European Journal of Molecular & Clinical Medicine

Background:  A persistent metabolic syndrome is diabetes mellitus marked mostly by chronic hyperglycemia. Recently,it is considered as state of prothrombosis,characterized by abnormalities in platelet function which has been recognized as a component of the metabolic syndrome. Aims are made to discover and demonstrate the utility of various blood tests, including platelet indices for the early diagnosis of diabetic problems.  Increased platelet activity  has a role in development of diabetic complications, thus platelet volume indices are considered as potential biomarkers in diabetics who have vascular issues.
Methods :  356 people with diabetes and 201 non-diabetics participated in the study. To perform a complete hemogram, a Sysmex KX-21 automatic blood counter and a Benesphera H51 coulter were used. From the records of the Central Clinical Laboratory, the HbA1c level was assessed using the immunoturbidometric inhibition technique. The statistical analysis was carried out using SPSS version 17 (Statistical Package for the Social Sciences) (Chicago, IL). Student's t-test was used to determine if there was a significant difference in HbA1c, PC, MPV and  PDW. Statistics were judged significant at P 0.05.
Results :  In our study, MPV and PDW was statistically significant in diabetic patients with complications (P<0.0001 and P=0.0001respectively). A positive correlation was seen between MPV and HbA1c. While  MPV was statistically significant in diabetic retinopathy, nephropathy, and diabetic foot, PDW was statistically significant in diabetic retinopathy and nephropathy.
Conclusion : An effective predictor of diabetic cardiovascular issues would be MPV. Additionally, we found a direct correlation between an increase in MPV and a rise in HbA1c levels. Therefore, we propose that MPV can be used as a simple and low-cost method to monitor the onset and control of Diabetes Mellitus and its cardio-vascular effects.

Background: Emergence agitation has potential to harm both patients and caregivers. This is more often witnessed in patient undergoing otolaryngology operations under general anesthesia with volatile anesthetic used for maintenance.
Aim: We investigated the effects of intra-operative dexmedetomidine infusion on emergence agitation and quality of recovery after functional endoscopic sinus surgery in adult patients.
Materials and Methods: One hundred patients undergoing functional endoscopic sinus surgery were randomized into two groups. The dexmedetomidine group (Group D, n = 50) received dexmedetomidine infusion at a rate of 0.4 mcg/kg/hr from induction of anaesthesia until extubation, while the control group (Group C, n = 50) received volume-matched normal saline infusion as placebo. Propofol (2 mg/kg) and fentanyl (2 mcg/kg) were used for induction of anaesthesia, and sevoflurane was used for maintenance of anaesthesia. The incidence of agitation, haemodynamic parameters, and recovery characteristics were evaluated during emergence. A 40-item quality-of-recovery questionnaire (QoR-40) was provided to patients 24 hours after surgery.
Results: The incidence of agitation was lower in Group D than Group C (28 vs 56 %, P = 0.018). Mean arterial pressure and heart rate were more stable intra-operatively and during emergence in Group D than in Group C (P < 0.05). Time to extubation, nausea and vomiting, and pain scores were similar between the groups. Global QoR-40 score at 24 hours after surgery was higher in Group D (mean 174.7 ± 6.99) compared with Group C (mean 169.4 ± 9.91) (P < 0.05).
Conclusion: Intra-operative infusion of dexmedetomidine provided smooth and hemodynamically stable emergence. It also improved quality of recovery after nasal surgery.

Introduction: Various types, positions and class of 3^rd molars cause different diseases of soft tissues and hard tissues. Surgical extraction of 3^rd molars is thus the treatment of choice. Post operative complications after the extraction of third molars poses a fear among the patients to go for the surgery and to avoid it, they delay the surgery leading to more serious complications. This study aims to find out ways to reduce the post operative complications after removal of 3^rd molars.

The present study was conducted to find out incidence of abruption placenta cases, risk factors associated with abruptio placentae and fetomaternal outcome in RDBP Jaipuria hospital associated with RUHS CMS, Jaipur.
Material and methods: A Prospective observational study was conducted at Tertiary care hospital (Government RDBP Jaipuria Hospital attached with RUHS CMS, Jaipur) during one year study period.
Results: 40 (70.68%) babies were live births, 11 (18.96%) babies were dead (IUFD), while 6 (10.34%) were stillborn and 7 (12.07%) expired in their early neonatal period. This concludes perinatal mortality rate of 22.41% in our study period. 19 (32.76%) patients developed PPH, 16 (27.59%) patient encountered hemorrhagic shock, 9 (15.52%) patients developed DIC, 15 (25.86%) patients had prolonged hospital stay, 8 (13.79%) had puerperal sepsis, 5 (8.6%) patients required ICU admission, 4 (6.89%) required ventilatory support and 2 (3.45%) cases complicated with Renal failure. There was one maternal mortality in our study duration.
Conclusion: Placental abruption has a profound impact on both maternal and perinatal complications including PPH, shock, DIC, renal failure, couvelaire uterus with severe birth asphyxia and perinatal death.

Introduction: Many foramina and fissures are located in the sphenoid bone that carries nerve and blood vessels of the head and neck. Sphenoid bone is an unpaired centrally situated bone. In the cranium it lies anteriorly and to the middle cranial fossa its contribution is large. Also contributes to the posterolateral wall of the orbit and the lateral wall of the skull. Foramen spinosum is a very small foramina situated at the edge of the sphenoid bone in the middle cranial fossa. In the greater wing of the sphenoid bone foramen of spinosum is one of two foramina present. The foramen rotundum is a circular opening in the sphenoid bone that connects the pterygopalatine fossa. The foramen rotundum is a spherical opening positioned in the floor of the skull.

Osteoarthritis of the knee is one of the most common causes of painful disability in elderly people. Surgical treatment has been and is still a major challenge for the knee surgeon. The results after surgical treatment, especially knee replacement are of great importance, not only for the individual person, but for the whole society as well. Total Knee Arthroplasty being gold standard treatment for knee Osteoarthritis. Total Knee Arthroplasty is one of the most common orthopaedic surgeries, with over 7000 procedures performed in 2014 in US and projected increase in coming decades (3). The use of Total Knee Arthroplasty implants and following check x-rays give a good assessment of reduction and ideal positioning of implant hence preventing the complications that could occur. This study puts in a sincere effort to study the long term results after Total Knee Arthroplasty.

Background & Method: The aim of this study is to identify the risk factors and complications of pre-eclampsia and eclampsia. The patients were selected from patients who were admitted to as emergency cases in labour room patients were irrespective of age and parity. On a specially designed proforma for this study, the patient particulars like detailed obstetric history, examination and laboratory findings were recorded; were studies.
Result: In the current study incidence of preeclampsia and eclampsia was found to be 1.03% and 2.23% respectively. Our institute being a tertiary center resulting in higher referral rate would probably accounts for this high incidence of eclampsia.
Conclusion: Eclampsia is an ongoing challenge for the whole medical community, the root of which lies in the soil of illiteracy, poverty and poorly implemented health care system. Eclampsia is associated with significant maternal and perinatal morbidity and mortality. In majority of pre-eclampsia and eclampsia patients systolic blood pressure on admission was more than 150 mmHg and diastolic blood pressure was more than 110 mmHg. Serum Urea and cretinine was found to be within normal limit in majority of pre-eclampsia and eclampsia patients.
 

Background: Benign nodular goiter is the most common endocrine disorder requiring surgical treatment, especially in places with a high prevalence of iodine deficiency worldwide. The present study was conducted to assess post- operative complications in patients undergoing benign nodular thyroid surgery.
Materials & Methods: 110 patients who underwent benign nodular thyroid surgery of both genders were enrolled and parameters such as operation techniques applied and complications were recorded.
Results: Out of 110 patients, males were 45 and females were 65. Type of surgery performed was lobectomy + istmectomy in 10, near total thyroidectomy in 54, total thyroidectomy in 30, bilateral subtotal thyroidectomy in 16 patients. The difference was significant (P< 0.05). Common complications were temporary hypoparathyroidism in 35, flap edema in 11, temporary recurrent laryngeal nerve injury in 5, permanent recurrent laryngeal nerve injury in 6, seroma in 3 and hematoma in 2 cases. The difference was significant (P< 0.05).
Conclusion: Common complications were temporary hypoparathyroidism, flap, temporary recurrent laryngeal nerve injury, permanent recurrent laryngeal nerve injury, seroma and hematoma.

Background: Cochlear implantation (CI) in children was originally described in the 1970s. The present study was conducted to assess the incidence of co-morbidities in children undergoing cochlear implant.
Materials &Methods: 120 patients who had undergone cochlear implantation procedure were studied. Parameters such as unilateral/ bilateral surgery, cause of deafness, co-morbidities, premedication, PONV & peri-operative complications were recorded.
Results: Out of 120 patients, males were 80 and females were 60. Unilateral surgeries were seen in 100 and bilateral in 20. Anaesthesia maintenance involved inhalational sevoflurane in 20, propofol in 40 and thiopentone in 60 patients. Intra-operative anti-emetics used was iv ondansetron in 95 and iv ondansetron+ dexamethasone in 32 patients. Complications included was mortality in 1, flap necrosis in 2 and the procedure was abandoned in 3 patients. The cause of deafness was congenital in all 120 cases.  Co-morbidities found were 2 operated cases of PDA.  The mean duration of the implantation procedures was 2.4 hours. 2 patients received blood transfusion. PONV was observed in 10 patients. The difference was significant (P< 0.05).
Conclusion: Cochlear implantation in children is a relatively safe procedure. It involves few perioperative complications.

Background: Periampullary adenocarcinomas are a set of neoplasms that arise near the ampullaof vater. Although they are all adenocarcinomas, they arise from the different mucosal tissues of the pancreatic duct, bile duct, ampulla, and duodenum, they are treated with pancreaticoduodenectomy also known as whipples procedure, which is a complex, high risk surgical procedure. Before 1980,pancreaticoduodenectomy has been associated with a high rate of morbidity(40%-60%) and a high mortality rate up to 20%1 . Since that time, the in-hospitalmortality rate has decreased substantially with high-volume tertiary care centers reporting in-hospital mortality rate of 4% or less2,3. Luft et al. 4 provided theempirical relationship between higher surgical volume and lower post-operative mortality.

Background: Diabetic patients have an increased risk of developing micro- vascular and macro vascular disease, and platelets may be involved as a causative agent with respect to altered platelet morphology and function. Aim of our study was to determine if platelets were activated in diabetes and to see if there was a difference in MPV in diabetics and non-diabetics.
Methodology: A cross sectional study had been conducted to study the impact of HBA1C on mean platelet volume in Type 2 diabetic patientsand to find out association of mean platelet volume and development of microvascular complication (neuropathy, nephropathy andretinopathy) in diabetics in western Rajasthanattending the Medicine Outdoor and indoor at M.D.M. Hospital Jodhpur.
Conclusion: Platelets in Diabetes Mellitus become more reactive and agreeable and their Mean Platelet Volume (MPV) is increased. Increase in HbA1c concentration is directly proportional to increased MPV, thus poor glycemic control causes increase in MPV which result in more chance of developing microvascular complication. However, the increased MPV as the cause or the end result of microvascular complications needs to be further explored. Hence, we propose that MPV can be used as simple and cost effective tool to monitor the progression and control of Diabetes Mellitus and its associated microvascular complications.

Background:Dental implants have become a valuable alternative to dental prostheses supported by remaining teeth or adjacent oral soft tissues. The present study was conducted to assess prosthetic complications of dental implants.
Materials & Methods: The present retrospective study was conducted on 87 patients who received 120 dental implants of both genders. Type of complications was recorded in all.
Results: Out of 87 patients, males were 40 and females were 47. Age group 18-28 years had 5 males with 8 implants, 6 females with 10 implants, age group 28-38 years had 12 males with 18 implants and 14 females with 21 implants, 38-48 years had 13 males with 7 implants and 12 females with 17 implants, >48 years had 10 males with 13 implants and 15 females with 16 implants. The difference was non- significant (P> 0.05). Prosthetic complications were ceramic veneer fracture in 4 cases, prosthesis screw loosening in 3, prosthesis debonding in 2 cases, abutment loosening in 8 cases and abutment fracture in 1 case. The difference was significant (P< 0.05).
Conclusion: Authors found that common complications were ceramic veneer fracture, abutment loosening, abutment fracture, prosthesis screw loosening and prosthesis debonding

This manuscript describes six cases of thoracic spinal anaesthesia for patients with for
certain cases such as laparoscopic surgeries who are considered at high risk while under
general anesthesia. Anesthesiologists are hesitant to perform spinal anesthesia above the
termination of the conus medullaris due to fear of injuring the spinal cord. However,
thoracic spinal anesthesia has been demonstrated as a safe and effective method for
various surgeries. Although not routinely used, the procedure has been shown as
beneficial in maintaining hemodynamic stability for these patients and reducing side
effects encountered with general anesthesia. This activity describes the procedure of
thoracic segmental spinal anesthesia and explains the role of the interprofessional team
in managing patients who have undergone this procedure.

Background: To evaluate the incidence, clinical manifestation and management of
duplex moiety in children and also to study the outcome of duplex system in children.
Materials and Methods: Retrospective and prospective study of children who
underwent treatment for duplex moiety in a total of 24 cases for a period of 2 years.
Results: Of the 24 patients included in the study, n= 7 (29.1%) were in the age group of
<1year, n= 10(41.6%) were in the age group of 1-3 year. Right side was involved more
commonly. Upper moiety was more commonly involved in this study. UTI was most
common presentation in this study. Out of 24 cases in this study, 22 cases were managed
surgically and 2 cases managed conservatively. Cystoscopic puncturing of ureterocele
was done in 2 cases of ureterocele in this study (n=2, 8.3%). 2 cases of PUJO were
managed surgically by Anderson hynes dismembered pyeloplasty (n= 2, 8.3%).Out of
22 cases managed surgically from 24 cases, open surgeries were done in 17 cases(n=
17,77.27%) and 3 cases were managed by laparoscopically (n=3, 13.6) and cystoscopy
was done in 2 cases (n= 2, 9.09%). Out of 22 cases managed surgically, in 20 cases
there are no post op complications (n=20), 2 cases had complications(n= 2).
Conclusion: The anatomy and function of the duplex moiety are critical for making
management decisions. In comparison to late identification, early detection of the
duplex moiety and early management had a positive prognosis

Background: Hypocalcaemia is a common complication following thyroid surgery,
cause of which is multifactorial. The aim of this study was to identify risk factors for
development of post-operative hypocalcaemia in cases of total thyroidectomy, near total
thyroidectomy, and completion thyroidectomy with or without neck dissection.
Materials and Methods: From 1st November 2020 to 31st October 2021, 40 consecutive
patients undergoing total thyroidectomy, near-total, sub-total or completion
thyroidectomy at Govt Medical College & Hospital, Suryapet were enrolled in this
prospective study, longitudinal, cohort study. The primary endpoints were the
occurrence of post-operative hypocalcaemia as by defined as a nadir corrected serum
calcium less than 8.0 mg/dL or symptomatic hypocalcaemia.
Results: 40 patients were analyzed. The average age was 42.53±15.86 years with 86.7%
female. The most common indications for surgery were benign thyroid disease (80%).
27 patients (67.5%) experienced postoperative hypocalcaemia with 14 (35 %) requiring
intravenous calcium infusion. Risk factors for postoperative hypocalcaemia included
inadvertent parathyroid removal during surgery further exemplified by the fact that
there is lesser incidence of post-operative hypocalcaemia in patients undergoing near
total thyroidectomy.
Conclusion: Patients undergoing total thyroidectomy and in whom parathyroid could
not be identified and preserved or auto transplanted may benefit from more vigilant
pre-operative preparation and postoperative calcium and vitamin D supplementation.

Introduction: Laminoplasty is indicated in patients with cervical spondylotic myelopathy
(CSM) who have multilevel cervical spinal cord compression and a neutral or lordotic
cervical spine alignment. However, axial neck pain is a common complication post-surgery,
which may be caused by surgical damage to the semispinalis cervicis (SSC) muscle
attachment on the C2 spinous process. Modified C4-C7 laminoplasty with C3 laminectomy
completely preserves the SSC insertion on C2 and reduces the incidence of axial neck pain at
subsequent follow-ups.
Aim: Our study aims to evaluate the clinical and radiological outcome of C4-C7 laminoplasty
with C3 laminectomy for CSM in the Indian population.
Materials and Methods: We performed a retrospective analysis of 21 patients who
underwent the surgery for CSM with a minimum one-year follow-up. Clinical improvement
is measured using the modified Japanese Orthopedic Association (MJOA) score and visual
analogue scale (VAS). Radiographic parameters evaluated were the C2-C7 lordosis angle and
the cervical range of motion (ROM).
Results: In our study, the mean age of the patients was 54±7.7 years, and follow-up period
was 20.5±4.6 months. At a one-year follow-up, the mean pre-operative MJOA score
improved from 9.5±1.9 to 14.9±1.1 (p<0.001). Pre-operative axial neck pain was present in
nine patients with a mean VAS score of 4.9±0.8, which improved to 3.7±0.7 (p<0.001) at
three-month follow-up. At the final follow-up, only four patients had axial neck pain with a
mean VAS score of 1.1±1.4.
Conclusion: C3 laminectomy with C4-C7 laminoplasty is a safe, effective technique, which
achieves good neurological improvement and reduces the incidence and severity of postoperative
axial neck pain in the Indian population

Background:Supraglottic-airway devices (SAD) are divided into first-generation and second-generation devices. Baska Mask and i-gel device are the two commonly used second-generation SADs in anaesthetic practice. This study compares the i-gel and Baska Mask in terms of efficacy and safety as a ventilatory device in anaesthetized patients undergoing elective surgeries.
Materials and Methods: The study was carried out in Department of Anaesthesiology, Government Medical College and Dr.Sushila Tiwari Hospital, Haldwani. Patients were allocated into 2 groups: Group A (i-gel, n=35) and Group B (Baska Mask, n=35). All patients were pre-oxygenated for 3-minutes and anaesthesia was induced. Successful insertion of the device was confirmed by chest wall movement, auscultation of breath sounds and square wave capnographic tracing. At the end of the surgical procedure, anaesthesia was discontinued and patients were reversed with the standard dose of neostigmine and glycopyrrolate after proper suctioning. Complications, if any were noted after 2 hours and 24 hours period.
Results: The mean age of the study population was 35.83±9.50 years. Among i-gel group, there were 24 (68.6%) males and 11 (31.4%) females. Among Baska Mask group, there were 20 (57.1%) males and 15 (42.9%) females. The percentage of patients with easy insertion was 80% and 68.6% for i-gel and Baska Mask respectively. The mean time taken for SAD was significantly more among Baska Mask (24.49±4.39) in comparison to i-gel (16.19±2.38). Sore throat at 2 hours was seen in 3 (8.6%) and 2 (5.7%) patients of i-gel and Baska Mask group respectively. Dysphagia at 2 hours was seen in 2 (5.7%) and 1 (2.9%) patient of i-gel and Baska Mask group respectively, while dysphagia at 24 hours was seen in 1(2.9%) patient of i-gel group only, also hoarseness at 2 hours was seen in 1(2.9%) patient of i-gel group. Incidence of all the complications reported with i-gel and Baska Mask group were comparable.
Conclusion: This study demonstrated that both Baska Mask and i-gel provided a similar performance in airway management. In terms of the total time taken for insertion, i-gel has a lesser time of insertion than the Baska mask. The success rate of insertion of Baska Mask and i-gel was comparable and ease of insertion was also comparable. Complications observed in both devices were minimal.

Background:An infection of the natal cleft and sacrococcygeal area that affects mostly teenagers and young adults. The biggest disadvantage is wound healing. The lack of a superior surgical procedure is due to the numerous proposed surgical techniques. The study will describe the modified Bascom procedure and its effects in individuals with pilonidal illness. Objectives:The purpose of this study is to evaluate the modified Bascom procedure and its results in patients with pilonidal disease.
Materials and Methods: From October 2020 to May 2021, patients presenting to JSS Hospital, Mysuru with pilonidal sinus were studied prospectively. Patient selection is based on a thorough history, physical examination, and basic pre-operative examinations. Thirty cases receive modified Bascom. The patient's rate of cure, postoperative complications, and recurrence are observed.
Results: In this study of 20 patients, there was a 9:1 male preponderance. 20.46 + 9.42yrs mean age of presentation Pilonidal sinus is widespread in persons who sit for long periods of time as drivers, students, etc. Acute pilonidal sinus to chronic discharge sinus. These patients' hospital stay, healing time, wound infection, wound dehiscence, and recurrence were evaluated, and the results were favourable. Our patients had wound infection and dehiscence, although the rate of recurrence and complications, hospital stay (4.42 + 1.24 days), and wound healing time (19.6 + 1.22 days) was low compared to previous operations.
Conclusion: Study demonstrates pilonidal illness affects guys in their 30s and 40s. Occupation and local anatomical factors play a role in illness development. Pilonidal disease is diagnosed clinically. There are several options for treating pilonidal disease. The primary closure is the most effective, with low recurrence rates, less problems, and faster healing

Background: Postoperative complications seen following orthopedic surgeries are
commonly the hemotologic complications encountered globally.
Aims: The presentretrospective clinical study was conducted to assess the various
postoperative hematologic complication seen in the subjects following orthopedic surgery.
Materials& Methods: In 78 subjects who underwent orthopedic surgery medical records
were assessed including transfusion details. The collected data were subjected to statistical
evaluation and the results were formulated.
Results: Coded strokes were seen in 3.84% (n=3) subjects, blood transfusion was done in
6.41% (n=5) study subjects following surgery, major bleeding following orthopedic surgeries
were seen in 24.35% (n=19) subjects, and myocardial necrosis in 2.56% (n=2) study subjects.
Other minor complications seen were seen in the 1.28% (n=1) subject. Total complications
reported in study subjects were in 37.17% (n=29) study subjects
Conclusion: The present study concludes that the prevalence of hematologic complications
in subjects undergoing orthopedic surgeries is high. However, more studies prospectively are
needed to reach a definitive conclusion.

Aim: To evaluate the role of intraoperative abdominal fat augmented duroplasty in
spinal intradural tumors for prevention of CSF related complications.
Material and methods: The present prospective interventional study was conducted
among 20 patients with an IST were operated, who attended Bangur Institute of
Neurosciences, IPGME & R and SSKM Hospital, Kolkata during February 2021 to
April 2022.After endotracheal intubation and line placement inthe supine patient, the
left paraumbilical area is prepared and draped. Fat was harvested though a 2
cmparaumbilical incision. The harvested fat isplaced in antibiotic saline in a sterile cup
until neededfor closure.All patients had neurophysiologic monitoring throughoutthe
operation. Once the tumor was resected, the durawas closed with 5-0 Prolen stitches in a
running fashion.Any evidence of a CSFleak or pseudomeningocele was evaluated
prospectively. The fat-tissue dynamics on postoperative MRIs were also assessed.
Results: The hospital stay lasted anywhere from 2 to 11 days (on average 5 days), with
follow-up lasting anywhere from 1 to 12 months. Despite postoperative irradiation and
treatment, one patient, a lady in her mid-40s with a grade III conus/cauda astrocytoma,
died 1 year later as a result of disease progression and CSF seeding throughout her
neuraxis. During follow-up, no evidence of tumour recurrence was seen in any other
patient.No sign of a CSF leak or a pseudomeningocele was seen on physical examination
or neuroradiologic follow-up.
Conclusion: The use of autologous fat grafting in the future enables a watertight dural
closure and eliminates the dead space generated by surgical exposure, muscle dissection,
and bone removal.

Introduction: Coverage of open tibial fractures presents unique defects requiring the
ingenuity of the surgeon in devising flaps for stable coverage. In our country road
traffic accidents are the most common cause of lower limb trauma, followed by fall
from height. Though well established norms are in place regarding the time and nature
of cover, it requires a team effort with involvement of the orthopaedic surgeon as a rule,
and allied specialities like plastic surgeons, general surgeons
Aims: To analyzefasciocutaneous flaps reliability in coverage of open tibial fractures
Materials and methods: This study was conducted in the Department of Plastic and
reconstructive Surgery, Osmania General Hospital, Hyderabad over a period of 24
months from DEC 2019 to DEC 2021. 50 cases age group 10-60yrs of both genders who
present with open tibial fractures that are covered with fasciocutaneous flaps, small to
medium sized tissue defects of leg. Timing of coverage was classified into Acute- within
72 hours, Subacute- 3 days to 6 weeks, Chronic- Greater than 6 weeks. All the patients
included in the study were admitted to the trauma ward under the care of the attending
orthopedician and received first aid.They were then resuscitated to minimize bleeding,
restore airway and correct shock.
Results: The overall incidence of complications in this series of fasciocutaneous flaps
was 42%. Distally based fasciocutaneous flaps had a higher complication rate. major
complications, usually a failure of the intended coverage, actually more common for
proximally based flaps (12.9%) than those distally based (6.3%),although not stastically
different(p=0.436). Infection was the most common complication - 16% of all
complications. Total flap loss was seen in only 2 patients which indicated a successful
wound coverage in 96%.
Conclusion: Flap coverage is best done within 72 hours of injury. Overall early surgery
significantly reduces patient’s morbidity, decreased hospital stay and early return to
work.

Background:Recently, a number of publications have raised concern about the rising
prevalence of diabetes mellitus in Telangana. The International Diabetes Federation has
named Saudi Arabia among the top 10 countries with the highest prevalence of diabetes
Objective of the Study: To observe and evaluate the incidence and complications seen in
infants of diabetic mothers.
Materials and Methods: It is a prospective observational time bound study conducted
Yashoda Hospital, Telangana, India from December 2019 to November 2020. All live
babies born to mothers with GDM or pregestational DM were enrolled in study.
Maternal history and complications during labour were recorded. APGAR scores
assessed. Investigation for glucose estimation, PCV, serum calcium, serum bilirubin was
sent. Chest X ray was done in babies with respiratory distress. 2D ECHO, USG
abdomen, USG cranium were done in all babies after stablisation.
Results: 70 neonates were born to diabetic mothers. 2 IUD and 6 still born were
excluded from study and 62 neonates were evaluated. 2 neonates died.70.96% were
term babies and 29 % preterm. 40 infants (64.5%) were born to GDM mothers, 20
(32.3%) to mothers with type 2 DM and 2(3.2%) to type 1 DM. 16.2% were LGA while
12.9% were SGA. Hypocalcemia was seen in 4 neonates (6.7%). Hyperbilirubinemia
was seen in 4 (13.3%). Sepsis was seen in 8 neonates. CHDs were seen in 42.9%, most
common being ASD/PFO 21.3%. VSD was seen in 10.7%, PDA in 7.1% and septal
hypertrophy in 3.5%. One case had pyloric atresia and one had RDS. Association
between HbA1c levels and complications like macrosomia, hypoglycemia, congenital
anomalies was not significant in our study.
Conclusion: Neonates born to diabetic mother are at a high risk of developing
complications like hypoglycemia, hypocalcemia and cardiac defects.

Over a two-year period, individuals with mandibular fractures underwent surgical treatment, and the complications that resulted from that are examined. 225 patients (mean age 32.6 (SD ±14.6) years) who underwent surgery for a mandibular fracture between two years. There were 426 fracture lines in all. 29 of the 213 dentate patients were largely treated with intermaxillary fixation (IMF). On 99 patients, IMF and osteosynthesis were carried out. To enable open reduction and internal fixation (ORIF), 79 individuals solely underwent IMF during surgery. Three of the 12 edentulous patients had Gunning splint treatment. Internal fixation and manual reduction were used to treat nine patients.442 plates and 1965 screws in all were used. Sixty (26.7%) of the patients had problems, including TMJ dysfunction, dysocclusion (15 patients), contaminated osteosynthesis material (15 patients), and (temporary) hyposensibility of the lip and chin (34 patients) (five patients). For the surgical retreatment required to address a dysocclusion, four patients. The findings of this study provide crucial information for improving the treatment of the broken mandible, and they partially accord with those of other studies.

Haemorrhoids are one of the most frequently encountered anorectal conditions in the clinical practice of a surgeon. Haemorrhoidectomy is the most effective approach for haemorrhoidal disease especially for grade III and grade IV disease and also in grade II disease which do not respond to conservative and non-invasive treatment. However, postoperative pain is a major concern, and the surgery itself is with complications including notably bleeding, wound sepsis, pain, and anal stenosis. The patients were explained about their disease and modalities of treatment as Open or closed haemorrhoidectomy with advantages and disadvantages of each. 25 patients were operated by open haemorrhoidectomy and another 25 patients by closed haemorrhoidectomy under spinal anaesthesia. Data was collected according to proforma which included detailed history, clinical examination and investigation. Data was tabulated, analyzed and results interpreted. The mean immediate post-operative pain score in open group was 2.88 ± 0.53 VAS and in closed group was 2.44 ± 1.9 VAS; these differences were significant with p value of 0.027. The mean duration hospital stay in open group was 4.64± 0.9 days and in closed group was 4.28 ± 0.9 days (p value= 0.18) the differences were not significant. People who underwent open procedure took 17.5 days and closed group patient took 16. 4 days to resume their normal activity, these differences were not significant (p Value = 0.42).

Background: The advent of Laparoscopic cholecystectomy (LC) has revolutionized the treatment of gall bladder disease. Laparoscopic cholecystectomy is preferred because of accompanying less postoperative pain, shorter hospital stay, faster recovery, improved cosmetic results, early return to work. In present study, we retrospectively analysed cases underwent laparoscopic cholecystectomy during last 4 years at our tertiary hospital.
Material and Methods: This retrospective, descriptive study was conducted among patients, who underwent laparoscopic cholecystectomy.
Results: During study period, 366 laparoscopic cholecystectomies were performed. Mean age was 40.45 ± 13.25 years, majority were female (78.69 %) as compared to male (21.31 %). Mean body weight was 58.78 ± 13.51 kgs, while mean BMI was 23.81 ± 2.23 kg/m². Various risk factors noted among cases were gall bladder contracted (18.85 %), raised bilirubin (16.12 %), acute attack (6.28 %), raised alkaline phosphates (3.55 %), previous laparotomy (3.01 %) & previous ERCP (1.64 %). Indication for surgery were Chronic calculous cholecystitis (61.75 %), Symptomatic cholelithiasis (15.30 %), Gallstone pancreatitis (13.11 %), Acute cholecystitis (6.28 %), Gall bladder mucocele (3.01 %) & Cholecystoduodenal fistula (0.55 %). Majority surgeries were done by 4 ports (88.52 %) as compared to 3 ports surgery (11.48 %). Mean duration of surgery was 77.49 ± 24.27 minutes. Drain placed in 20.22 % cases while 5.19 % cases required conversion to open cholecystectomy. Complications noted were leakage of bile (7.92 %), postoperative haemorrhage (4.10 %), subhepatic abscess (3.01 %), port site induration (2.73 %) & retained bile stone (0.55 %). Average length of stay was 2.53 ± 1.24 days.
Conclusion: Laparoscopic cholecystectomy is safe and efficacious surgery, with advantages such as shorter duration of surgery, less intra and post-operative complications, early discharge and mobilization.

Background & Method: The aim of the study is to study the Complications and Associated Risk Factors of Dengue in Children. Dengue sero positive patients are selected and examined clinically for hepatomegaly and jaundice and subjected to complete blood count, liver function tests, ultrasound abdomen, PT, APTT, Widal, HBsAg, HCV and analysed. Bilirubin reacts with sulphanilic acid to produce an azo compound, the colour of which could be measured at 546 nm and this gives an estimate of concentration of bilirubin.
 
Result: In this study, Dengue has affected male and female children almost equally. Thrombocytopenia has occurred in 74% of patients with probable dengue, 98% with warning signs and 100% in severe dengue.
 
Conclusion: In developing country like India, incidence of dengue outbreaks is increasing. Hepatic involvement of varying degrees has been reported. As hepatic dysfunction in dengue is transient and reversible, early identification of the same would help to reduce life threatening complications. Dengue is a self-limiting disease that is caused by viral infection. Dengue must be well treated even if patients are asymptomatic. Complications of Dengue can be manifested in many organs, including neurological, Gastrointestinal, Hematology, Cardiac & Renal systems

Introduction: Clavicle fracture is a common traumatic injury and account for approximately 2.6% of all fractures. The middle-third fractures (80-85%) are most common of all clavicular fractures and were conservatively treated. Several recent multicenter, randomized control studies reported that open reduction and internal fixation (ORIF) had much lower nonunion and malunion rates as well as better shoulder function compared with non-operative treatment there are few precise data on the complications and functional outcome rates of each plate based on different fracture classifications. The current study aims to understand the complications and functional outcome with various plates.
Material and Methods: A prospective study was done in 40 patients with mid clavicular fractures type B according to Robinsons classification selected by purposive sampling method, during December 2018 to May 2021 in a tertiary care teaching hospital. After obtaining institutional ethical clearance and informed consent, history was collected, findings on general, systemic and local examination were recorded. Clavicular fixation was done under general anaesthesia using plates (reconstruction plate/dynamic compression plate/locking compression plate) and cortical screws. Follow up done to note complications and functional outcomes with different plates and analyzed statistically by chi-square test with P<0.05 as significance level.
Results: Majority of the patients were in the age group of 19-29 years (20 patients/50%) with mean patient age was 32 years. Majorities were males (32 patients/80%). In 20 patients (50%) reconstruction plates were used. In 10 patients (25%) locking compression plates were used.
 
In 10 patients (25%) Dynamic compression plates were used. The functional outcome was assessed by Constant and Murley score, 29 patients (67.5%) had excellent functional outcome, good functional outcome in 5 patients (12.5%), fair functional outcome in 6 (15%) patients and poor in 2 patients (5%).
Conclusions: Functional outcome was either excellent or good (80%) and complications (45%) were less common in patients managed with non-reconstruction plate compared to reconstruction plate, which was statistically significant.

Background: The history of end-stage liver diseases has been changed by liver transplantation. Egypt’s high prevalence rate of liver diseases has increased the number of patients requiring liver transplantation. Living donor liver transplantation has many advantages over deceased donor liver transplantation; nevertheless, biliary complications, which are the commonest intractable problem, are more likely to occur after living donor liver transplantation. Magnetic Resonance Cholangiography is a non-invasive method to assess the biliary system’s anatomy.
Objective: In this study, we aimed to assess the anatomic variations of the biliary tree among the Egyptian population using Magnetic Resonance Cholangiography.
Patients and Methods: We conducted this study on 353 patients who underwent MRC procedures between May 2010 and December 2015. Anatomical variations of intrahepatic bile ducts were studied based on the variable insertion of the right posterior hepatic duct according to Huang classification; moreover, the presence of accessory ducts was also noted.
Results: Based on the Huang classification, variations were divided into five types.Type 1 (typical type) occurred in 207 cases (58.6%) while type 2 (triple confluence) occurred in 61 cases (17.3%). Type 3, Type 4, and Type 5 were noted in 66 cases (18.7%), 14 cases (4%), and 5 cases (1.4%). We observed accessory duct in 14 cases (4%of all studied cases).
Conclusions: Our findings provide a precise understanding of the variations of the intrahepatic bile ducts among Egyptians. This is important for both donors and recipients to ensure a successful liver transplant and reduce subsequent biliary complications.

The review presents current data on the role of the immune system in the development after surgical complications during endoprosthetics hip joint. Surgical stress, exerting different powers oppressive effect on the immune system is a powerful factorcreating the preconditions for the development of secondary immunosuppression or- aggravating it against this background, the likelihood of postoperative complications are enough high. The conducted research has established the involvement in the process: osteogenesis and bone resorption Polypeptide growth factors - cytokines. The use of immunological methods allowed researchershighlight: criteria and develop ways to predict development complications in arthroplasty, the results were analyzed endoprosthetics of the hip joint in overweight patients body.

Diabetes has a significant incidence of illness, health care effects and lead to a high mortality rate due to its complications in both developed and developing countries so far. Diabetes can be divided into three main types: Type 1 diabetes, Type 2 diabetes and Gestational diabetes, the most common type is Type 2 diabetes (T2D). Our work focuses on researching the relationship of complications and their cost of treatment in order to make the treatment plan and minimize its costs in at the Thanh Nhan hospital in Hanoi, Vietnam. Therefore, the research results show that there are many different types and rates of complications of T2D depending on key factors such as: age and duration of the disease, by determining the complication rate and analyzing multivariate logistic regression models to find the risk factors associated with an increase in the number of complications of the disease from the Social Science Package Statistics (SPSS) software and other.

Extractions are the most common surgical procedures carried out and postextraction bleeding is most commonly seen complication. The aim of this review was to determine the effectiveness of topical hemocoagulase as a hemostatic agent and its role in reducing postextraction bleeding and its comparison to routine saline pressure pack after tooth extraction. Various differences was present between the hemostatic agent and saline pressure pack in relation to pain, swelling, wound healing, bleeding time, and other complications. Topical hemocoagulase is effective in reducing bleeding, pain, and swelling after extraction when compared to saline pressure packs. It also act as a promoter of wound healing.

Medical emergencies at dental office are a rare situation. When the dentist encounters such occasional incidences, they should initiate emergency procedures to save the life of the patient. In case of an emergency, the roles and activities of the dentist and the team members should be planned, documented, and displayed. The staff members should be trained and updated in first aid, cardiopulmonary resuscitation, and other emergency procedures. The knowledge of management of medical emergencies will increase the confidence of the dental surgeons in their clinical practice. The objective of this review article is to provide a vision to the commonly occurring medical and dental emergencies and complications in dental practice and their management.

Pneumonia is a disease that has an acute course and is characterized by an infectious and inflammatory lesion of the lungs. The high level of one-stage morbidity of community-acquired pneumonia, mainly in the variant of severe and life-threatening course in combination with concomitant pathology (75.4%), causes significant damage to the health of the population and deaths are observed in 6.7%. The problem of manifestations of long-term results of pneumonia is becoming increasingly relevant today in connection with the sharply increased rate and intensity of working activity of people, improving the quality of work, as well as environmental pollution and concomitant pathology also leaves its mark on human health. In case of community-acquired pneumonia, the concomitant pathology will influence the long-term results, further observation of these patients will show for 2, 3 years, depending on the severity of the course.

In this work, we analyzed the frequency of violations of the vaginal microbiota and the development of infectious and inflammatory complications during post-placental intrauterine contraceptive administration during abdominal delivery. Currently, the incidence of infectious and inflammatory diseases in obstetrics does not tend to decrease. In the structure of infectious and inflammatory diseases, a significant place is occupied by postoperative purulent-septic complications – endometritis, suppuration of wounds on the uterus and anterior abdominal wall after cesarean section. One of the tasks solved in the course of this study was to identify the correlation between the state of the birth canal microbiota and the development of complications when using IUDs during cesarean section.

Diabetic complications, such as, retinopathy, nephropathy lead to blindness and end stage renal failure respectively, various neuropathies, and ultimately increased mortality. While the exact mechanisms that lie behind the pathological changes associated with diabetes remain obscure, however, it is widely believed that chronic or intermittent hyperglycemia may alter various metabolic pathways at the tissue level, for instance, increased flux through the polyol and the hexosamine pathways as well as a persistent activation of protein kinase C (PKC). Reducing sugars such as glucose and fructose may react non-enzymatically through their carbonyl groups with free amino groups of proteins (commonly the Ɛ amino group of lysine) to form a Schiff base intermediate which then rearranges to a more stable structure known as Amadori product. The Amadori products generated by the aforementioned Maillard reaction may then undergo further reactions, including dehydration, oxidation and rearrangement resulting in the irreversible formation of heterogeneous advanced glycation end products (AGEs)

Chicken pox is one of the leading places in prevalence after acute respiratory infections. The urgency of the problem is determined by the high incidence of chickenpox, the widespread spread of the pathogen, an increase in the specific gravity in the general infectious pathology, and the ineffectiveness of preventive measures implemented in practice (isolation of patients, quarantine). Despite the low incidence of chickenpox in adults, the risk of severe complications and even death is higher than in children. The greatest risk of the dysfunctional course of chickenpox is noted in people with immunodeficiency. This is characteristic, first of all, for patients with HIV infection and patients with chronic diseases (diabetes mellitus, autoimmune diseases, bronchial asthma, chronic hepatitis, systemic diseases of the connective tissue).
The aim of the study was to conduct a retrospective analysis of the clinical and laboratory features of the course of chickenpox in children and among the adult population of the Samarkand region, as well as to offer practical measures for the prevention of disease in practical health care.

IntroductionChildhood obesity is termed as excess body fat accumulation which negatively affects a child's health or well-being. As methods to work out body fat directly are difficult, the diagnosis of obesity is usually supported by BMI. A Body mass Index of 30 or more is considered as obesity. Children are considered to be obese if they are above the normal weight for their height in relation to their age. The problem is global and is steadily affecting many low and middle income countries. The rising prevalence of obesity in children and its many adverse health effects it's being recognized as a significant public health concern. AimThe aim of this study is to assess the Knowledge, awareness and risk factors of childhood obesity among the adolescent population.
Materials and MethodThis is a survey based study and was conducted on an online forum, Survey Planet with a sample of 100 participants .Adolescents of age group between 10-21 participated in the study. A questionnaire with 10 questions was circulated among the Chennai population. The responses were collected. The data was summarised as the number and percentage and analysed using SPSS.Chi square test was done and a P value of < 0.05 was considered statistically significant.
ResultsIn this survey, we observed that 29% of them consider their current weight to be harmful for their health. 40% of them check their weight regularly. Half of the population were aware that chronic stress can lead to weight gain. Only 41% of the participants have the habit of exercising regularly. 67% of the participants were aware of the complications of obesity. Among all the respondents 28% of them had a family history of obesity.
ConclusionWithin the limits of this survey, we can conclude that awareness on childhood obesity is present among the adolescent population. Females were more aware of Childhood obesity than males. However regular exercise and healthy diet is essential to maintain a healthy weight and prevent obesity.