether gum chewing could aid in the post-operative recovery of gastrointestinal function following caesarean section. Materials and Methods: This prospective study was carried out in the SV medical College, Tirupati, from September 2024 to February 2025. The study included consecutive participants who underwent caesarean sections. For the study, all post-partum women who took part gave written informed consent. An equal number of matched controls were used for analysis and comparison of the parameters. Results: The software SPSS 23.0 Version is a statistical tool. Descriptive statistics were used to characterise the data by employing frequency analysis and percentage analysis for categorical variables, and mean and standard deviation for continuous variables. The Unpaired Sample t-test was employed to assess the presence of a statistically significant difference between the bivariate samples in the independent groups. Fisher's exact test was employed when the expected cell frequency in 2x2 contingency tables was below 5, which also applied to the determination of statistical significance in the Chi-Square test for categorical data. All of the statistical approaches listed above recognise a significance level of 0.05. Conclusion: Our research has confirmed that chewing gum is associated with a faster restoration of intestinal function after a caesarean section. This can potentially lead to shorter hospital stays and quicker occurrences of the first flatus passage, first bowel sound, first bowel movement, and defecation. Keywords: Chewing gum, post-operative recuperation, gastrointestinal system, and caesarean section.

Background: Aim: To collate the pelvic floor measurements during rest and valsalva measured by transperineal/ translabial ultrasonography and dynamic MRI, in patients with pelvic floor dysfunction. Materials and Methods: This is a hospital-based prospective study performed on 50 patients with various pelvic floor dysfunction referred to radiology department from the gynecology and urology departments of Kurnool Medical College and Government general hospital. They were classified into those with stress incontinence, urge incontinence, fecal incontinence and mass per vagina and were subjected to two-dimensional transperineal ultrasonography (TPU) and dynamic magnetic resonance imaging. The study examined the measurements of bladder base below the pubococcygeal line (PCL), uterus below the pubococcygeal line, and "H" line with two modalities which were compared and analysed independently. Results: In the present study, the data showed that, for age distribution, the majority (48%) of study group were within the 51-60 years age range. The BMI distribution was divided into three categories, with 52% falling within the 26-30 kg/m² range. The most common parity was 5, accounting for 34% of the group. The study showed that for measurement of bladder base below the PCL line, the findings were consistent between MRI and TPU. The correlation analysis for the bladder base below the PCL line between MRI and TPU measurements shows strong and significant correlations in all conditions. The paired sample t-test for the bladder base below the PCL line reveals significant correlation between MRI and TPU measurements in all conditions. But it was noticed that TPU can underestimate the need for surgical intervention as compared to MRI. For the measurement of uterus below the pubococcygeal line (PCL), both MRI and TPU provided consistent results. For the H-line measurement, MRI and Transperineal Ultrasound (TPU) showed minor variations but with both methods showing consistency in the mean H line measurement across different conditions. The paired sample t-test for the H line shows significant correlation between MRI and TPU measurements in all conditions. The results indicate statistically significant correlation between the two modalities. Conclusion: The study concluded that transperineal ultrasound can be used as screening tool for evaluation of women with various pelvic floor dysfunction. Overall, the integration of ultrasound and dynamic MRI improves diagnostic precision and aids in the development of more effective management plans for pelvic floor disorders. Keywords: MRI, PCL, USG, TPU, ‘H’ Line, Pelvic Floor Disorder.

Background: Bowel anastomosis remains an essential surgical procedure in gastrointestinal surgeries. Despite advances in surgical techniques anastomotic leaks continue to be a significant risk factor for morbidity and mortality. With leak rates reported between 2–5%, Identifying modifiable risk factors for anastomotic leak is important for improving outcomes. Materials and Methods: A cross-sectional observational study was conducted at the Department of General Surgery, of a tertiary care medical institute. A total of 60 patients undergoing bowel anastomosis, both electively and emergency, were included in this study. Demographic, clinical, laboratory, and intraoperative variables were recorded. Hand-sewn two-layer anastomosis was predominantly employed. Patients were monitored postoperatively for evidence of anastomotic leaks. Statistical analysis was performed using SPSS 23. p-value less than 0.05 considered significant. Results: The overall anastomotic leak rate was 10%. Significant risk factors identified included age >50 years (P=0.004), diabetes mellitus (P=0.04), clinical pallor (P=0.007), history of smoking (0.006) hypoalbuminemia (<3 g/dl, p=0.001), and total leukocyte count more than 11,000/mm3. Operative factors like contaminated peritoneal cavity (P=0.02), prolonged surgery duration (>2.5 hours, P=0.02) and time to perform anastomosis (> 30 min, P=0.01) were also associated with higher leak rates. Mortality among patients with leaks was 100%. Conclusion: Anastomotic leaks remain a serious postoperative complication. Advanced age, diabetes, smoking, hypoalbuminemia, emergency surgery and prolonged operative time significantly predispose patients to anastomotic dehiscence. Focused preoperative optimization and meticulous surgical technique are essential strategies to mitigate the risk of leak and improve patient outcomes. Keywords: Anastomotic Leak, Bowel Anastomosis, Risk Factors, Intestinal Surgery, Hypoalbuminemia.

Background: Aim: Gastrointestinal stromal tumor [GIST] is the most common mesenchymal tumors of gastrointestinal tract. The aim is to explore the clinical, histomorphological, immunohistochemical aspects and to know the tumour biology. Material and Methods: A retrospective study was conducted for a period of 6 years from January 2018 to June 2023 in department of pathology, ESICMC & PGIMSR, Bangalore. Results: Total cases were 16 with age range of 38-75 years. Male to female ratio is 1.7:1. Abdominal mass is the commonest clinical presentation in 56.2 % cases, followed by pain abdomen and bloody stools. Stomach [43.7%] is the most common location, next being small intestine, rarely seen in esophagus, appendix, rectum and as extraintestinal mesenteric GIST. The tumor size ranged from 1-18 cms and cut surface showed well circumscribed, firm, grey white, lobulated mass. Microscopically, spindle cell morphology [11 cases] is commonest. Epitheliod and Mixed cell type seen in 2 and 3 cases respectively. On Risk assessment, majority [37.5%] belonged to high risk category. CD117 was positive in 87.5% cases. CD 34, SMA and S-100 were positive in 43.7%, 43.7% and 37.5% cases, respectively. Two cases of CD 117 negative GIST was found to be DOG 1 positive. Conclusion: GIST needs to be distinguished from other mesenchymal tumors. Clinical, histomorphological along with Immunohistochemistry [IHC] enables definitive diagnosis. DOG1 is useful in diagnosis of C-kit negative GIST. Risk stratification considering the anatomical location, size and mitosis prompts optimum management and targeted therapy. Keywords: GIST, CD34, Immunohistochemistry, Mesenchymal tumors

Background: Diabetes mellitus and thyroid disorders are two main endocrine disorders interrelated to each other and are encountered in clinical practice. Diabetes Mellitus is a leading cause of death in developing countries like India. Thyroid hormones and insulin both are involved in cellular metabolism antagonistically. Therefore, excess or deficit of any one of them may result in metabolic derangement of the other. The aim of our study is to determine the spectrum of thyroid dysfunction among type 2 diabetes mellitus. Materials and Methods: The present study was undertaken to understand the associated trend of thyroid dysfunction with diabetic process by monitoring blood glucose, thyroid hormones -T3, T4, and TSH . A total of 80 cases, diagnosed as type 2 Diabetes and 100 non-diabetic healthy controls were included in the study. Results: The study showed that thyroid dysfunction was more prevalent in diabetic subjects than in controls. In 80 patients of diabetic mellitus, subclinical hypothyroidism seen in 22 patients; 6 patients were hypothyroid. Subclinical hyperthyroidism seen in 4 cases; and hyperthyroid were 4.44 patients were found to be euthyroid. Among diabetics having hypothyroidism, subclinical hypothyroidism (27.5%), was more common than overt hypothyroidism (7.5%). The TSH mean in Diabetic Mellitus patients was 6.56 ± 10.3 more as compared to non-diabetic patients 5.3± 7.1& this difference is statistically significant(‘p’ value 0.03). The mean T3 &T4 in Diabetic Mellitus patients as compared to non-diabetic patients their difference was found statistically significant (‘p’ value 0.04 & 0.03 respectively). Conclusion: Although thyroid disorders are increasing among type 2 DM but it is frequently overlooked and not properly diagnosed in the early stage. Sub-clinical hypothyroidism in diabetics is more among females than males .Thus, the present study is conducted to find out the relationship between type 2 DM & thyroid dysfunction, as the benefits of identifying at an early stage is beneficial. Keywords: Diabetes mellitus, Hypothyroidism, TSH, subclinical hypothyroidism.

Background: Inflammation and poor lung development are major factors that contribute to bronchopulmonary dysplasia, a serious condition in premature newborns. Recent research has shown that probiotics may help reduce inflammation and improve outcomes for newborns. The effectiveness of probiotics in reducing BPD among preterm newborns is being investigated in this double-blind randomised controlled experiment. Material and Methods: This study was conducted at the department of Paediatrics, Sambhram Medical College (Territory Care Centre) from the June 2023 to July 2024. For the first two weeks of their lives, premature babies born before 32 weeks of gestation were given a probiotic supplement or a placebo. The occurrence of BPD, which is defined as oxygen dependency at 36 weeks postmenstrual age, was the main outcome measure. Growth parameters, rates of necrotising enterocolitis (NEC), and rates of sepsis were included as secondary outcomes. We used intention-to-treat principles to analyse the data. Results: There are a number of significant clinical practice implications that could result from this study. As a potential component of standard care for premature infants in NICUs, probiotics could be suggested if they are demonstrated to decrease the occurrence of BPD. Considering that BPD is a major contributor to preterm infants' long-term morbidity—often necessitating extended hospital stays, more oxygen, and potentially even long-term respiratory support—this would be a huge step forward. Conclusion: One safe and effective way to lower the risk of BPD in premature babies is to give them probiotics. Potentially pivotal in enhancing newborn outcomes are their anti-inflammatory and gut microbiota-modulating characteristics. To determine the best strains and dosage regimes, additional research is necessary. Keywords: Probiotics, Bronchopulmonary Dysplasia, Preterm Infants, Neonatal Care.

Background: Newborns, particularly those in neonatal intensive care units, are at risk for a dangerous infection known as late-onset neonatal pneumonia. Improving clinical outcomes requires a prompt and correct diagnosis of LONP. The purpose of this research is to determine whether C-reactive protein in saliva and mean platelet volume may be used to diagnose LONP in newborns. Material and Methods: Over the course of six months, researchers at a tertiary care hospital ran this prospective observational study. This study was conducted at the department of Paediatrics, Sambhram Medical College (Territory Care Centre) from the December 2022 to November 2023. One hundred infants with what was thought to be late-onset pneumonia were included. Clinical symptoms and subsequent radiological confirmation formed the basis of the diagnostic criteria for LONP. Results: Among the 100 newborns, 45 were found to have pneumonia that manifested later in life. Compared to the non-pneumonia group, the pneumonia group had much higher mean salivary CRP levels. As with the non-pneumonia group, the pneumonia group had higher MPV. While MPV had a sensitivity of 72% and specificity of 68%, salivary CRP showed an 84% sensitivity and 75% specificity for detecting LONP. The diagnostic accuracy was enhanced when the two markers were used together, reaching 89% sensitivity and 80% specificity. Conclusion: Two biomarkers that show promise for the detection of late-onset newborn pneumonia are salivary C-reactive protein and mucoprotein V. Early detection and management of LONP in newborns can be improved with the potential development of a non-invasive and cost-effective diagnostic instrument that combines these markers. Keywords: Salivary CRP, mean platelet volume, biomarkers, neonatal infection, diagnostic accuracy.

Background: Accurate estimation of the postmortem interval (PMI) is critical in forensic investigations, yet conventional physical signs often yield wide margins of error. Biochemical changes in the vitreous humor, particularly shifts in potassium levels, offer a more quantifiable and reliable alternative due to the fluid’s anatomical isolation and resistance to early decomposition. The objective is to evaluate the temporal changes in vitreous humor electrolytes—specifically potassium, sodium, and chloride—and assess their utility in estimating time since death. Materials and Methods: This prospective, one-year study was conducted at the Department of Forensic Medicine, ESIC Medical College Hyderabad, involving 80 medico-legal autopsies with known time of death. Clear vitreous samples were aspirated under sterile conditions and analyzed using ion-selective electrode methods. Correlations between electrolyte concentrations and PMI were assessed using regression modeling. Results: Potassium levels exhibited a statistically significant linear rise with increasing PMI (p < 0.001), forming the basis for a regression model: PMI (hours) = 5.21 × [K⁺] – 29.8. This model demonstrated strong predictive reliability within the first 48 hours after death. In contrast, sodium and chloride levels showed no meaningful temporal trend or statistical significance (p > 0.05). Conclusion: Vitreous potassium concentration is a dependable postmortem biochemical marker for estimating early PMI. Its integration into forensic protocols may enhance the accuracy of time-of-death estimations, particularly when used alongside other investigative findings. Keywords: Postmortem interval, Vitreous humor, Potassium, Electrolyte analysis, Forensic time estimation, Autopsy biomarkers.

Background: In agricultural areas in particular, OP pesticide poisoning poses a serious threat to human health. Its extensive availability and high toxicity make it a major contributor to illness and death. Excessive cholinergic stimulation and severe clinical symptoms are the results of OP drugs' action via inhibiting acetylcholinesterase. The purpose of this research is to analyze the characteristics, treatment, and results of patients hospitalized to a medical college hospital with acute OP poisoning. Materials and Methods: A year-long retrospective observational study was carried out at a hospital that provides tertiary care, medical college at Department of Forensic Medicine and Toxicology, ESIC Medical College, Sanathnagar, Hyderabad, India between February 2024 to January 2025. The medical records of patients were combed through for information on their demographics, clinical symptoms, biochemical markers, treatment plans, and results. For this study, we included all cases of verified OP poisoning; cases of mixed poisoning or unexplained hazardous intake were excluded. Descriptive statistics, such as percentages, means, and standard deviations, were employed to analyze the data. Results: A total of 60 cases of acute organophosphate poisoning were recorded, with a male predominance (68.3%, n=41) and a higher incidence in the 20–40 years age group (58.3%, n=35). The most common presenting symptoms included miosis (83.3%, n=50), respiratory distress (73.3%, n=44), excessive salivation (68.3%, n=41), and altered mental status (53.3%, n=32). The majority of patients received standard treatment, including atropine (100%, n=60) and oxime therapy (75.0%, n=45), along with supportive care. The mean duration of hospital stay was 5.6 ± 2.1 days. In terms of severity, mild poisoning was observed in 17 patients (28.3%), moderate poisoning in 28 patients (46.7%), and severe poisoning in 15 patients (25.0%). Conclusion: To increase survival rates, acute OP poisoning must be diagnosed early and treated promptly; it is a major medical emergency. In order to decrease mortality, the study stresses the need of raising public awareness, implementing stronger restrictions to limit the availability of OP, and improving critical care facilities. Assessing preventative measures and the long-term consequences of poisoning need additional investigation. Keywords: Organophosphate poisoning, insecticide toxicity, acetylcholinesterase inhibition, cholinergic crisis, medical college hospital, case fatality rate, atropine therapy.

Background: The aim of present study was to compare laparoscopic port site skin closure versus skin adhesives. Materials and Methods: The present study was a prospective study. The present study was carried out in the Department of general surgery in Mahatma Gandhi Memorial hospital. The study was carried out for a period of 24 months, i.e., from August 2022 to September 2024. Patients undergoing laparoscopic surgeries irrespective of age group both in the emergency and elective setup were included. Results: In the present study, most subjects in both the groups were belonging to the age group of 41 to 50 years (34.28 % and 37.14% in group A and B respectively). There was a female preponderance (51.42 % and 54.28 % in group A and B respectively). Study subjects were diagnosed with appendicectomy (28.57 %, 25.71 %); cholecystectomy (22.85 %, 20 %); hernioplasty (17.14 %, 20 %); laparoscopy (17.14 %, 22.85 %) and ovarian cystectomy (14.28 %, 11.42 %). Majority subjects had no complications (94.28 %, 91.42 % in group A and B respectively).There was no significant difference between the groups in terms of age, gender, mean height , mean weight and diagnosis, complications of subjects (p: 0.46, 0.127, 0.0914, 0.00872, 0.46, 0.35).There was no significant difference between the groups in terms of mean wound length of subjects postoperatively and on day 14 (p: 0.114, 0.71 respectively) but a statistically significant difference was observed on Day 5 (p: 0.01).Wound length was lesser in group A subjects comparatively on Day 5.There was a significant difference between the groups in terms of mean time taken for wound closure (p: 0.04). Wound closure was faster in group A subjects comparatively. There was a highly significant statistical difference in the distribution of subjects basing on outcome on Day 5 (p: 0.001). Majority subjects in group A had healthy outcome comparatively. Conclusion: The present study concluded that Laparoscopic port sites closed using 2-octyl cyanoacrylate have better short term cosmetic appearance. Keywords: 2-octyl cyanoacrylate, appendicectomy, Wound closure, Skin closure, Adhensives.

Background: The aim of present study was to identify the factors influencing and evaluate preventive measures for perianal fistula development following incision and drainage of perianal abscesses. Materials and Methods: It was a prospective study. The present study was carried out on patients referred to the department of General surgery, who underwent perianal abscess drainage in the outpatient department, Mahatma Gandhi Memorial Hospital / Kakatiya Medical College, Warangal. The study was carried out from August 2022 to December 2024. Results: In the present study, there was no statistical difference in the distribution of subjects basing on their age, gender, area of residence; education; occupation; (p: 0.93; 0.36; 0.77; 0.92; 0.55). There was a statistical difference in the distribution of subjects basing on their addictions, co-morbidities; previous perianal abscess; presence of fistula at 3rd month follow-up (p: 0.04; 0.0003; 0.0001; 0.001). More subjects in A had addictions, co-morbidities. More subjects in group B had previous perianal abscess, fistula at 3rd month follow-up. There was no statistical difference in the distribution of subjects basing on their age, gender, area of residence; education; occupation; (p: 0.93; 0.36; 0.77; 0.92; 0.55). There was a statistical difference in the distribution of subjects basing on their addictions, co-morbidities; previous perianal abscess; presence of fistula at 3rd month follow-up (p: 0.04; 0.0003; 0.0001; 0.001). More subjects in A had addictions, co-morbidities. More subjects in group B had previous perianal abscess, fistula at 3rd month follow-up. Conclusion: The present study conclude that depth of the abcess cavity,amount of pus drained, feacal organisms in culture increase the chance of fistula formation following perianal abcess drainage. Where as plain tap water used for sitz bath reduce the chance of fistula formation. Keywords: Perianal Fistula, Fistula, Abscess, Co-morbidities, Incision.

Amoebiasis is present all over the world though most cases occur in the developing world. About 480 million people are currently infected with about 40 million new cases per year with significant symptoms. This results in the death of between 40,000-1,00,000 people a year. Our case reports a 12 year old male child in Hyderabad hailing from a below average socio economic region and consumption of infested food and water. Presented in septic shock with colon perforation who required an emergency laparotomy and complications of pleural effusion and soft tissue involvement (due to metastasis). Reporting this case with a view for health care workers as how a simple disease can lead to so many complications when presented with non typical symptoms and how with protocolised treatment, morbidity and mortality can be reduced. Keywords: Invasive amoebiasis; Entamoeba histolytica; necrotizing fasciitis; pleural effusion; pediatric colonic perforation; metronidazole; paromomycin.

Background: Chronic kidney disease (CKD) defined as either damage or decreased kidney functions for 3 or more months and is a pathophysiologic process associated with abnormal kidney functions and progressive decline in glomerular filtration rate (GFR). Among the renal replacement therapy HD is the most convenient modality after renal transplantation. Frequency of HD cycles differ among individual patients but 3 cycles per week lasting for 3-5 hrs are usual requirement. HD cycle frequencies, duration, adequacy and complications usually monitored and ensured by different laboratory tests. Materials and Methods: This prospective cross-sectional case control study was conducted in hemodialysis unit of MIMSR Medical College, Latur, Maharashtra, between April 2024 and March 2025. Results: The difference in RBC Count, Haemoglobin, MCV, MCH and HCT values was highly significant and lower in CKD patients on HD patients than control groups. MCHC, RDWCV and PDW found no significant difference between CKD patients on HD patients and control groups. Platelet count and MPV significantly dropped in CKD-HD patients. Conclusion: This study concluded anemia is most common finding in CKD patient on hemodialysis along with changes in TLC and differential leukocyte count. This study also showed that drop in platelet count along with MPV. Keyword: Blood Count Analysis, CKD, Hemodialysis.

Background: Antibiotic resistance poses a significant challenge for clinicians when treating infections. The detection of ESBL and MBL among the members of Enterobacteriaceae family guides us to use beta-lactam antibiotics carefully. Aim: The study was aimed to detect ESBL and MBL production in MDR Enterobacteriaceae isolates using phenotypic methods. Materials and Methods: The hospital based cross sectional study was conducted over a period of 6 month from January 2023 to June 2023. A total of 226 Enterobacteriaceae isolates were identified from 8244 clinical samples received during the study period. Antimicrobial susceptibility testing was performed by using the Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. Bacteria showing resistance to at least three different classes of antibiotics were considered multidrug resistant (MDR). Extended spectrum beta-lactamase production was detected by combined disc method using cefotaxime and cefotaxime/clavulanic acid discs. Similarly, metallo beta-lactamase production was detected by combined disc assay using imipenem and imipenem / ethylene diaminetetracetate discs. Results: Out of a total of 8,244 clinical samples received for bacterial culture and sensitivity testing during the study period, 1,133 samples (13.74%) showed positive culture results. Among these, 226 (19.94%) were identified as Enterobacteriaceae isolates. Of the Enterobacteriaceae isolates, 46 (20.35%) were found to be multi-drug resistant. Out of 46 isolates, 11 isolates (23.91%) were confirmed ESBL producers and 29 isolates (63.04%) were confirmed MBL producers. The co-occurrence of ESBL and MBL was reported in 6 isolates (13.04%). Escherichia coli (54.54%) was the highest ESBL producer followed by Klebsiella oxytoca (27.27%) and Klebsiella pneumoniae (18.18%). Similarly, the highest producer of MBL was Klebsiella pneumoniae (48.27%) followed by Escherichia coli (31.03%), Klebsiella oxytoca (6.89%), Pseudomonas aeruginosa (6.89%), Citrobacter freundii (3.44%) and Citrobacter koseri (3.44%). Conclusion: The study reveals an alarming rise in the prevalence of ESBL and MBL producing multidrug resistant Enterobacteriaceae. Therefore, it emphasizes the importance of indentifying multidrug resistant Enterobacteriaceae strains to ensure effective treatment for sever and mild bacterial infections. Keyword: Enterobacteriaceae, MDR, ESBL, MBL, Co-occurrence.

The escalating cost of healthcare has driven global interest in generic medicines as affordable alternatives to branded drugs. This review explores the definition, characteristics, and regulatory requirements of generics, highlighting their proven bioequivalence and safety. It examines global trends, policy frameworks, physician and pharmacist perceptions, patient acceptance, and country-specific experiences in the promotion of generics. Although generics offer significant cost savings and expanded access to essential medicines, adoption remains uneven due to regulatory gaps, stakeholder scepticism, and inconsistent public awareness. This study emphasizes the importance of harmonized regulatory standards, educational campaigns, and strong policy enforcement to improve acceptance and utilization. The future of generics, including biosimilars, appears promising with increased international collaboration and focus on quality assurance to enhance global healthcare equity. Keywords: Generic medicines, bioequivalence, healthcare cost, regulatory policy, patient perceptions.

Small group teaching (SGT) has become an essential component of modern medical education, providing an interactive platform for students to engage in active learning, critical thinking, and collaborative problem-solving. This review explores the historical evolution, theoretical foundations, benefits, methods, and future directions of SGT in medical colleges. An extensive review of the literature was conducted to analyse key studies and evidence-based practices related to small group teaching. Various instructional models such as problem-based learning, case-based learning, and team-based learning were examined, along with the integration of technology and student perspectives. SGT has been shown to enhance student comprehension, retention, clinical reasoning, and communication skills. Despite challenges including faculty resource demands and group management, innovative teaching strategies and hybrid learning models offer practical solutions. Student feedback consistently affirms the effectiveness and appeal of SGT over traditional lecture-based methods. SGT remains a pivotal instructional strategy in medical education, aligning with the principles of student-centred and outcome-based learning. Its continued evolution, supported by technological advancements and faculty development, promises to further improve the quality of medical training globally. Keywords: Small group teaching, medical education, active learning, student engagement, clinical reasoning.

Background: Tumors of the external auditory canal (EAC) are rare and exhibit a broad histopathological range, from benign neoplasms to aggressive malignancies. Given their rarity and nonspecific clinical presentations, these tumors often pose significant diagnostic challenges. Histopathological evaluation is pivotal in confirming diagnoses and determining appropriate management strategies. This study aims to evaluate the incidence and histopathological spectrum of benign and malignant tumors of the external auditory canal at a tertiary care center over a five-year period. Materials and Methods: A retrospective analysis was conducted at the Department of Pathology, Government ENT Hospital, Koti, covering the period from July 2014 to June 2019. Neoplastic lesions of the EAC were included, while inflammatory and infectious lesions were excluded. Clinical data were gathered, and histopathological slides were reviewed to classify lesions as either benign or malignant. Results: Out of 119 EAC biopsies and excision specimens received, 45 cases (37.8%) were identified as neoplastic. Of these, 18 cases were benign, with common types including papillomas and osteomas. Malignant tumors comprised 27 cases, with squamous cell carcinoma (SCC) being the most prevalent, followed by adenoid cystic carcinoma (ACC) and basal cell carcinoma (BCC). The majority of malignant cases presented with symptoms such as otalgia and persistent otorrhea. Conclusion: Although EAC tumors are uncommon, they exhibit a diverse histopathological spectrum. Early detection and histopathological diagnosis are critical for guiding treatment, especially for malignant lesions, where timely intervention plays a significant role in improving prognosis. Keywords: EAC, benign tumors, malignant tumors, osteoma, squamous cell carcinoma.

Background: The median nerve is usually made up of the lateral root and another root that joins with it. The roots go around the third part of the axillary artery and then come together right in front of or to the front and side of the axillary artery, below the pectoralis minor. Materials and Methods: The purpose of this study is to look back at colonoscopies that were done at ACSR Government Medical College and GGH, Nellore, Andhra Pradesh, India. People were sent to the hospital for a variety of reasons, including anemia, weight loss, stomach pain, gastrointestinal bleeding, and screenings for colon cancer. The tumors were categorized by their size, histology, and where they were located in the body. In this study, 120 cases were used, with 60 men and 60 women respectively. Results: We saw several different ways that the median nerve formed. For the men who took part, 25% of the time, the median nerve was made up of three roots. In particular, the third root came from the musculocutaneous nerve 8.93% of the time and the lateral cord of the brachial plexus 25% of the time. Twenty-four percent of the female cases had three bases. In this group, 14.28% had a root that came from the lateral cord of the brachial plexus and 7.14% had a root that came from the musculocutaneous nerve. It was found that 5.36% of cases involving men had four roots and 7.14% of cases involving women did. Only 11% of cases showed the development of the median nerve in the arm, but 26% showed the development of the nerve next to or in front of the axillary artery in the axilla. Conclusion: Anatomists and doctors should both know about the different ways the median nerve is formed. In addition, it helps and is helpful for a number of surgical procedures done in the axilla area. Keywords: Variation development, course, and distribution of the median nerve.

Background: The aim of the study is to compare equipotent doses of intrathecal 0.5% levobupivacaine (hyperbaric) to 0.5% Bupivacaine (hyperbaric) in patients undergoing peri anal surgeries Materials and Methods: It is prospective study in department of anesthesia is done for a period of 2 years in 60 patients. 3ml of 0.5% levobupivacaine [hyperbaric] 3ml of 0.5% Bupivacaine [ hyperbaric] - Spinal needle Local anesthetic for infiltration. Results: The baseline characteristics, including age, weight, height, and duration of surgery, were comparable between the groups, ensuring that observed differences are due to the anesthetics themselves. Both anesthetics provided high-quality anesthesia, with no statistically significant difference in patient satisfaction scores. While the onset and regression of sensory block were similar, Bupivacaine had a significantly longer duration of anesthesia and motor block, leading to delayed recovery times compared to Levobupivacaine. Levobupivacaine was associated with a significantly lower incidence of hypotension, though other adverse events like bradycardia, nausea, and vomiting were comparable between the two groups. Conclusion: Levobupivacaine is a preferable option for spinal anesthesia in short peri-anal surgeries due to its effective anesthesia and superior safety profile. This evaluation underscores the importance of considering both efficacy and safety in anesthetic selection to improve patient outcomes and enhance clinical practice. Keywords: Levobupivacaine, American society of anesthesiologists, Bupivacaine, Subarachnoid block.

Background: Globally, Diabetic retinopathy (DR) is an important cause of loss of vision, contributing significantly to the socioeconomic burden due to its impact on working-age adults. Since obesity is implicated in diabetes mellitus (DM), which is a strong risk factor for DR, it is natural to assume that obesity would be linked to DR. However, this has not been proven. Aim: To study the correlation between BMI and the severity of diabetic retinopathy in Type 2 Diabetes and to assess role of weight control in prevention, retardation and management of diabetic retinopathy. Material and Methods: All patients attending the Departments of General Surgery, General Medicine and Ophthalmology at the Northern Railway Central Hospital, New Delhi, who were found to have a raised blood sugar or a history of DM were enrolled from August 2022 to December 2024. It was an observational, analytical, cross-sectional study. A consecutive sampling method was used, and 200 patients were enrolled during the study period. A total of 200 cases were evaluated. All patients were evaluated to establish the diagnosis, duration, and level of control of DM. They underwent HbA1c examination, and their previous reports were also reviewed. Subsequently, they all underwent retinal examination, and DR grading was done as per the ETDRS classification. All patients underwent anthropometric evaluation, and their height and weight were measured. The BMI was then calculated using the formula BMI = Weight in Kgs/ (Height in metres) 2. Results: The range of BMI (Kg/m2) in the study was 22.7 to 41.3, with a mean +/- SD of 29.907 +/- 4.3107. The break-up values were 29.5 +/-3.3, 29.3 +/- 4.7, and 33.4 +/- 5.2, for normal, NPDR, and PDR subjects, respectively, with a p-value of 0.011. Conclusions: BMI was found to have a statistically significant association with the presence and severity of DR. Keywords: Type II Diabetes Mellitus, Diabetic retinopathy, Body Mass Index.

Background: Intertrochanteric fractures are common in the elderly and are associated with significant morbidity. The use of dynamic fixation methods has been standard; however, the role of statically locked proximal femoral nails with set screws remains underexplored. Aim: To evaluate the radiological and functional outcomes of intertrochanteric fractures managed with statically locked proximal femoral nailing using a set screw. Materials and Methods: This quasi-experimental study included 30 patients with AO/OTA-classified intertrochanteric fractures managed with short proximal femoral nailing using a helical blade locked statically with a set screw. Patients aged ≥30 years without prior hip/femur surgeries were included. Standardized intraoperative and postoperative protocols were followed. Patients were assessed at 1- and 3-months using radiographs and the Harris Hip Score (HHS). Statistical analysis was conducted using SPSS version 20 with significance set at p < 0.05. Results: The mean age was 70.5 years; 60% of patients were female. AO classification showed 50% A1, 40% A2, and 10% A3 fractures. At 3 months, union was observed in 91.3% of patients. HHS showed good-to-excellent outcomes in both stable and unstable groups. Average femoral neck length shortening in stable fracture was 1mm and in unstable fracture pattern was 2mm and both are statistically not significant. Horizontal femoral offset decreased significantly in both groups (p = 0.024 for stable; p = 0.041 for unstable). Limb length changes were minimal and not significant. Femoral neck-shaft angle increased significantly in both groups. Tip apex distance remained within acceptable limits in all cases. Conclusion: Statically locked proximal femoral nails with helical blades can provide stable fixation in intertrochanteric fractures without compromising union rates. Proper fracture reduction with cortical contact is essential for optimal outcomes. Keywords: Intertrochanteric fracture, Proximal femoral nail, Helical blade, Static locking, Set screw fixation.

Background: Patient satisfaction is considered to be a vital factor to assess the quality of service of health care facility. A research on patient satisfaction can be an important assessment tool for Gap analysis and to improve upon the gap in the quality of services provided. Materials and Methods: A descriptive cross sectional study was conducted in a tertiary care teaching hospital from January-April 2023. Those who had availed services from Community Medicine Clinic for animal bite in order to prevent Rabies was included in the study. A questionnaire was created to measure patient satisfaction(NQAS adapted). Results: Out of the 256 patients who participated in the study, most 201(78.5%) of the patients had been referred from other peripheral health care institutions. Majority of the patients in our study was aged more than 30years 142(55.4%) Majority of the patients were males 138(53.9%) compared to females 117(45.7%) and others comprised 1(0.4%). 186(72.7%).of the patients belonged to SES- BPL category . Most of the patients had been referred to CMC 201(78.5%) from elsewhere.The waiting period for meeting doctor was 16.37+ 13.66 minutes.The time spent at the counter was 14.22 + 11.91 minutes. Most of the patients were satisfied with the available infrastructure. Keywords: Patient Satisfaction, Community Medicine Clinic, Medical College, Kerala.

Background: Road traffic accidents (RTAs) are a major public health concern in India, with motorcycle accidents accounting for a significant proportion of fatalities. This study aims to investigate motorcycle-related factors contributing to deaths in RTAs in Mumbai. This study aims to identify motorcycle-related factors, such as vehicle condition, road conditions, and helmet usage, associated with fatal road traffic accidents involving motorcycles in Mumbai. Materials and Methods: This single-center cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology of a tertiary care hospital in Mumbai from January 2024 to June 2024. Data was collected from post-mortem examination reports, police records, and crime scene investigations. Tyre ridges depth and brake-pad thickness were measured and compared with Bureau of Indian Standards. Results: The study included 132 medico-legal autopsies related to two-wheeler RTA deaths. Males were significantly more affected (82.57%) than females (17.43%), with the majority of victims aged 21-40 years (56.1%). Most victims were from urban areas (66.67%), with a significant proportion being graduates or holding high school certificates (73.47%). A large number of accidents occurred when the age of the motorcycle was between 2 to 4 years (34.09%). Maximum accident cases i.e 57 (43.18%) occurred when brake-pad condition were between 1.1-2mm followed by 46 (34.85%) cases between 0-1mm. Furthermore, 41.67% of cases occurred when tyre ridges depth was between 0-1mm. In 57.58% of cases, both tyre ridges depth and brake-pad condition were below the legal limit. Skid and fall accidents were the most common type of collision (47.73%). Conclusion: The study highlights the importance of motorcycle maintenance, adherence to traffic regulations, and road safety awareness to reduce fatal motorcycle accidents in Mumbai. Keywords: Motorcycle Accidents, Road Traffic Accidents, Tyre Condition, Brake-Pad Thickness, Forensic Medicine.

Background: Motorcycle accidents are a significant cause of morbidity and mortality, particularly in low- and middle-income countries like India. With an increasing number of motor vehicles on the road, the incidence of road traffic accidents (RTA) has surged. This study aims to analyze injury patterns and causes of death in motorcycle accident victims. Objectives: To assess the demographic distribution, injury patterns, and causes of death among motorcycle accident victims and establish the correlation between vehicle conditions and the severity of injuries in fatal cases. Materials and Methods: A prospective observational study was conducted on 132 fatal motorcycle accident cases brought for autopsy at a tertiary care hospital from January 2016 to June 2017. Data were collected from post-mortem reports and analyzed for demographic variables, injury patterns, and associated risk factors using Microsoft Excel. Results: Males (82.57%) constituted the majority of victims, with most cases occurring in the 21-40 years age group (56.1%). Urban residents (66.67%) were more affected. Only 30.30% of victims used helmets. Skull fractures were observed in 53.78% of cases, with linear fractures being most common (66.19%). The frontal region was the most affected cranial site (41.37% in riders). Subdural and subarachnoid hemorrhages were the most common intracranial injuries (78.57%). Lower limb fractures (33.92%) and thoracic injuries (32.14%) were frequent. Head injury was the leading cause of death (56.06%). Conclusion: Motorcycle accident-related fatalities predominantly affect young males, with head injuries being the primary cause of death. Helmet use remains low despite its proven protective effect. Enhancing public awareness, enforcing helmet laws, and improving road conditions are essential to reducing motorcycle-related fatalities and injuries. Keywords: Motorcycle accidents, Head injury, Road traffic accidents, Skull fractures, Helmet use.

Background: Intrathecal administration of local anesthetics, primarily hyperbaric bupivacaine, is a common practice for achieving effective spinal anesthesia. However, the quest for enhanced analgesic quality and extended duration of action has led to the exploration of various adjuvants. Midazolam, a benzodiazepine with central nervous system activity, has been hypothesized to improve the efficacy and safety of spinal anesthesia when used as an adjuvant. This study aimed to evaluate the clinical effects of intrathecal midazolam added to hyperbaric bupivacaine, focusing on analgesia quality, duration of sensory and motor block, postoperative analgesic requirement, and safety profile. Materials and Methods: In a prospective analysis, 200 patients who received a combination of intrathecal midazolam and hyperbaric bupivacaine for various surgical procedures were evaluated. The primary outcomes were the duration of anesthesia, quality of postoperative analgesia, and occurrence of adverse effects. Data were analyzed using descriptive statistics, odds ratios, and chi-square tests for significance. Results: The addition of midazolam to hyperbaric bupivacaine significantly enhanced the analgesic effect, with 90% of patients reporting effective analgesia (Odds Ratio: 9.0; 95% CI: 8.1-10.0; P<0.0001). The duration of sensory and motor block was extended in 75% of cases (Odds Ratio: 3.0; 95% CI: 2.7-3.3; P<0.0001). Postoperative analgesic requirement was notably reduced, and 85% of patients experienced enhanced comfort. Adverse effects were minimal, with only 2.5% of patients observing significant side effects. Conclusion: Intrathecal midazolam is an effective adjuvant to hyperbaric bupivacaine, improving the quality and duration of spinal anesthesia while maintaining a favorable safety profile. This combination could be considered a valuable option for enhancing patient outcomes in surgeries requiring spinal anesthesia. Keywords: Intrathecal Midazolam, Hyperbaric Bupivacaine, Spinal Anesthesia.

Background: Pseudoexfoliation syndrome (PEX) is a common age-related systemic disorder characterized by the production and accumulation of fibrillar extracellular material in ocular tissues, particularly on the anterior lens capsule, iris, and trabecular meshwork. It is a significant risk factor for the development of both cataracts and secondary open-angle glaucoma. The presence of pseudoexfoliative material can complicate cataract surgery due to its association with zonular weakness, poor pupil dilation, and increased intraocular pressure. Purpose: To investigate the relationship between serum sodium, potassium, and chloride levels and pseudoexfoliation syndrome (PEX) in patients with senile immature cataracts. Materials and Methods: This cross-sectional study, conducted at R. L. Jalappa Hospital, Kolar, India, enrolled 32 patients with visually significant senile nuclear cataracts and PEX (case group) and 32 age- and sex-matched patients with cataracts but without PEX (control group) from January to April 2025. Serum sodium, potassium, and chloride levels were measured. Demographic data (age, sex) and clinical parameters were analyzed. Independent t-tests compared electrolyte levels between groups, with p<0.05 considered significant. Results: Mean age was 61.72±5.14 years in the PEX group and 59.94±4.31 years in the control group (p=0.138). Both groups had identical sex distribution (46.9% female, 53.1% male). The PEX group showed significantly higher mean serum sodium (141.19±2.93 mmol/L vs. 135.94±2.05 mmol/L, p<0.001) and chloride (106.19±1.64 mmol/L vs. 103.38±1.77 mmol/L, p<0.001), and lower potassium (3.61±0.55 mmol/L vs. 4.25±0.43 mmol/L, p<0.001) compared to controls. Conclusion: Ocular pseudoexfoliation is associated with elevated serum sodium and chloride and reduced potassium levels, potentially reflecting systemic oxidative stress, endothelial dysfunction, or altered ion transport. These electrolyte imbalances may contribute to PXF pathophysiology, including zonular weakness and intraocular pressure (IOP) regulation. Further studies are needed to explore these associations and their clinical implications. Keywords: Pseudoexfoliation Syndrome, Serum Electrolytes, Senile Cataract, Oxidative Stress, Intraocular Pressure.

Background: Rhino-Orbito-cerebral mucormycosis (ROCM) is a life-threatening opportunistic fungal infection seen in immunocompromised patients. ROCM being a rapidly progressive, even a slight delay in diagnosis or appropriate management can have devastating effect on patient’s survival. When the clinical features are supported by diagnostic nasal endoscopy findings, or contrast-enhanced MRI or CT Scan, the patient is considered as Probable ROCM. The objective was to describe the correlation of clinical ophthalmic findings with the imaging findings in patients with ROCM. Materials and Methods: This retrospective study was conducted on 45 patients after obtaining approval from the Institutional Ethics Committee in the department of Ophthalmology and Radiology. Retrospectively the case records were reviewed for demographic, ocular manifestations and biopsy/culture proven data of invasive ROCM patients. CT and/or MRI images were obtained and correlated with stages of Mucormycosis. Results: The cases categorized based on the staging system which follows the anatomical progression of ROCM from nasal mucosa to brain were, stage 1d (14), Stage 2d (12), stage 3b (8), and 3 each of stage 1c, 3c and 4b. Maxillary sinus was the most commonly affected sinus observed in 35 (77.8%), followed by Pansinusitis was detected in 17 (37.7%). Combination of maxillary, ethmoid and sphenoid sinus involvement was noted in 21 (46.7%), maxillary & ethmoid in 10 (22.2%) and Ethmoid & sphenoid in 4 (8.9%). Bone erosion was seen in 2 cases. Proptosis was noted in 5 cases and orbital decompression was performed in 1 case. Conclusion: Study shows the presentation of patients in all the stages of the disease spectrum even with extensive extra sinus involvement. Imaging like CT and MRI shows a spectrum of findings in ROCM, is said plays a major role in assessing the extent of involvement and complications as “Early diagnosis can be lifesaving”. Keywords: COVID-19, diabetes mellitus, magnetic resonance imaging, mucormycosis, paranasal sinus.

Background: The aim of the present study was to assess the role of diffusion weighted MRI in identification and characterization of focal liver lesions. Materials and Methods: This prospective study was done in the Department of Imaging Science & Interventional Radiology of Meenakshi mission hospital & research centre, Madurai, Tamil Nadu after getting approval from Ethical & Scientific committee of hospital from March 2013 to May 2014. Results: We analyzed 100 focal lesions which included 65 malignant (HCC n=25 & Metastasis n=40) and 35 benign (hemangioma n=15, cysts n=10, adenoma n=6 & FNH n=4) lesions. Major part of our patients was between 41-71years of age group (total 61 patients (71.7%). The average age of the patients was 56years (range 18-85years). Out of total 85 patients 43 patients were female while 42 patients were male. Major part of the focal lesions was between 2-4cm with size range 2.5-18 cm with average size of lesions 7.8 cms. 95% sensitivity was due to 3 false negative lesions. There was no significant difference between ADC values of HCCs & metastases (p=0.19). ADC values of FNHs showed no significant difference from adenomas (p=0.066). HCCs and metastatic lesions presented significantly lower ADC values compared to haemangioma, adenoma, FNH and cysts (p<0.001) and ADC values of cysts were significantly higher when compared to all other lesions (hemangiomas, adenomas and FNHs, HCCs and metastasis (p<0.001). Conclusion: In conclusion, quantitative and qualitative evaluations of ADC values of hepatic parenchyma and focal hepatic lesions better fulfils our criteria included in aims and objectives of our study. Qualitative and quantitative analysis of ADC can better characterize hepatic lesions & is very useful for the differentiation between malignant and benign lesions. Significantly lower ADC values are seen in malignant lesions when compared with benign ones. But there is also overlap between different types of lesions specially FNH, adenoma, normal liver parenchyma & malignant lesions with few benign lesions showing restriction of diffusion and may look like malignant lesions. So DWI alone should not be taken as a stand-alone procedure. Keywords: Diffusion weighted MRI, HCC, focal liver lesions.

Background: Retropharyngeal space infections, though rare, remain potentially life-threatening, particularly in developing countries like India. Delayed diagnosis, especially in rural populations, often leads to complications. A significant but under-reported cause is old, impacted foreign bodies in the pharynx. The objective is to analyze clinical presentation, radiological findings, and surgical outcomes in patients with retropharyngeal abscesses associated with retained foreign bodies over a two-year period. Materials and Methods: A retrospective observational study was conducted in the ENT department between August 2020 and August 2022. Twenty-one patients with confirmed retropharyngeal space infections and a history of foreign body ingestion were included. All underwent clinical examination, radiological evaluation (X-ray and CT scan), laboratory investigations, and surgical management. Foreign bodies were identified and removed during incision and drainage procedures. One patient with airway compromise required tracheostomy. Results: 19 adults and 2 children; 11 patients were diabetic. Fish bones (n=19), mutton bone (n=1), and glass pieces (n=1) were the culprits. Average 14–21 days after foreign body ingestion. X-ray and CT imaging confirmed abscess and foreign body in all cases. 20 patients underwent general anesthesia-guided incision and drainage; 1 required tracheostomy. All foreign bodies were successfully removed; no recurrences or complications were reported on follow-up. Conclusion: Retropharyngeal abscess due to foreign bodies remains a critical condition in India due to delayed presentation and inadequate initial treatment. Prompt diagnosis using plain radiography and CT, followed by surgical drainage under general anesthesia, is effective. Institutional protocols and early ENT referral are vital, especially for paediatric and diabetic patients. Keywords: Retropharyngeal abscess, Foreign body ingestion, Deep neck space infection, Tracheostomy, Fish bone, CT scan, Emergency otolaryngology, Surgical drainage.

healthcare systems worldwide, necessitating the consolidation of resources to confront the crisis. Initially reported as an unusual respiratory illness in Wuhan, China, the virus rapidly spread, prompting the World Health Organization (WHO) to declare it a Public Health Emergency of International Concern (PHEIC) on January 30, 2020. Throughout the pandemic, reliable morbidity and mortality statistics have proven essential for informed decision-making. Given their variability over time and across regions, accurately measuring these figures is crucial for planning and executing effective response strategies. This review critically examines the multifaceted challenges posed by COVID-19, evaluates the management and mitigation measures adopted, and assesses the preparedness of the healthcare system in Delhi. It highlights how the pandemic tested existing health infrastructures and underscores the need for adaptive, evidence-based approaches in crisis management. By reflecting on the response in Delhi, this review offers insights into systemic gaps and successful interventions, contributing to the global discourse on pandemic preparedness. Ultimately, the findings aim to inform future strategies to manage better and mitigate the impact of similar public health emergencies. Keywords: COVID-19, Challenges, Mitigation, Pandemic.

Aim: To compare the surgical outcome of submucous diathermy and partial turbinectomy in comparison to each other. Materials and Methods: The prospective study conducted at Government Kakthiya Medical College, MGM Hospital Warangal during the period from January 2021 –September 2022. Patients clinically presenting with Inferior Turbinate Hypertrophy and Nasal Obstruction with or without allergic rhinitis were taken up. Results: This prospective study was conducted totally in 100patients. based on our finding, Partial inferior turbinectomy was more effective in relieving the symptoms of nasal obstruction as compared to submucosal diathermy 50out of 100 underwent SUBMUCOUS DIATHERMY in which 45 patients (95%) recovered completely without any symptoms at the end of 6 months of follow up. 5 patients had mild nasal obstruction and dryness of nose. PARTIAL INFERIOR TURBINECTOMY was done in 50 patients of whom 48 (98%) completely recovered. Only 2 patients had rhinitis till the end of 6 months of post- operative follow up. Submucosal diathermy was most efficient method in reducing the total symptoms score. Submucosal diathermy had least complications compared to other technique. PARTIAL INFERIOR TURBINECTOMY was found to be more effective in reducing nasal obstruction long term basis. However, submucosal diathermy was a better procedure in respect of complications such as bleeding and crusting. Conclusion: Our study recommends as Partial inferior turbinectomy an effective technique for the treatment of inferior turbinate hypertrophy, as no need for further nasal surgery for 6-month follow-up. Keywords: Submucous Diathermy, Partial Inferior Turbinectomy, Nasal Bleeding, Rhinitis

Meckel’s diverticulum is a common congenital anomaly of the gastrointestinal tract, yet it often presents with nonspecific or unusual symptoms, leading to diagnostic delays and dilemma. This case series reviews nine patients treated at our institution, highlighting the varied clinical manifestations and the importance of a high index of suspicion in diagnosis. Keywords: Meckel’s diverticulum, gastrointestinal bleeding, intestinal obstruction, chronic abdominal pain, umbilical sinus, appendicitis.

Background: Caesarean sections performed during the second stage of labor are associated with increased maternal and neonatal risks compared to first-stage and elective caesarean sections. This retrospective study was undertaken to analyze the demographic and obstetric characteristics, intraoperative and postoperative complications and neonatal outcomes associated with second-stage C-sections. Materials and Methods: This retrospective study was conducted by reviewing medical records of women who underwent second-stage caesarean sections over a period of 3 years in the department of Obstetrics and Gynaecology, Malla Reddy Narayana Multispecialty hospital which is a tertiary care teaching centre. Data was collected on demographic variables (maternal age and parity), obstetric variables (Booking status, gestational age and indication for C-section), intraoperative complications (uterine incision extension, blood loss and organ injury), postoperative outcomes (fever and wound infection) and neonatal parameters (Apgar scores, NICU admissions and neonatal morbidity). Results: The analysis revealed that second-stage C-sections were more common in primigravida and were frequently associated with indications such as non-progress of labor and fetal distress. Intraoperative complications included a higher incidence of postpartum hemorrhage and uterine incision extensions. Postoperative morbidities such as febrile illness and wound infections were noted. Neonatal outcomes showed increased NICU admissions and lower Apgar scores, particularly in cases with prolonged second stage or difficult fetal extraction. Conclusion: Second-stage Caesarean sections are associated with a higher risk of maternal and neonatal complications. Early identification of risk factors and timely obstetric interventions are crucial to improving outcomes. Retrospective analysis of such cases helps in understanding patterns and guiding future clinical practice. Key words: Second stage caesarean section, deeply impacted head, difficult extraction, full dilatation, Patwardhan technique.

Background: Diabetes mellitus is a major cause of both end-stage kidney disease (ESKD) and visual impairment globally. Ocular complications are frequently overlooked in diabetic patients on dialysis, leading to delayed diagnosis and irreversible visual loss. This study aimed to evaluate the prevalence and severity of ocular changes, including visual outcomes and complications, in diabetic ESKD patients. Materials and Methods: A hospital-based, cross-sectional study was conducted over one year among 100 diabetic patients undergoing hemodialysis for ESKD. Detailed ophthalmic evaluation included best corrected visual acuity, intraocular pressure, slit-lamp examination, indirect ophthalmoscopy, and optical coherence tomography. Diabetic retinopathy (DR) was graded using ETDRS criteria. Data were analyzed using SPSS v26, with p<0.05 considered statistically significant. Results: The mean age of patients was 58.4 ± 9.7 years; 61% were male. DR was present in 80% of eyes, with moderate NPDR being the most common stage (32%). Diabetic macular edema was observed in 28%, and cataracts in 49% of eyes. Visual impairment affected 62% of patients, including 12% who were legally blind. A significant correlation was found between dialysis duration ≥12 months and higher DR severity (p=0.021). Visual acuity showed progressive decline with increasing DR grade. Conclusion: Ocular complications are common in diabetic patients with ESKD and are significantly influenced by dialysis duration and metabolic control. Routine eye screening and multidisciplinary care are essential to prevent irreversible vision loss in this high-risk group. Keywords: Diabetic retinopathy, macular edema, hemodialysis, end-stage renal disease, visual impairment, ocular complications.

functional outcomes of unstable distal end radius fractures treated using Joshi’s external stabilization system (JESS) and volar locking compression plate (LCP). Materials and Methods: A prospective study was carried out involving 20 patients aged 20 to 60 years with closed, unstable distal radius fractures. They were randomly allocated into two treatment groups (10 patients each). Clinical follow-up and outcome assessment were performed over a 9-month period. Results: At the 9-month follow-up, functional outcomes assessed using the Modified Mayo Wrist Score showed a distribution of excellent to poor results in both groups, with the LCP group exhibiting a higher proportion of good outcomes. Conclusion: Volar plating allows for quicker recovery of wrist function in the early postoperative period. However, the long-term outcomes between the two methods are comparable. This suggests that while volar plating may be beneficial for patients needing a quicker return to activity, JESS remains a viable option. Keywords: distal radius fracture, external fixation, volar plating, Joshi’s stabilization system, wrist injury, orthopaedic trauma.

Background: Aim: To compare the efficacy of magnesium sulphate as an adjuvant to a ropivacaine-fentanyl mixture for epidural labour analgesia in terms of onset time, duration of analgesia, maternal satisfaction, and neonatal outcomes. Materials and Methods: A prospective, randomized, double-blind clinical study was conducted on parturients in active labour. Two groups were formed: Group RF received 0.1% ropivacaine with 2 mcg/ml fentanyl, and Group RFM received 0.1% ropivacaine with 2 mcg/ml fentanyl plus 50 mg magnesium sulphate. Epidural analgesia was initiated and maintained with intermittent boluses. Pain was assessed using a visual analog scale (VAS), and onset time, duration, total drug consumption, side effects, and Apgar scores were recorded. Results: The onset of analgesia was significantly faster in the RFM group. Duration of effective analgesia was longer in Group RFM, and total drug consumption was lower. VAS scores were significantly reduced at multiple intervals. Maternal hemodynamic stability and neonatal Apgar scores were comparable between groups. Conclusion: Magnesium sulphate, when added to ropivacaine-fentanyl epidural mixture, significantly enhances the onset and duration of analgesia without adverse maternal or neonatal effects. It is a promising adjuvant for labour analgesia. Keywords: Magnesium Sulphate, Ropivacaine, Fentyl Mixtures, Adjuvant, Epidural Labor Analgesia.

Background: The aim & objective is to study the Microvessel density (MVD) and Vascular endothelial growth factor (VEGF) as prognostic indicator in colorectal carcinoma and correlate with PTNM staging. Materials and Methods: The present study is an observational study and cross sectional done on 50 Colorectal resection specimens received by the Department of Pathology, Gandhi Hospital, Secunderabad for a period of 18 months from October 2022- March 2024. Relevant clinical details of all the 50 patients diagnosed with Colorectal carcinoma are documented. The specimens received are fixed, processed and embedded in paraffin wax. Serial sections of 4-5 µ thickness are obtained and stained with H&E. Results: Routine processing and H&E staining were done followed by immunohistochemistry with MVD and VEGF. In the present study, the age of the patients with Colorectal carcinoma was ranging from 36-70 years and majority of the subjects were males with M:F ratio of 1.77:1. Majority of the tumours were moderately differentiated and Poorly differentiated adenocarcinoma belonged to stage III and IV. MVD and VEGF immunoexpression was correlated with clinicopathological parameters like grade and stage of the tumour to analyse the usefulness of these immunomarkers in prognosis. In Present study, MVD and VEGF expression was more in Moderately differentiated tumours and Poorly differentiated tumours than in Well differentiated tumors. Present study shows that there is a statistically significant correlation of MVD and VEGF positivity with stage of the tumor. There is higher expression of MVD and VEGF in higher stage tumours (Stage III and Stage IV). Conclusion: The present study concluded that, MVD and VEGF represent important prognostic indicators in colorectal carcinoma. As the predominant angiogensis factors in the growth and maturation of new vessels- MVD, VEGFs are associated with incidence of metastases and decresed survival. Combined targeting of MVD and VEGF pathways may offer a novel and potentially promising chemotherapeutic strategy for treatment and/or prevention of Colorectal neoplasia. Keywords: MVD, VEGF, Colorectal Carcinoma, Adenocarcinoma, Immunohistochemistry.

Background: Aim: The aim of this study is to analyze the clinical presentation, imageology, resectability, to know the incidence of different types of tumors in intradural extramedually compartment and to study the surgical outcome. Materials and Methods: This is a prospective study of 30 cases of intradural extramedullary tumors were treated in the department of Neurosurgery, government General Hospital, Guntur from September 2024 to April 2025. Results: In the present series among all the spinal tumors the incidence of intradural extramedullary spinal tumors is 53.57%. Most of the intradural extramedullary tumors in the third decade (36.66%) Mean age of presentation for Meningioma is 36 years and for nerve sheath tumors is 39.5 years. In our series among the intradural extramedullary tumors, nerve sheath tumors contributed 50% followed by Meningioma 30%. Nerve sheath tumors shown male predominance (73%) as compared to Meningiomas, which are common in females (100%). Most of the followed by tumors were located in thoracic region (60%) followed by cervical (23.33%) and lumber (16.66%). Total excision of tumors is achieved in 93.33% cases. Early post operative complications were CSF leak (6.66%), wound infection (3.33%) and meningitis (3.33%). No neurological deterioration was seen post operatively. Immediate improvement is seen in (60%) and gradual improvement is seen in (36.66%) and one patient (3.33%) showed no improvement. Mean follow-up period was 11 months, maximum of 24 months and minimum of 6 months during this period. No recurrence of tumor noted. Percentage of syndromic lesions was 3.33% (1 patients had NF-II). Conclusions: The present study concluded that, Nerve sheath tumors and Meningiomas are the most common in intradural extramedullary spinal lesions and complete excision is possible in all most all cases. Prognosis is usually good, in spite of poor neurological status at the time of presentation. Keywords: Intradural extramedullary tumors, Meningiomas, Nerve sheath tumors.

Background: Aim: To evaluate demographic data, clinical presentation in terms of functional disability, complications of multilevel (2 or more) cervical spondylotic myelopathy. Cervical spondylotic myelopathy is common cause of neurological dysfunction in old age little rare in younger age people which is diagnosed by clinico-radiological evaluation and surgery is the ideal treatment of choice whether to go through anterior or posterior surgical approach is still a matter of debating. Materials and Methods: This is a prospective study done from August 2024 to March 2025 on patients with cervical spondylotic myelopathy by surgical decompression- anterior approach (anterior cervical discectomy with or without fusion with auto/allo graft (implants)), and posterior approach (cervical laminectomy with or without fusion with lateral mass fixation) in Department of Neurosurgery, Guntur General Hospital without randomizing the grouping were included for comparison. Clinical presentation, duration or surgery, blood loss and length of hospital stay were compared. Post operatively surgical complications were noted. Neurological improvements were evaluated by functional outcome scales (Nurick grading system and mJOA scores). Results: The commonest age group of presentation is 51-60 years i.e. 31% of the study population with the mean age group of presentation is 50 years. Cervical spondylotic myelopathy was common in male gender with male to female ratio of 4:1. The commonest mode of presentation is motor dysfunction of extremities, graded sensory loss, disturbances in gait and balance with or without sphincter disturbances—depending on involvement patients categorised by two functional outcome scales- Nurick grading & mJOA scoring system. All the patients were investigated with x-ray c-spine (AP, Lateral, flexion, & extension views), CT c-spine, MRI c-spine were done. Most of the patients had 2-3 level (>70%) segmental spondylotic changes compared to 4 -5 level spondylotic changes. Of the patients included in the study, patients were assessed with Nurick grading and it was found that lower Nurick grades (1,2) had improvement in symptoms than for patients with higher Nurick grades (3,4) after 1 year of post surgery follow up. This difference was found to be statistically significant on chi square test. The mean amount of blood loss was less in anterior approach as compared to posterior approach. This difference was found to be statistically significant on unpaired t test (P value<0.05). Neck pain was more common in posterior approach than anterior approach. Complications like dysphagia was more common in anterior approach, CSF leak was more significantly common in posterior approach. The overall length of stay in hospital was more for posterior approach when compared to anterior approach. Conclusion: Both anterior approach and posterior approaches were associated with betterment in postoperative neurological function for multilevel CSM. And there is no significant advantage in doing anterior approach in multilevel CSM. Keywords: CSM, Dysphagia, Nurick Grading, mJOA scoring, Anterior approach, MRI c-Spine