Current Issue

In present study 200 cases of acute pancreatitis were evaluated and following conclusions were made. MDCT is an excellent imaging modality in diagnosis of acute pancreatitis with depiction of pancreas, peri pancreatic changes and also associated complications. No significant correlation seen between pancreatic enzymes and severity of pancreatitis. Significant correlation with modified CT severity index and length of hospital stay, interventions, organ failure is noted. MCTSI is good indicator for outcome of patient especially with the organ failure and also length of stay. CECT with modified CT severity index shows good correlation with grading of severity of pancreatitis and extent of disease process. CT is the most sensitive and specific imaging modality for the evaluation of acute pancreatitis and its complications. Keywords: MDCT, MCTSI, CECT, Pancreatitis.

Background: Patient safety is the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. One of the outcomes frequently analysed in studies addressing this theme is the occurrence of adverse events. This study was conducted to assess anaesthesia related peri-operative adverse events. Materials and Methods: This study comprised of 100 anaesthetic procedures in all. The subjects had been asked for consent. The adverse events were noticed. Statistical analysis had been conducted using SPSS software. Results: The most common adverse event was perioperative cardiac arrest observed in 29 subjects, followed by unexpected difficult airway seen in 16 subjects. Perioperative pulmonary aspiration was noticed 10 subjects. Stroke/coma was seen in 9 subjects and malignant hyperthermia was seen in 3 subjects. Total 67 complications had been observed. Conclusion: The most common perioperative complication was cardiac arrest followed by unexpected difficult airway. Other complications were pulmonary aspiration, stroke or coma, and malignant hyperthermia. Keywords: Anaesthesia, Complications, Cardiac Arrest.

Background: The synovium, a soft tissue lining diarthrodial joints, tendon sheaths, and bursae, plays a pivotal role in various arthritides. This study aims to evaluate the histopathological spectrum of synovectomy and synovial biopsies, assessing their diagnostic value in neoplastic, granulomatous diseases, and infections. Materials and Methods: This cross-sectional descriptive study was conducted in the Department of Pathology at Siddhartha Medical College, Vijayawada, from January 2021 to January 2023. A total of 100 synovectomies and synovial biopsies, obtained via open or arthroscopic methods, were included. Samples were fixed in 10% buffered formalin, processed, and stained using hematoxylin and eosin and special stains as necessary. Clinical, demographic, histopathological, radiological, and serological data were reviewed. Results: The study revealed a higher prevalence of synovial lesions in individuals aged 51-70 years (38%) and 71-90 years (32%), with females predominantly affected (60%). Inflammatory joint diseases comprised 40% of cases, with chronic nonspecific synovitis (18%) being the most common. Septic arthritis (10%), tuberculous synovitis (6%), and rheumatoid arthritis (6%) were also notable. Degenerative joint diseases accounted for 22% of cases, including osteoarthritis (10%), gout (3%), pseudogout (3%), ochronosis (2%), and avascular necrosis (5%). Tumor and tumor-like lesions constituted 37% of cases, with giant cell tumor of the tendon sheath (15%) and synovial chondromatosis (8%) being prominent. Conclusion: The study emphasizes the diagnostic value of histopathological examination in early and ambiguous cases of synovial pathology. The prevalence of inflammatory, degenerative, and tumor-like conditions reflects the necessity for comprehensive evaluation in managing joint diseases. Keywords: Synovium, histopathology, synovectomy, synovial biopsy, arthritis, inflammatory joint disease.

Background: Dengue fever is a prevalent mosquito-borne viral illness with potential complications, including thrombocytopenia. Objective: This study aimed to investigate the relationship between platelet indices and the presence of thrombocytopenia in individuals diagnosed with dengue fever. Materials and Methods: A total of 100 dengue-confirmed cases were enrolled, and their platelet count, platelet distribution width (PDW), and plateletcrit (PCT) were measured during the acute phase of the disease. Results: The findings of this study revealed a substantial incidence of thrombocytopenia among the participants, aligning with the well-established association between dengue infection and platelet reduction. Notably, a modest but significant correlation was demonstrated between PDW and PCT and the severity of thrombocytopenia. Subgroup analysis based on dengue virus serotypes unveiled varying patterns of platelet indices, hinting at potential differences in disease pathogenesis. Conclusion: The results of this study underscore the potential utility of platelet indices as informative markers for assessing the degree of thrombocytopenia in dengue fever cases. The observed correlations between platelet count, PDW, and PCT provide insights into the complex interplay between platelet dynamics and dengue infection. Further prospective investigations are warranted to elucidate the underlying mechanisms driving these correlations, which could contribute to enhanced understanding, diagnosis, and management of dengue-associated thrombocytopenia. Keywords: Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT) and Platelet Large Cell Ration (P-LCR).

Background: This study aims to investigate the diverse etiologies leading to the need for mechanical ventilation in neonates and to analyze the outcomes associated with this intervention. Materials and Methods: A prospective observational study was conducted on a cohort of 60 neonates admitted to the neonatal intensive care unit (NICU) at Gandhi Hospital during a specified period. Data were collected from medical records, including demographic information, clinical presentation, and diagnostic findings. Etiologies necessitating mechanical ventilation were categorized, and relevant clinical parameters were assessed. Outcomes such as survival rates, duration of ventilation, and potential complications were analyzed. Results: The study included a total of 60 neonates who required mechanical ventilation during the study period. The primary etiologies identified encompassed a range of conditions including respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), congenital anomalies, sepsis, and neurological disorders. Each etiology was further analyzed for its contribution to the need for mechanical ventilation and associated outcomes. The outcomes revealed varying survival rates among different etiological groups. Additionally, the duration of mechanical ventilation was assessed, and potential complications such as ventilator-associated pneumonia, bronchopulmonary dysplasia, and intraventricular hemorrhage were investigated. Conclusion: This study sheds light on the intricate web of etiological factors leading to mechanical ventilation in neonates and provides valuable insights into the associated outcomes. Understanding the diverse challenges faced by neonates requiring mechanical ventilation is crucial for improving clinical management strategies and ultimately enhancing the overall care and survival rates of this vulnerable population. The findings of this study contribute to the existing body of knowledge on neonatal care and may guide future research and clinical practices in the field of neonatology. Keywords: Etiologies, Neonatal Intensive Care Unit (NICU), Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome (MAS), Ventilation, BronchoPulmonary Dysplasia(BPD).

Background: To evaluate radiological and functional outcome of malunited distal radial fractures treated with iliac crest bone graft and Volar plating with or without K- wires. Materials and Methods: This is a prospective study conducted on twenty adult patients with distal radial fractures treated at Department of Orthopaedics, Rangaraya Medical College, Kakinada between September 2021 to August 2023. Results: The study included twenty cases of malunited distal radius fractures in adults treated with osteotomy, ipsilateral tri cortical iliac crest bone grafting, and volar Ellis plating over a 12- to 18-month period. Right side (dominant wrist) was involved in 12 (60%) patients and the left side involved in 8(40%) patients. In the present study 13 (65%) patients had union within 2-3 months and 7(35%) patients had union in 3-4monthsThere were no cases of delayed union or non –union. Mean preop DASH score – Mean postop DASH score>25 Excellent Mean preop DASH score–Mean postop DASH score16-25 good Mean preop DASH score–Mean postop DASH score 6-15 fair Mean preop DASH score–Mean postop DASH score≤5 poor. Osteotomy, ipsilateraliliac crest bone grafting and volar Ellis plating demonstrates good reproducible outcomes with minimal risk in appropriately selected cases of Malunion. This technique can provide adequate restoration of normal anatomy and soft tissue and vascular preservation, in addition to minimal patient morbidity, which may facilitatea more rapid return to function. Conclusion: We can conclude that osteotomy, tricortical iliac crest bone grafting, and volar Ellis plating are a simple, reliable, and effective method for restoring normal distal radius radiological parameters, particularly in young adults. Functional end results have a direct relationship with anatomical end results, especially in young adults, though good functional results can be obtained even when anatomical results are poor in elderly people due to innate mobility of the wrist joint. Keywords: Osteotomy, Distal radial fractures, DASH score, volar Ellis plating.

Background: Perianal fistula or fistula-in-ano, is a chronic abnormal communication, usually lined by granulation tissue, which runs outwards from the anorectal lumen (the internalopening) to an external opening on the skin of the perineum and gluteal region. Perianal fistula develops as a result of anorectal sepsis. Ligation of intersphincteric fistula tract (LIFT) is a new sphincter saving method with good result in the management of fistula. Aim of this study: To evaluate the effectiveness and functional outcomes of the LIFT patients operated at Shri Jagannath Medical College and Hospital, Puri, Odisha. Materials and Methods: This prospective study includes 20 patients who were operated for perianal fistulas at during the period of October 2022 to September 2023. Patients of all ages with or without history of recurrence are included. Patients with fistulas due to crohn`s disease, anal cancer and tuberculosis were excluded. A performa with detailed history, clinical presentation, per rectal examination and supportive imaging studies with pre and post-operative status were done for all cases. Results: In this study most of the patients were male and few of them are recurrent fistula with perianal discharge. All the 20 patients with perianal fistula underwent Ligation of intersphinsteric fistula tract (LIFT). Patients were followed for a period of 3 months. Most of the cases healed completely within 2-4 weeks (90%), few cases took 6 weeks for healing (10%). Recurrence of fistula occurs in 5 cases (20%). In recurrent fistula re-recurrence occurs in 2 cases (40%). Conclusion: The LIFT procedure is highly safe and effective means of treatment for perianal fistula with no risk of incontinence, less postoperative pain score and also better for recurrent fistulas. Keywords: Perianal fistula, Anorectal sepsis, LIFT, Recurrence.

Background: Hemorrhoid is very common ano rectal disease causing painless bleeding after defecation. Hemorrhoidectomy is still the most effective surgical treatment for hemorrhoidal disease, but it is, however, associated with complications such as pain in post-operative period. Aim of this study: is to evaluate to break the “vicious circle” of “pain–sphincteric spasm–pain” with the postoperative use of self-mechanical anal dilation. Materials and Methods: 30 patients undergoing hemorrhoidectomy as suffering from hemorroids were divided randomly in two groups by odd & even method, one group was assigned as dilator group where self-mechanical 33 mm Anal Dilator for 15 mins was used for a period of 02 weeks and in another group no anal dilator used although both had fibre diet amd laxative with sitz bath in post-operative period. Pain, oedema, discharge, bleeding and incontinence was observed on Ist, 3rd, 7th and 15th day. Results: 15 Patients who had undergone self-mechanical anal dilator showed less pain compaired to no dilator group (P<0.05). Bleeding, discharge and oedema was significantly low in both group, faecal incontinence was present in dilator group for 7 days but disappeared on 15th day(P=050). Conclusion: This prospective study confirms that self-mechanical anal dilatation reduce pain after haemorrhoidectomy. No faecal incontinence noticed. Keywords: Hemorrhoids, Hemorrhoidectomy, Self-Mechanical Anal Dilatation, Pain.

Background: Dexmedetomidine, renowned for its sedative, anxiolytic, and opioid-sparing properties, exerts its effects primarily within the locus ceruleus of the brainstem. By diminishing sympathetic outflow, it effectively attenuates stress responses. Despite its growing popularity, optimal dosing remains uncertain, particularly within the Indian population. This study aimed to compare the hemodynamic response attenuation achieved by two dexmedetomidine doses: 0.5 mcg/kg and 1 mcg/kg during laryngoscopy and intubation. Materials and Methods: One hundred elective surgery cases were consecutively enrolled in this prospective study after obtaining informed consent. The patients were randomly allocated into two groups, each comprising 50 cases. Group A received intravenous dexmedetomidine at 0.5 mcg/kg, while Group B received 1 mcg/kg, both diluted with 20 ml of normal saline over a 10-minute infusion using a pump. Hemodynamic responses from both the groups were then recorded. Results: Baseline diastolic blood pressure was comparable between groups, and at 10 minutes post-drug administration, as well as during intubation and 1 minute post-intubation (p>0.05). However, post-intubation diastolic blood pressure was significantly lower in Group B compared to Group A at 3 minutes post-intubation and remained lower through subsequent readings until 10 minutes post-intubation. Similarly, mean arterial pressure was significantly lower in Group B compared to Group A for all readings up to 10 minutes post-intubation. Conclusion: In the context of attenuating the hemodynamic response to laryngoscopy and intubation, this study establishes the superiority of intravenous dexmedetomidine at 1 mcg/kg over 0.5 mcg/kg dosing. The higher dose may be particularly beneficial for patients with a history of myocardial ischemia, hypertension, or cerebrovascular accidents, for whom excessive stress response during laryngoscopy and intubation is undesirable. Caution is advised when administering the 1 mcg/kg dose due to potential bradycardia during drug infusion. Keywords: Anesthesia, Dexmedetomidine, Hemodynamic, Intubation, Laryngoscopy, Sympathetic outflow.

Background: Proximal humerus fractures are defined as fractures occurring at or proximal to the surgical neck of humerus. Various methods are used for treating such conditions with mixed results. The purpose of this study was to assess the outcome of these fractures treated by Crosslinked percutaneous pinning (CLiPP) and Joshi’s External Stabilizing System (JESS) in terms of time of union, functional outcome and complications. Materials and Methods: A prospective comparative study was done in a period of 1 year (2019-2020), which included 30 patients where 15 cases underwent surgery via CLiPP and other 15 cases via JESS. Neer’s 2 and 3 part fractures, skeletally mature patients and patients presented within 3 weeks of presentation were included in the study. After the surgery, patients were followed up at 4 weeks, 6 weeks, 8 weeks, 12 weeks and 6 months and shoulder function was assessed using Constant Murley Score. Results: Time of radiological union by both techniques showed no significant difference. Better functional result was observed by CLiPP group at 3 months whether at 6 months there was not significant difference between them. Excellent results were found in 20% patients with CLiPP group and 13.33% with JESS group. Same percentage (6.67%) of patients showed poor results in both the groups. 2 (13.33%) patients had pin tract infection of each group and 1 (6.67%) patient had pin loosening in JESS group. Conclusion: Both the techniques are cost effective, enables early mobilisation with less soft tissue dissection and provides good results in treating Neer’s 2- and 3-part fractures. CLiPP is better than JESS in terms of better early functional result. Keywords: Proximal humerus fractures, CLiPP, JESS.

Background: Chronic Kidney Disease (CKD) is a prevalent condition with significant morbidity, necessitating comprehensive understanding of its demographic distribution, risk factors, and impact on quality of life. This study assesses the demographics, risk factors, and quality of life among CKD patients attending a dialysis unit at a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted among 100 CKD patients. Data on demographics, education, occupation, economic status, and risk factors were collected. The quality of life was assessed using the SF-12 questionnaire, focusing on physical and mental health components. Results: The majority of patients were male (78%) and aged 41-60 years (62%). A significant portion had no formal education (74%) and belonged to the lower socioeconomic class (59%). Hypertension was the most prevalent risk factor (76%), followed by alcohol consumption (41%), sedentary lifestyle (37%), and tobacco use (34%). The quality of life assessment revealed that physical functioning (28 ± 25.44) and general health (28 ± 23.37) were the worst affected domains in the Physical Health Component. In the Mental Health Component, social functioning (6.5 ± 19.33) and role limitation due to emotional problems (24.12 ± 12.34) were most impacted. The overall quality of life score was 31.33 ± 15.24, indicating significant impairment. Conclusion: CKD patients exhibit a high prevalence of multiple risk factors, especially among lower socioeconomic classes, with substantial impairment in both physical and mental health-related quality of life. These findings highlight the need for targeted interventions to address the multifaceted challenges faced by CKD patients. Keywords: Chronic Kidney Disease, CKD, Dialysis, Quality of Life, Risk Factors, Socioeconomic Status, SF-12, Hypertension.

Background: On 16th January 2021, India began the world’s largest vaccination program for COVID-19. Healthcare workers were the first group to be offered the vaccine, however, vaccine hesitancy emerged as a barrier. Vaccine hesitancy refers to a delay in acceptance or refusal of vaccination despite the availability of vaccination services. It was listed as one of the ten threats to global health by WHO. The aim of this study was to determine the rate of vaccine acceptance and reasons for vaccine hesitancy among UG (undergraduate) medical students of Bihar. Our study was necessary because UG medical students do not contribute directly to the frontline of healthcare but are exposed to multiple cases of COVID-19 during clinical teachings and they are also the future of any country’s healthcare system. Material and Methods: A cross-sectional study was carried out on the UG medical students of Bihar using an anonymous online survey. The survey link was sent electronically via WhatsApp. All the questions of the survey were closed-ended, in the form of multiple-choice questions and tick boxes. The data was analyzed on SPSS software. Results: Out of 394 responses received, 205 (52.03%) were males, 384 (97.46%) belonged to the age group of 18-25 years. In the bivariate model, attributes like the male sex, being well informed about the vaccines, being at high risk of exposure, and the belief that vaccination can overcome the pandemic were associated with a higher likelihood of accepting the vaccine. Participation of professors in vaccination was the most common source of motivation (209/357; 58.5%) in vaccine acceptors, while insecurity about the efficacy of the vaccines (16/37; 43.2%) was the most common reason among vaccine deniers. Conclusion: We recorded a high vaccine acceptance rate of 90.6% in our study. Further, 78.4% of vaccine deniers believed that they would have accepted the vaccine if they were provided appropriate information on the vaccines prior to the vaccination. Therefore, we reach a conclusion that pre-vaccination orientation sessions aimed at UG medical students will significantly help in addressing their vaccine hesitancy. Keywords: COVID-19, COVID-19 vaccine, Medical students, Vaccine Hesitancy.

Background: According to a report by the World Health Organization (WHO) in 2015, approximately 600 million individuals, equating to nearly one-tenth of the global population, become sick due to consuming contaminated food each year. Furthermore, the report indicates that 420,000 individuals perish annually as a result, leading to the loss of 33 million healthy life years (DALYs). Among these cases, 40% of the burden of foodborne diseases affects children under the age of five, resulting in 125,000 deaths annually. Objectives: To distinguish the attitudes towards food safety practices in urban and rural households based on the WHO Five Keys. Materials and Methods: A cross-sectional study was conducted in Urban and rural households located in the field practice areas of Jawaharlal Nehru medical college in Belagavi Taluka, and District of Karnataka State. The study took place from January 1, 2017, to December 31, 2017. Results: In urban participants, 30.0% were aged 25 to 35 years whereas for rural participants, 35.8% were aged 18 to 25 years. The mean age for urban participants was 37.96 ± 14.9 years, and for rural participants, it was 33.48 ± 13.5 years. The difference in mean ages between urban and rural participants was statistically significant (χ2 = 39.53, p < 0.001). According to Modified B. G. Prasad's Classification of socio-economic status of urban participants, 34.3% of study participants belonged to Class IV whereas in rural participants, 41.3% in Class IV, differences in socio-economic status between urban and rural participants were statistically significant (χ2 = 59.61, p < 0.001). Conclusion: The study underscores the importance of recognizing and addressing the distinctive demographic characteristics between urban and rural populations, which can have implications for healthcare, education, and socio-economic interventions tailored to the specific needs of each community. Keywords: WHO, Urban, Rural, Food, Safety, Household.

Background: HPV infection is a well-known cause of cervical cancer. In India, an estimated 77,348 deaths occur each year (Globocan2020). Less than 1% of girls in India have received the HPV vaccine. (NFHS-5) So, this study is done to analyse perceptions of MBBS students about HPV and the vaccine used to treat it. The Objectives was 1. To assess the knowledge of medical students about human papilloma virus and 2. To assess the knowledge, attitude, and practice of medical students about HPV vaccine. Material and Methods: Cross sectional study was conducted among 250 MBBS Students of GIMS, Kalaburagi, Karnataka. Simple random sampling was used to achieve the required sample size. Data was collected from Nov 2023 to Jan 2024 using a semi-structured questionnaire. Scoring System was used for analysing the knowledge. Data was entered in MS excel and was analysed using SPSS version 26. Results: The response rate of the students was 100 %. 50.4 % of the students had good knowledge of HPV virus and HPV vaccine whereas 23.2% students had very good knowledge of the same. 56.4 % of students agreed that they would get vaccine if it was free. 54.8 % students strongly agreed that would pay for vaccine, 51.6% and 54.8 % of the students strongly agreed that they would recommend it to their friends and their future clients respectively. Only 5.6 % of female students were vaccinated against HPV. Conclusion: Despite good knowledge and attitude, the vaccination coverage was very poor among female medical students and nil among boys. Keywords: Awareness, Human Papillomavirus, Vaccination, Students, Medical.

Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood. Asthma is a chronic respiratory disease characterised by episodes of wheeze, cough, and shortness of breath. Hence, the present study was conducted for assessing the Quality of Life and factors affecting it in children diagnosed with Attention – deficit/ hyperactivity disorder versus Bronchial asthma. Materials and Methods: A total of 50 children within the age range of 8 to 16 years were enrolled. Out of these 50 children, 25 were children with recently established diagnosis of ADHD and remaining 25 were children with established diagnosis of Bronchial Asthma. Complete demographic and clinical details of all the subjects was obtained. Pediatric Quality of Life Scale (PedsQL) and Parenting Practices Questionnaire were used. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the subjects of the ADHD group and asthma group was 13.2 years and 14.1 years respectively. Majority proportion of subjects were boys. While comparing the parent’s report of QoL among two study groups, significantly better results were obtained in the Asthma group. However, while comparing the child’s report of QoL among two study groups, non-significant results were obtained. Also, significant correlation was seen among parenting style and QoL. Conclusion: ADHD is a childhood ailment that is equally debilitating as a persistent physical illness such as Asthma. The quality of life for the kid can be greatly enhanced via therapy and an emphasis on parenting approaches. Keywords: Quality of life, Attention-deficit, Bronchial asthma.

Background: Among micronutrients, vitamin B12 (B12) and folate (FA) are critical as they are required in a plethora of metabolic and biological functions. Hence, the present study was conducted for assessing the prevalence of cobalamins and folate deficiency amongst adolescents. Materials & Methods: A total of 500 adolescents were enrolled. Complete demographic and clinical details of all the patients were obtained. A proforma was made, and detailed clinical profile was evaluated. Blood samples were obtained, and serum cobalamin and folate levels were evaluated. Results: A total of 500 adolescents were evaluated. The mean age of the patients was 12.3 years. Prevalence of cobalamins and Prevalence of folate deficiency was 31.8 percent and 28.5 percent respectively. Among boys, cobalamins deficiency was seen in 89 patients while folate deficiency was seen in 63 patients. Among girls, cobalamins deficiency was seen in 70 patients while folate deficiency was seen in 79 patients. Non-significant results were obtained while correlating prevalence of cobalamins and folate deficiency among boys and girls. Conclusion: Our results demonstrate a high prevalence of folate and cobalamin deficiency among adolescents. Key words: Folate, Cobalamin

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, necessitating improved diagnostic and prognostic markers. Immunohistochemical (IHC) markers such as alpha-fetoprotein (AFP), glypican-3 (GPC3), heat shock protein 70 (HSP70), and cytokeratin 19 (CK19) have shown promise in HCC detection and prognosis. However, their utility in clinical practice remains to be fully elucidated. Materials and Methods: We conducted a retrospective study analyzing 129 HCC tissue samples for the expression of AFP, GPC3, HSP70, and CK19 using IHC staining. Clinicopathological parameters, including tumor size, grade, presence of cirrhosis, and patient survival, were correlated with marker expression. Survival analysis was performed using Kaplan-Meier curves and log-rank tests. Results: Our analysis revealed variable expression patterns for AFP, GPC3, HSP70, and CK19 in HCC tissues. AFP and GPC3 exhibited moderate to high expression levels, while HSP70 showed moderate expression, and CK19 demonstrated lower expression. Positive correlations were observed between marker expression and tumor size, grade, and the presence of cirrhosis (p < 0.05). Additionally, higher expression levels of AFP, GPC3, and HSP70 were associated with shorter overall survival and lower survival rates at 1 year and 3 years (p < 0.001). In contrast, lower expression levels of CK19 were associated with better overall survival and higher survival rates. Conclusion: Our study highlights the diagnostic and prognostic potential of AFP, GPC3, HSP70, and CK19 in HCC. These markers exhibit distinct expression patterns and associations with clinicopathological parameters and patient outcomes, underscoring their utility in guiding clinical management decisions. Further validation studies in larger cohorts are warranted to confirm our findings and facilitate the integration of these markers into routine clinical practice. Keywords: Hepatocellular carcinoma, Immunohistochemistry, Alpha-fetoprotein, Glypican-3, Heat shock protein 70, Cytokeratin 19, Prognosis.

Background: Among children, one of the main causes of morbidity and death is acute respiratory infection (ARI). Because of their constantly changing developmental physiology, children are more susceptible to environmental exposures that determine respiratory disorders. On the other hand, children exposed to environmental risk factors also have a higher risk of these diseases when it comes to social determinants of health. Acute respiratory infections (ARIs) are more likely to occur and be fatal due to a number of causes. These included living situations that were subpar, seasonal fluctuations, exposure to indoor and outdoor pollutants, low birth weight, inadequate breastfeeding, malnourishment, inadequate housing arrangements, inadequate sanitation, and limited access to preventative and therapeutic services. Materials and Methods: In Jagdalpur, Chhattisgarh, at the government Medical College and Hospital, the study was carried out. The study had childrens under the age of fifteen as participants. In total, there were 59 samples. A systematic random sample was the sample technique employed. The study informant, the mother of the child, was interviewed using a pretested semi-structured questionnaire. SPSS was used for statistical analysis after three months of data collection. All children below 15 years of age were included in this study. Results: In this study, there were 59 participants; 28 were girls and 31 were boys. Of the thirty-one boys, ten were one to five years old, thirteen were five to ten years old, and eighteen were ten to fifteen years old. Of the twenty-eight girls, six were one to five years old, ten were five to ten years old, and twelve were ten to fifteen years old. There were 40 individuals with upper respiratory tract infections and 19 with lower respiratory tract infections. Ten people had bacterial infections, eleven had mixed ARIs and 38 had viral infections.18 people reported nasal blockage, 14 people had sore throats, 20 people had cough. Conclusion: Environment played a major role in childhood acute respiratory infections. By implementing programs to improve community awareness and economic standing as prevention strategies against childhood ARI. It should be the duty of general practitioners and pediatricians to give caregivers the proper advice on how to take care of their children at home. Keywords: Acute Respiratory Infection, Environmental Factors, Children.

Background: To assess the factors influencing the functional outcomes of Surgery for Hirschsprung’s Disease, and to compare Duhamel and Soave Pullthrough procedures based on Postoperative complications andQuality of life. Materials and Methods: A total number of 30 cases were studiedfrom 2018 to 2021 at Government General Hospital/Guntur Medical College, Guntur, and the follow-up period varied from 6 months to 18 months. This study was done to compare the results of both the Pull through procedures (Duhamel and Soave) with respect to age at definitive procedure, gender, aganglionic segment type, postoperative course, and outcomes of both procedures based on postoperative Complications and Quality of life. The analysed data were compared with other series in the literature and discussed. A master chart dealing with all aspects has been designed and presented. Statistical analysis is done with SPSS VERSION 16 and the Chi square test. Results: Both the Groups was matched and the results was studied regarding Voluntary Bowel movements, Soiling, Constipation, Micturition disturbance, Quality of life, Postoperative Enterocolitis and with features of Bowel Retraction and Perineal Excoriation. Voluntary Bowel movements were present in 80% of study subjects operated by Duhamel procedure compared to 86.7% of study subjects who underwent Soave. Soiling was observed in 6.7% of study subjects who underwent the Duhamel procedure and is 20% with Soave. Constipation was observed in 6.7% of study subjects who underwent the Duhamel procedure and is 13.3% with Soave. Soiling and constipation was a major complaint following Soave surgery than with Duhamel procedure. Constipation was slightly more common in the Soave than Duhamel group (24 percent vs. 4 percent; p=0.04), while the soiling rate was comparable in the Duhamel (21 percent) and Soave (8 percent) groups (p=0.26). 13.3% with Duhamel procedure, and 6.7% with Soave procedure had a history of enterocolitis. Diarrhoea with explosive stool was found to be 13.3% each in study subjects who got operated by Duhamel and Soave procedures, respectively. Bloody stool was among 13.3% of study subjects who got operated by Duhamel procedure, when compared to soave it is only 6.7%. Perineal Excoriation was seen in 20% of subjects with Duhamel procedure compared to 6.7% with Soave. Conclusion: The incidence of voluntary bowl movements, soiling and perennial excoriation is better in soave than Duhamel. Retraction and constipation is more with soave. There was no significant difference between the outcomes of the two procedures, and in the light of the present findings. both the procedures appear similar in terms of efficiency and associated complications. Both the procedures have their own advantages. The Quality of life in patients who underwent Duhamel and Soave procedures appears to be almost similar in our study. Keywords: Pullthrough, Constipation, Soiling, Excoriation, Micturition, Enterocolites.

Background: Laparoscopic cholecystectomy is gold standard procedure for routine gall bladder removal nowadays. It has become the preferred surgery of choice for patients with symptomatic cholelithiasis in the last two decades due to its shorter duration of hospital stay, reduced post operative morbidity and better cosmesis Materials and Methods: A retrospective observational study was done in 75 patients who underwent laparoscopic cholecystectomy in Vydehi Institute of Medical Sciences & Research Centre Bangalore. Patients were divided into 2 groups based on gender and comparison in terms of age of presentation, intra operative complications, duration of surgery, post operative complications, POD 1 pain was done. The duration of hospital stay was also compared Results: The duration of surgery was significantly greater in males (50.65 +/- 8.73) than female group (37.80 +/- 8.78, p < 0.001). Normal anatomy was significantly in greater proportion in females (63.6% ) than males (25.0% , p < 0.001). Intra operative complications such as bile spillage (12.9%), bleeding (6.5%) and bile leak (3.2% ) was significantly more in male than females (p < 0.42). The hospital stay and post op day 1 pain was seen more in males than females. There was no difference between the genders with respect to age (0.118) and post operative complications (p = 0.222) Conclusion: This study suggests that male gender can be a predictor of difficult laparoscopic cholecystectomy. Keywords: Laparoscopic cholecystectomy, Cholelithiasis

Background: To describe Clinical & demographic profile of the patient admitted with poisoning, drug overdose, drug adverse effects and anaphylaxis. Materials and Methods: This is a retrospective hospital record-based study conducted in a tertiary care hospital in Kolhapur, Maharashtra. Medical records of 408 admitted patients were included from May 2018 – Dec 2023 after permission from the Institutional Ethics Committee. Medical records having incomplete details were excluded from the study. Data was collected in predefined proforma. Results: Maximum Patients admitted were of 21 to 30 years of age group with duration of stay up to 4 days. Male (224, 54.90%) were predominant over female (184, 45.09%).Most common diagnosis at admission was poisoning (209, 51.22%), followed by drug adverse effects (115, 28.18%), overdose (57, 19.97%) and drug induced anaphylaxis (27, 6.61%). At early age (up to 40 years) poisoning and drug overdose were common, at middle age (41 to 60 yrs) anaphylaxis was common while at elderly age (51 yrs and more) drug adverse effects were most common. Organophosphorus poisoning is most common with male predominance while household poisoning is commoner in females. Drug induced hypoglycemia is most common drug adverse effect with male predominance followed by drug induced hyponatremia with female predominance. Most common outcome at the time of discharge was complete recovery (283, 69.36%) followed by leave against medical advice (81, 19.85%), and death (31, 7.59 %). Paraquat poisoning is the most common cause of death followed by Organophosphorus. Conclusion: Maximum admissions were from 21 – 30 years of age.Overall males are predominating over female but up to 20 years of age females are more than males.Poisoning and overdose is most common in young generation while in middle age anaphylaxis is common and in old age group drug adverse effects are commonest. Among causes of hospital admissions poisoning is most common in which Organophosphorus poisoning is commonest followed by paraquat poisoning. Keywords: Poisoning, overdose, drug adverse effects, anaphylaxis, pharmacovigilance.

Background: To assess the impact of orally given itopride and levosulpride on non-ulcer dyspepsia. Materials and Methods: A total of 120 patients were divided equally into two groups, with 60 patients in each group. Group A consists of 60 patients. Subjects were randomly allocated to receive a 50 mg dose of itopride hydrochloride, administered three times per day prior to meals. Contrarily, Group B received a 75 mg dose of Levosulpiride, which was likewise administered three times daily prior to meals. The therapy regimen was adhered to for a duration of two weeks, and then continued for a total of three months. This study included individuals between the ages of 18 and 60 (both males and females) who had symptoms of non-ulcer dyspepsia, such as bloating or pain in the upper abdomen, nausea, and heartburn, lasting for a minimum of 12 weeks. Results: After two weeks of therapy, the Itopride group had 46.66% of patients experiencing remarkable or full reduction of symptoms, 30% experiencing moderate relief, 16.67% experiencing little relief, and 6.67% experiencing no improvement. Within the Levosulpiride group, 40% of participants saw significant or total alleviation, 36.67% experienced moderate alleviation, 15% experienced little alleviation, and 8.33% experienced no alleviation. Both medications demonstrated efficacy, however, the Itopride group had a greater proportion of significant or full alleviation. Incidents with negative consequences were documented and compared between the two groups. Within the Itopride group, 13.33% of patients had minor gastrointestinal discomfort, 8.33% experienced headaches, and 3.33% experienced dizziness. Within the Levosulpiride group, 15% of participants had minor gastrointestinal distress, 5% reported headaches, and 8.33% reported dizziness. Both groups saw a comparable occurrence of minor negative effects, while the Levosulpiride group had a significantly greater occurrence of dizziness. Before and after therapy, a series of biochemical tests were performed, including a hemogram, blood urea nitrogen (BUN), serum creatinine, liver function tests (AST, ALT, γ-GT, Alk. Phos), bilirubin, total cholesterol, fasting blood sugar (FBS), and QT-interval. Conclusion: Our investigation showed that both Itopride and Levosulpiride are effective in relieving symptoms of non-ulcer dyspepsia, and they have a comparable safety profile. However, Itopride shown a much higher incidence of persons achieving substantial or complete relief from symptoms. Keywords: Dyspepsia, Itopride, Levosulpiride, Relief.

Background: To assess the functional outcome of PHILOS (proximal humerus internal locking system) plating in proximal humerus fractures. Materials and Methods: Twenty-five displaced fractures of proximal humerus (in twenty-five patients) treated with PHILOS(proximal humerus locking system) plate between MAY 2021 and APRIAL 2023. The study was conducted in department of Orthopedics & Traumatology Government General hospital, Rangaraya Medial College Kakinada, Andhra Pradesh, India. Patients between 18 to 49 yrs age with proximal humerus fractures. Results: The present study was done to evaluate functional out come and complication following surgical management of proximal humerus fracture by locking compression plate. (PHILOS PLATE). In PHILOS (proximal humerus internal locking system system) system of the threaded heads of the screws in the plate itself provides for a construct with angular and axial stability, eliminating the possibility of screw toggling or sliding of the screws in the plate holes. Coupled with a divergent or convergent screw orientation to head of humerus provide improved resistance to pull out and failure of fixation. Also, whereas conventional plating systems depend on compression between the plate undersurface and bone for stability, this is not the case for the locking plates. This lessens the chance of stripping the thread in osteoporotic bone, as the plate/bone interface is not loaded along the screw axis. This also allows for a more biological fixation as the underlying periosteum and blood supply to the fractured regions are much less compressed. Conclusion: In conclusion proximal humerus internal locking system (PHILOS) is mechanically and biologically an advantageous implant in proximal humeral fractures particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization. Keywords: PHILOS, Humerus Fracture, Biological Fixation, Conventional Plating system.

Background: High risk pregnancy is one which is complicated by risk factor that adversely affects the maternal outcome or perintal outcome or both. The antepartum fetal surveillance of high risk pregnancies with Cardiotocographycan effectively help for reducing perintal mortality and morbidity. One of the biophysical methods which is being used extensively in the management of high risk pregnancy is (CTG) Cardiotocography. Aims & Objectives: 1. To assess the benefit of cardiotocography to improve the fetal outcome in high risk pregnancy. 2. To find out the suitable time and mode of delivery of the fetus at risk. Materials and Methods: This is a prospective observational study conducted at Government General Hospital attached to Government Medical College, Kadapa from the month of July 2023 to the month of june 2024. Study includes 100 high risk pregnancies with singleton fetus of 32 weeks or more than 32 weeks of gestation CTG performed within 3 days prior to delivery will be considered for fetal outcome. In all cases detailed history, clinical and obstetric examination USG and alntepartum, intrapartum CTG will be performed and decision for mode of delivary is planned and different Perinatal outcome are assessed as 1 min and 5 min apgar score and NICU admissions. Results: Among 100 high risk pregnancies included in the study the most common risk factor is preeclampsia (25%) followed by oligos (16%). The incidence of non-reactive intrapartum CTG are 33 in number (33%). Out of 100, 43 underwent cesarean section, 54 delivered vaginally and 3 delivered instrumentally. Out of 100 cases one minute apgar was 5-7 in 41 subjects, 8-10 in 58 subjects and <4 in 1 subject. Among the study group 30 (30%) had NICU admissions. Conclusion: CTG is simple, cheap, non invasive cost effective with less training & best screening test to identity patients at a greater risk of intrapartum fetal hypoxia. CTG is effective tool to evaluate fetal condition, to detect fetal distress and there by early intervention to improve the Perinatal outcome. Keywords: Cardiotocography, High risk pregnancies, Perinatal outcome.

Background: The human foot is an extremely robust and intricate anatomical system, that provides an effective flexible surface necessary for weight transfer, shock absorption, ground plane adaptation, and mobility. The normal, pes planus, and pes cavus three types of foot have been suggested based on the structure of the Medial Longitudinal Arch. Aim: Comparison of the Medial Longitudinal Arch of the hilly and plain Garhwalis of the Uttarakhand. Materials and Methods: This study includes 400 individuals. 100 male and 100 female from each region of hilly and Plain Garhwal. The distance from the floor to the navicular tuberosity is measured and marked on the custom-made index card on a non-weight-bearing and weight-bearing individual and then noted with the help of the digital vernier calliper for the Navicular Drop Test. For measuring the Medial Longitudinal Arch Angle, the digital goniometer is placed on the foot with having its one limb placed on the head of the 1st metatarsal other limb is placed on the medial malleolus and the body is placed on the Navicular tuberosity. Results: The flat foot was maximum seen in hilly Garhwali’s in comparison to Plain Garhwali’s according to the Navicular Drop test. According to the Medial Longitudinal Arch Angle, Plain Garhwalis were found with a maximum number of flat feet. Conclusion: The present study follows the hypothesis as it states hilly individuals have flat feet in comparison to plain region individuals according to Navicular Drop. The right foot has the max % of flat feet than the left foot. Keywords: Medial longitudinal arch angle, Navicular height, Navicular drop, Body mass Index, Right foot, Left foot.

Background: Tobacco use is the single leading cause of preventable death globally, killing millions of people annually, more than HIV/AIDS, tuberculosis, and malaria. Tobacco kills 0.8-1.0 million people each year in India and most of these deaths occur in people who are young. India is one of the fewer countries in the world where prevalence for smoking and smokeless tobacco use is high as well as characterized by dual use of tobacco use of both smoking and smokeless tobacco products also contributes to a noticeable proportion. Materials and Methods: This is a descriptive cross-sectional study on pattern of tobacco abuse among the selected population regarding socio-demographic characteristics and their views about the pricing of tobacco products. Study unit was people of either sex, of more than 18 yrs and less than 60 yrs in age residing in Lucknow district and after applying multi-stage random sampling, 640 subjects were selected. Results: the prevalence of tobacco abuse in the urban area was 36.0 %, while 4.3 % were past users whereas in rural areas prevalence of tobacco abuse was found to be 54.1% while11.9 % were past users (p=0.001). Age groups <30 yrs and 46-60 yrs had a greater proportion of subjects abusing tobacco products compared with the age group 30-45 yrs. There was a significant association between sex and tobacco abuse (p<0.001) in both urban and rural areas. Conclusion: It was observed that the prevalence of tobacco abuse was at a significant level, however as per latest GATS-2 findings overall consumption of tobacco products has fallen in both urban and rural India. Stricter tobacco sale and taxation laws needs to be reviewed for a tobacco free society. Keywords: Tobacco, smoking, smokeless, GATS, taxation.

Background: Premenstrual syndrome (PMS) is a group of condition with physical, emotional, cognitive, affective and behavioural symptoms, in absence of organic or underlying psychiatric disease, that occur cyclically during luteal phase of the menstrual cycle and resolve quickly at or within a few days of the onset of menstruation. In India prevalence of PMS ranges from 14.3%–74.4% and these symptoms affect social and interpersonal relationship, health related quality of life, academic performances, daily living activities, occupational productivity. Objectives: To estimate the prevalence and assess the risk factors of PMS among medical undergraduates, GIMS, Kalaburagi. Materials and Methods: This was a cross-sectional study conducted among 240 girl students of Gulbarga institute of medical sciences, Kalaburagi using simple random sampling from May to December 2023. Data were collected using self-administered questionnaire and PMS was assessed by Premenstrual Symptoms Screening Tool (PSST). Data were entered in Microsoft excel sheet and analysed using SPSS version 20. Results: The prevalence of PMS and PMDD was found to be 38% and 7% respectively. Irregular menstrual cycle, dysmenorrhea, family h/o PMS/PMMD, tobacco and alcohol consumption, frequent experience of stress, experience of emotional or physical abuse and BMI were significantly associated with PMS. Conclusion: Incorporating educational modules will aid in providing accurate information, emotional, and medical assistance for women's menstrual health issues and improve their health seeking behaviour and quality of life. Keywords: Premenstrual syndrome, PMS, PMDD, PSST.

Background: Surgeons have always aimed to produce less visible scars, with techniques evolving from simple sutures to advanced materials like absorbable sutures, tapes, and adhesives. Cosmetic outcomes are particularly important in thyroid surgeries, common in women aged 30-40, as these surgeries often involve anterior neck incisions. While suturing is reliable, it requires skill and time, prompting the search for easier alternatives. Octyl-cyanoacrylate adhesives have gained popularity for their diverse applications, including wound closure. This study aims to compare the efficacy of octyl-cyanoacrylate to sub-cuticular sutures in thyroidectomy skin closure to meet patients' cosmetic expectations. Materials and Methods: 60 patients scheduled to undergo thyroidectomy were included in the study after taking a written informed consent. This prospective observational study was conducted in the Department of Surgery, over a period of 1 year. Results: Tissue adhesive (octyl-cyanoacrylate) was found to be better in terms of time required to close the wound, cosmetic appearance of wound and less number of wound related complications. Conclusion: The study concludes that tissue adhesives are better in wound closure during initial 1 month of post-operative period in comparison to suturing. However, over period of time, the cosmetic appearance of suturing is almost on par with tissue adhesives. Keywords: Tissue adhesive, cyanoacrylate, thyroidectomy, neck scar, sub-cuticular sutures.

Background: Chronic Kidney Disease (CKD) is linked to systemic inflammation, which may be influenced by the oral microbiome. This study aimed to compare the oral microbiome of CKD patients with that of healthy individuals and examine its impact on systemic inflammation. Materials and Methods: The study included 100 participants: 50 CKD patients and 50 healthy controls. Microbial diversity indices, dominant phyla distribution, and key genera abundances were assessed using high-throughput sequencing. Systemic inflammation markers, such as C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor-alpha (TNF-α), were measured. Correlation analyses were performed to explore the relationships between microbial abundances and inflammation markers. Results: CKD patients showed significantly lower microbial diversity compared to healthy controls (Shannon Index: 3.2 ± 0.5 vs. 4.1 ± 0.6; Simpson Index: 0.76 ± 0.1 vs. 0.84 ± 0.1). Dominant phyla in CKD patients included Firmicutes (45%), Proteobacteria (30%), Bacteroidetes (15%), and Actinobacteria (10%), while healthy controls had Firmicutes (50%), Bacteroidetes (25%), Actinobacteria (15%), and Proteobacteria (10%). Notable genera differences included higher abundances of Streptococcus and Neisseria in CKD patients and higher abundances of Lactobacillus and Prevotella in healthy controls. Systemic inflammation markers were elevated in CKD patients (CRP: 6.2 mg/L ± 1.2 vs. 2.1 mg/L ± 0.8; IL-6: 8.5 pg/mL ± 1.5 vs. 3.2 pg/mL ± 0.9; TNF-α: 12.4 pg/mL ± 2.1 vs. 5.3 pg/mL ± 1.4). Positive correlation was found between Streptococcus abundance and CRP levels (r = 0.72, p < 0.001), and a negative correlation between Lactobacillus abundance and IL-6 levels (r = -0.65, p < 0.01). Conclusion: CKD patients exhibit altered oral microbiome profiles and increased systemic inflammation. These findings suggest a connection between oral microbiome imbalance and systemic inflammation in CKD, highlighting the importance of further research on potential therapeutic approaches. Keywords: Chronic Kidney Disease, Oral Microbiome, Systemic Inflammation, Microbial Diversity, C-Reactive Protein.

Background: This study aims to compare treatment outcomes in patients with Triple-Negative Breast Cancer (TNBC) and HER2-Positive Breast Cancer, evaluating clinical responses, survival rates, recurrence rates, quality of life (QoL), and adverse events. Materials and Methods: A total of 100 female patients were included, with 50 diagnosed with TNBC and 50 with HER2-Positive Breast Cancer. Data on demographics, treatment regimens, clinical outcomes, survival rates, recurrence rates, QoL scores, and adverse events were collected and analyzed. Results: Mean age was 52.3 ± 9.7 years for TNBC and 54.1 ± 10.2 years for HER2-Positive patients. Surgery was performed in 90% of TNBC and 85% of HER2-Positive patients. Chemotherapy was administered to all patients. Radiation therapy was given to 60% of TNBC and 65% of HER2-Positive patients. Targeted therapy was administered to 10% of TNBC and 95% of HER2-Positive patients. Complete response rates were 20% for TNBC and 35% for HER2-Positive patients. Partial response rates were 40% for TNBC and 45% for HER2-Positive patients. Progressive disease occurred in 15% of TNBC and 10% of HER2-Positive patients. Survival rates at various time points are provided in Table 4. The 1-year overall survival (OS) rate was 80% (40 patients) for TNBC and 90% (45 patients) for HER2-Positive patients. The 2-year OS was 60% (30 patients) for TNBC and 75% (38 patients) for HER2-Positive patients. Local recurrence was 30% for TNBC and 20% for HER2-Positive patients. Distant metastasis occurred in 40% of TNBC and 25% of HER2-Positive patients. Grade 3-4 neutropenia was reported in 25% of TNBC and 20% of HER2-Positive patients. Cardiotoxicity was observed in 5% of TNBC and 10% of HER2-Positive patients. Conclusion: HER2-Positive patients exhibited better clinical outcomes and survival rates than TNBC patients but had a higher incidence of cardiotoxicity. These findings underscore the need for tailored treatment approaches and vigilant monitoring of adverse events. Keywords: Triple-Negative Breast Cancer, HER2-Positive Breast Cancer, Clinical Outcomes, Survival Rates, Recurrence Rates, Quality of Life, Adverse Events.

Background: The challenges faced by the pilgrims who visit the cave are multifaceted. Firstly, the high altitude, rough terrain, harsh weather, lack of adequate health care infrastructure. Secondly the devotees/pilgrims come from all over India and also abroad. So there are different morbidity profiles, different language, lack of social support. Materials and Methods: A prospective study was carried out at SKIMS wherein all pilgrims of Shri Amarnath Ji Yatra who were referred to SKIMS from July-August 2023 were studied for their profile, cost expenditure and outcome of the treatment. Results: Out of total 146 patients received, 21(14.3%) were having cardiac symptoms and among those 21 patients, ten,[10] had to undergo interventional procedures. The stents were placed in 08 patients and dual chamber pacemaker in 02 patients. Conclusion: The present study shows that two groups of patients dominate; one with high altitude pulmonary edema and another with cardiac disease having acute coronary syndrome (ACS). It was seen that HAPE and ACS cases were handled well at the base camp. The no. of referred patients had decreased significantly in present study which may be attributed to better pre yatra health checkup and up gradation of health care facilities enroute Amarnath cave. Keywords: Amarnath ji, Pahalgam, Acute Coronary Syndrome.

Background: Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD) worldwide. Identifying the incidence and risk factors for progression to ESRD in patients with diabetic nephropathy is crucial for effective clinical management. Objective: This prospective observational study aimed to determine the incidence and identify risk factors for progression to ESRD in patients with diabetic nephropathy. Materials and Methods: A total of 50 patients with diabetic nephropathy were recruited from 2018 to 2022 and followed for two years. Baseline demographic and clinical characteristics were collected. The primary outcome was progression to ESRD. Multivariate Cox proportional hazards regression analysis was used to identify significant risk factors for progression to ESRD. Results: The mean age of the patients was 60.4 ± 10.2 years, with 30 males (60%) and 20 females (40%). The average duration of diabetes was 15.8 ± 6.7 years. Baseline eGFR was 45.3 ± 12.6 mL/min/1.73 m², and baseline albuminuria was 430 ± 230 mg/g. During the follow-up period, 12 patients (24%) progressed to ESRD. Significant risk factors for progression included lower baseline eGFR (HR: 1.95; 95% CI: 1.12-3.42; p=0.01), higher baseline albuminuria (HR: 1.68; 95% CI: 1.03-2.75; p=0.04), and longer duration of diabetes (HR: 1.22; 95% CI: 1.05-1.41; p=0.02). Blood pressure control had a protective effect but was not statistically significant (HR: 0.75; 95% CI: 0.50-1.12; p=0.16). Glycemic control showed no significant association with progression to ESRD (HR: 0.98; 95% CI: 0.87-1.10; p=0.72). Conclusion: This study highlights the high incidence of progression to ESRD in patients with diabetic nephropathy and underscores the importance of monitoring baseline eGFR, albuminuria, and diabetes duration. Early interventions targeting these risk factors may reduce ESRD progression. Keywords: Diabetic nephropathy, End-stage renal disease, ESRD, Risk factors, eGFR, Albuminuria, Diabetes duration.

Background: To study and make a comparative analysis on knowledge, attitude, and practice pattern regarding eye donation amongst MBBS, BDS, Homeopathy and Nursing students in a tertiary care medical college hospital in Central India. Materials and Methods: It is a population based cross sectional study involving 369 MBBS & Paramedical students. A structured questionnaire including 21 questions divided in three sections assessing knowledge, attitude and practice pattern is noted. Chi square test is done for dependent and independent variables. Test performed at 95% confidence interval with p value <0.05 considered statistically significant. Results: Mean knowledge score was 3.875±2.185. MBBS students had a mean score of 5.150 (SD = 1.400, range 1-9) indicating a higher level of knowledge than other medical courses. Knowledge score among nursing students was the least 2.180 (SD = 2.222, range 0-7). Willingness to donate eyes also showed a significant association with knowledge (χ2=371.471, p<0.001). Conclusion: MBBS students had better knowledge than paramedic students. Higher knowledge is linked to positive attitude towards eye donation. The practice pattern regarding pledging is poor in all the students. Thus, structured eye donation awareness programmes targeting medical and paramedical students are recommended. Keywords: Eye Donation; Medical students; Corneal Blindness; Corneal Transplant; Awareness.

Background: Maternal near-miss known as severe maternal morbidity provides valuable information on obstetric care, hence allowing corrective action to be taken on the identified problems to reduce related morbidity and mortality. This study was conducted aiming to evaluate the maternal near-miss among women in a public tertiary hospital in Klang Valley, Malaysia. Material and Methods: A retrospective study was conducted for two years (from January 2010 until December 2011). Data were retrieved from the labour room and intensive care registry using the World Health Organization (WHO) near-miss evaluation tools based on clinical and management criteria. Results: There were 18 676 deliveries and 18531 live births with 160 near-miss cases and five maternal deaths during the study period. The prevalence of maternal near-miss morbidity was 0.86%, making maternal near-miss Ratio (MNMR) of 8.6 cases per 1,000 live births. Meanwhile, the Maternal Mortality Ratio (MMR) of 27/100 000 live births, the maternal near-miss mortality ratio (MNMMR) obtained was 32:1 and a relatively low mortality index of 3.03%. Hypertensive disorder (61.2%) and major obstetric haemorrhage (30.0%) were the two main causes of maternal near-miss morbidities followed by ICU admissions (20.6%). The hypertensive disorder primarily severe pre-eclampsia was found significantly associated with ICU utilisation (p=0.001). Conclusion: The quality of obstetric care received by maternal near-miss patients in urban Malaysia was optimal with a relatively low mortality index and comparable prevalence of maternal near-miss and mortality worldwide. Hypertensive disorders and obstetrics haemorrhage are the most common maternal morbidities in Malaysia. On top of that, sepsis is also an essential entity that needs to be emphasised in the future. Key words: Obstetrics near-miss, Maternal near-miss, Maternal Health, Maternal Mortalities, Severe Maternal Morbidity.

Background: Otitis media with effusion (OME) is a common childhood otological condition. The middle ear effusion is mucoid or seromucinous in nature, but not purulent. The condition lasts for at least 3 months; this sets it apart from persistent effusion after acute otitis media, which disappears after 2 months in 90% of cases. OME has a high prevalence in children and is responsible for most of the hearing losses in school going age group (5-12 years). Most cases of OME are relatively asymptomatic with nearly 25% discovered incidentally. Despite this apparent absence of symptoms, the potential impact on hearing, speech, language and cognition highlights the need for timely intervention. Aim: To estimate the risk factors associated with OME and to detect different types of microorganisms in the middle ear fluid of children with OME. Materials and Methods: A cross-sectional study was conducted on 458 children presenting with features of OME. A questionnaire was used to determine the risk factors for OME among these children. Otoscopy and tympanometry were used to diagnose and confirm OME. The pure tone average for children with OME was measured. Assessment of risk factors were done in all children. Myringotomy was performed in children with obvious fluid in the middle ear and a sample was sent for culture and sensitivity. Results: OME was highly linked with age less than 9 years in univariate analysis. The mean age of the sample was 8.71 years with the median age being 2.5 years. There are several risk factors related to OME, with nasal allergies (22.9%) and adenoid hypertrophy (22.9%) being the most prevalent. Middle ear fluid was sterile in 74.7% cases whereas 9% of the samples showed Streptococcus pneumoniae & Haemophilus influenzae as the microorganism. Conclusion: Nasal allergies and adenoid hypertrophy were the most common risk factors of OME in children less than 18 years. Otoscopy, tympanometry and pure tone audiometry should be used as screening tools for OME. Middle ear fluid was sterile in majority of cases and hence routine use of antibiotics for treatment of these cases is not recommended. Keywords: Adenoid hypertrophy, Otitis media with effusion, Serous otitis media, Tympanometry.

Background: Home-based prophylaxis is recommended for optimal management of hemophilia. However, barriers limit its implementation in developing countries like India. This study aimed to identify barriers to home therapy in India. Materials and Methods: A qualitative study was conducted through interviews of 20 participants including persons with hemophilia, caregivers, healthcare workers and volunteers. Participants were randomly selected and interviewed using a semi-structured guide. Data was analysed thematically to identify barriers. Results: Four major categories of barriers emerged - technical expertise in self-infusion, logistical challenges of home care, lack of motivation among patients and caregivers, and inadequate advocacy efforts. Difficulties finding veins, fear of improper injection, issues maintaining cold chain, and reluctance to start therapy due to complexity were reported. Discussion: Barriers identified align with previous studies from other developing nations. Addressing skills-training, logistics, motivation and advocacy through targeted interventions like enhanced education, counselling and community engagement can help optimize home therapy uptake. Conclusion: The study provides guidance on key barriers preventing optimal home prophylaxis in India to inform development of context-specific solutions. Keywords: Hemophilia, home therapy, prophylaxis, barriers, qualitative research.

Post-traumatic stress disorder (PTSD) is a frequent psychiatric complication in patients with Compound fractures. The purpose of this study was to determine the prevalence and risk factors of PTSD in patients with Compound fractures. A cross-sectional study was conducted in a Tertiary care hospital in India. Consenting patients with Compound fractures, aged 18 years to 70 years, were administered clinician administered PTSD scale (CAPS-5) pre and post operatively upto 6-month period. 109 patients were recruited for the study over 2 years. The prevalence of PTSD was 16.5% (18 of 109 patients). Factors increasing the risk of PTSD were Motor vehicle collision, Poly trauma, Higher VAS scale for pain. Keywords: PTSD, Compound fractures, prevalence, risk factors.

Background: Screen-time is the amount of time a person spends in front of an electronic/digital device such as television, a smartphone, a tablet or a computer. Objective: To study the impact of screen timeon children’s mental and physical health. Materials and Methods: This cross-sectional study was carried out in the Pediatric Outpatient Department to examine screen habits in 280 children between the ages of 1 and 5 years. Results: The study population had a mean age of 40.9 months, with females making up 63.57% of the participants and males accounting for 36.4%. A majority of the study participants belonged to the lower middle-class category, comprising 44.6% of the sample. Older children (48 - 60 months) exhibited higher levels of electronic media exposure compared to younger age groups (12-24 months) (p< 0.001). Minimal high media exposure time was observed in males compared to females (p=0.048). Conclusion: The most commonly used electronic media devices in the population were smartphones (95.7%) and televisions (98.5%). On average, families had 3.37 ± 0.79 electronic media devices. Higher electronic media exposure was noted in the upper and upper-middle socioeconomic groups compared to other socioeconomic categories (p<0.001). Keywords: Screen Time, Neurodevelopment, Sleep, Behavior and Health, Children Aged 1-5 Years.

Background: Thalassemia is a genetic blood disorder in children that results in the production of abnormal hemoglobin, leading to severe anemia and the need for frequent blood transfusions. Without proper management, these transfusions can cause iron overload in the body, which can damage vital organs such as the heart and liver. Therapy with oral iron chelators is crucial for these children, as it helps to remove the excess iron and prevent potential complications. The aim of this study was to assess and compare the effectiveness and safety of oral iron chelators, both when administered alone and in combination, in children with thalassemia who receive several blood transfusions. Materials and Methods: The study was carried out in the Department of Pediatrics, Sri Balaji Medical College and Hospital, over a period of ¬¬¬¬24 months. The study included 75 children with thalassemia who had undergone several transfusions and were receiving daily treatment with iron chelation. Results: The current study included 75 children with thalassemia who had received multiple blood transfusions. For duration of 12 months, they received daily iron chelation therapy with either deferiprone alone (Group 1), deferasirox alone (Group 2), or a combination of the two (Group 3). The serum ferritin levels were found to be reduced in all 3 groups, however the difference was not significant. The hepatic T2- MRI values had increased from baseline to follo-up, however the difference was significant only in Group 3. The reduction of cardiac T2* MRI value was significantly reduced in Group 3 from baseline to follow-up. Conclusion: This study concluded that deferiprone and deferasirox were effective and safe when administered alone in children with thalassemia who had received several transfusions. Keywords: Children, thalassemia, safety, innovative combination, and comparative efficacy.

Background: When an alpha 2 adrenergic agonist and a local anesthetic are coupled, the analgesic effect's quality and endurance are enhanced. While clonidine's effects on local anesthetics have been thoroughly investigated, there aren't many studies that show how epidural dexmedetomidine affects the same. Materials and Methods: The patients were randomly assigned to two groups, one receiving ropivacaine with clonidine (RC) and the other receiving ropivacaine with dexmedetomidine (RD), Group RC was administered 15 ml of 0.75% ropivacaine with 1 microgram per kilogram of clonidine, while group RD was given 15 ml of 0.75% ropivacaine with 1 microgram per kilogram of dexmedetomidine epidurally. Results: The dexmedetomidine group showed significantly improved start (RD-7.53 ± 1.81, RC-10.93 ± 1.96) and duration (RD-317 ± 29.5, RC-285 ± 37) of sensory blockade sedation. Hemodynamic alterations and the start of motor blockage did not differ significantly. Conclusion: Similar to clonidine, dexmedetomidine works as an efficient adjuvant to ropivacaine for epidural anesthesia at doses of 1 ⃬g/kg. Keywords: Clonidine, dexmedetomidine, epidural, ropivacaine.

Background: Road traffic accidents (RTA) are major causes for morbidity, mortality and disability among all age group and people of all socioeconomic status. Considering the increased number of people using motorized vehicle leading to rise in road traffic accidents, our cross-sectional study conducted in a tertiary care hospital in northern Karnataka, India Materials and Methods: A pre-designed semi-structured questionnaire for duration of six months aimed to study the socio demographic profile of road traffic injury victims, to find the antecedent factors influencing the road traffic accidents and also to study the pattern of injury in victims. Results: Total of 516 patients were included in the study. In our study we have found that human error is the most common factor responsible for accident 43.4% followed by drunk and drive 30.6% and most of the accidents occurred in highway 21.1% and drivers are most commonly the victims of accident 69.2%. We have also found that skid is the most common manner of accident. It is very alarming to see that only 33.7% of the participants had valid driving licence. Also, among the people who rode two-wheeler only 7% wore helmet and among persons who drew four-wheeler only 10% wore seat belt. Conclusion: Most participants were male (86%), mostly from rural areas (70.3%), and lived with their families (88%). The findings highlight the need for better road safety measures, stricter traffic regulations, increased public awareness, and improved infrastructure to reduce road traffic accidents. Keywords: Road traffic accidents, Causes, Risk factors, Human error, Drivers.

Background: Women of reproductive age play a crucial role in determining maternal and child health, yet they face significant health challenges such as iron deficiency anemia (IDA) and the double burden of malnutrition. The present study aimed to assess the effect of positive attitudes, subjective norms, perceived behaviour control, and intentions of mothers (15-49 years) on their dietary intake in two districts of India. Materials and Methods: A cross-sectional study was conducted in South-West Delhi and Gurugram, India, among mothers aged 15-49 years. A total of 337 women per district were surveyed using systematic random sampling. Data were collected on socio-economic profiles, healthy eating intentions, and dietary diversity through a semi-structured questionnaire. The dietary diversity score was calculated based on the consumption of at least five out of ten food groups in the past 24 hours. The study employed generalized linear regression models to assess the effects of positive attitude, subjective norms, intentions, and perceived behavioural control on dietary intake, adjusting for age, income, social class, and education. Results: The median age of mothers was 26 years, with a median monthly income of INR 15,000. About 15% of mothers had a dietary diversity score of less than five. All the parameters (positive attitudes, subjective norms, intentions) had positive correlation with dietary intake. There was a 0.19-point increase in the dietary diversity score per one-unit increase in the intentions of the mothers. Conclusion: The study highlights the importance of perceived behavioural control, positive attitudes, subjective norms, and intentions in influencing the dietary intake of mothers. These results highlight the importance of understanding the influence of social and behavioural factors on dietary practices to design effective nutritional interventions and policies. Keywords: Dietary habits, Nutritional status, Behavior, Intentions.

Background: Diabetes mellitus (DM) poses a significant public health challenge in the twenty-first century. With an estimated global prevalence of 537 million in 2021, this figure is expected to rise dramatically. India ranks second after China in the global diabetes epidemic, with millions remaining undiagnosed for years. Lack of awareness, particularly in regions with low socioeconomic status and limited access to quality education, exacerbates the problem, often leading to complications such as retinopathy, nephropathy, and neuropathy. Aim: This study aims to assess the level of awareness and knowledge about DM and its complications, treatment options, lifestyle modifications, and self-monitoring among diabetic patients in Puri, Odisha. Materials and Methods: A hospital-based cross-sectional study was conducted at Shri Jagannath Medical College and Hospital, Puri, Odisha, from August 15 to October 15, 2022. A total of 211 patients with a prior diagnosis of DM participated. Data were collected using a structured questionnaire covering demographic information, knowledge, and awareness of DM. Analysis was performed using SPSS version 22.0, with categorical data presented as percentages and frequencies, and the mean age of diabetes onset expressed as mean ± standard deviation. Results: The study included 211 patients, predominantly aged 51-60 years (24%), with a mean age of 53.3 ± 16.4 years. The prevalence of diabetes was higher in males (55.5%) than females (44.5%). Most participants were from rural areas (59%). Educational levels varied, with 32% having completed high school, 27% middle school, 25% illiterate, and 16% graduates. Regarding awareness, 84% knew diabetes involves elevated blood sugar levels, and 79% recognized common symptoms. However, only 41% were aware of diabetes complications, and 18% knew hypoglycemia symptoms. Discussion: Despite recognizing symptoms and understanding basic disease mechanisms, patients' knowledge about complications and treatment options was limited. Many patients held misconceptions about the disease, including the belief that diabetes could be permanently cured (67%) and that it is caused by excessive sugar intake (84%). These misconceptions highlight the need for better education and awareness programs. Conclusion: The study reveals a significant lack of knowledge and awareness about DM among patients in Puri, Odisha. Misconceptions about the disease and a shift towards alternative medications pose risks for severe complications. There is an urgent need for community-based awareness campaigns and educational initiatives to promote early diagnosis and effective management of diabetes. Keywords: Diabetes mellitus, awareness, knowledge, complications, treatment, lifestyle modifications, Hospital based.

Background: Endometriosis is a chronic estrogen dependent condition involving deposition of ectopic endometrial-like tissue, typically on the ovaries, pelvic peritoneum, and sometimes extra-pelvic regions. Despite being one of the common causes of infertility, endometriosis often remains underdiagnosed and imposes considerable emotional and financial burdens on those affected. Materials and Methods: 80 patients presented to the OPD of Department of Obstetrics and Gynaecology of Shadan Institute of Medical Science, over 12 months period, i.e., from January 2023 to December 2023. Results: The prevalence of endometriosis in present study was 35%. Most of the patients with endometriosis belonged to the age group of 31-40 years. Ovaries, followed by Pouch of Douglas were the most common sites of endometrial implants. Most of the patients had Stage III (moderate) endometriosis. Out of 28 patients, 26 patients underwent laparoscopic ablation and 2 were on conservative treatment. 16 patients reported successful pregnancies after treatment (20%). Conclusion: The study concludes that early detection and management of endometriosis is associated with higher rates of successful conceptions. Keywords: Endometriosis, infertility, adhesions, tubal blocks.

Background: Preterm rupture of membranes (PROM) refers to the breaking of the amniotic sac and leaking of amniotic fluid before labor begins, specifically before 37 weeks of gestation in the case of preterm PROM (PPROM). This condition is associated with several adverse maternal and neonatal outcomes, including infection, preterm birth, and complications related to prematurity. High vaginal swab culture (HVSC) is a diagnostic procedure used to detect and identify microorganisms in the vaginal flora. Owing to the scarce literature on the relationship between HVSC results and feto-maternal outcomes following PROM, this study was conducted to evaluate the same. Materials and Methods: 100 antenatal women who presented to the Labour room in the Department of Obstetrics and Gynaecology, Shadan Institute of Medical Sciences with PPROM and PROM, over 18 months, i.e. from 1st July 2022 to 30th November 2023, were studied. Results: most of the women belonged to 20-30 years of age group. 30% of women had a positive result for high vaginal swab (HVS) culture and sensitivity. The most common organism isolated in present study was E.coli, followed by Klebsiella. Most of the neonates had normal birth weight. 30% of the neonates required NICU admission. Conclusion: Premature rupture of fetal membranes is associated with increased risk of intrauterine infection, and it has been one of the most common causes of perinatal deaths and NICU admissions. Keywords: Preterm rupture of membranes, high vaginal swab, vaginal flora, neonatal sepsis, neonatal NICU.

Background: The study aims to assess the heart rate variability in non-dialysis chronic kidney disease patients. Materials and Methods: This was a cross-sectional study, carried out in the Department of Physiology, Dr RMLIMS, Lucknow. 102 patients in the age group of 30-60 years, having chronic kidney disease but not on dialysis were taken from the OPD of Nephrology. Samples were collected and serum was analyzed for lab parameters like creatinine, and blood urea. eGFR was calculated. HRV of the patient was done in the physiology department. Results: A total of 102 patients fulfilling both criteria were enrolled in the study. The mean age was 45.44±11.13 years. Males constituted of 65.7% of the study population, while female were mere 34.3%. In terms of Blood pressure, SBP and DBP of the study population were 140.92±20.75 mmHg and 82.32±15.13 mmHg. Respiratory rate was 14.28±2.56 breaths per minute. At the first visit, kidney function was accessed using Urea, Creatinine, and eGFR and was recorded as 67.78±33.97 mg/dL, 2.82±1.73 mg/dL, and 36.35±24.58 respectively. Majority of the patients had reduced HRV (73.5%), while the remaining had HRV within the normal range (26.5%). Conclusion: HRV, a non-invasive tool can be used for assessment of autonomic dysfunction in chronic kidney disease who are not on dialysis. Lower HRV has been associated with adverse outcomes in end-stage renal disease (ESRD). Hence the estimation of LF/HF can provide prognostic information on CKD progression and in its management. Keywords: Creatinine, Urea, Heart Rate Variability, Estimated Glomerular Filtration Rate, Chronic Kidney Disease.

Background: Hospital-acquired infections (HAIs) are a significant concern in intensive care units (ICUs), leading to increased morbidity, mortality, and healthcare costs. This study aims to determine the incidence, types, risk factors, and outcomes of HAIs in the ICUs. Materials and Methods: A prospective observational study was conducted, including 100 patients admitted to the ICUs for more than 48 hours. Data on patient demographics, clinical details, and infection monitoring were collected. Statistical analysis, including univariate and multivariate methods, was used to identify risk factors for HAIs. Results: The incidence of HAIs was 30%, with Ventilator-Associated Pneumonia (VAP) being the most common (40%). Other infections included Catheter-Associated Urinary Tract Infections (CAUTIs) (30%), Central Line-Associated Bloodstream Infections (CLABSIs) (20%), and Surgical Site Infections (SSIs) (5%). Significant risk factors for HAIs included prolonged ICU stay (p = 0.02), use of invasive devices (p = 0.01), broad-spectrum antibiotic use (p = 0.03), and comorbidities (p = 0.04). Patients with HAIs had longer ICU stays (15 vs. 8 days, p = 0.01), higher mortality rates (25% vs. 10%, p = 0.03), and more complications (30% vs. 5%, p = 0.02). Conclusion: The study highlights a high incidence of HAIs in ICUs, with significant impacts on patient outcomes. Targeted interventions and stringent infection control measures are essential to mitigate these infections. Keywords: Hospital-acquired infections, Intensive care units, Ventilator-associated pneumonia, Risk factors, Outcomes, Infection control.

Background: Peripheral arterial disease (PAD) generally occurs as a result of progressive narrowing of arteries within the lower extremities and is a manifestation of systemic atherosclerosis. We define PAD with the aid of using the dimension ankle-brachial index (ABI) which is the most accurate tool and determination of ABI is a simple non-invasive procedure that can be easily performed on an outpatient basis. The cut-off point for diagnosis of peripheral arterial disease (PAD) & cardiovascular risk is ABI ≤ 0.90 or ≥ 1.30. Materials and Methods: This cross sectional study involves 47 newly diagnosed hypertensive patients of age between 30-50 years. Anthropometric measurements and ABI of all the patients were done in the research lab of the Physiology department. The ABI measurements were performed by using an automated oscillometric device (Watch BP Office, Microlife, Widnau, Switzerland). In this procedure, the blood pressure was measured simultaneously on both arms followed by both ankles in the supine position. Results: In our study out of 47 patients, 31 (66.0%) were male and 16 (34.0%) were female of mean age 43.79±6.82 years. The prevalence of deranged ABI in the present study was 10.64% according to Right ABI, while it was 6.38% according to Left ABI. A significant correlation was found for ABI in the Right ankle with SBP in the right upper limb (P=0.013) & both right and left lower limb (P˂0.001 & P=0.028 respectively), while a significant correlation was also found for Left ABI with SBP in both right and left upper limbs (P=0.007 & P=0.003 respectively). We also found that 29.8% of the subjects have a low normal value of ABI (i.e., between 0.9-1.1), this is significant, even in asymptomatic patients, for Peripheral Arterial Disease (PAD). Conclusion: So we can conclude that in newly diagnosed hypertensive patients, ABI are valuable tools for early detection of cardiovascular damage. By identifying subclinical changes before symptoms arise, healthcare providers can implement early, targeted interventions to manage hypertension more effectively and reduce the risk of long-term complications. Keywords: Ankle brachial index, newly diagnosed hypertensive patients, peripheral arterial disease.

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. It is characterized by dopamine deficiency which leads to classical motor dysfunctions. In addition, Parkinson’s disease may include several non-motor impairments, including autonomic and cardiovascular dysfunction. At present clinical diagnostic criteria for Parkinson’s disease are exclusively based on motor symptoms and the treatment for Parkinson’s disease mainly improves motor symptoms. Non motor symptoms, especially autonomic symptoms are still under recognized in clinical practice. The current study aimed to evaluate these autonomic functions by using Heart Rate Variability (HRV) and Composite Autonomic Symptom Score 31 questionnaire (COMPASS 31). Materials and Methods: This cross-sectional study included 137 diagnosed cases of PD. The resting autonomic balance was assessed by HRV test which included frequency domain indices, time domain indices and nonlinear parameters. Non motor symptoms were assessed by using COMPASS 31 questionnaire which evaluated six domains namely orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder and pupillomotor domains. The six domain scores sum to a total score of 0 to 100 with a higher score indicating more severe autonomic symptoms. Results: The participants showed a sympathetic overdrive on assessing with HRV. Among the non-motor symptoms gastrointestinal symptoms were the most common symptoms (95.62%) in Parkinson’s disease patients. Subsequently there was involvement of secretomotor (85.4%), bladder symptoms (71.53%), pupillomotor symptoms (52.55%), orthostatic intolerance symptoms (50.36%) and vasomotor symptoms (13.14%) on evaluating autonomic functions by COMPASS 31 questionnaire. A statistically significant correlation was observed between HF (ms2) and COMPASS 31 questionnaire (p<0.05). Conclusion: The autonomic function tests can be used as a screening tool in outpatient department of Neurology. This could reduce the morbidity of Parkinson’s disease patients as we employ these autonomic function tests as an early intervention for Parkinson’s disease. COMPASS 31 questionnaire can be used in health care centres for early detection of neurodegenerative disorders like Parkinson’s disease which could prevent the disease progression and aid in early treatment plan. Keywords: Parkinson’s disease, neurodegenerative disorder, autonomic function test, HRV, COMPASS 31 questionnaire.

Background: Intercondylar humerus fractures significantly impact patients' quality of life, with traditional treatment methods often resulting in prolonged immobilization and suboptimal recovery. Orthogonal plating has emerged as a technique that may offer enhanced stability, potentially allowing for earlier mobilization and improved outcomes. Material and Methods: A retrospective and prospective analysis was conducted at Indira Gandhi Medical College, Shimla, involving 22 patients with intercondylar humerus fractures treated with orthogonal plating. This study aimed to assess the impact of early mobilization on functional recovery, analyzing range of motion, Mayo Elbow Performance Score (MEPS), and persistent pain at final follow-up. Results: Early mobilization following orthogonal plating showed significant improvements in functional outcomes. The majority of patients (59.1%) achieved a range of motion between 80-100 degrees, and 50.0% reported good MEPS scores. Pain levels were predominantly mild, with 50% of patients reporting no pain at final follow-up. The interval between injury and surgery was inversely related to pain and directly correlated with range of motion and MEPS scores, highlighting the benefits of early surgical intervention and rehabilitation. Conclusion: Orthogonal plating, combined with early mobilization, significantly optimizes functional recovery in patients with intercondylar humerus fractures. This study supports the adoption of early mobilization protocols to enhance the quality of patient outcomes. Keywords: Intercondylar humerus fractures, orthogonal plating, early mobilization, functional recovery, rehabilitation strategies.

Background: Malleolar fractures are one of the most common fractures in orthopedic traumatology. Treatment of these fractures is complicated and challenging as the outcome influences the locomotion; inadequate and improper treatment may result in long-term orthopedic complications and disability. The purpose of this study is to analyze the factors influencing the outcome of operative management of malleolar fractures. Material & Methods: A hospital based prospective study done on twenty patients with malleolar fractures of ankle presenting in department of orthopaedics at JLNMC, Ajmer, Rajasthan, India during one-year period were operated with open reduction and internal fixation by various methods. All patients were assessed clinically, radiologically. The stability of the structures involved at the fracture site, damage to the neighboring structures, mechanism of injury was assessed. Radiologically, tibiofibular clear space of >2 mm and widening of the medial clear space of >2 mm were considered as indicators of syndesmotic instability. Follow-up of cases was done at regular intervals of 6 weeks for a minimum of 6 months and assessed using Biard and Jackson’s ankle scoring system. Results: Out of 20 there were 15 males and 5 females, in 12 patients (60 %) right ankle was involved and in 8 patients (40%) it was left ankle. Functional outcome was assessed using Biard and Jackson’s ankle scoring system at follow-up. 12 (60.0%) showed excellent functional score, while 5 (25%) had good score. Two patients showed fair and one patient showed poor outcome due to infection. Pain was the common complaint in 11 (55%) patients of whom 10 patients had Grade B, i.e., pain with strenuous activities and only one patient had mild pain with activities of daily living. None of the patients had clinical instability. Conclusion: We conclude that anatomical reduction is essential in all malleolar fractures of ankle as it is a weight bearing joint. Open reduction and internal fixation guaranty high standard of reduction besides eliminating the chances of loss of reduction. Keywords: Malleolar Fracture, Open Reduction, Internal Fixation, Functional Outcome, Ankle Joint.

Background: The dermatologic diseases of the external ear draw the attention of various medical specialists, including dermatologists, otorhinolaryngologists, general practitioners, and general and plastic surgeons. The present study was conducted for assessing skin diseases of external ear to older adults. Materials and Methods: This observational study examined 100 patients with external ear lesions. Clinical data including patient age, gender, lesion location, and types of dermatologic disease were extracted from patient medical records. Data analysis was done using SSPS-22 software. Results: In terms of lesion distribution, the majority of lesions were found in the earlobe (26, 26%), followed by postauricular lesions (33, 33%). Helix, concha, tragus, crus of helix, antihelix, and triangular fossa accounted for 18%, 7%, 5%, 5%, 3%, and 3% of the lesions respectively. Regarding disease distribution, the most prevalent condition was benign tumor, accounting for 52% of cases, followed by infectious disease (20%). Premalignant disease and malignant tumor were reported in 6% and 18% of cases, respectively, while non-infectious diseases accounted for 4% of the cases. Conclusion: A significant number of older adults presented with premalignant and malignant diseases, predominantly affecting the antihelix and post auricular region. Keywords: External ear; Skin.

Background: The aim of this study is to determine the clinical profile and imaging features of the pediatric acquired demyelinating disorders of the central nervous system. Materials and Methods: One-year hospital based cross sectional study was done in Department of Radio-diagnosis from January 2021- December 2021. 30 pediatric patients clinically suspected of having demyelination disease were included in the study. The patients were subjected to MRI brain and spine scan. The study population were analysed based on age, gender, clinical history, abnormalities on MRI brain, optic nerve & spine imaging. Results: Among ADEM on follow up scan complete resolution was seen in 50.00 % cases with minor residuals in 6.25% and no follow up scan was done for 43.75% participants. Among MOGAD on follow up scan, complete resolution was seen in 28.57 % cases but minor & moderate residuals were seen in 14.29% cases each (1) and no follow up scan was done for 3 (42.86 %) participants. Among NMOSD on follow up scan 42.86 % (3) cases showed minor residuals and14.29% (1) showed complete resolution. No follow up scan was done for in 3 (42.86 %) participants. Conclusion: In our study, the majority (43.33%) were aged between 7 to 12 years with mild female predominance. The most common diagnosis was ADEM (53.33%) followed by equal distribution of MOGAD & NMOSD. ADEM cases showed lesions in bilateral cerebral hemispheres in an asymmetric distribution with predominant supratentorial brain involvement and majority of the cases showed large lesions. In MOGAD cases, brain parenchyma showed predominantly large lesions in supratentorial distribution. Spinal cord lesion was predominantly LETM with statistically significant involvement of the lumbar spinal cord. In NMOSD cases, statistically significant association was seen with area postrema syndrome and periaqueductal grey matter & area postrema lesions on MRI brain. Spinal cord lesions in NMOSD was predominantly LETM with involvement of the cervical and thoracic spinal cord involvement. Keywords: Pediatric demyelinating disorder, MRI, ADEM, NMOSD, MOGAD.

Background: Nosocomial infections significantly contribute to morbidity and mortality in hospital settings specially by drug resistant bugs. The Methicillin-resistant Staphylococcus Aureus (MRSA) appears to be one of those notorious bacteria. MRSA spreads through contact between healthcare workers (HCWs) and patients. Essential accessories such as stethoscopes, mobile phones, wristwatches, spectacles, and pens are frequently used by HCWs. This study aims to monitor these items for the detection of multidrug-resistant species specially MRSA in a tertiary care center. Materials and Methods: This study was conducted in healthcare workers of 5 different ICUs and 5 Wards in a tertiary care centre north India. A total of 60 healthcare workers participated in the study, with 168 objects including stethoscopes, mobiles, wristwatches, Spectacles, Pen and Vanity Bag being examined. Results: This study found that MRSA and Methicillin-resistant coagulase negative Staphylococcus (MR-CONS) were present in 24.30% of and17.10% of ICU doctor objects respectively and 19.20% and 26.90% in ward doctor objects respectively. For nurse’s objects, 11.70% of MRSA was found in ICUs and 11.10% in wards. No MR-CONS was found in ICU nurse objects, but 22.20% was found in ward nurse objects. This study also found 8.57% of MRSA was present in ICU worker objects and 10% in ward worker’s objects.28.5% MR-CONS was found in ICU worker’s objects, but 20% was found in ward worker’s objects. Conclusion: This study concludes that the significant bacterial contamination present on inanimate objects used by healthcare workers. Implementing stringent hygiene practices of frequently used devices can help reduce the risk of infection transmission within healthcare environments. Keywords: Nosocomial infections, Health‑care workers, multidrug resistance, Staphylococcus spp.

Background: Neonatal seizures, characterized by abnormal electrical activity in the brain, represent a prevalent and distinctly identifiable clinical manifestation indicative of dysfunction within the central nervous system of newborns. The primary objective of this comprehensive study is to employ rigorous and standardized clinical criteria to accurately diagnose neonatal convulsions. Additionally, this study aims to meticulously evaluate the concomitant presence of any underlying biochemical abnormalities that may contribute to or result from the seizure activity. Materials and Methods: This prospective study was conducted over a one-year period, including 75 neonates who presented with seizures to the casualty. Results: In present study, males were predominantly affected. Most of the patients had institutional delivery. Term gestation and normal vaginal delivery were most common. Majority of the babies were appropriate for gestational age and weighed >2.5kg. Tonic seizures were the most common type followed by clonic seizures. Hypoglycaemia was the most common metabolic abnormality. Conclusion: Biochemical abnormalities are frequently observed in neonates presenting with seizures, contributing to the underlying etiology in a significant number of cases. These abnormalities include electrolyte imbalances, hypoglycemia, and metabolic disorders. Early identification and management of these biochemical disturbances are crucial for improving the prognosis and preventing long-term neurological sequelae. Keywords: neonatal seizures, hypoglycaemia, tonic clonic, hyponatremia, and hypocalcemia.

Aim: Preterm delivery is a significant contributor to perinatal morbidity and mortality, prompting numerous studies to explore the associations between maternal lipid levels during pregnancy and the risk of preterm birth. Consequently, the present study aims to evaluate the potential of serum cholesterol levels as an indicator of preterm delivery. Materials & Methods: A total of 100 subjects were enrolled. Complete demographic and clinical details of all the subjects was obtained. Only those subjects were included which had gestational age of between 14 weeks to 20 weeks. All the results were analyzed using SPSS software. Univariate analysis was done using SPSS software. Results: A total of 100 subjects were enrolled. Among these 100 subjects, preterm delivery was seen in 21 percent of the patients while in term delivery was seen in 79 percent of the patients. Mean serum cholesterol levels among preterm and term delivery was 298 mg/dl and 214.9 mg/dl respectively. Mean serum cholesterol levels were significantly higher among patients with preterm delivery. Conclusion: Preterm delivery is linked to higher levels of cholesterol in the maternal serum. Keywords: Cholesterol, Labor, Pregnancy.

Background: Stroke, the second leading cause of death globally, predominantly manifests as ischemic stroke. This review synthesizes current evidence on blood-based protein biomarkers for diagnosing ischemic stroke, aiming to enhance early detection and treatment strategies. Materials and Methods: Adhering to PRISMA guidelines, we systematically searched PubMed, Cochrane, Embase, and Web of Science databases for studies published up to 2024, focusing on blood-based protein biomarkers in ischemic stroke diagnosis. Quality assessment and data extraction were meticulously performed, emphasizing biomarker sensitivity, specificity, and diagnostic value. Results: Our review included 190 studies, highlighting several promising biomarkers such as GFAP, and S100B for their diagnostic accuracy in distinguishing ischemic stroke from other stroke types and healthy controls. Conclusion: Blood-based protein biomarkers demonstrate significant promise for early and accurate ischemic stroke diagnosis. Their integration into clinical practice could revolutionize stroke management, offering a non-invasive, rapid diagnostic tool. However, further large-scale studies are necessary to validate these findings and establish standardized protocols for their clinical application. Keywords: Ischemic stroke, Biomarkers, Protein biomarkers, Stroke diagnosis, Acute Stroke, Neurological Biomarkers, Predictive value of tests, early diagnosis.

Background: Prompt diagnosis and treatment are crucial to prevent long-term disabilities in Monteggia fracture. Treatment varies from closed reduction in children to open reduction and internal fixation in adults. Objectives: The study aims to analyse outcomes and complications across Bado classifications. Material and Methods: Retrospective analysis of 43 Monteggia fracture cases from July 2022 to December 2023 included demographic data, injury mechanisms, surgical details, and follow-up evaluations up to 9 months. Parameters assessed included m-DASH scores, complications, and functional outcomes. Results: Out of 43 patients we got 22, 16, 3 and 2 patients’ with Bado type 1,2,3 and 4 respectively. The m-DASH score at 9 months showed better functional outcome in Type 1 and Type 2 Bado classification patient as compared to Type 3 and Type 4 patient. Conclusions: Timely surgical intervention and individualized approaches are critical for managing Monteggia fractures. Anatomical reduction, implant selection, and complications are essential for optimizing patient outcomes and minimizing long-term disabilities. Keywords: Monteggia fracture, PIN palsy, open reduction, observational, Non-union.

Background: Aim: This research is aimed at the measurement of the functional and radiological out-come of the subjects surgically treated for posterior malleolus fracture. Materials and Methods: The present study includes Adults (age group 18-60 years old) admitted with ankle fractures involving posterior malleolus who have undergone surgical management will be recruited into the study. King George Hospital, Visakhapatnam, AP. Results: In the present study, 40 subjects were added up in to the study, of which 27 being male & 13 female patients. Among the 40 patients 31 sustained injury due to a road traffic accident and 9 due to an accidental fall from height. All the patients were initially investigated with x-rays and CT scans and classified according to Bartonicek classification. All patients were treated surgically & the posterior-malleolus was surgically treated with a buttress-plate or a CC-screw applied either anterior-to-posterior or posterior-to-anterior fashion. The subject reassessment was performed at 4th wk, 6th wk, 12th wk. Also, at 6 months and were assessed clinically by AOFAS score and radiologically using Kristenson criteria. l According to Kristenson grading 32 patients had good out come and 8 patients had fair outcome. According to AOSAF grading 12 patients had excellent out-come while 6 patients had fair outcome and 22 had good out-come functionally. 6 patients had post-operative stiffness while 4 had hardware related soft tissue irritation,2 had deep infection and 2 patients had wound dehiscence. Conclusion: In conclusion, the patients treated operatively for posterior malleolus fracture had excellent to good radiological and functional out-come. The patients who had some degree of ankle stiffness were either due to poor mobilization and physiotherapy either due to deep infection or hardware irritation. Keywords: Malleolus fracture, AOSAF, Radiological, Kristenson criteria, Functional outcome.

Background: The leading cause of death and reduction in years of life with a handicap globally is ischemic heart disease. The mortality rate is greatly decreased when patients with acute myocardial infarction are identified and treated promptly. Cardiovascular biomarkers do play a significant role in the early diagnosis and treatment of patients with ACS, in addition to ECG and other clinical characteristics. Serum Ischemia Modified Albumin (IMA) should be measured within 6 hours of the onset of chest pain, and its results should be correlated with LDH, CK-MB, TGL, T-CHOL, HDL, LDL, and VLDL. Materials and Methods: The INDEX Medical College and Hospital Department of Biochemistry has undertaken this study. One hundred patients with acute coronary syndrome symptoms were included as subjects in the causality study. Their ECG results were correlated and were presented within six hours of the onset of discomfort. One hundred controls, matched for age and sex, served as the control group. Lipid profile, CKMB, LDH, SGOT, and IMA (ACB test) estimation were performed on blood samples. Results: The control and study groups' respective mean IMA values were 36.98±15.7 and 114.87±16.63. Ischemia altered albumin's substantial association with CK-MB, lipid profile, and LDH was demonstrated by Pearson's correlation. Conclusion: The current study's results support earlier research that found the Albumin Cobalt colorimetric assay can discriminate myocardial ischemia patients from non-ischemic patients (p<0.001). The IMA assay offers a quantitative, precise laboratory method for determining the occurrence of an ischemic myocardial event, which includes different kinds of angina. Acute Coronary Syndrome is diagnosed in individuals with continuous myocardial ischemia in the emergency department by measuring modified albumin levels. The diagnostic sensitivity of the procedure is increased by measuring IMA in addition to ECG and other indicators. Keywords: Acute coronary syndrome, IMA, LDH, CPKMB & SGOT.

Background: Chronic non-communicable diseases are assuming greater importance among the adults in both developed and developing countries. The prevalence of chronic disease is showing an upward trend in most countries, and for several reasons this trend is likely to increase. In India, there are estimated 77 million people above the age of 18 years are suffering from diabetes (type 2) and nearly 25 million are prediabetics. More than 50% of people are unaware of their diabetic status which leads to health complications if not detected and treated early. Madras Diabetes Research Foundation (MDRF, Chennai) developed the Indian Diabetes Risk Score (IDRS) as a simple tool to help detect undiagnosed T2DM in the community. Present study was done using MDRF-IDRS to find subjects at high risk of developing Type 2 Diabetes Mellitus. Materials and Methods: A cross-sectional hospital based study was carried out among adults aged 35 years and above in the General medicine OPD by simple random sampling technique. The duration of study was three months from October to December 2022. Data entered in excel and analysed using SPSS® software version 22. To test for differences in the two proportions, Chi-square test is employed. Results: The mean age of participants was 49.24 ± 10.578 years, and majority were females (51%). Overall majority of the participants i.e., 88 (56.8%) were at high risk of developing T2DM, 62 (40%) study participants were at moderate risk and 5 (3.2%) were at low risk of developing T2DM. Conclusion: The MDRF - IDRS is a simple, fast, non-invasive and reliable tool to identify individuals at high risk for T2DM. Our study observed a significant prevalence of modifiable risk factors among participants, such as lack of physical activity and abdominal obesity. Efforts should be made to educate all people to adopt healthy lifestyle for decreasing the prevalence of non-communicable diseases including diabetes. Keywords: Diabetes Mellitus, Non-Communicable Diseases, Indian Diabetic Risk Score.

Background: Adolescent pregnancy, defined by the World Health Organization as pregnancy in girls aged 10-19, remains a significant global health issue, especially in low- and middle-income countries (LMICs). Despite a decline in adolescent birth rates globally, approximately 21 million adolescent pregnancies occur annually in LMICs. This study examines the socio-demographic characteristics and perinatal birth outcomes of adolescent pregnancies in India. Materials and Methods: An observational, cross-sectional comparative study was conducted at the Obstetrics & Gynaecology Department of GGH Vijayawada over two months. The study included 376 antenatal women, divided equally into two groups: adolescents (15-19 years) and adults (>20 years). Data were collected using a pre-tested semi-structured questionnaire covering socio-demographic and obstetric characteristics. Statistical analysis was performed using descriptive statistics, t-tests, and Chi-square tests, with a p-value <0.05 considered statistically significant. Results: Adolescent mothers had a mean age of 17.15 years, whereas 26.46 years was mean age for adult mothers. A higher percentage of adolescent mothers were housewives and had lower total monthly family incomes. Gestational age at delivery was significantly lower for adolescents (36.32 weeks) compared to adults (37.44 weeks). Maternal complications such as anemia (41.5% vs. 27.7%), hypertensive disorders (11.7% vs. 4.8%), preterm deliveries (47.3% vs. 25%), and prolonged labor (55.3% vs. 36.7%) were significantly higher among adolescents. Neonatal outcomes were also poorer for adolescents, with higher rates of low birth weight (38.3% vs. 22.9%), ICU admissions (62.8% vs. 40.4%), and marginally higher instances of neonatal jaundice and sepsis. Conclusion: The study highlights significant socio-demographic and perinatal health disparities between adolescent and adult pregnancies. Adolescent pregnancies are associated with higher risks of maternal and neonatal complications, underlining the need for targeted interventions to address the unique challenges faced by young mothers in India. Improving education, economic opportunities, and access to quality healthcare for adolescents could mitigate these adverse outcomes. Further research and policy attention are required to address the complex factors contributing to adolescent pregnancy and its associated health risks. Keywords: Adolescent Pregnancy, Maternal Outcomes, Perinatal Outcomes.

Background: Diabetes is the leading cause of non-traumatic limb amputations. Diabetic patients tend to have an ongoing atherogenic process in the peripheral arteries, which is more manifest in patients with diabetic foot. This study aims to evaluate the association between diabetic foot and prevalence of peripheral arterial disease. Materials and Methods: This prospective study was conducted by the department of surgery over a period of 1 year and included 100 patients with diabetic foot. Results: The prevalence of peripheral arterial disease in patients with diabetic foot was 54% in this study. The prevalence of PAD was significantly more in male patients, in patients with duration of diabetes >20 years, in patients who have undergone amputation procedures. Conclusion: With the rising prevalence of diabetes and diabetic foot being associated with higher prevalence of peripheral arterial disease in males, and in patients with diabetes above 20 years duration, one must regulary screen at-risk population for PAD. Keywords: Diabetes, diabetes foot, peripheral arterial disease.

Background: Clavicle fractures make up about 3-5% of all adult fractures. The vast majority of fractures, approximately 80%, is located in the midshaft of the clavicle and more than half of these fractures are displaced. In comminuted fracture with single or multiple (segmental or butterfly) pieces in the middle which gets aligned vertically, which given the appearance of ‘Z’ in X-ray. Objective: This study aims to know the functional outcome in comminuted clavicle Z fractures treated with locking contoured J-plate. Materials and Methods: This study was conducted in our institute between January 2016 to January 2023 on 29 patients of mid-third clavicular fracture. Closed comminuted middle third clavicular fracture patients aged between 20 to 60 years were included in the study. Results: Twenty-nine isolated closed comminuted clavicle middle third fracture patients were included in our study as per the inclusion criteria. Their mean age was 32.8 years. All fractures united at a mean duration of 13.2 weeks with more than 90% patients having excellent to good results and none of the patients had poor outcome. Conclusion: We conclude that fixation of comminuted clavicle fractures with contoured locking J – plate gives excellent results, maintaining the length and alignment of the clavicle. Consider ‘Z’ fracture as a separate entity and we advised to manage it surgically to get good functional outcome and early functional recovery. Keywords: Clavicle, J – plate, Comminuted, Z – fracture.

Background: Due to the rise in the incidence of thyroid disorders, the number of patients undergoing thyroidectomies has also increased. This skill demanding surgery is associated with certain permanent post-operative complications, which can be avoided in most of the situations. This study was done to evaluate the post-operative complications occurring in patients who have undergone thyroidectomies in a tertiary care center. Materials and Methods: A total of 75 patients who had undergone thyroidectomies in the Department of Surgery____ over a period of 1 year have been included in this prospective observational study. Results: There was female preponderance in the study, with female: male ratio being 6.5:1. The majority of the patients belonged to 31-40 years of age group. Colloid goitre was the most common pre-operative diagnosis. Hemithyroidectomy was the most commonly performed surgery. Hoarseness of voice was the most common post-operative complications and bleeding during surgery was the most common intra-operative complication. Conclusion: Total thyroidectomy has a higher rate of post-operative complications, especially hypocalcemia (hypoparathyroidism) and hypothyroidism compared to hemi-thyroidectomy. The surgeon must be careful to preserve the nerve and parathyroid glands to avoid such complications which could be permanent. Keywords: Thyroidectomy, post-operative complications, hypocalcemia, Recurrent laryngeal nerve palsy.

Background: Total hip anthroplasty is a commonly performed study these days. The hip joint is subjected to daily stress as it bears the weight of the upper body. Osteoarthritis of the hip may cause irreversible damage. Proximal geometry of the femur, like neck shaft angle and torsion, is important in designing prostheses for a specific population. Materials and Methods: Present study was a descriptive cross sectional study on 50 Dry femora (25 right and 25 left) which were randomly obtained from the Department of Anatomy, Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana during the period of August 2022 to December 2022. We included dried, intact and non-pathological femurs and femur with tumor, fracture, trauma and any pathological abnormality were excluded. Anthropometric instruments like Osteometric board, Digital Verneir caliper, Goniometer were used for measurements of parameters. Results & Conclusion: The accuracy and success of the hip replacement surgery demands complete knowledge of the morphometry of the proximal femur which is highly specific among the races, region and gender. Keywords: Femur neck length, neck shaft angle, morphometry.

Background: Heart failure is becoming increasingly prevalent worldwide, especially in emerging nations like India. Newer biomarkers of heart failure, such as Red Cell Distribution Width (RDW), provide valuable insights for heart failure risk assessment and prognosis. RDW measures variability in erythrocyte (red blood cell) size, which indirectly reflects overall cardiovascular health and inflammation. This study assesses the efficacy of RDW as a prognostic indicator of morbidity and mortality among patients with heart failure and compares it with already established. Materials and Methods: This hospital based prospective observational study was carried out from December 2021 to September 2022. A total of 140 patients who presented to the hospital with signs and symptoms of acute heart failure were included. Results: The study included 140 subjects with a mean age of 51.7±16.7 years and a male to female ratio of 1.15:1. Coronary artery disease was the most common cause of heart failure. The mean RDW at admission was 16.7% (SD 2.8%). Subjects were divided into quartiles based on a median RDW of 16.3%, with the 4th quartile having RDW > 18.3%. The mortality rate increased from 8.6% in the 1st RDW quartile to 51.4% in the 4th quartile. High NT PROBNP values (>35000) were found in 45.7% of cases in the 1st RDW quartile and 71.4% in the 4th quartile. Conclusion: Higher RDW values were significantly associated with increased risk of mortality, prolonged hospital stay and correlated with higher NTpro-BNP values. Patients whose RDW decreased during their hospital stay had a better overall prognosis. Keywords: Red cell Distribution Width (RDW), Heart Failure, NTpro BNP, Mortality.

Background: Meconium-stained amniotic fluid (MSAF) is a common obstetric finding that can signal potential fetal distress and complicate labor and delivery. It occurs when the fetus passes meconium, the first stool, into the amniotic fluid before or during labor. MSAF is associated with various maternal and fetal factors, including gestational age, parity, and fetal monitoring results. The impact of MSAF on neonatal outcomes is significant, with meconium consistency (thin vs. thick) playing a crucial role in determining the risk of complications such as meconium aspiration syndrome (MAS). Thick meconium, in particular, is associated with higher morbidity and a greater need for neonatal intensive care unit (NICU) admission. Aims: 1. To evaluate the perinatal outcomes of fetuses affected by meconium aspiration syndrome (MAS).2. To identify the factors responsible for meconium-stained amniotic fluid (MSAF). Materials and Methods: This was a retrospective study was conducted at the Department of OBG & Pediatrics, Government General Hospital & KMC, Kurnool, Andhra Pradesh from November 2023 to April 2024. The study included 300 cases of meconium-stained amniotic fluid (MSAF) and was performed across the labour ward, postnatal ward, and Special Newborn Intensive Care Unit (SNICU). Participants were selected based on specific inclusion criteria: they were either primigravidae or multiparous women, carrying singleton pregnancies in cephalic presentation, and presenting with meconium-stained amniotic fluid. Results: In our study, meconium-stained amniotic fluid (MSAF) was notably more common among primigravidae, with 67.28% of cases observed in first-time mothers compared to 15.20% in multigravidae. Regarding meconium consistency, thin meconium was more prevalent (64.8%) than thick meconium (35.2%). Notably, thick meconium was associated with higher morbidity, as evidenced by 80% of meconium aspiration cases being linked to thick meconium. NICU admissions were more frequent among babies with non-reactive non-stress tests (51.8%) compared to those with reactive tests (13.4%), highlighting a significant association (P = 0.001). Conclusion: Our study underscores several important findings regarding meconium-stained amniotic fluid (MSAF). Primigravidae are more frequently affected by MSAF compared to multigravidae, and emergency cesarean sections are the predominant mode of delivery in such cases. Most MSAF cases involve term babies, diverging from studies suggesting a stronger association with post-term and large-for-gestational-age infants. Thin meconium is more common than thick meconium, but the latter is associated with higher neonatal morbidity, particularly meconium aspiration syndrome. Keywords: Downe’s score, Fetal distress, Meconium staining, Very low birth weight.

Background: Thyroid swelling is a common clinical presentation that can be indicative of benign or malignant conditions, necessitating accurate diagnostic modalities for effective management. Fine-Needle Aspiration Cytology (FNAC) is a minimally invasive procedure that provides cytological analysis, crucial for differentiating between benign and malignant thyroid lesions. Ultrasound of the neck (USG) complements FNAC by offering detailed morphological assessment of thyroid nodules, aiding in the precise localization and characterization of lesions. Materials and Methods: this prospective study was conducted over 1-year period in the Department of Radiology, Katuri Medical College, during which 75 patients with thyroid lesions were included. Results: the study population was a female predominant one. Most of the patients were aged between 21 – 30 years. Most of the patients had hypothyroidism. Most of the swelling were soft in consistency, were >10 mm in size, involving either of the lobes (solitary). FNAC was able to detect both malignant and benign lesions which USG thyroid gland couldn’t. Conclusion: The confluence of morphological data derived from USG and cellular insights obtained from FNAC enables clinicians to make judicious decisions regarding the management of thyroid nodules. This integrative diagnostic strategy is instrumental in the early detection of thyroid malignancies, informing treatment protocols, and optimizing patient prognoses. Hence, the correlation between FNAC and USG findings is fundamental to the efficacious evaluation of thyroid nodules, ensuring precise diagnosis and superior patient care. Keywords: FNAC, Ultrasonography, Thyroid Lesions.

Background: The anal sphincter complex, comprising the internal and external anal sphincters, plays a vital role in maintaining fecal continence, with dysfunction leading to conditions like fecal incontinence and chronic anal pain. Diagnosis and treatment of these dysfunctions are crucial, often involving advanced imaging techniques such as transperineal ultrasonography and MRI. While MRI provides superior soft tissue contrast and detailed anatomical assessments, transperineal ultrasonography offers a cost-effective, non-invasive alternative. The choice between these modalities depends on clinical context, resource availability, and patient-specific factors, highlighting the need for a tailored diagnostic approach. Materials and Methods: all patients with anal dysfunction aged 18 years and above presenting to the Department of Radiology of Katuri Medical College over 12 months’ period were included in the study. Results: most of the patients belonged to younger age group i.e., between 21-40 years. Females were predominantly involved in both groups. Rectovaginal fistula was the most common abnormality observed in present study. MRI showed higher diagnostic accuracy in comparison with trans-perineal ultrasonography. Conclusion: The study concluded that MRI provided a slight edge in diagnostic accuracy over trans-perineal ultrasonography in identifying sphincter abnormalities. Keywords: Trans-perineal ultrasound, MRI perineal area, anal dysfunction, anal sphincter, fistula.

Background: Assessment of quality of care is an important metric in evaluation of universal access to reproductive health. Due to the inefficiency of maternal mortality alone in accurate assessment of the same, a new entity, maternal near miss (MNM) was evaluated to assess morbidity involved in obstetric care. Materials and Methods: The occurrence of such MNM cases was studied at a tertiary care centre and the data related to patient demographics, common causes, pre-existing conditions were collected. Results: Haemorrhage and hypertension were the leading causes of both MNM and maternal mortality. Haemorrhage accounts for 55.74% of near misses and 38.46% of maternal deaths. Hypertension constituted 37.9% of near miss and 30.7% of maternal mortality. Maternal mortality was higher in the third trimester and postnatal period (38.5%). This signifies the need for improvement of quality of care during the puerperal period and postnatal period. The Near Miss to Mortality Ratio in our study was 13.38: 1. A higher ratio correlates to a better survivability of sick cases in the obstetric ICU. Anaemia (54.02%) was the most common underlying cause of MNM. The incidence of which can be decreased by proper antenatal care. Conclusion: Haemorrhage (55.74%) was the leading cause of MNM followed by Hypertensive disorders in pregnancy (37.93%). Anaemia (54.02%) was the most common underlying cause of MNM which indirectly led to other complications. Another ratio, the Mortality Index which represented mortality risk of critical patients was studied which was 6.95 in this study. Keywords: maternal near miss; maternal mortality; severe acute maternal morbidity.

Background: Tuberculosis (TB) is a chronic infectious disease, and its persistent morbidity and mortality burden remains one of the major public health challenges in India. According to estimates provided by the World Health Organization (WHO), there were 10.6 million cases of TB in 2021 globally, 11% of which were in children under the age of 15. Objectives: to know the burden of tuberculosis in under fifteen years age group children, its distribution with respect to age, gender, type of TB. Materials and Methods: A Hospital based Retrospective descriptive study conducted in a tertiary care centre Kurnool, Patient records of children aged less than 15 years of age group who were registered at district tuberculosis centre in the Government General Hospital, Kurnool were collected form January 2017 to December 2021.Collected data was entered in to Microsoft Excel and analysed by using SPPS22 version software. Results: There were 1266 (63.4%) of pulmonary tuberculosis cases and 730 (36.5%) cases of extra pulmonary cases. There was nearly an equal division of pulmonary tuberculosis cases among males 49.2% and females 50.7%. Even there was similar distribution pattern with extra pulmonary cases as males 50.9% and females as 49%. Conclusion: Among all the TB cases 4.6%were children aged under 15 years old. Hence compared to the global estimated report which is 11.3% in 2021 there was under diagnosis in India. Keywords: Paediatric Tuberculosis, Pulmonary Tuberculosis Extra pulmonary tuberculosis, WHO, Mortality

Background: Injudicious usage of antibiotics may lead to severe antimicrobial resistance, which has been highlighted by World Health Day 2011 theme “Antimicrobial resistance: No action today, no cure tomorrow.” Aim: To describe the rational prescription practices in the Kurnool district primary Health centres Materials and Methods: After getting approval from IEC, Kurnool medical college, Kurnool, Permission was obtained from the District Medical & Health Officer, Kurnool District to carry out the study. Before visit to PHC, medical officer of respective PHC was contacted and informed about the visit. Each PHC was visited in person by investigator and using pretested, semi structured questionnaire, Study was conducted among the PHCs of Kurnool District. A total of 600 exit interviews (from each PHC-30 interviews) were conducted among patients, who attended the OPD, on every Monday and Friday. Results: In the current study, on an average12.25 prescriptions had the antibiotics, 7.15 prescriptions had injections, 2.85 prescriptions were encountered with polypharmacy in each PHC. Average consultation time for 50 patients was 92.2 min, and average dispensing time for 50 patients in each PHC was 8973 sec (149.55 min). Average drugs prescribed for 50 patients from each PHC was 88.7 and average drugs dispensed was 80.3. Average drugs adequately labelled were 59.9. All the PHCs included in the study sample had Essential medicines formulary and E-aushadi. Conclusion: It was found in the present study that the prescription practices don't conform to the stipulated guidelines in majority of cases, especially use of antibiotics. Hence there is a need to train the health care providers about the rational use of injections and antibiotics. Keywords: Antibiotics, PHC, Prescription, Rational use.

Background: Sepsis, a common cause of critical illness, is significantly associated with high morbidity, mortality, and often acute kidney injury (AKI), termed sepsis-associated acute kidney injury (SA-AKI) when it occurs in this context. While the link between sepsis and AKI has been explored, the absence of a reproducible and standardized consensus definition has hindered the clarity of available research. Materials and Methods: This retrospective study was conducted in the Department of Emergency Medicine, Kamineni academy of medical sciences and research centre, L.B Nagar, Hyderabad, Telangana, India. over a period of one year, i.e. from Nov 2022-2023. The study included patients aged 18 years and above with diagnosis of sepsis with AKI. Out of the 250 patients who had been diagnosed with sepsis, 150 patients had AKI. Results: Patients with AKI had higher serum creatinine levels than non-AKI group. Presence of septic shock, higher APACHE III score, lower mean arterial pressure, positive blood cultures for bacteria and higher in-hospital mortality are few other parameters which were found at significant levels in patients with AKI. Conclusion: Addressing complications and identifying at-risk patients for early intervention are vital in improving survival rates and outcomes for SA- AKI. Keywords: Sepsis, acute kidney injury, smoker, diabetic, hospital mortality, septic shock.

Background: Percutaneous nephrolithotomy (PCNL) is the first choice for treatment of large renal stone >2 cm. The prone position is the classical position preferred by most surgeons. Aiming to improve patient anesthesia and surgery-related inconveniences of the prone position, Valdivia et al., 1987, described the performance of PCNL with the patient in the supine position. Hence, we aimed to study the safety and efficacy of flank-free modified supine position in PCNL compared to the standard prone position. Materials and Methods: In this prospective study, conducted in Department of Urology, Tirunelveli Medical College, 120 patients with renal stones of size 2-4cm who underwent PCNL were analyzed during the period from June 2022 to June 2023. Patients were divided into two groups of each 60 patients: Group I – PCNL done in prone position Group II – PCNL done in modified flank supine position. Patient’s demographics, size, location and Hounsfield unit of the stone, number of tract, fluoroscopy time, operative time were recorded. Postoperatively drop in haemoglobin; need for blood transfusion, fever, urine leakage, hospital stay, stone-free status, and other complications were assessed. Results: There was no statistically significant difference between the prone and supine positions regarding stone size Hounsfield unit, body mass index and fluoroscopy time. The mean intra operative time was 78.3 min in supine group and 96.7 min in prone group. The mean hemoglobin drop was 1.18 g/dl and 1.24 g/dl in supine and prone position. Fever occurred in 3.3% of cases in each group. Blood transfusion was needed in one patient in prone group. The mean post-operative hospital stay was 4.1 and 3.86 days in supine and prone group. Two patients in each group require relook PCNL. Stone free rate at 1month was 94.5% in supine and 93.2% in prone group. Conclusion: PCNL in the modified supine position proved to be a safe and effective choice compared to the prone position for adult patients with renal calculi. Supine PCNL proved to be less time consuming and quick to perform and comparable to prone PCNL in respect to other operative parameters. Keywords: Supine, Prone, PCNL, renal stone.

Background: Dengue fever, caused by the dengue virus transmitted through Aedes mosquitoes, is a significant global health issue. Early diagnosis is crucial for effective management and reducing morbidity. Leukopenia, a reduction in white blood cell count, is a common hematological finding in dengue patients, but its diagnostic value remains debated. This study aims to evaluate the role of leukopenia as a diagnostic marker for dengue fever and its correlation with clinical outcomes. Materials and Methods: This prospective observational study included 100 patients aged 5 months to 65 years diagnosed with dengue fever in June 2024. Dengue diagnosis was confirmed using the Dengue card test. Patients were categorized based on the presence or absence of leukopenia. Clinical and laboratory parameters, including white blood cell count (WBC), platelet count, and hemoglobin levels, were recorded. The duration of hospital stay, recovery rate, and complications were analyzed. Sensitivity and specificity of leukopenia in diagnosing dengue were calculated, and odds ratios for various factors were assessed using logistic regression. Results: Among the 100 patients, 78 (78%) had leukopenia. The leukopenia group had a significantly lower WBC count (2539.9 ± 828.1 cells/mm³) compared to the non-leukopenia group (5650.9 ± 1329.3 cells/mm³, p<0.0001). Platelet counts and hemoglobin levels did not differ significantly between groups. Patients with leukopenia experienced a longer hospital stay (8.7 ± 2.1 days vs. 6.3 ± 1.6 days, p=0.025) and a lower recovery rate (79.5% vs. 95.5%, p=0.041). Complications such as bleeding and organ failure were more prevalent in the leukopenia group (bleeding: 17.9% vs. 9.1%, p=0.011; organ failure: 7.7% vs. 0.0%, p=0.034). The sensitivity of leukopenia for detecting dengue was 93.3%, while specificity was 68.0%. The odds ratio for leukopenia as a predictor of dengue was 3.51 (95% CI: 0.81 - 6.85, p=0.202). Conclusion: Leukopenia is a highly sensitive marker for dengue fever, though with moderate specificity. It is associated with more severe clinical outcomes, including prolonged hospital stay and higher complication rates. While leukopenia can be a useful diagnostic indicator, it should be used in conjunction with other diagnostic tests for accurate dengue diagnosis and management. Keywords: Dengue fever, leukopenia, sensitivity, specificity, platelet count.

Background: To study the risk factors and management of early pregnancy loss in tertiary care maternity hospital. Materials and Methods: It is a hospital based observational study in tertiary maternity hospital for a period of 2 years in pregnant woman with early pregnancy loss before 12 weeks 6 days of gestational age, both primary and secondary and Singleton pregnancy. Results: The age at which most early pregnancy losses occurred was between 31-35 years followed by >36 years. The occurrence of early pregnancy loss was observed to be more in educated subjects when compared to illiterate subjects. Early pregnancy loss more common in women who were unemployed when compared to employed women. The present study showed that rate of early loss of pregnancy was maximum in those women who were conceiving for the first time compared to women who have conceived before. Majority of the early pregnancy losses occurred in the gestational age of 6 – 9 weeks compared to the other gestational ages in weeks. The major type of abortion that was diagnosed among the subjects was complete abortion followed by incomplete abortion, missed abortion and septic abortion. The majority of subjects were given MVA followed by medical management, D&C and expectant management. Complications followed by management were looked into and it was observed that majority of the subjects had anaemia followed by hypovolemic shock, haemorrhagic shock and septicaemia. The body mass index of the subjects was also looked into and it was observed in the present study that majority of the subjects were obese followed by overweight, normal weight and underweight. Conclusion: Findings of the current study shown that risk factors of miscarriages included age of mother, increased BMI and previous history of miscarriages. All these factors need to be considered while providing antenatal care to mothers to mitigate the risk of miscarriages. Keywords: Pregnancy Loss, Risk Factors, Miscarriages, Antenatal Care.

Background: Thrombocytopenia, characterized by low platelet counts, is a common hematologic condition associated with abnormal bleeding. This study investigates its diverse causes and clinical impact in patients at a tertiary care center, aiming to identify associated morbidity and mortality risks. Early recognition of thrombocytopenia's etiology is crucial for managing bleeding complications effectively. Materials and Methods: This is a descriptive cross-sectional study conducted at Bangalore Medical College and Research Institute aimed to investigate the etiology, clinical profile, morbidity, and mortality of thrombocytopenic patients at a tertiary care hospital in South India. Over a four-month period from April to July 2024, 118 eligible patients from various departments were enrolled based on a platelet count below 1.5 Lakhs/mm³. Data collection involved detailed demographic information, symptomatology related to bleeding manifestations, physical examination, and comprehensive laboratory investigations. Treatment followed standard hospital protocols, including the administration of blood products as clinically indicated. Statistical analysis was performed using SPSS. Results: In this study of 118 patients, 62.7% were male and 37.3% were female, with the most common age group being 18-30 years (33.1%). Most patients (62%) hailed from rural areas. Fever (83.9%) and cough (21.2%) were predominant symptoms, while bleeding manifestations occurred in 38.98% of cases, including petechiae and bleeding gums. Dengue fever (24.5%) and sepsis (16.1%) were the leading diagnoses. Diabetes mellitus and hypertension affected 13.6% and 11% of patients, respectively. Most patients (82.4%) did not require blood products, though 8.4% needed PRBCs and 8.4% required platelet transfusions. Isolated thrombocytopenia (64.4%) was the most common peripheral smear finding. The majority (85.5%) recovered, while 2.6% died primarily due to septic shock while the rest were started on long term treatment based on their diagnosis. Conclusion: In our study, thrombocytopenia predominantly affected young males presenting with fever, fatigue, and myalgia. Dengue emerged as the leading cause, followed by sepsis and malaria, often associated with bleeding. Vitamin B12, and folate deficiencies were common non-infective causes of Thrombocytopenia. Diabetes posed a higher risk for bleeding complications. Isolated thrombocytopenia was the most frequent blood picture observed. While some cases were severe, the majority of patients recovered fully, highlighting a favorable prognosis. Further extensive research is needed to better understand the diverse causes and treatments of thrombocytopenia. Keywords: Thrombocytopenia, Fever, Dengue, Sepsis

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and hyperglycemia. Mean platelet volume (MPV) has been proposed as a potential marker for vascular complications in diabetes. This study aimed to investigate the relationship between MPV and glycated hemoglobin (HbA1c) levels in patients with T2DM. Materials and Methods: This case-control study included 50 patients with T2DM with more than five years duration of diabetes (cases) and 50 healthy individuals (controls). Demographic data, MPV, and HbA1c levels were collected for all participants. The correlation between MPV and HbA1c was analyzed in the case group using Pearson's correlation coefficient. Results: The mean MPV was significantly higher in the T2DM group compared to the control group (10.8 ± 1.2 fL vs. 9.5 ± 0.9 fL, p < 0.001). In the T2DM group, a positive correlation was observed between MPV and HbA1c levels (r = 0.62, p < 0.001). Conclusion: The findings suggest that elevated MPV is associated with higher HbA1c levels in patients with T2DM. MPV may serve as a potential marker for glycemic control and vascular complications in T2DM patients. Further research is warranted to explore the clinical implications of this relationship. Keywords: Type 2 diabetes mellitus, mean platelet volume, glycated hemoglobin, HbA1c, vascular complications.

Background: The acetabulum is a part of hip bone which is cup shaped and is contributed by ilium, ischium and pubis. Measurements of acetabulum are important in determining stability of hip joint, assessment of acetabular dysplasia, diagnosing various clinical conditions and monitoring patient’s recovery. Aims: The aim of the present study was to examine the normal acetabular morphometry and to determine any side and gender variations in the anatomical parameters of the acetabulum. Material and Methods: 200 normal X-rays of pelvis with bilateral hips of males (100) and females (100) of the age group 20-50 years were used in the present study. For each hip, the acetabular diameter and acetabular depth were measured. Results: The overall mean value of acetabular diameter in males was found to be 54.1 + 3.4 mm. The mean values of acetabular diameter in males was found to be 54.3 + 3.6 mm on the right side, while on the left side it was found to be 53.7 + 3.3 mm. The overall mean value of acetabular diameter in females was found to be 53.0 + 3.1 mm. The mean values of acetabular diameter in females was found to be 53.6 + 3.2 on the right side, while on the left side it was found to be 52.4 + 3.1 mm. In males, the mean value of acetabular depth on the right side was found to be 12.5 + 3.3 mm while on the left side it was found to be 12.1 + 3.1 mm making an average acetabular depth of 12.3 + 3.2 mm. In case of females, the mean value of the acetabular depth on the right side was found to be 11.4 + 2.5 mm while on the left side it was found to be 11.2 + 2.6 mm making an average acetabular depth of 11.3 + 2.5 mm. Conclusion: There were significant gender and side variations in Kashmiri population for both the examined anatomical perimeters of acetabulum. Knowledge about the average dimensions of acetabulum will assist in carrying out various surgical procedures like total hip replacement and designing of various prostheses suitably according to need. Keywords: Acetabulum, hip joint, morphometry, acetabular dysplasia, prostheses.

Background: Diagnosing chronic abdominal pain presents a considerable clinical challenge due to its complex and often elusive nature. Laparoscopy, a minimally invasive technique, holds promise not only as a diagnostic tool but also as a therapeutic option for patients suffering from chronic, undiagnosed abdominal pain. This study aims to thoroughly assess the effectiveness of laparoscopy in diagnosing and managing such patients, exploring its potential to uncover underlying causes that other methods might miss. Materials and Methods: 75 patients aged above 18 years with chronic abdominal pain of > 3 months duration were admitted by the Department of Surgery to undergo diagnostic laparoscopy. Results: Most of the patients were females. Younger age group, (30 years) constituted the majority of the patients. Most of the people had abdominal pain since 12-18 months of duration. Post-operative adhesions were the most common cause of chronic abdominal pain, followed by recurrent appendicitis. Most of the patients had positive outcomes (i.e, decrease in abdominal pain). Conclusion: By evaluating the role of laparoscopy, we hope to provide insights into its utility as a vital investigative modality for improving patient outcomes in cases of persistent abdominal pain. Keywords: Chronic abdominal pain, laparoscopy, adhesions, appendicitis, cholecystitis.

Background: Psoriasis is a common chronic inflammatory skin disease with complex pathophysiology. The role of vitamin D has recently arisen in many skin and systemic diseases including psoriasis through its modified effect of inflammatory and immunological mechanisms. Several studies have demonstrated its effects on keratinocytes' proliferation and differentiation, cutaneous immune system, regulating the microbial flora and the response to infective diseases. Materials and Methods: This is a prospective, observational and case-control study was conducted in the Department of Dermatology, American International Institute of Medical Sciences. Clinically diagnosed 186 patients of chronic plaque psoriasis and 63 healthy controls were studied. A detailed history was inquired and clinical examination was done with evaluation of serum vitamin D levels. Clinically diagnosed chronic plaque psoriasis patients and healthy controls of age > 15 years of any sex were included. All patients were subjected to full history taking, clinical examination, and laboratory investigations. Serum vitamin D levels were measured by using enzyme linked immunosorbent assay technique. Results: Among the cases with severe PASI, 26 (97%) had vitamin D deficiency and 1 normal vitamin D level. With moderate disease, 42 (71.9%), 13 (22.1%), and 5 (6%) had deficient, insufficient, and normal levels of vitamin D respectively. Ten (28%), 25 (65.9%), and 4 (8.2%) had a normal, insufficient, and deficient vitamin D in mild disease. A significant negative correlation was found between serum 25(OH) D level and PASI (r= −0.6289, P= 0.01). A receiver operating characteristic curve was performed and an optimal cutoff PASI value of 4.05 (AUC=0.889, P<0.001) was obtained. Above this value, patients had a high risk of vitamin D deficiency with the sensitivity of 84.1% and specificity of 82.4%. Conclusion: It is necessary to bear in mind that vitamin D deficiency is more common in psoriasis patients than controls and that infers the role of vitamin D in the pathogenesis of the disease. Decreased 25 OH vitamin D serum level was found in psoriatic patients. The 25 OH vitamin D serum level may be used as a marker of psoriasis severity and response to treatment. Keywords: Psoriasis, oral vitamin D, treatment.

Background: To assess the effects of immediate vs delayed breast reconstruction on postoperative recovery and quality of life. Material and Methods: The study was conducted using the Health Survey (SF-36), along with clinical and sociodemographic questionnaires. Initially, 90 patients were recruited for the study. All participants were diagnosed with breast cancer and had undergone mastectomy followed by breast reconstruction. Results: Patients who underwent immediate reconstruction reported higher median scores for physical functioning (80, IQR: 70-90) compared to those with delayed reconstruction (75, IQR: 65-85) and mastectomy without reconstruction (70, IQR: 60-80) with a p-value of 0.045. The role physical scores were similarly higher in the immediate reconstruction group (75, IQR: 60-85) than in the delayed reconstruction (70, IQR: 55-80) and mastectomy without reconstruction groups (65, IQR: 50-75), with a p-value of 0.038. In terms of bodily pain, patients with immediate reconstruction had lower pain scores (65, IQR: 50-75) compared to delayed reconstruction (60, IQR: 45-70) and mastectomy without reconstruction (55, IQR: 40-65) with a significant p-value of 0.032. General health scores were highest in the immediate reconstruction group (70, IQR: 60-80), followed by delayed reconstruction (65, IQR: 55-75) and mastectomy without reconstruction (60, IQR: 50-70) with a p-value of 0.041. Vitality scores were also higher in the immediate reconstruction group (60, IQR: 50-70) than in the delayed reconstruction (55, IQR: 45-65) and mastectomy without reconstruction groups (50, IQR: 40-60) with a p-value of 0.039. Social functioning, role emotional, and mental health scores followed similar patterns, all showing statistically significant higher scores for immediate reconstruction compared to the other groups. Patients who underwent immediate reconstruction reported the highest overall quality of life scores (SF-36), faster physical recovery, better mental health, lower postoperative pain, and lower complication rates. Delayed reconstruction showed moderate results across these variables, while mastectomy without reconstruction had the lowest outcomes. All these differences were statistically significant, highlighting the benefits of immediate breast reconstruction in terms of postoperative recovery and quality of life. Conclusion: In conclusion, immediate breast reconstruction offers significant advantages in terms of postoperative recovery, quality of life, and mental health, as supported by the findings in this study and corroborated by multiple other studies. The data strongly suggest that immediate reconstruction should be considered the preferred option when feasible, to enhance patient outcomes and overall well-being. Keywords: Immediate, Delayed, Breast reconstruction, Quality of life.

Background: There are still unacceptablely high perinatal mortality rates, with up to three million stillbirths and three million neonatal deaths occurring annually across the world. Because of the high frequency of anaemia, problems with maternal health care, and unfavourable birth outcomes in Kanpur. In the course of this research, which was carried out in Kanpur city, Uttar Pradesh, India, we looked into the factors that led to perinatal mortality as well as the issues that were experienced by the mothers of these infants. Setting and design: Descriptive cross-sectional study, Ganesh Shanker Vidyarthi Medical College, Kanpur city, Uttar Pradesh, India. Materials and Methods: Total of 212 women were recruited. Data collection focused on sociodemographic and anthropometric factors, as well as reporting of prenatal care and obstetric difficulties during pregnancy, birth outcome (preterm, late, and term), and mode of delivery (normal, caesarean, and stillbirth). Statistical Analysis: Data were expressed as mean (standard deviation) and percentage (%). Chi-square, Student's t-test, and analysis of variance were used to compare measured variables. Results: Overall, 21.2% of subjects had severe anaemia; 12.7% of participants had APH; 9.9% of participants had ante-partum eclampsia; 7.5% of participants had PET; 4.7% of participants had NSPET; and 0% of participants had GDM or IHCP. Overall, 76.4% of participants had TT vaccination; 45.8% of participants had preterm delivery; 1.4% of participants had Rh-negative pregnancy; 0.5% of participants had hypothyroidism; 0% of participants had IUD; 61.3% of participants had COVID vaccination; 6.1% of participants had foetal congenital anomalies; and 0% of participants had heart disease. Conclusion: The prevalence of severe anaemia and maternal anaemia in pregnant women, in addition to APH, preterm eclampsia, PET, and NSPET, is much higher than what is considered acceptable. Keywords: Maternal mortality, Preterm delivery, Anaemia, Maternalcomplications, Perinatal mortality.

Background: Serous ovarian cancer of low grade histology (LGSOC) is a rare ovarian cancer which differs from High grade serous carcinoma (HGSC) in epidemiology, pathogenesis, presentation and prognosis. Due to its rare incidence, LGSOC has been understudied, prompting this retrospective review. The aim is to contribute to the limited pool of data on this histologic subtype by describing the clinico-radiological features, management strategies, and survival outcomes of cases treated at a single cancer care centre. Materials and Methods: This was a retrospective observation study of histologically proven low grade serous ovarian cancers which had undergone surgery during the five-year study period. Hospital records were reviewed to find the demographics, clinical features, tumor characteristics, pathological findings, surgical data, FIGO stage, adjuvant treatment, and survival data of the patients. Results: Only seven cases of LGSOC underwent surgery during the period of study. The mean age of presentation was 51.7 years. 5 cases presented in early stage (FIGO stage IA, IB) and only 2 in advanced stage (FIGO stage IIIB, IVB). Early stage cases underwent primary debulking surgery while 2 advanced cases received chemotherapy (NACT) followed by debulking surgery. 30 months was the median follow-up duration. To date, all patients were alive and only one had recurrence at 25 months post primary treatment. The mean progression free survival (PFS) of the patients was 31.85 months. Conclusion: Optimal debulking surgery aimed at eradicating residual disease appears to be a contributing factor to improve outcome in cases of LGSOC. Given the limited response of these tumors to chemotherapy, it is imperative to explore targeted treatment approaches alongside surgery. Keywords: Low grade serous ovarian cancer (LGSOC), High grade serous cancer (HGSC), Progression free survival (PFS), Debulking surgery.

Background: Adolescence, a key transition from childhood to adulthood, is critical for health issues like anaemia, which affects around 1.62 billion people globally. In India, the National Family Health Survey - 5 reported a 59.1% prevalence among adolescent girls, with 49.4% in Karnataka. Despite government efforts, anaemia remains widespread in rural areas. Aim and Objective: The aim of the study was to assess the prevalence of nutritional anaemia in late adolescent girls in rural areas of Belagavi, evaluate their knowledge about nutrition, and examine the current dietary practices in their households. Materials and Methods: This cross-sectional study, conducted from January to December 2021 in Vantamuri, involved 365 adolescent girls aged 16 to 19. Participants were selected using systematic random sampling from a master list prepared by ASHA. Data were collected through a pre-designed questionnaire covering sociodemographics, knowledge, attitude, and practices. Haemoglobin levels were measured using the cyanmethaemoglobin method. Data analysis included descriptive statistics, bar and pie charts, and various tests (t-test, ANOVA, Chi-square, Fisher's Exact Test) for assessing associations and significance. Results: The distribution of participants showed that the majority were in the 16 to 17 age group (71.78%), and most (91.23%) were Hindus. Additionally, 90% of the participants were below the poverty line. The prevalence of anaemia in the study was 42.19%. Among those with anaemia, 51.3% had mild anaemia, 37.6% had moderate anaemia, and 11.1% had severe anaemia, according to WHO guidelines. About one-third of the participants had some awareness of anaemia, and 20% recognized it as a health problem. The availability and consumption of iron and folic acid in schools were associated with a decreased prevalence of anaemia. Although dietary habits generally did not significantly impact anaemia, excluding milk products and eggs showed a beneficial effect. The study also found a statistically significant decrease in weight and BMI among participants with anaemia. Conclusion: The study identified a high prevalence of anaemia among 16 to 17-year-olds, with most participants below the poverty line. Severity varied, and awareness of anaemia was low. Increased availability of iron and folic acid in schools and excluding milk and eggs from the diet were associated with reduced anaemia. Additionally, anaemia was linked to decreases in weight and BMI. Keywords: Anaemia, Nutrition, Prevalence, Dietary Habits, Adolescent girls.

Background: The early detection of premalignant conditions prevents their progression to an invasive carcinoma which leads to increased quality of life among the patients. lipid profile has been one of the predominant biomarkers for predicting prognosis or monitoring the disease progression from premalignant to malignant. Aims: The study aims to elucidate the correlation between serum lipid profiles and the presence of head and neck cancers, potentially contributing to early diagnosis and improved patient outcomes. Materials and Methods: Total of 60 patients, premalignant-20, malignant-20, control group-20 Histopathological, head and neck malignancy were divided as premalignant, malignant and control group. With proper written informed consent, Fasting blood samples were collected and the lipid profile studied for these parameters: TC, HDL, LDL, VLDL, TGL. Results: These distributions suggest that head and neck malignancies are more prevalent in the middle-aged population, particularly those between 50 and 60 years of age. Total Cholesterol (TC) and High-Density Lipoprotein (HDL) levels were significantly lower in the premalignant and malignant groups compared to the normal group, suggesting their potential as early diagnostic markers. Low- Density Lipoprotein (LDL) levels were notably lower in the malignant group, indicating its specific association with malignancy. Triglycerides (TG) and Very Low-Density Lipoprotein (VLDL) also exhibited significant differences, highlighting their relevance in disease detection. Conclusion: The present study's results demonstrated an inverse association between head and neck cancer and serum lipid profile levels, supporting the idea that lipid profile levels can be used as a diagnostic criterion for cancer early detection. Keywords: Total Cholesterol (TC) and High-Density Lipoprotein (HDL), premalignant conditions.

Background: Ultrasound (USG) guided Supraclavicular (SC) Brachial Plexus Block is the gold standard BLOCK for anaesthesia and post-operative analgesia of upper limb surgeries. The in-plane approach is commonly used for single injection blocks, whereas the Out-of-plane approach is commonly used for blocks with catheter insertion. Objectives: In this study, we will compare the In-Plane/Out-of-Plane approach in USG guided Supraclavicular Brachial Plexus Block for Anaesthesia of below elbow surgeries. Material and Methods: 140 patients scheduled to undergo below elbow surgeries were taken and randomly divided into 2 Groups. Group I (In-Plane) received the USG guided SC Brachial plexus block via In-Plane approach and Group O (Out-of-plane) received the block via Out-of-plane approach. The time from the insertion to removal of the block needle, the number of attempts of manipulation to reach the Brachial Plexus, time required for onset of Sensory and Motor block and complications and side effects (if any) were recorded. Results: The procedural time, number of attempts, motor block, were found to be similar and comparable in both In-Plane/Out-of-Plane Groups. Whereas the Onset of sensory blocks was shorter in the Out-of-plane group. The mean procedural time was 7.57 ±1.62 and 6.84 ±1.62 minutes. The mean onset time for the sensory block was 3.8 ±0.75 and 3.5 ± 0.75 minutes and the motor block was 5.75 ±0.6 and 5.55 ± 0.75 minutes in Group I and Group O respectively. Conclusion: In our study, we have found thatIn-Plane/Out-of-Plane has similar procedural time and motor block. However, onset to sensory block was significantly shorter in Out-of-plane group. The results of our study allows more scope for the Out-of-plane approach. Keywords: USG guided Supraclavicular Brachial plexus block, Out-of-plane approach.

Background: To study and describe the clinical features, laboratory manifestations in patients diagnosed with scrub typhus at a tertiary hospital in Assam. Materials and Methods: A total of 28 patients in whom the diagnosis of scrub typhus was confirmed admitted between 1st January 2021 to 30 September 2022 in Unit 1 of Department of Medicine in AMCH who filled the inclusion and exclusion criteria were analysed. Results: 28 confirmed cases of scrub typhus were studied over a period of 21 months. The mean age of patients was 46±19.1. The female to male ratio was 2.5:1. The maximum number of cases i.e. 14 (50%) patients belong to 20-40 years age group, 27 patients (96.4%) come from rural background with maximum number of patients being farmers and mostly working in paddy field i.e. 15 (53.5%). For the clinical features, 100% patients presented with fever. The average duration of fever was 7±3.1. 20 patients (71.4%) presented with myalgia. Jaundice was seen in 25% cases of cases. Respiratory symptoms seen in 7 cases (25%). Neurological manifestations were seen in 7 cases (25%) where 3 cases (10.7%) cases presented with altered sensorium. Renal symptoms seen in 7 cases (25%). Pedal edema seen in 9 cases (32.1%) Eschar seen in 3 patients (10.7%). Complications of scrub typhus, ARDS was observed in 1 (3.5%) cases, Meningeal signs seen in 2 (7.1%) cases, Decompensated liver disease with Ascites seen in 5 cases (17.8%). ALT and AST raised in 22 (78.5%) and 24 (84.7%) cases respectively. Leucocytosis seen in 30% cases. Ultrasonography shows hepatomegaly in 2 cases (7.1%) splenomegaly in 4 cases (14.2%) hepatosplenomegaly in 2 cases (7.1%) hepatic parenchymal disease with dilated portal vein in 5 (17.8%) cases. 15 cases (53.5%) with raised total bilirubin, 4 cases (14.2%) with Serum Creatinine > 1.6 mg/dl i.e. patients developing AKI. Conclusion: Scrub typhus is prevalent in the northeastern part of India. It mimics infections like malaria, leptospira, dengue, salmonella typhi, pneumonia for which it should be considered as a differential diagnosis in a patient presenting with acute febrile illness associated with or without gastrointestinal symptoms, altered sensorium etc. and with Leucocytosis and thrombocytopenia and elevated liver enzymes. A history patients residing in rural areas and agriculture based occupation should raised the suspicion of the diagnosis being more towards scrub typhus. Keywords: Fever, Orientiatsutsugamushi, scrub typhus, eschar, Rural area, laboratory abnormalities, Doxycycline.

Background: The spleen plays a crucial role within the hematologic and reticuloendothelial systems. The splenic notches located along the superior margin serve as a valuable clinical reference for the palpation of an enlarged spleen. Hence, the present study was conducted for morphometric assessment of cadaveric spleen. Materials & Methods: A comprehensive examination was conducted on 50 formalin-fixed spleens from adult cadavers of both genders, with damaged specimens being excluded from the study. The morphological characteristics of the spleen specimens were meticulously analyzed, and various morphometric parameters were recorded. Measurements of the spleen's length, breadth, and width were taken using Vernier calipers. Additionally, splenic notches were noted along both the superior and inferior margins. The weight of each spleen was determined using an electronic balance. The study also documented the diverse shapes of the spleens. The collected data underwent statistical analysis utilizing SPSS software. Results: Mean length, breath, width and weight were 10.96 cm, 7.85 cm, 4.84 cm and 141.7 gm respectively. On the superior border of the spleen, no notch was seen in 8 percent, one notch was seen in 24 percent of the patients while two notches were seen in 36 percent of the patients respectively. On the inferior border, one and two notches were seen in 24 percent and 20 percent of the patients respectively. No inferior notch was seen on inferior border in 52 percent of the patients. Conclusion: The role of the spleen in the immune response and its function in defending against infections necessitates a conservative management strategy for cases of splenic rupture. A thorough understanding of the spleen's anatomy and physiological functions is crucial for evaluating its significance in various disease processes. Keywords: Cadaveric, Spleen.

Background: Psychiatric morbidity is a significant concern in rural health settings, particularly in areas like Sikar, Rajasthan, where healthcare resources are limited and accessibility to mental health services is constrained. Rural Health Training Centre (RHTC) play a crucial role in providing healthcare services to underserved populations. Understanding the prevalence and types of psychiatric disorders in these settings is essential for developing targeted interventions. Materials & Methods: This cross-sectional study was conducted at RHTC affiliated with Sikar Medical College over six months. The study included 500 patients attending the RHTC, selected based on calculated sample size using a 95% confidence level and 5% margin of error. Data were collected through structured interviews using the General Health Questionnaire (GHQ-12) and the Patient Health Questionnaire (PHQ-9). Socio-economic status was assessed using the Kuppuswamy scale. Results: Out of 500 patients, 24% were diagnosed with psychiatric morbidity. Specific disorders included depression (10%), anxiety (8%), substance abuse (6%), somatization disorders (3%), psychotic disorders (2%), bipolar disorder (1.6%), and PTSD (1%). A significant portion of patients with severe conditions were referred to tertiary care centre. Conclusion: The high prevalence of psychiatric morbidity highlights the urgent need to integrate mental health services into primary healthcare at RHTC. Addressing socio-economic factors, improving mental health infrastructure, and implementing telepsychiatry are essential steps to enhance mental health outcomes in rural areas. Keywords: Psychiatric Morbidity, Rural Health, Mental Health, Rural Training Centre, Sikar, Rajasthan.

Background: In spite of modern criteria of preoperative groundwork, antimicrobial prophylaxis, and operative procedure, postoperative/surgical site wound infections persist as a serious threat. So the aim of this study is Bacteriological Spectrum of Surgical Wound Infections. Materials and Methods: This study was conducted in Department of Microbiology, Heritage Institute of Medical Sciences, Varanasi. The present study was carried out on the patients admitted in surgical wards. This study were included 200 cases. Out of 200, pus samples were 140 and wound swabs 60 were collected. The duration of study was 3 Years. Results: This study included a total of 200 cases of surgical wound infections. Among them, 61% of cases involved patients under the age of 30, while the remaining 39% were from those aged 30 and above. Positive bacterial growth was observed in 42% of the cases, while the rest showed no growth. The most common organisms identified were Pseudomonas (33.4%), followed by Staphylococcus aureus (25%), Escherichia coli (15.4%), Proteus (8.4%), CONS (5.9%), Klebsiella spp. (4.7%), Acinetobacter baumannii complex (3.5%), Enterobacter (2.3%), and Citrobacter spp. (1.1%). Conclusion: Gram negative pathogens are the most common cause of post-operative wound infections, with emergence of drug resistance against commonly used antimicrobial drugs. Keywords: Surgical wounds, Bacterial spectrum, Antimicrobial Resistance.

Background: To evaluate the efficacy of T2-weighted imaging, dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted imaging (DWI) for detecting prostate cancer in patients with total serum prostate-specific antigen (PSA) levels of 4–10 ng/mL, which is referred to as the “gray zone. Material and Methods: This prospective study included a total of 108 patients with lower urinary tract symptoms (LUTS) and serum PSA between 4 and 10 ng/mL, without abnormal digital rectal examination (DRE) findings of prostate. PIRADS score (V2) was calculated using multi-parametric magnetic resonance imaging (mp-MRI) before TRUS biopsy of prostate. Relationships among PIRADS score, PSA& presence of carcinoma prostate in TRUS biopsy were statistically analyzed. Results: Mp MRI had a sensitivity and specificity of 100% and 84.59 % respectively for overall cancer detection. Whereas, the sensitivity was 100% for clinically significant prostate cancers. The negative and positive predictive values were 85.89% and 78.57%% respectively for overall cancer detection whereas the negative predictive value (NPV) was 72.37 % for clinically significant cancer. Conclusion: Combined T2-weighted imaging, DWI, and DCE-MRI findings appearto be potentially useful for detecting and managing prostate cancer, even for patients with gray-zone PSA levels. Our result shows that use of MpMRI could have avoided 67.59 % of unnecessary biopsies without missing any of cancers. Keywords: Prostate Cancer, Biopsy, PSA, MpMRI, PI-RADS version.

Background: Seasonal influenza poses significant health risks, particularly for high-risk populations, including the elderly and those with chronic health conditions. Vaccination is a primary preventive measure aimed at reducing the incidence of severe outcomes, such as hospitalization. Objective: This study aimed to evaluate the impact of seasonal influenza vaccination on hospitalization rates among high-risk populations. Material and Methods: A total of 100 high-risk individuals were included in this observational study, with 60 participants in the vaccinated group and 40 in the unvaccinated group. Hospitalization rates due to influenza-related complications were compared between the two groups. Relative risk (RR), absolute risk reduction (ARR), and number needed to vaccinate (NNV) were calculated. Subgroup analyses were performed based on age (≥65 years) and presence of chronic health conditions. Results: The hospitalization rate was significantly lower in the vaccinated group (20%) compared to the unvaccinated group (45%). The relative risk of hospitalization for vaccinated individuals was 0.44 (95% CI: 0.26–0.74), indicating a 56% reduction in hospitalization risk. The ARR was 25%, with an NNV of 4. Subgroup analysis revealed consistent results, with the vaccinated group showing lower hospitalization rates across age and chronic health condition subgroups. Adverse events were minimal, with 25% of vaccinated participants reporting mild side effects. Conclusion: Seasonal influenza vaccination significantly reduces the risk of hospitalization in high-risk populations. These findings support the continued promotion of influenza vaccination, especially among vulnerable groups. Keywords: Seasonal influenza, vaccination, hospitalization, high-risk populations, observational study, relative risk, absolute risk reduction, chronic health conditions.

Background: Malnutrition is common in patients with malignancy and is associated with poor treatment outcomes. There is a need for a reliable and valid scoring system to identify patients with poor nutrition status at the time of admission. Aim: The aim of the present study was to determine the effect of preoperative nutritional status on early post-operative outcomes in patients undergoing surgery for Hepato-pancreato-biliary malignancy. Material and Methods: All patients who underwent surgery for HPB malignancy in the Department of Surgical gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad between March 2018 to March 2019 were included. It was a prospective cross-sectional study. Various nutritional indices were calculated which include the Nutritional Risk Index (NRI), Prognostic nutritional index [PNI], Malnutritional Universal screening tool (MUST)and Subjective global assessment (SGA). Patients were considered well-nourished if SGA -A, NRI>100, PNI>50, MUST – 0 (Low risk) Rest were considered malnourished. The effect of nutritional status as defined by the aforementioned parameters was studied on various outcome measures such as morbidity, mortality and Length of hospital stay. Results: A total of 49 patients underwent pancreatic surgery for malignancy during the study period. Malnutrition was seen in a high percentage of the patients undergoing surgery for pancreatic cancer in the present study. It ranged from 42.85% as estimated by NRI to 77.54% as estimated by MUST. All the four nutritional indices NRI, PNI, MUST and SGA were associated with poor post-operative outcomes after pancreatic surgery. Patients with high NRI had a significantly lower incidence of Delayed gastric emptying(DGE) after pancreatic surgery. In the present study, Post-operative pancreatic fistula(POPF) and mortality were significantly higher in malnourished patients (SGA B,C). A total of 24 patients underwent surgery for hepatobiliary malignancy during the study period. Malnutrition was seen in a significant percentage of the patient’s undergoing surgery for hepatobiliary cancer in the present study. It ranged from 29 % as estimated by MUST to 43.83% as estimated by PNI.All four nutritional indices NRI, PNI, MUST and SGA were not associated with significant post-operative complications in patients who underwent hepatobiliary surgery. Conclusion: In patients undergoing pancreatic surgery for malignancy. 1.Malnutrition identified by nutritional indices NRI, PNI, MUST and SGA were associated with increased postoperative complications. 2. MUST was associated with most post-operative complications. 3. Subjective Global Assessment(B&C) patients were associated with increased risk postoperative pancreatic fistula. Keywords: Nutritional Status, Surgery, Hepato-Pancreato-Biliary Malignancy.

Background: There is an increase in the incidence of Colorectal cancer (CRC), especially among young adults. Lynch syndrome is the most common genetic type with predominance of right side cancer and an early age of onset. There is dearth of literature regarding the prevalence of MMR deficiency in colorectal cancers and it's association with outcome in Indian populations. Screening patients using IHC for MMR protein expression offers an economical alternative to select patients requiring genetic testing. Aim: The aim of the present study was to determine the incidence of Mismatch repair deficiency in colorectal cancer patients. Material and Methods: This prospective, cohort study was conducted in the Department of Surgical Gastroenterology, Nizams Institute of Medical Sciences, Hyderabad from October 2019 to November 2021. All patients diagnosed with colorectal cancer were included. Immunohistochemistry for MLH1, MSH2, MSH6, and PMS2 was performed to check MMR gene expression at the protein level. Results: A total of 77 patients with a diagnosis of colorectal cancers were included in the study. The median (range) age of the study group was 52.5 years (17-73 years) with a male preponderance. There were 11 (14%) patients with MMR protein loss. There were 5 (10.4%) patients with deficient MMR above 50 years age. The comparison between patients with deficient MMR and patients with non-deficient MMR showed that the clinical and demographic profile were similar between the groups except, right sided colonic tumours were significantly higher in the MMR deficient group (p =0.011). The patients with deficient MMR had significantly early-stage tumours than patients with non-deficient MMR (p=0.032). Sixteen (20.7%) and 50(64.9%) patients of the study group received neoadjuvant, and adjuvant therapy respectively. On median (IQR) follow up of 20 months (6-27 months), 4 patients (liver, n=2; Nodal, n=1; Anastomotic site, n=1) had a recurrence of the disease, and 6 patients were expired. All deaths were observed in the nondeficient MMR group. Conclusion: The incidence of the MMR deficiency in CRC patients is 14%. The patients with MMR deficiency had significantly more right sided and early stage I & II malignancy. The two year overall survival was similar between two groups Keywords: MMR (Mismatch Repair), Colorectal cancer (CRC).

Background: Fever represents the most prevalent symptomatology encountered in outpatient departments (OPD). Thrombocytopenia is clinically delineated by a platelet count below 150,000 per cubic millimeter (cu.mm). The concurrence of fever and thrombocytopenia constitutes a predominant indication for hospital admission. This study endeavors to systematically evaluate the clinico-etiological profile of patients presenting with the concomitant manifestations of fever and thrombocytopenia. Materials and Methods: This study was conducted in the Department of General Medicine, Katuri Medical College, Guntur over a period of One year June 2021 to May 2022. The study included 150 patients who got admitted with fever and thrombocytopenia. Results: he present study 66.7% are males. Most common age group is between 20-40 years. malaria was the most common cause of fever with thrombocytopenia. 5.3% of the patients had died. Conclusion: Early recognition and prompt treatment are pivotal in patients suffering from fever with thrombocytopenia. Keywords: Clinical profile, laboratory profile, fever, thrombocytopenia, platelet transfusion.

Background: The Prognostic Nutritional Index (PNI) is commonly utilized to assess surgical risk in individuals with gastrointestinal cancers. Aim: This study aimed to analyze PNI values to forecast outcomes across several types of abdominal surgeries, with the goal of identifying high-risk patients to prevent complications and death. Material and Methods: This prospective study included 100 patients, aged 18 to 80 years of both genders, who underwent surgical procedures for abdominal conditions in either emergency or elective settings. The PNI for each patient was determined using the formula: 10 × albumin (g/dl) + 0.005 × total lymphocyte count (per mm³). The patients were divided into two groups based on their PNI: low PNI (PNI < 46) and high PNI (PNI > 46). Statistical analysis was performed using the chi-square test or Fisher's exact test, with a p-value of < 0.05 considered significant. Results: In the present study, Female patients were more likely to have a low PNI. Additionally, there was a higher prevalence of co-morbidities in patients with low PNI, and more of these patients required ICU care. The PNI < 46 group also had longer hospital stays and a higher mortality rate. Conclusion: The Present study concluded that the PNI proved to be a simple and effective biomarker for identifying baseline risk, predicting postoperative complications, and forecasting long-term outcomes in abdominal surgery. Keywords: PNI, Gastrointestinal cancers, ICU, Albumin, Mortality.

Background: Type II diabetes mellitus (T2DM) is a growing global health issue linked to physical as well as psychological challenges. The chronic nature of T2DM, lifestyle demands, and complications contribute to mental health burdens. There is a pressing need to assess psychological well-being of patients with T2DM. Comprehensive care of patients with T2DM should address both physical and psychological well-being in patients. Materials and Methods: This cross sectional study assessed the psychological well-being of 80 T2DM patients at a tertiary care institute using the Diabetes Distress Scale (DDS). Demographic details, diabetes duration, medications, and comorbidities were documented. Participants rated distress levels on a 1-6 scale. Data were analyzed with SPSS software, employing paired t-tests for quantitative data and Chi-square tests for qualitative data. A p-value < 0.05 was considered statistically significant. Results: This study analyzed 80 T2DM patients, revealing a male predominance (65%) and an average age of 54.57 years. The majority were overweight or obese, with a mean BMI of 28.96. Socioeconomic status and education levels varied. Distress levels as assessed by diabetes distress scale ranged from no distress (22.50%) to severe distress (21.25%), with an overall mean DSS score of 3.01. Females, older age, higher BMI, longer diabetes duration, and comorbidities were significantly associated with increased psychological distress. Higher socioeconomic and educational levels correlated with reduced psychological issues, emphasizing the multifactorial nature of diabetes-related psychological burdens. Conclusion: Routine psychological assessment particularly high-risk individuals T2DM patients is crucial for early detection and intervention improving treatment adherence, diabetes management and overall quality of life. Keywords: Type 2 Diabetes Mellitus, Psychological health, mental health, Diabetes Distress scale.