European Journal of Molecular & Clinical Medicine

Manganese-Zinc Ferrite is a very high permeability magnetic material. The permeability is
depended on the amount of manganese and zinc used in the synthesis of ferrite
material.Reagent graded raw materials were used as initial material to synthesize and get a
characterization of Mn-Zn based spinel ferrite. The nanocrystalline powders of manganese
ferrite were obtained by the process of citrate precursor method. The obtained nanocrystals
of Mn-Zn were doped by Gadolinium which further it was employed to produce specimens
of Mn0.5Zn0.5GdxFe2-xO4 (x = 0, 0.01, 0.03). The study of doped (Gd) Mn-Zn ferrite
nanocrystals was characterized by X-ray diffraction (XRD) and scanning electron
microscopy (SEM). The results of XRD data determine the average crystallite size of doped
(GD) Mn-Zn nanocrystals in the range of 40nm to 45nm. The images obtained through
FE-SEM shows the flake-like structure of doped (Gd) Mn-Zn ferrite nanocrystals. Further
studies of doped (Gd) Mn-Zn ferrite were done by FTIR and Raman spectroscopy.

Online Banking Services are accessible to all the customer who have their valid user and id allocated by
the bank. The System provides the different facilities like Balance enquiry, Funds transfer to another
account in same or different bank, Request for cheque book, change in address, stop payment of cheques,
viewing monthly and annual statements. Online Banking System has attractred the attentions of banks,
securities, insurance companies in developing nations sice the 1990s and the rapid and significant growth
in electronic sectors and commerce.
The main motive of the online banking system is is to provide customer with alternative that is more
responsive and less expensive also time saving.
Online banking system is the most important financial activity which is now a days mostly carried out by
any person who has an account in the bank. Not only unique id and password is allocated with that an
new UPI code system is added as a security the bank.If a wrong password is given thrice in the session,
that account gets locked and the customer is not able to use their account and an warning is pop up that
the account is locked and the same locking system goes with UPI code.
Whenever we deal with the Online banking system services the main concern of the customer is always
related to the security regarding to the banking transaction and account login activities.
The E-Banking services now deals with the single sign-in log on and it is not secured . Authentication is
now an proposed system, in this activity of linking an individual process on the basis of username and
password and basically the password is consist of characters, numbers, alphanumeric values, special
character and etc.. to make the password strong so that the attackers chould not guess the password easily
it might be difficult to remember the password but the strong password are mandatory otherwise the
software shows the message as the password is weak and it doesnot accept that weak password until we
create the strong password.

The adnexal masses represent a variety of diseases, ranging from normal luteal cysts
to ovarian cancer, from gynecological or non-gynecological origins. Transvaginal sonography
(TVS) has turned into the first step imaging method for describing adnexal masses. Transvaginal
ultrasonography is the initial method for detection of adnexal masses, it can visualize the deeper
structures and even note the fine details of the organs like fallopian tube and ovary, also
distinguish between benign and malignant lesions. Gynecologic Imaging Reporting and Data
System (GI-RADS): is a new system based on BI-RADS for reporting findings in adnexal masses
identified by TVS. Thick papillary projections, thick septa, solid areas with/without ascites,
defined according to the International Ovarian Tumor Analysis criteria and vascularization within
solid areas, papillary projections or central area of a solid tumor on Color or Power Doppler
assessment are suggestive signs of malignancy.

Intra-articular distal humerus fractures remain one of the most difficult injuries to
manage. These fractures comprises 2-6% of all fractures and have bimodal age
distribution. The majority of these fractures occur either as low energy falls or high
energy trauma. Most fractures in elderly patients are intra- articular with bi-columnar
involvement. They are commonly multifragmental and occur in osteopenic bone. High
energy injuries occur in adults, which are accompanied with other associated injuries.
The elbow is anatomically a trocho-ginglymoid joint in which distal humerus bifurcates
into two divergent cortical columns, termed as medial and lateral columns. The articular
segment functions architecturally as a tie arch. The elbow is one of the most constrained
joints of the body and tolerates immobilization poorly and any alteration within the
architecture of the joint has the potential to limit motion and compromise
function.Treatment outcomes are often related to elbow stiffness, weakness and pain.
Meticulous planning is required in obtaining an anatomic intra-articular reduction, and
creating a fixation construct that is rigid enough to tolerate early mobilization. Usually,
70% of patients that sustain an elbow fracture, fall directly on to the elbow because they
are unable to break their fall with an out stretched arm. This randomized, prospective
study was undertaken to compare the functional outcomes of distal humerus intraarticular
fractures in adults treated with parallel plates and orthogonal plates. From a
clinical perspective, a parallel plating method appears to provide better rigid fixation that
is adequate for obtaining bone union. However, no statistical significant differences were
observed between the orthogonal and parallel double plating methods in terms of clinical
outcomes and complication rates. If meticulously applied, with suitable plates, both
parallel and orthogonal positioning can provide adequate stability and anatomic
reconstruction of the distal humerus fractures.

Background: Liver cirrhosis (LC) is an irreversible condition which results from necrosis
of hepatocytes with loss of reticular network and nodular regeneration of residual liver
tissue. This study was undertaken to assess the relation between serum prolactin levels and
the severity of the liver cirrhosis.Materials & methods: This cross-sectional observational
study was conducted during one calendar year at a tertiary care center in Western India
among 50 cases of established liver cirrhosis. Serum Prolactin was estimated using ADVIA
Centaur® CP Immunoassay System (Siemens®) by Chemiluminescent technique. The
modified Child Pugh score was calculated for each study participant. The patients were
categorized into Classes A, B or C based on the score obtained. Hepatic encephalopathy
was diagnosed and graded as per West Haven classification system. The grade I-II were
taken as mild and grade III-IV as advanced hepatic encephalopathy for calculation of the
modified Child-Pugh score. Ascites was graded as mild, moderate and severe. All the data
were stored in excel sheet using Microsoft® Office 2007. Results: The mean serum
prolactin, serum albumin, serum Bilirubin and INR were 48.1±26.8 ng/ml, 2.8±0.6 g/dl,
4.8±4.9 mg/dl and 2.2±1.0 respectively. (Table No. 1) The mean serum prolactin level in
alcoholic cirrhosis (49.2±25.1 ng/ml) does not statistically differ from non-alcoholic
cirrhosis (46.6±29.4 ng/ml) cases (p > 0.05). The mean serum prolactin level was
statistically significantly higher among cases in Modified Child Pugh Class-C (68.91 ±
17.80 ng/ml) compared to Class B (33.26 ± 7.41 ng/ml) and Class A (10.03 ± 4.01ng/ml)
cases. The mean serum prolactin level was 81.36 ± 19.85 ng/ml in cases with severe ascites,
60.09 ± 18.05 ng/ml in moderate ascites cases, 36.1583 ± 15..06 ng/ml in mild ascites cases
and 19.79 ± 12.29 ng/ml in cirrhosis cases without ascites. The difference in mean serum
prolactin level was significant among different severity of ascites. The serum prolactin
level was 81.08 ± 18.04 ng/ml in cases with advanced hepatic encephalopathy, 56.89 ±
15.05 ng/ml in cases with mild hepatic encephalopathy and 26.16 ± 13.99 ng/ml in
cirrhosis cases without encephalopathy. Conclusion: Serum Prolactin levels showed
positive correlation with Modified Child Pugh Score and Fibroscan in predicting the
severity of disease.

Leisure-time physical activities (LTPA) can improve children’s physical fitness, their ability to control negative emotions, even their school performances. As the factors that influence schoolchildren’s willingness to participate in LTPA are multifaceted, an appropriate and valid measurement tool is critical for advancing the discussion of this topic. The purpose of this study is to develop a questionnaire about schoolchildren’s willingness to participate in LTPA and to verify its content validity and potential user validity. The research procedures involved three stages. The first stage was the development of the questionnaire. The questionnaire items were developed through systematic collection, review, and summary of the literature. The second stage involved eight experts in testing the content validity of the questionnaire. The third stage was to test the potential user validity with eight upper-grade students as questionnaire respondents. The systematic collection, review, and summary of the literature resulted in five factors: individual, interpersonal interactions, parents, environment, and school policies. Based on these, 36 items were drafted for the questionnaire, named “Influences on Schoolchildren’s Willingness to Participate in LTPA.” The questionnaire was validated by the eight experts. The item-content validity indexes (I-CVI) ranged between .88 and 1.0, and the summative content validity index (S-CVI) was .9. As for the items’ wording appropriateness, the I-CVI ranged between .75 and 1, while the S-CVI was .96. For potential user validity, the students rated the comprehensibility of the 36 items. Their responses fell between 3 (mostly understandable) and 4 (completely understandable). In conclusion, the expert content validity and potential user validity testing confirmed that the questionnaire has good content validity. In the future, the questionnaire will be administered to a large sample of schoolchildren to verify its construct validity and reliability

Worldwide, oropharyngealcancer accounts for 1.6% of all the new cases and 1.5% deaths in 2020. Overall42176, is the incidence of oropharyngeal cancers occuring in Asia, and account for approximately 30% of all the cancers in India. Oropharyngeal carcinoma is eleventh most common cancer worldwide and accounts for approximately 10 per cent of the annual worldwide incidence of head and neck squamous cell carcinoma. In India, head and neck cancers contribute up to 7.8% of the global cancer burden and 8.33% of the global cancer deaths.In 2020, the incidence of oropharynx cancer worldwide is 98,412 ¹. In India incidence rate is 6794 ². Incidence rates are more than twice as high in men as in women³.The tonsil is the most frequent subsite of oropharyngeal cancer followed by the base of tongue.

Aim: To evaluate drug utilization pattern of antidiabetic drug in type-2 diabetic patients
attending at private diabetes clinic. So that, this information can be used in assessment of
quality of care provided as well as to facilitate the rational use of drugs in populations
Objective: To evaluate the current trends of prescribing patterns of antidiabetic drug in type
2 diabetic patients
Material and Methods: An observational prospective study undertaken at diabetes clinic from January 2015 to April 2016 after approval from institutional ethic committee. Total 600 patients of type 2 diabetes mellitus were enrolled. Data related to demographic details of the patient (age, gender and BMI, occupation, social status), past history, family history, personal history, all investigations, drug treatment and adverse drug reaction were recorded in suitable case record form. Follow up was carried out for all patients every 3^rd, 6^th, 9^th and 12^th month visit for glycaemic control. Data were entered into Microsoft excel 2010 and analysed by descriptive statistics (percentage, mean, standard deviation) and chi square test.
Results: Out of 600 patients, 58.67% were males and 41.33% were females. The mean age of the patients was 51.85 ± 4.24 years. Hypertension (31%) was most common co-morbid illness.Most common complaint was weakness (18.33%). Majority prescriptions had fixed dose combination (FDC) of two antidiabetic drugs (93.2%). Most commonly prescribed FDC was of sulfonylureas (Gliclazide) and Biguanide group (Metformin)in 552(92%). Average number of drugs per encounter was 3.02, 0.3 % drug was prescribed by generic name, 4.17% drug was antibiotic, 7.7% drug was injectable medicine, 14.27% drugs was prescribed from national list of essential medicine and 11.35% drugs were prescribed from WHO essential list of medicine. Fixed dose combinations were prescribed in 57.27% of patients. Glycaemic controlled was observed in 32.84 % patients.
Conclusion: Sulfonylurea and Biguanide combination most commonly used to treat type 2 DM and among them Gliclazide and Metformin combinations was most commonly prescribed.

Background: Ankle arthrodesis for diabetic complications, such as osteomyelitis and Charcot
neuroarthropathy (CN), constitute an entirely separate group that calls for different surgical
approaches for successful outcomes. Diabetes mellitus is currently the most common cause of
neuroarthropathy. Abnormal nociception and proprioception lead to progressive destruction of
the joint. Ankle arthrodesis and ankle arthroplasty are the two common operative treatments
used in end stage ankle arthritis (ESAA). Recent clinical evidence suggests that ankle
arthroplasty leads to superior functional outcomes over ankle arthrodesis. Ankle arthrodesis is
indicated for patients with ESAA that failed a minimum of 3 month of conservative treatment.
Both internal and external fixation may be used in ankle arthrodesis. Retrograde
intramedullary arthrodesis is typically reserved for arthrodesis of both the ankle and subtalar
joints. Two standardized methods of ankle arthrodesis for ESAA is described here: Open and
arthroscopic.

The present study is aimed to clinico pathologically characterize a subset of mucormycosis and aspergillosis cases presented as Sinonasal and rhino orbital fungal infection in post coronavirus disease. The study comprises a microscopic analysis of specific histopathologic variables on 35 cases of mucormycosis that were diagnosed and treated in a six month period. We reviewed Sino nasal and orbital biopsies of 35 patients whose specimens received in a tertiary care hospital histopathology lab. All patients were admitted for suspected fungal sinonasal and rhino orbital infections. Detailed microscopic examination  and clinicopathological correlation study were done. Fungal load in the tissue (graded as mild, moderate and marked), degree of neutrophilic and granulomatous response, tissue invasion and necrosis were graded.
We noted that necrosis is seen in all cases. Co infections with aspergillosis are also commonly noted. Vascular changes are marked. Angioinvasion, bone marrow invasion and peri neural/neural invasion are frequently noted. Fungal culture can become negative in histologically proven mucormycosis. History of diabetes present in majority of cases. Use of glucocorticoids and hypoxemia is also noted in many cases. The prevalence of mucormycosis  fungal infections is very high in post coronavirus patients especially in diabetic patients. Histopathologic examination remains one of the major diagnostic tools in diagnosis of mucormycosis. Early diagnosis with surgical excision, appropriate debridement, proper antifungal treatment and management of risk factors lead to subsequent reduction in mortality and morbidity.

Aim: The aim of the present study to determine the patterns of adverse drug reactions reported in the tertiary care hospital.
Methods: This observational, retrospective study was done in the Department of Pharmacology, Darbhanga medical college, Bihar, India. A total of 200 ADRs were reported during the study period. Each ADR was analyzed for demographic data, relationship to drugs as per causality assessment, and frequency of ADRs.
Results: A total of 200 ADRs were reported from both outpatients and inpatients of various departments. Most of the ADRs were found in females (55%) and patients of the age group 20 to 50 years (85%). Most of the ADRs were reported from the ART center (39%), dermatology (20%), oncology (11%), pediatrics (9%), and medicine (8%). The number of ADRs was distributed according to the department where they were reported. Overall, 40% of the ADRs are due to the anti-retroviral therapy, 29% due to the antibiotics, and 14% due to the nonsteroidal anti-inflammatory drugs (NSAIDs). Causality assessment was done by using the WHO-UMC scale, in which most of the ADRs were reported as probable (50%) followed by possible (48%). Severity assessment was done by a modified Hartwig and Siegel scale, in which most of them are mild (74%).The most commonly occurred ADRs were rash (40%), followed by nausea and vomiting (25%).
Conclusion: The maximum number of ADRs were reported with ART drugs. So, it is advisable to have close monitoring of the ART to prevent ADRs in these patients. Serious ADRs such as SJS and TEN are most familiar with analgesics and sulpha antibiotics.

Introduction Although, the primary goal of bariatric surgery is body weight control,
other various beneficial effects have been confirmed especially the improvement in type
2 diabetes mellitus and associated comorbidities after surgery.
Patients and Methods:
A prospective study to compare the effect of sleeve gastrectomy and minigastric bypass
on obese patients with type II DM, divided into 2 groups, each containing 22 patients.
Results:
The follow-up was 12 months for both groups. Duration of surgery was different in both
groups with Mean ± SD 89.5 ± 15 in SG group and 105 ± 11.1 in MBG. There was 2
cases had intraoperative bleeding that managed immediately intraoperative. Leak test was
done and 2 patients were positive in MGB and intraoperative repair was done One case of
leakage was detected after SG and managed nonsurgically with percutaneous drainage for
intraabdominal collection and Mega stent insertion. Both surgical procedures achieved
T2DM remission. Both FPG and HbA1c at 1 year are significantly lower in diabetic
patients treated by MGB when compared to SG patients (SG from 201 ± 17.8 to 98.8 ±
12.7, MGB from 214.2 ± 27.6 to 83.9 ± 6.3 for FPG); (SG from 7.6 ± 0.71 to 5.5 ± 0.41
,MGB from 7.9 ± 0.53 to 5.3 ± 0.38 for HbA1c).
Conclusion:
MGB and SG achieved T2DM remission, but MGB provided a better performance than
SG at 1 year.

Stegnography is the technique of hiding confidential information within
anymedia.Inrecentyearsvarious stegnography methods have been proposed to
makedatamoresecure.Atthesametimedifferentsteganalysismethods have also evolved. The
number of attacks used by thesteganalyst has only multiplied over the years. Various
toolsfor detecting hidden information’s are easily available over theinternet, so securing
data from steganalyst is still considered
amajorchallenge.Whilevariousworkhavebeendonetoimprove the existing algorithms and
also new algorithms havebeenproposedtomakedatabehindtheimagemoresecure.Wehave still
been using the same public key cryptography likeDeffie-
HellmanandRSAforkeynegotiationwhichisvulnerable to both technological progress of
computing
powerandevolutioninmathematics,sointhispaperwehaveproposeduseofquantumcryptograph
yalongwithstegnography.Theuseof this combination will
createkeydistributionschemesthatareuninterceptable thusprovidingour dataaperfectsecurity.

Stress and anxiety have been implicated as contributors to many chronic diseases and to
decreased quality of life, even with pharmacologic treatment. Efforts are underway to find
non-pharmacologic therapies to relieve stress and anxiety, and yoga is one option for
which results are promising. The focus of this review is on the results of human trials
assessing the role of yoga in improving the signs and symptoms of stress and anxiety. A
significant decrease in stress and/or anxiety symptoms when a yoga regimen was
implemented; however, many of the studies were also hindered by limitations, such as
small study populations, lack of randomization, and lack of a control group. Biochemical
and physiological markers of stress and anxiety, but yielded inconsistent support of yoga
for relief of stress and anxiety. Evaluation of the current primary literature is suggestive of
benefits of yoga in relieving stress and anxiety, but further investigation into this
relationship using large, well-defined populations, adequate controls, randomization and
long duration should be explored before recommending yoga as a treatment option.

Self-medication is an important health issue especially in developing countries like India.
This study aims to evaluate the practice of self-medication in the patients coming to A.H
Vijaypur for OPD consultation. The study was conducted on a total of 100 patients and
data was collected by interview using a questionnaire. Our study revealed the demographic
profile of the people who resorted to self-medication, the drugs used as self-medication,
reasons behind the practice, the source of information regarding the self-medication and
the depth of knowledge if any about the drugs used as self-medication. . It is hoped that
this study will stimulate more attention towards research on the practice of self-medication
which is an important but controversial medication issue.

Background: Ovarian cancer (OC) is considered the most lethal cancer of the female
reproductive system and ranked as the seventh most frequent cancer diagnosed
worldwide and the eighth leading cause of cancer-related death among women
worldwide. The most common type of Ovarian cancer is that originate from the ovarian
surface epithelium "Epithelial ovarian cancer" (EOC) which accounts for over 90% of
all ovarian malignancies and is the most lethal gynecologic malignancy. Sex
determining region Y-box 2 (SRY)-box 2 (SOX2) is one of the main members of the
Sox family which consists of at least 20 members that are divided into 8 groups (from A
to H, based on their high mobility group (HMG) sequence identity in humans). SOX2
expression has been reported at both the RNA and protein levels for many tumors, data
available from The Cancer Genome Atlas indicates that SOX2 mRNA is elevated in
many cancers, relative to normal tissue. The level of SOX2 expression in a tumor
represents a prognostic factor to determine the clinical outcome for a cancer patient.
As SOX2 has a great role in cancer stemness so SOX2 expression in OC is an
interesting issue for studying.

Family planning or Family welfare means planning by individuals to have only the
Children they want, when they want them. Family welfare includes not only
planning of births, but also their welfare of whole family by means of total family
health care. The family welfare schemes has high priority in India, because its
success depends upon the quality of life of all citizen (specially women). Here, we
should know that the family planning program was started in 1951 and in 1977 the
government of India redesigned the "National Family planning programme" as the
"National Family welfare programme." This paper is primarily trying to highlight
the understanding of women about various Health Scheme under National Rural
Health Mission (NRHM).

Stroke is considered one of the leading causesof morbidity and mortality in many
countries. Many studies investigated the outcomes after the occurrence of stroke.
Some of those research studies indicated that obesity and the increasein the
bodymass index areestablished risk factors for mortality among stroke patients.
However, the results of these studies were inconsistent.The main aim of this review
article was to examine the association between bodymass index and mortality
among stroke patients. The majority of the studies had shown a possible effect of
overweight on mortality among stroke patients; the evidence regarding the
association's presence is limited.On the other hand, the majority of the studies had
shown a protective effect of obesity (mild obesity, bodymass index between 30-35)
onreducingthe risk of mortality among stroke patients. This means underweight
stroke patients have more risk of mortality. Thus, the argument regarding the effect
of high bodymass index on mortality has been explained by the obesity paradox.
However, most of those studies were observational, and results could be attributed
to the methodological flaw. There is a need to well-designed prospective studies that
to overcome the limitation of the previous studies.

Sarah Medan General Hospital in recent years has faced the problem of decreasing
patient loyalty levels, this can be seen from the level of BOR in the last seven months in 2020
which tends to decrease every month. The marketing mix is considered to be a solution to the
problem of patient loyalty, especially related to service quality, price, promotion, and good
communication with customers. The study aimed to analyze the influence of marketing mix on
inpatient loyalty in Sarah Medan General hospital. The study was a quantitative survey with a
cross-sectional approach. The sample was 132 hospitalized. Data were analyzed using logistic
regression. The result shows that there was a significant influence between the marketing mix
seen from the process aspect and the physical appearance of the hospital on patient loyalty.
Where the physical appearance variable was the most dominant variable with a large odds ratio
of 5,134, which means that the better the physical appearance of the hospital, it is predicted that
it will increase patient loyalty by five times higher than the poor physical appearance of the
hospital. It is recommended for Sarah Medan Hospital to pay attention to and improve again
regarding the speed of availability of treatment rooms for inpatient registration and the speed
of response from medical personnel in taking medical actions, as well as maintaining
consistency of service flow.

Introduction: Abnormal uterine bleeding (AUB) is the most common problem among patients coming to gynaecology outpatient department. There are various pathologies which can lead to AUB. History, blood investigations, ultrasonography, hysteroscopy and endometrial aspiration are the methods to rule out different causes. Later on, they are classified as per PALM-COEIN classification. It helps in better and successful management of AUB patients.
Material and Methods: This prospective interventional study was carried out in the Department of obstetrics and gynaecology, in our institute enrolling 300 consenting subjects having AUB coming to outpatient department and in doored to gynaecology ward of our tertiary care hospital. Subjects with confirmed diagnosis of abnormal uterine bleeding as per “PALM- COEIN” classification and on ultrasonography, fulfilling the criteria and ready to follow up were enrolled in the study. The final medical treatment assigned to the patients depending upon aetiology (PALM-COEIN classification) ,age of the patient ,desire of fertility and options available. Different medical treatment options like LNG-IUS (MIRENA), ormeloxifene (SERM), progesterone only pills, OC pills, tranexamic acid were given to the patients in this study for treatment of AUB.
Results: In our study, out of 300 , total 121 (40.3 %) study participants were given ormeloxifene, 65 (21.7%) were offered OC pills, 60 patients (20.0%) given LNG-IUS(MIRENA), 44 patients (14.7%) were treated with Progesterone and 10 (3.3%) study participants were medically treated with tranexamic acid. Subjects were followed every monthly for initial 3 months of treatment, followed by 6 monthly up to 1 ½ year of treatment. In every follow up PBAC score, Haemoglobin level, endometrial thickness and quality of life (QoL) score was done to assess effectiveness of medical treatment assigned to patients. In our study out of 284 subjects who completed medical treatment for AUB, 72% subjects achieve normal menses, 14.3% subjects had scanty menses & 25(8.3%) subjects developed amenorrhoea. 2.7% subject loss follow up and 2.7% subjects underwent hysterectomy out of which 8 subjects removed LNG-IUS and opted for hysterectomy within 6 months of treatment.
Conclusion: Classification of AUB as per PALM-COEIN helps in better understanding of disease and successful management of patients. Medical management is found very effective in treatment of AUB so that unnecessary hysterectomies and morbidity associated to it can be avoided.

Introduction:Colorectal cancer (CRC) is the third most diagnosed malignancy and the
fourth leading cause of cancer-related deaths in the world. P53 protein is a nuclear
biomarker that is most investigated for its predictive value in CRCs.Aim: to evaluate the
relationship between P53 expression and colorectal carcinoma. Materials and methods:In
this study we investigated the expression of P53 in colorectal carcinoma using
immunohistochemistry on 60 cases collected retrospectively from Department of Pathology,
Faculty of Medicine, Zagazig University.Results:30/60 (50%) of the cases showed positive
P53 expression, the commonest Dukes stage was stageA which forms 25/60 (41.7%), There
was a high statistically significant difference (p<0.001) between the studied subgroups as
regard histopathology, age, lymph node metastasis, distant metastasis and DUKES, a
significant difference (p=0.002) between the studied subgroups as regard lymph vascular
invasion. Conclusion: P53 overexpression in colorectal carcinoma was associated with
DUKES stage, lymph node metastasis, distant metastasis, and lympho-vascular invasion.

INTRODUCTION
NECK LESIONS ARE FREQUENTLY ENCOUNTERED IN CLINICAL PRACTICE AND FOUND RESPONSIBLE FOR SIGNIFICANT MORBIDITY AND MORTALITY IN INDIA. SOME OF THE LESIONS OF THE NECK REGION INCLUDE TUBERCULOSIS & OTHER CHRONIC INFLAMMATORY LESIONS, PLEOMORPHIC ADENOMA & CYSTS. MALIGNANT LESIONS-PRIMARY AS WELL AS METASTATIC, COMMON TO THE CERVICAL
GROUP OF LYMPH NODES, ARE ALSO FREQUENTLY NOTED.
FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IS A SIMPLE, ECONOMICAL, HIGHLY ACCURATE TOOL IN THE DIAGNOSIS OF CERVICAL LESIONS. IT IS ALSO IDEAL FOR SAMPLE COLLECTION FOR ANCILLARY STUDIES SUCH AS CBNAAT. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) SAMPLES FROM THE NECK REGION OF PATIENTS CAN BE REVIEWED IN ORDER TO EVALUATE THE EFFICACY OF THIS METHOD IN THE DIAGNOSIS OF CERVICAL LESIONS. THE MAIN EMPHASIS OF THIS STUDY IS TO DETERMINE DIFFERENT CYTOMORPHOLOGICAL ENTITIES
AND PROVIDE THE DETAILS OF BURDEN OF TUBERCULOSIS IN THE TRIBAL AREA.TUBERCULOSIS IS THE MOST COMMON CAUSE OF LYMPHADENOPATHY IN DEVELOPING COUNTRIES SUCH AS INDIA AND SHOULD BE CONSIDERED IN EVERY CASE OF GRANULOMATOUS LYMPHADENOPATHY UNLESS PROVED OTHERWISE.[1]

Aim: To evaluate the safety and efficacy of Vitamin D supplementation in erectile dysfunction patients with Vitamin D deficiency.
 
Material and Method: This study was carried out in Department of Urology, S.M.S. Medical College and attached Hospitals between March 2018 to April 2019 among patients in the age group 20-60 years presenting with ED and having severe Vitamin D deficiency. Patients were randomized into three groups. First group was treated with Tadalafil 10mg once a day while the second group had Tadalafil 10mg once a day plus Vitamin D 60,000 IU once a week, and third group was given Vitamin D 60,000 IU once a week only. Efficacy of drugs was evaluated at base line and after 12 weeks on the basis of International Index of Erectile Function Questionnaire scoring.
 
Results: After 12 weeks of treatment IIEF-5 scoring was nearly same as that of the base line with no significant difference in group C patients. On the other hand, IIEF-5 scoring was significantly improved in group A and B patients (P<0.001). On comparing group A and B patients there was significant improvement in group B compared to group A (P < 0.05). In comparison to group C, group A and group B patients had more side effects (P<0.05), but of mild intensity and prescribed medications were well tolerated. Group A and B patients had no significant difference in side effects.
 
Conclusion: This study showed that the use of Tadalafil in combination with Vitamin D in Vit D deficient ED patients act better than Tadalafil or Vit. D alone.
 
Keyword: ED, Vitamin D, Tadalafil, IIEF

Luliconazole, an FDA sanctioned novel azole antifungal drug that combats fungal
contagions caused by Trichophyton rubrum and Epidermophyton floccosum, specifically
tinea pedis, cruris and corporis. It is existing in the souk as topical cream 1%. Topical
formulations possess diversified benefits for instance escaping of first pass metabolism,
easiness of application, evades oscillation in drug planes, tranquil cessation when
desirable, and amplified bioavailability. FDA advocates characterization parameters of
luliconazole cream should include assessment of appearance, particle/globule size
distribution, polymorphic forms, rheological behaviour, In-Vitro Release Test (IVRT), In-
Vitro Permeation Test (IVPT) and In-vivo bioequivalence study for a generic product.
FDA endorses usage of appropriate apparatus for IVRT technique as pronounced in USP
General Chapter <1724>. These comprise diverse models of a vertical diffusion cell (VDC),
an immersion cell, and a flow through cell used with USP Apparatus 4. The current
research work addresses the evaluation of IVRT of two luliconazole cream formulation
(Brands A and B) with that of lab made reference luliconazole gel using semi-automatic
VDC apparatus through synthetic membrane. The study was done for 4 hours and
analysed by UV-spectroscopy. The release kinetics was construed with various
mathematical prototypes like zero order, first order, higuchi model and korsmeyer-peppas
model. The outcomes showed that brand B of commercial cream formulations was found
to be analogous to that of the reference formulation. The release kinetics of the
formulations were found to be zero order that fits into Korsemeyar-peppas model. The
variance between the in-vitro release rate of the two brands may be ascribed to diverse
bases incorporated into the product. Zero-order indicates that the drug release is constant,
independent of concentration. Fitting into Korsemeyer-peppas plot indicates that the
release mechanism is diffusion controlled and follows Super case II transport as R2 value
is more than 0.89.

Background: Tooth surface modification by root conditioning results in improved connective tissue attachment and advancement in the the goal of reconstructive periodontal treatment.
Aim:Evaluation and comparison of novel root canal irrigant- MTAD and QMix on periodontally involved teeth.
Settings and design:30teeth were collected and stored in saline.By making two parallel grooves with a cylindrical bur under copious saline irrigation, samples were taken from the cervical third of the root. First groove is prepared at cemento-enamel junction and another 7 mm apical to it. Root surfaces of  the teeth were scaled with an ultrasonic scaler and thoroughly planed with #1-2, 3-4 Gracey curettes for the elimination of all the diseased cementum. The dentin sample of dimension 4 mm x 6 mm were prepared and stored in normal saline before use.
Materials and method: Samples were randomly divided into three groups: BioPure MTAD ™, QMix ^TM 2 in 1 and saline. Specimens were actively burnished for 3 min and following treatment, were prepared for scanning electron microscopy and examined at 5000X magnification. Samples were scored according to sampaio’s index.  Mann - Whitney U test and chi square tests were being applied.
Results and conclusion: BioPure MTAD ™ is most efficacient in removing the smear layer and showed significant dentinal tubules opening followed by QMix ^TM 2 in 1 and saline.
Keywords: BioPure MTAD ™, QMix ^TM 2 in 1, saline, scanning electron microscopy

Background: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections account for a
substantial proportion of liver diseases worldwide. These viruses are responsible for liver
damages ranging from minor disorders to liver cirrhosis and hepatocellular carcinoma
(HCC). Approximately 7% of the world’s population (350 million people) are infected with
HBV and 3% (170million people) with HCV.
Aim & Objectives: To study Prevalence of Hepatitis B & Hepatitis C viruses infections in
Chronic liver disease patients .
Materials & Methods: A total of 100 Cases of CLD attending Gastroenterology department
were included in the study during the period of January 2015 – June 2016. Demographic
data and clinical findings were recorded using a structured proforma. All the samples were
screened for HBsAg detection( ERBALISA SEN HBsAg)& anti HCV antibodies detection by
ELISA (HCV MICROLISA) following the kit manufacturer’s instructions.

One of the difficulties diabetic women face is recurrent yeast infection of the vulva
and vagina.The substantial increase in the incidence of vulvovaginal candidiasis
especially in diabetic women demands prompt treatment that would restore the
normal vaginal flora and also keep the blood sugar levels in check. Homoeopathy, a
safe alternative method, based on the idea of individualization uses a holistic
approach towards these cases. Being a safe and cost-friendly intervention, it not
only relieves the complaints of the individuals but also help them boost up their selfesteem.
This study aims at exploring the effectiveness of Homoeopathic medicines in
vulvovaginal candidiasis in women with type II Diabetes mellitus. In this study, 15
women with Candidiasis and type II Diabetes mellitus selected from SKHMCH
OPD and IPD and rural centers, were prescribed with the homoeopathic similimum
after thorough case taking and analyzing the investigation reports. Follow ups were
taken every month for three months and the improvement of the cases were
assessed based on the signs, symptoms and investigation reports. After the
administration of the Homoeopathic similimum, notable improvement was elicited
in the signs and symptoms and also the lab reports. Mercurius solubilis was noted to be
the most effectively used medicine and 200 th potency was noticed as the most
frequently used potency.

Background: Brachial plexus block provides excellent anaesthesia and analgesia for upper limb surgeries. It was found that when dexamethasone was added as an additive to local anaesthetic agent, it shortens the onset of sensory and motor blockade. This study was carried out to compare the onset of sensory and motor blockade on addition of dexamethasone to local anaesthetics versus local anaesthetics only in supraclavicular brachial plexus block.
Materials and Methods: This was a prospective, randomized and controlled study conducted on 60 ASA class I & II physical status patients undergoing elective upper limb surgery after obtaining approval of Institutional Ethics Committee. After written informed consent, patients were randomly allocated to two groups i.e. Group A and Group B of 30 each. Group A (control) received lignocaine with adrenaline 14 ml and bupivacaine 16 ml. Group B (study) received lignocaine with adrenaline 14 ml and bupivacaine 16 ml along with dexamethasone 4 mg. Time for onset of sensory and motor blockade was recorded.
Result: The average age of the patients was 33.401±9.1 years in Group A and 35.101±6.8 years in Group B. The average weight of the patients was 60.411±3.4 kg in Group A and 63.349±4.1 kg in Group B respectively. Both groups had predominantly male patients accounting for nearly two third of the total study population in each group. The difference in age, weight and sex distribution was statistically insignificant. The observed average time for onset of sensory blockade was 10.18±0.87 minutes in Group A and 8.24±0.72 minutes in Group B. The average time for onset of motor blockade was 12.11±3.52 minutes in Group A and 10.51±2.38 minutes in Group B.
Conclusion: Dexamethasone when added to local anaesthetic agents in supraclavicular brachial plexus block significantly shortens the onset of sensory and motor blockade without any untoward side effect.

Chemotherapeutic agents have long been used to treat cancer either as a single drug or as a
combination. Cancer drugs have a great potential to induce acute, chronic, reversible and
irreversible damage in any organ system. Ocular toxicity produced by chemotherapeutic
agents is relatively uncommon as eye is usually considered as a protected site. Many of the
side effects in the eye are usually undetected either by the patient or by the clinician.
However, some of these side effects which are potentially reversible and treatable in the early
stages, turn out to be irreversible by the time the symptoms are detected. Hence, it is
important for the ophthalmologist to be aware of the potential ophthalmic complications to
treat them or sometimes even to prevent them.
Ophthalmic complications of these chemotherapeutic agents are sometimes underestimated
and neglected. Priority is usually given to the life-threatening effects of the drugs. Ocular
surface side effects have been extensively examined by many authors, though the possible
underlying mechanisms are poorly understood [1][2].
The quality of life takes a huge hit when the patient develops side effects like continuous
watering or dry eye some of which can be easily managed before potential irreversible side
effects develop[3][4]. An ophthalmic baseline examination for all patients planned for multiple
chemotherapeutic cycles and those undergoing these cycles becomes indispensable part of
patient care.
The aim of our study was to compare the baseline ocular status of the patients undergoing
combination chemotherapy before the start of chemotherapy and after a minimum of three
chemotherapeutic cycles.

Background: The desire to procreate is universal phenomenon. Childlessness is considered
as a curse in many societies and is one of the causes of marital breakups. WHO has defined
infertility as ‘Failure to conceive over 12 months of uninterrupted sexual practice. USG has
become a well-established technique for imaging ovarian and uterine pathologies. Methods:
This is a hospital based cross sectional, observation study,included total of 51 cases. The
patients with chief complaints of infertility presenting to gynaecology OPDs were referred to
the department of Radiodiagnosis,Guru Nanak Dev Hospital, Amritsar and all patients were
subjected to transabdominal ultrasonography using 3.5 MHz sector transducer. Results: Out
of 51 cases studied, 35 were of primary infertility and 16 were of secondary infertility.
Duration of infertility varied from 1.75- 17 years in patients with primary infertility and 2-10
years in patients with secondary infertility,maximum cases between 2-4 years.. Nonspecific
enlargement of uterus on one case, 3 with fibroid, 3 with endometrial calcification, one with
infantile uterus and one bicornuate uterus. Ovaries were normal in 37 cases, abnormal in 9
cases, not visualized in 3 cases on left and 1 on right side. Left ovary enlarged in one case.
Ovarian cyst in 3 cases, T.O masses in 5 cases and PCOD in one case. Fluid in POD in 4
cases.Conclusion: It is concluded that ultrasound is very helpful in assessment of uterus and
adnexal pathologies. USG is non-invasive, cheap, acceptable, easily available modality. It can
diagnose structural abnormality and helps in making diagnosis of etiologic factor in patients
of infertility and also in management and follow up of patients of infertility.

Aims: Blood transfusion saves life but there is risk of Transfusion Transmission Infection (TTI), like Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), malaria and syphilis. Aim of this study to find prevalence of HBV and HCV in blood centre.
Settings and Design: This is an observational study at Blood centre of Tertiary care hospital from January 2018 to December 2020.
Methods and Material: Donor Screened and selected according to National Aids Control Organisation (NACO), blood units were collected and processed. HBV and HCV reactive cases were diagnosed by enzyme-linked immunoassay (ELISA) analyser. HBV and HCV reactive donors further processed for Liver Function Test (LFT), Prothrombin Time (PT) and Complete Blood Count (CBC) were done.
Statistical analysis used:  Performed with SPSS software version 15. Chi-square proportion test has been used to compare the proportions of HBV seropositive between voluntary blood donor collection (VBD) and replacement blood donor (RBD) groups.
Results: Blood units collected were 9,750,) numbers of VBD was ) 5,305  and RBD was 4425, during the study periods of three years in the blood centre, HBV and HCV reactive cases were diagnosed 50 and 02 respectively, and 35 HBV reactive in RBD. The p value of chi square test for testing two group (proportions of HBV infection between VBD and RBD group) proportions at 95% confidence interval is 0.0017.
Conclusions: TTI can be prevented by promoting the voluntary donors, educate donors for TTI during donor screening, evaluate the methods of TTI screening.

Background: Propofol is a popular anaesthetic agent used for induction of general anaesthesia. However, it causes cardio-respiratory depression in vulnerable patients.
Materials and Methods: This prospective, randomized and controlled trial was conducted on 60 patients admitted for elective neurosurgical procedure after ethical clearance from Institutional Ethics Committee. After written informed consent, the patients were randomly allocated to two groups, I and II of 30 each. Group I received Inj. midazolam 0.02 mg/kg as premedication five minutes before induction with propofol infusion. Group II received only propofol infusion for induction of general anaesthesia. Total dose of propofol required for induction of anaesthesia was noted. Haemodynamic parameters were noted from baseline till 08 minutes post laryngoscopy and intubation.
Results: Samples in both the groups were comparable with respect to age, weight and gender. On comparison with the standard bolus dose of propofol (2mg/kg) for induction, reduction in the doses of propofol in Group I and Group II were 0.7 mg/kg and 0.3 mg/kg respectively. The reduction in the dose of propofol in Group I as compared to Group II was 0.4 mg/kg i.e. 20%. This difference was statistically significant (P<0.001). No statistically significant difference in the haemodynamic parameters between the two groups was observed (p>0.05).
Conclusion: Propofol infusion after midazolam premedication reduces the dose of propofol for induction of general anaesthesia and confers haemodynamic stability

Over years, many more techniques were developed as the plexus is accessible at different anatomical regions depending on the clinical purpose required. In 1970, Alon Winnie described the first consistently effective and technically suitable approach to the brachial plexus block at the level of the cricoid cartilage between the anterior scalene and middle scalene muscles called as interscalene brachial plexus block. This was a prospective observational study started after attaining approval from the departmental dissertation committee and institutional ethics committee. Clinical Trials Registry-India (CTRI) registration was also obtained. Informed consent was taken by all patients included. In DMD group, 30 subjects belong to ASA-PS-I and 16 subjects belong to ASA-PS-II, In DXM group, 35 subjects belong to ASA-PS-I and 11 subjects belong to ASA-PS-II. The mean duration of surgery in DXM group was 115.52 mins and in DMD group was 119.67 mins.
 
Keyword: Brachial plexus block, arthroscopic shoulder surgeries, clinical profile
 

Procedural sedation is not a routine during neuraxial blocks, but it is advisable that anesthesiologists should provide their blocks comfortably. Sedation also alleviates anxiety thereby reducing autonomic fluctuations and eases induction of spinal anaesthesia and improves its quality. All American Society of Anesthesiologists Physical Status-1 patients aged between 20 years to 60 years, undergoing elective surgeries under spinal anaesthesia, who can understand and willing to give consent will be included. In our study, there is no hemodynamic variation among the two groups as we had used bolus doses of propofol and ketamine itself has positive inotropic effects. However, one patient had airway obstruction due to tongue fall once sedated and was managed with nasopharyngeal airway in Group A. This can be attributed to deeper plane of sedation due to administration of high dose of propofol as the patient’s BMI was high.
 
Keyword: Propofol, ketamine, midazolam
 

Benzodiazepine receptors are closely linked with GABA receptors and appear to facilitate the activity of the latter. Activated GABA receptors open chloride ion channels which then either hyperpolarize or short-circuit the synaptic membrane. Propofol is one of a group of alkylphenols. The alkylphenols are oils at room temperature and insoluble in aqueous solution, but they are highly lipid soluble. It has pH of 7 and pKa of 11, appears as a slightly viscous, white milky substance. It is stable at room temperature and is not light sensitive. Detailed pre-anaesthesia check-up was be done on the day prior to surgery and appropriate investigations was be carried out. The anaesthesia technique and questionnaire was explained to the patient and written informed consent was be taken. Time to induce spinal in A+B group is 25.85 Seconds. Number of attempts on an average in A+B group is 1.35.Patient Comfort score in A+B group 8.33. Patient satisfaction score in A+B 86.42.
 
 Keyword: Nanoparticle, ferrite, structural, morphological and spectroscopy properties

In extensive mishap such as those associated with earthquakes, tidal bore, airplane
crashes, and acts of terrorism, forensic odontology has exhibited a paramount relevance in
medico-legal investigations directed in identifying mortal remains. Denture recognition is
essential for ailing patients or patients in geriatric associations. One method of
identification in forensic odontology is labeled dentures. It is a well-documented practice to
mark dentures with some means of identification but not a very well-practiced one.

A comparative study of the regulatory effect of the preparation of ecdisten
(created based on the phytoecdysteroid ecdysterone) and nerobol (a synthetic anabolic
preparation) on protein biosynthesis was carried out in mammals (mice) in in vivo and in vitro
experiments. We have defined that the activation of protein-synthesizing processes by ecdisten
in the organism of higher animals is not associated with its effect on the synthesis of mRNA,
but is only a reflection of the acceleration of translational processes. The corresponding
action of Nerobol is directed primarily at transcription processes with subsequent generalized
stimulation of the synthesis of protein macromolecules at the cytoplasmic level due to an
increase in the number and activity of polyribosomes.

Introduction: According to WHO, Adolescence has been defined as the period between 10-19years of life. Adolescents constitute one-fifth of the world’s population and in India. Adolescent girls constitute a vulnerable group, particularly in India, where the female child is the neglected one. For billions of women and girls worldwide, menstruation is a monthly reality. Menstrual Health and Hygiene encompasses Menstrual Hygiene Management and the broader systemic factors that link menstruation with health, well-being, gender equality, education, equity, empowerment and rights. The mothers play a vital role in shaping the girls’ ideology about Menstruation. The socio-economic status can also be a contributing factor in the knowledge regarding Menstruation and related aspects. 
Materials & Methods: A prospective study in 9-16 years 200 urban & 200 rural school going menstruating girls and their socio demographic Profile was done, and results analyzed. 
Observations: The observations were recorded in tabular form and analyzed.
Discussion: The age profile, maternal education, other socio demographic profiles and cultures practiced are similar to various other studies. 
Conclusion: Menstruation being a normal biological phenomenon has many implications on female health, and maternal education, socio economic status has a greater role in maintaining good healthy menstrual practices, minimizing adverse health conditions in adolescent girls. 

Aim: To study of visual functions with multifocal versus monofocal intraocular lenses after phacoemulsification in patients with age-related cataract.
Methods: This prospective observational study was carried out in the Department of Ophthalmology, Madhubani Medical College and Hospital, Madhubani, Bihar, India for 10 months. Patients between 40-80 years reporting with cataract (less than grade 3), managed by phacoemulsification and willing for implantation of multifocal IOLs and having astigmatism less than 1.5D cylinder were included in the study. Group A underwent phacoemulsification with multifocal [refractive-diffractive design] IOL implantation. Group B underwent phacoemulsification with monofocal IOL implantation
Results: In multifocal group, the number of female patients were more as compared to male patients, thus difference among the two groups was not statistically significant, the p-value being 0.112(>0.05). On post-operative day 1, the UCVA was found to be 6/12 in 15 patients (30%), 6/9 in 11patients (22%), 6/18 in 11 patients (22%), 6/24 in 8 patients (16%) while 6/6 in 5 patients (10%) while in monofocal it was 6/9 in 21 patients (42%) and 6/12 in 17 patients (34%) while 6/18 in 7 patients (14%) and 6/6 in 5 patients (10%). At the last follow-up, there were 22 patients (44%) with 6/9 vision, 16 patients (32%) with 6/12, and 12 patients with 6/6 vision while in monofocal group 25 patients (50%) had 6/12 vision, 18 patients (36%) had 6/9 vision while only 7 patients (14%) had 6/6 vision (Table 1). However, both at first post-operative day and last follow-up the two group’s visual acuity was found to be statistically insignificant with p-value less than 0.05. There was no significant change in the near visual acuity in the monofocal group with 35 patients (70%) with N18 visual acuity, 9 patients (18%) with N12 and 2 patient (4%) with N24 visual acuity, thus showing there was paramount statistical significance between the groups with p-value higher than 0.05. In monofocal group at last follow-up 35 patients (70%) had N24 visual acuity, 12 patients (24%) had N18 visual acuity and only 3 patients with N10 visual acuity. Thus, showing there was paramount statistical significance between the groups with p-value higher than 0.05.
Conclusion: Mutifocal IOLs decrease the spectacle dependence of patients without compromising the subjective visual functions.

Background:Breast cancer is a major public health problem for woman. Several
studies suggestedthat development and progression of malignant tumors are
characterized by an interaction with the cells in the tumor microenvironment
including infiltrating immune cells.
Aim:The aim was to investigate relationship between tumor infiltrating
lymphocytes(TILs) in infiltrating breast carcinomaand other recognized
clinicopathological factors.
Material and Methods: 100 cases of infiltrating breast carcinomas were included in
the study.Stromal.TILs status was evaluated using hematoxylin and eosin staining.
For all statistical data chi-square test was applied using SPSS and Spearman
correlation.P‐values of less than 0.05 were considered as significant.
Results: Stromal TILs correlated with well-established prognostic markers:HER2
positivity(P=0.001),higher tumour grade (P=0.016), ER negativity (P=0.015), PR
negativity (P=0.008),lymphnode status(P=0.005) and lymphovascular invasion(LVI)
(P=0.001), molecular classification (P=0.000) , and p53 positivity (P=0.013). No
correlation between CD10 positivity or high proliferative index( KI67)and stromal
TILs.
Conclusion:Stromal TILs is directly correlated more aggressive phenotype:HER2
positivity ,ER negativity, PR negativity ,molecular classification, present LVI,
higher tumor grade and greater nodal involvement;so TILs could be used as novel
predictive and prognostic parameter and used to develop newer drugs
(immunotherapy).

Epilepsy is categorized as a prevalent misunderstood chronic neurologic disorder. Epilepsy
episodes occur as a result of abnormal neuronal excitability that was reported to occur due to a
disruption depolarization and repolarization mechanisms. In addition to that, currently there are
numerous studies that attribute idiopathic epilepsy to a genetic factor as it was found that there is
an increased familial incidence of epilepsy. Several studies estimated that around 69 million
people worldwide are diagnosed with epilepsy and it is one of the most common neurological
disorders occurs to children where approximately 150,000 children experience unprovoked
seizure every year, and about 30,000 of them develop epilepsy. Many of these cases
demonstrated some neuropsychiatric comorbidity, which consequently affects the quality of their
lives in a significant manner. Cognitive impairments might be represented as memory problems,
mental defects, and attention impairment, analyzed as the most common comorbid disorders in
epilepsy. Thus, it is important to analyze the factors that contribute to cognitive difficulties.
Many agents was shown to have a debilitating effect on cognitive function in epilepsy such as
the degree of epileptic activity and epilepsy causative factors, psychosocial status of patients in
addition to surgical or therapeutic treatment of seizures.

Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine
cavity. In the United States, the estimated prevalence of ectopic pregnancy is 1% to
2%, and ruptured ectopic pregnancy accounts for 2.7% of pregnancy-related
deaths. Risk factors include a history of pelvic inflammatory disease, cigarette
smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility. Ectopic
pregnancy should be considered in any patient presenting early in pregnancy with
vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not
yet been established. The definitive diagnosis of ectopic pregnancy can be made
with ultrasound visualization of a yolk sac and/or embryo in the adnexa. However,
most ectopic pregnancies do not reach this stage. More often, patient symptoms
combined with serial ultrasonography and trends in beta human chorionic
gonadotropin levels are used to make the diagnosis. Pregnancy of unknown
location refers to a transient state in which a pregnancy test is positive, but
ultrasonography shows neither intrauterine nor ectopic pregnancy. Serial beta
human chorionic gonadotropin levels, serial ultrasonography, and, at times, uterine
aspiration can be used to arrive at a definitive diagnosis. Treatment of diagnosed
ectopic pregnancy includes medical management with intramuscular methotrexate,
surgical management via salpingostomy or salpingectomy, and, in rare cases,
expectant management. A patient with diagnosed ectopic pregnancy should be
immediately transferred for surgery if she has peritoneal signs or hemodynamic
instability, if the initial beta human chorionic gonadotropin level is high, if fetal
cardiac activity is detected outside of the uterus on ultrasonography, or if there is a
contraindication to medical management

Background:Breast cancer is a major public health problem for woman. Several
studies suggestedthat development and progression of malignant tumors are
characterized by an interaction with the cells in the tumor microenvironment
including infiltrating immune cells.
Aim:The aim was to investigate relationship between tumor infiltrating
lymphocytes(TILs) in infiltrating breast carcinomaand other recognized
clinicopathological factors.
Material and Methods: 100 cases of infiltrating breast carcinomas were included in
the study.Stromal.TILs status was evaluated using hematoxylin and eosin staining.
For all statistical data chi-square test was applied using SPSS and Spearman
correlation.P‐ values of less than 0.05 were considered as significant.
Results: Stromal TILs correlated with well-established prognostic markers:HER2
positivity(P=0.001),higher tumour grade (P=0.016), ER negativity (P=0.015), PR
negativity (P=0.008),lymphnode status(P=0.005) and lymphovascular invasion(LVI)
(P=0.001), molecular classification (P=0.000) , and p53 positivity (P=0.013). No
correlation between CD10 positivity or high proliferative index( KI67)and stromal
TILs.
Conclusion:Stromal TILs is directly correlated more aggressive phenotype:HER2
positivity ,ER negativity, PR negativity ,molecular classification, present LVI,
higher tumor grade and greater nodal involvement;so TILs could be used as novel
predictive and prognostic parameter and used to develop newer drugs
(immunotherapy).

Approximately 5% (1 in 20) of all deliveries are operative vaginal deliveries. The
past 20 years have seen a progressive shift away from forceps in favor of the
vacuum extractor as the instrument of choice. This article reviews in detail the
indications, contraindications, choice of instrument, and Application and
Technique for vacuum-assisted vaginal delivery. The use of vacuum extraction at
the time of cesarean delivery will also be discussed. With vacuum extraction
becoming increasingly popular, it is important that obstetric care providers are
aware of the maternal and neonatal risks associated with such deliveries and of the
options available to affect a safe and expedient delivery.

Background: Hypophosphatemia is a metabolic disorder that can have significant
consequences and is frequently undiagnosed in critically ill children. While
hypophosphatemia is typically characterized by nonspecific symptoms such as
weariness and irritation, severe hypophosphatemia (less than 1.0 mg/dl) can result
in much more severe complications including such decreased diaphragmatic
contractility and cardiac arrhythmias.
Aim of the Study: Determine the prevalence of hypophosphatemia in critically ill
children, as well as the clinical consequences and risk factors associated with the
condition throughout patients' admission in the PICU.
Patients and Methods: A case-control study that was conducted over a period of one
year, from July 2019 to June 2021, at PICU of Pediatrics Department, Zagazig
University Hospitals.The study included 180 subjects that were classified into two
groups, each of 90 subjects as follows; patients group, which included 90 cases, and
the control group, which included 90 healthy infants and children.
Results: There was a statistically significant difference in weight, height percentile,
ESR and CRP, hemoglobin level, TLC, PT, INR, alkaline phosphatase a serum,
serum creatinine, PH, serum phosphorus level, presence of hypophosphatemia
(20%), number of patients with hypophosphatemia, percent change in serum
phosphorus, as well as percent change in serum phosphorus between the studied
groups.
Conclusion: In our investigation, the obvious probable source of hypophosphatemia
was prolonged TPN decision-making as well as sepsis. In the PICU, mild to moderate
hypophosphatemia occurred. Hypophosphatemia was related with an increased
length of stay in the PICU and poor outcomes.

Haemorrhoids are one of the most common benign anorectal problem worldwide. Various techniques of haemorrhoidectomy have been reported in an attempt to find the ideal operation with low morbidity and good clinical results. Open haemorrhoidectomy (Milligan-Morgan) is a widely-used and accepted procedure. A total of 77 consecutive patients between the age group of 20 and 85 years, diagnosed to have grade III or IV haemorrhoids were included in the study, divided into 2 groups, Group 1 undergoing Open haemorrhoidectomy (41 patients) and Group 2 undergoing Stapler haemorrhoidectomy (36 patients). The mean hospital stay for patients with stapler haemorrhoidectomy was 2.4±0.8 days in comparison to the open group where the mean hospital stay was 5±2.6 days (P-value<0.001). There was significant difference in complication between the two groups, stapler group having lesser post op complications during the study period. The stapler group patients returned to normal activity significantly early.
 
Keyword: Hemorrhoids, Stapler Hemorrhoidectomy, open Hemorrhoidectomy
 

Hernia repair is the most commonly performed procedure in general surgery. Even though several techniques have been followed since ages none of them are without complications and recurrence. The objective of the present study is to look for the outcome of inguinal hernia repair with Prolene Hernia System in terms of post operative pain, post operative complications, duration of hospital stay, duration to return to normal activities and recurrence. All cases who presented with uncomplicated inguinal hernia who are more than 18 years were included in the study. Complicated hernias like obstructed and strangulated inguinal hernias presented as emergencies were excluded from the study. The mean VAS score at 72 hours postoperatively was 1.2. The mean duration of hospital stay was 3 days. During the follow up period of 6 months, no recurrence was noticed. The PHS is a tension free mesh repair that provides a complete closure of the myopectineal orifice. It is a feasible procedure with minimal postoperative pain and related complications. It shows acceptable short term results with low incidence of chronic groin pain and reccurence during the follow-up period.
 
Keyword: Inguinal hernia, Prolene hernia system, VAS score

Haemorrhoids can be categorized by their location as well as by the size and degree of prolapse of the involved tissue. Internal haemorrhoids are located proximal to the dentate line, external haemorrhoids are distal to it, and 'mixed' haemorrhoids arise from both the internal and external plexi along with their anastomotic connections. A detailed history was taken and all patients were subjected to clinical examination including per rectal and proctoscopic examination. Routine lab investigations like blood and urine examination and screening of chest was done. In our study, the patients were in the age range of 21-84 years. Most of the patients in the stapler group were in the age group of 41- 50 years, while in the open group, the majority were in the range of 21-40 years.
 
Keyword: Haemorrhoids, Mucosal prolapse, Internal haemorrhoids
 

Indirect Hernia comprises around 80% cases of inguinal hernia. Almost all the hernias in women and children are indirect. It is also called oblique indirect hernia. The hernia enters through the internal inguinal ring lateral to inferior epigastric artery and descends obliquely downwards and medially and reduces obliquely. After routine investigations, Patients were informed about the various techniques and advantages of the PHS mesh. In those patients who agreed, consent was taken and patients were prepared for surgery. Patients were subjected to Prolene Hernia system repair. All patients were given preoperative antibiotic prophylaxis with Injection Ceftriaxone 1 gm. Spinal anaesthesia was administered. More than half of the patients presented with hernia on the right side (51.1%) followed by left (40.0%). Bilateral hernias were 8.9 %. The most common presenting symptom was swelling accounting for 66.7% followed by swelling with pain 33.3%.
 
Keyword: Inguinal Hernia, swelling, oblique indirect hernia

ABSTRACTBackground
and objectives:
Dermatoglyphics is a newer science of forensic based study involving the fingertip and palmar
prints. In the field of dentistry dermatoglyphics has been used to unveil various oral diseases like
precancerous lesion, malocclusion, dental caries, cleft lip and palate etc. Hence with the help of
dermatoglyphics we can explore the association between various dermatoglyphic patterns and
occurrence of Oral submucous fibrosis.
Methodology:
A total of 60 participants (30 Oral submucous fibrosis patients and 30 healthy controls) were
included in the study. Tobacco habits was recorded for all the participants. All the participants in
the study were examined for intra oral findings.Dermatoglyphic patterns were also recorded.
Results:
There was significant increase in the whorl pattern among Oral submucous fibrosis group
(55.8%), whereas in control group loop pattern (66.6%) was found to be significantly increased
(p<0.05) .dat angle was also significantly increased in Oral submucous fibrosis group.
Conclusion:
Whorl type of fingerprint pattern and dat angle found in our study would probably be served as a
candidate screening marker for susceptibility to oral submucous fibrosis in general population.

Background: Hypersensitivity to cow milk proteins is one of the main food allergies
and affects mostly but not exclusively infants, while it may also persist through
adulthood and can be very severe. Different clinical symptoms of milk allergy have
been established. The diagnosis of milk allergy differs widely due to the multiplicity
and degrees of symptoms, and can be achieved by skin or blood tests. The aim of
this study to assess the role of cow milk (CM) to induce asthma and compare
between the presence of cow milk protein allergy in asthmatic and non-allergic
children and to prevent occurrence of asthma among children, Subjects and
methods: This is a case control study, was conducted on 154 patients divided into
two groups (77 in each). This study was conducted in Pulmonology Unit of
Pediatric Department in Zagazig University Hospital. Result: There was high
statistically significant difference between the two studied groups as regards skin
pick test. There was high significant increase in the severity recorded in respiratory
function test in allergic group compared to control group. Conclusion: our study
showed that CMA can exacerbate the symptoms in children with asthma. Therefore,
it is worth considering a possible role of food allergy in asthma in young children,
particularly when asthma is not adequately controlled in spite of proper routine
management. Although SPT seemed to be more reliable than sIgE testing, both had
suboptimal reliability. A definite decision should depend on performing a titrated
oral challenge test.

Background: Allergic rhinitis (AR) is one of the most globally commondiseases and
usually persists throughout life. First-line drugs can be successfully used to control
AR. However, once these medications are terminated, the majority of AR patients
will reappear the symptoms of AR within a brief period. Thus, these medications do
not appear to exert a long-term effect on the baseline Total Nasal Symptom
Score.To study the relationship between the gut microbiota types and allergic
rhinitis. Patients and Methods: This case control study was carried out on 52
school-aged patients presented at Oto-rhino-laryngology, Head and Neck (ORLHNS)
Department and Microbiology and Immunology department at Zagazig
University. The patients were classified into 2 groups: Allergic rhinitis group: 26
individuals with allergic rhinitis Control group: 26 individuals without allergic
rhinitis. All patients in this study were subjected to the personal history taking,
physical examination and laboratory investigations including: eosinophilic count,
skin prick tests (SPT) for common perennial and seasonal allergens, measurement
of (total Ig E) and identifing bacteria (lactobacillus and bacteroides) by SYBR
Green real time PCR. Results: Age was distributed as 11.19±3.26 and 11.65±3.24
respectively between case and control with no significant difference between
groups. Mean disease duration was 6.15±2.01, the majority were Intermittent and
mild regard classification also the majority were trigger by inhalation. Skin prick
test among cases group showed majority were house dust and date palm pollens.
Absolute eosinophils counting was significantly higher among cases compared to
control one. Cases were significantly higher regard IgE distribution. Lactic acid
bacteria RNA was significantly higher among control group compared to cases
group while Bacteroid bacteria RNA was significantly higher among cases group
compared to control group. Conclusion: Lactic acid bacteria in gut microbiota of
school-aged individuals may influence sensitization to different allergens.

Background: Laparoscopic appendectomy (LA) is now the standard of management
for cases of acute appendicitis. LA has the benefits of minimal access surgery.
There are many methods for securing the base of the appendix, some of which are
expensive others are not available or technically demanding. This study is aimed to
compare between ligation and clipping techniques regarding fesibility , safety ,
efficacy, operative time , postoperative outcome and complications. Patients and
methods: A randomized prospective clinical trial study included 90 patients with
acute appendicitis. The patients were randomly distributed into 2 main groups
(A&B): 54 patients we secured the base of the appendix by ligation methods (group
A) and in 36 patients by clip application (group B). All patients were subjected to
classic history taking and clinical examination. Radiological investigation:
ultrasonography was routinely done for all patients. CT with contrast was requested
when indicated in suspicion of complications. Surgical ligation or clipping were
performed. Results: There is statistically non-significant difference between
patients underwent different surgical techniques as regarding application of
peritoneal drainor conversion to open. Two patients within ligation group (A) had
been converted to open due to presence of friable base in one case and intraoperative
bleeding in other case while three patients within clipping group (B) had
been converted to open due to intestinal injury, friable base and intra-operative
bleeding .Two cases in clipping group (B) had been converted to ligation techniques
due to very wide base which can't be secured by clip application. Conclusion:
Ligation and clipping techniques were effective, safe ,feasible and same in
complications rate. Clip application is related to less operative time , easier
application and simpler for trainee than ligation techniques which require
more experiences.

Background: Idiopathic clubfoot is characterized by an alteration of the morphology of the foot
that cannot physiologically move on the ground. Tibialis anterior tendon transfer was is an
effective method in the management of dynamic supination as well as prevention of clubfoot
relapse in children. The aim of the current study to confirm the best management of split tibialis
anterior tendon transfer in the treatment of residual clubfoot. Patients and methods: A
prospective study included 18 patients (22 feet) with residual dynamic supination deformity
following previous ponseti management. Patients underwent split transfer of the anterior tibial
tendon at Zagazig University hospitals. Clinical and radiographic assessment of outcomes is
performed at the end of healing. Results: The present study included 18 cases (12 males and 6
females) with mean age of 3.43 years ± 0.71 to assess outcome of split tibialis anterior tendon
transfer in management of residual clubfoot. Patient age ranged from 2.5 years to 5 years old at
the time of the operation, 9 with right foot affection, 5 with left foot deformity while 4 patients (8
feet) were bilateral. The majority of cases were males (66.7%) and females were (33.3%).Right
side was affected in 9 cases (50%), the left was affected in five .cases (27.8%) while four cases
(22.2%) were bilateral. The mean radiological measurment improvement of AP talocalcaneal
angle, AP talofirst metatarsal angle, Lattalocalcanael angle, Lattalo-first metatarsal angle, Firstfifth
metatarsal over lap, and the improvement of all angles were stastistically significant. The
complication rate was 16.7% (3 cases) all had superfecial infection only. Conclusion: The
anterior tibial tendon transfer is a practical method for achieving fully or split transfer due to
both techniques have an excellent outcomes with low complication. It is simple and effective softtissue
procedure to correct the muscle imbalance of the foot. The split tibialis tendon transfer are
still better because of low risk of over correction which preserve some inversion function.

Background: Surgical treatment is preferred in metacarpal and phalangeal
fractures in general can be treated surgically with K-wires, screws or hand plates.
Lag screws are the implant of choice for this type of fractures. The aim of this work
is to evaluate the outcome of fixation of oblique and spiral fractures of phalanges
and metacarpals of the hand by interfragmentary mini screws. Patients and
methods: Eighteen oblique and spiral fractures were included in this study with 6
metacarpals and 12 phalangeal fractures. Eight spiral and 10 oblique fractures
were followed up for 15 to 31 weeks. Gender distributed as seven females and 11
males with Patients’ mean age of 35 (range 19 - 51) years old. In range of motion,
functional and radiological results of treatment of oblique and spiral metacarpal
and phalangeal fractures by open reduction and internal fixation using
interfragmentary mini screws were evaluated. Results: In our study, the mean value
of TAM score for both metacarpals and phalanges at the end of follow up (mean
23.1 weeks) was 87% ± 11.6. Final range of motion assessment revealed three
(16.7%) fair, two (11.1%) good and thirteen (72.2%) excellent results. There was
statistically insignificant difference between the side of the affected hand with
phalangeal and metacarpal fractures and end results of final follow up.
Conclusion: Oblique and spiral hand fractures have special characters. They are
the result of torsional forces and can cause rotational mal-alignment. Interfragmentary
mini Lag screws fixation represents a very good method for dealing
with such rotationally unstable fractures.

Background: Cirrhotic patients are more liable to thyroid dysfunction especially
hypothyroidism and may have thyroiditis and hyperthyroidism. The aim of this
work is the evaluation of thyroid dysfunction in elderly patients with chronic liver
disease. Patients and methods: A cross-sectional study included 54 elderly patients
with clinical, biochemical, and ultrasound evidence of cirrhosis of liver which was
carried out in Internal Medicine Department, Faculty of Medicine, Zagazig
University Hospitals. All subjects included in this study were elderly over 65 years
and subjected to through clinical examination and full history taking with special
stress on age, sex, comorbidities, medications, symptoms of hepatic decompensation
and symptoms of hypothyroidism or hyperthyroidism. The technical part was done
at Biochemistry Department in Zagazig University. We assessed complete blood
count, serm bilirubin, serum albumin, serum ALT and AST, serum creatinine,
serum urea, PT, PTT, INR, TSH, free T3, T4 and lipid profile. Results: There was a
statistically significant positive correlation between serum TSH and weight, BMI,
Child score, total, direct bilirubin, INR, serum cholesterol, LDL cholesterol and
triglycerides. There is significant negative correlation between TSH and total
leucocytic count, platelet count, serum albumin. There was a significant negative
correlation between free T4 and both weight and BMI. There is significant positive
correlation between free T3 and total leucocytic count, and platelet count. There is
non-significant correlation between free T3 and neither weight, BMI, age,
hemoglobin, serum albumin, serum creatinine, ALT, AST, INR, LDL or HDL
cholesterol There was a significant negative correlation between child score and
TSH while there is significant positive correlation between child score and both Ft4
and FT3. There is significant relation between presence and degree of ascites and
all of free T4, free T3 and TSH. Conclusion: There is important relation between
Child pough class and all of free T4, free T3 and TSH. There is significant relation
between grade of hepatic encephalopathhy and all of free T4, free T3 and TSH.

Background: Postpartum haemorrhage is still the primary cause of maternal
death, particularly in underdeveloped nations. We aimed to see how tranexamic
acid and oxytocin compare in terms of preventing postpartum haemorrhage and
lowering blood loss, hospital stay, morbidity, and death during vaginal
birth.Patients and methods: A prospective, randomised clinical trial study was
conducted on 92 pregnant women who were being prepared for vaginal delivery
and were divided into two groups: Group (A) (TXA group) (46 patients) received 1
gm of tranexamic acid and Group (B) (Non-TXA group) (46 patients) received 10
IU of oxytocin. Hemoglobin and hematocrit readings were tested before and 24
hours after vaginal delivery, and additional basic laboratory tests were
performed.Results: In our study, there was no significant difference in HB at the
pre-test, but the Non-TXA group was considerably lower at the post-test, and the
Non-TXA group had a significant reduction. At the pre-test, there was no
significant difference in HCT, but the Non-TXA group was considerably lower at
the post-test, and the Non-TXA group had a significant reduction. In the TXA
group, the difference in HCT was much smaller. The TXA group had considerably
less blood loss.Conclusion: The use of tranexamic acid during delivery may assist to
minimise blood loss. It is a low-cost and widely available medication. The use of
TXA reduces the requirement for uterotonics, lowering morbidity and mortality.

Background: Different approaches can be performed for repairing abdominal wall
hernias as as laparoscopic transabdominal preperitoneal (TAPP) approach. This
study aimed to compare quality of life after laparoscopic transabdominal
preperitoneal repair (TAPP) and Lichtenstein hernioplasty according to EuraHS
QOL SCORE. Patients and Methods: This is a prospective clinical comparative
study upon 132 patients with inguinal hernia admitted to the surgical department of
Zagazig University for inguinal hernia repair. The patients were allocated into two
groups using closed envelope method of randomization. The patients were allocated
into two groups: Laparoscopic group (n=66) and Open group (n=66). All patients
involved in the study were subjected to full history and clinical examination and
routine investigations and EuraHS QOL Score Evaluation. Results: There is
statistically significant difference among both studied groups as regard intraoperative
complications (p<0.05). Operative time showed highly statistically
significant difference among both studied groups (p<0.001) with laparoscpoic
group longer than open group. Duration of stay showed highly statistically
significant difference among both studied group as regard (p<0.001). There is no
statistically significant difference among both studied groups as regard preoperative
pain felt during last week score (p>0.05), but there is statistically significant
difference among both studied groups as regard post-operative pain felt during last
week score after 1 month and post-operative pain felt during last week score after 3
months (p<0.05). Conclusion: Trans-abdominal pre-peritoneal repair (TAPP) is
better than lichtenstein hernioplasty in terms of quality of life (QOL) according to
EURAHS QOL SCORE.

Background: Rheumatoid arthritis in children and their families can be a
significant health burden. They're linked to the risk of physical impairment, a
lower quality of life, and a lot of direct and indirect expenditures. The goal of this
study is to characterise the clinical spectrum of Juvenile Idiopathic Arthritis
(JIA) in children at Zagazig University hospitals, as well as the frequencies and
various patterns of JIA. Patients and methods: A cross-sectional research
comprised 120 patients with an average age of 16 years. From December 2017 to
December 2019, data on juvenile idiopathic arthritis was gathered during a twoyear
period. Complete blood count, reactive protein, ANA, RF, C3&C4, creatine
phosphokinase, and EMG were all performed. Management and treatment
strategies were implemented, and data on the outcomes was gathered.
Results:Females account for the majority of our rheumatological illness patients.In
our analysis, JIA was the most frequent rheumatological illness, followed by SLE
and lastly HSP.In our study, oligoarticular JIA was the most prevalent subtype of
JIA, followed by polyarticular and then systemic onset type.SLE is the second most
prevalent illness in our research, with the majority of patients being women.The
majority of individuals had cutaneous symptoms and a fever.The most commonly
utilised drugs were corticosteroids, cyclophosphamide, and mycophenolate
mofetil.HSP was the most prevalent kind of vasculitis found in our research.The
majority of patients are females, and those with severe GI symptoms and nephritis
got corticosteroids. Conclusion: The prevalence of rheumatological disorders in
children is underestimated, and there is a lot of overlap in diagnosis. Because
paediatric onset is less apparent than adult start, some patients have a significant
diagnostic lag. Early identification and proper care of these children is critical for
them to have a normal or near-normal life, particularly in patients with
rheumatological illnesses that cause chronic morbidity, such as JIA.

Due to specialized property of multipotency of adult postnatal stem cells , these can be
experimentally induced to differentiate into various specialized cell lineages. This has
generated considerable interest in the arena of stem cell based therapeutics. Periodontal
ligament stem cell (PDLSC) are one of these type of cells within the periodontal ligament
which represents a significant development in this regard. Achieving predictable periodontal
regeneration has long been a challenge, and it is known that cells involved in the mechanisms
of periodontal wound healing are of mesenchymal stem cell MSC type. Thus, periodontal
ligament stem cell (PDLSC) based therapeutics may be a step towards predictable periodontal
regeneration and also these cells may have alternative potential applications in hard tissue
and tooth engineering. PDLSC may be isolated, grown under tissue culture conditions,
expanded, optionally genetically modified and then collected and transplanted. This paper
aims to overview the current knowledge, recent developments and methodology regarding
PDLS based applications.

Oral cancer is the sixth most common cancer throughout the world and is a crucial issue in
regions where tobacco habits, in the form of chewing and/or smoking, with or without alcohol
intake, are common. Squamous cell carcinoma is the cause for 95% of oral cancers and is
associated with avoidable aetiological risk factors. The most successful means to enhance the
survival and reduce morbidity, damage, duration of treatment and hospital cost is the
detection of oral cancer at an early stage. It is essential to study marker levels in patients with
oral precancer who are at a high risk of developing oral cancer.
The present study was carried out to evaluate usefulness of serum Total Sialic Acid (TSA)
and serum Lipid-Bound Sialic Acid (LSA) as markers of oral submucous fibrosis and oral
cancer. Study consisted of 60 patients and 30 controls. There were 3 study groups, Group I
control, Group II OSMF, and Group III oral cancer consisting of 30 patients each. Serum of
all the patients in the control group and study groups were collected and stored at -20 oC until
analyzed. Levels of serum TSA and LSA were estimated spectrophotometrically. The results
also demonstrated that the assessment of TSA and LSA by simple, in-expensive and
reproducible methods can provide significant clinical information about the extent of
malignant disease and can differentiate between patients with oral precancer and oral cancer.

Distal radius fracture is a very common injury representing 17.5% of all fractures seen in the emergency room. However, the most effective treatment is still unclear and controversially debated. For ten years, we have been facing a true revolution by the increasing use of open reduction and fixation by volar locking plates as an alternative to previous less invasive treatment such as closed reduction and percutaneous k- wire pinning. Several meta-analyses have compared the clinical results after closed reduction and percutaneous pinning and volar locking plate fixation. Volar locking plate fixation achieves better early functional recovery, better radiological outcomes and less minor complications. However, long-term results were similar for both fixation methods. In addition, worse radiological outcomes and more minor complications after closed reduction and percutaneous pinning seem not to be clinically relevant. Interestingly, volar locking plate fixation continues to be a more dominant treatment method compared to percutaneous pinning in operative care of distal radius fractures. Surgeon characteristics such as age, profession as well as location and type of the clinic seem to play a role in the decision for the surgical treatment method. It appears that implant cost plays a minor role in treatment choice between closed reduction and percutaneous pinning and volar locking plate fixation.

Occult hepatitis B (OBI) was defined as the detection of hepatitis B virus (HBV)
DNA in the liver (with or without HBV DNA in serum) without HBsAg[1].
The prevalence of OBI varies from region to region worldwide. This variability
relies upon the sensitivity of HBV DNA detection assays, the sample size, and the
detection of HBV DNA in liver tissue and serum by nested PCR or real-time PCR.
The prevalence of OBI varies from 1% to 87% in different regions of the world[2],
there is no standard assay for diagnosis of OBI in liver tissue or in serum, and the
only reliable method is the detection of HBV DNA by nested PCR or real-time
PCR[3].
The mutations in the HBsAg gene have been observed among patients coinfected
with hepatitis C virus (HCV)[4].
It has been described that about one-third of patients with chronic HCV infection
had detectable serum HBV DNA but undetectable HBsAg[5]. When the coexistence
of both HBV and HCV genomes occurs in the same hepatocyte, the replication of
HBV is inhibited due to the interference of HCV molecules, which therefore results
in the creation of OBI with low replication of HBV DNA[6].
The presence of OBI in chronic HCV infected patients increases the risk of
HCC[7]. Blood transfusion is a main risk factor for transmission of OBI and the
prevalence of OBI among blood donors varies from country to country provided
that the screening of blood donors is done with less security[8].

Aim: To evaluate the effect of Dexmedetomidine added to Ropivacaine in Supraclavicular Brachial Plexus block.
 
Material and Methods: This study was performed in the Department of Anaesthesia at Shri Suman Subharti Medical College, Dehradun during March 2016-February 2017 after approval by the Institute Ethics Committee. After getting written informed consent from patients, this study was carried out as a controlled, randomized (chit method), double blind, prospective study in 60 patients. Sensory and motor blockade of radial, median, musculocutaneous and ulnar nerves were recorded at regular intervals (at each min till complete blockade) after drug injection. Following observations were noted intra and post operatively. The duration of analgesia or first request for analgesic defined as the time to attain a Visual Analogue Score (VAS) of 4 or >4 after Ropivacaine administration. The VAS was recorded post-operatively every 30min till the score of 4 or >4.
 
Results: Duration of sensory block was significantly longer in group RD as compared to group R (p<0.001). It was found that duration of motor block increased more with Dexmedetomidine addition (407.33±53.09 min) than with Ropivacaine alone (278.66±44.77 min). There was significant increase in duration of analgesia in group RD (685.33±90.02 min) than with group R (344.00±52.06 min). In RD group 2 patients developed haematoma and only 1 patient develop blood in aspiration due to arterial puncture, and in R group 1 patient develop haematoma and 2 patients developed blood in aspiration.
 
Conclusion: We conclude that Dexmedetomidine is a good adjuvant in supraclavicular brachial plexus block for upper limb surgeries.
 
Keyword: surgery, upper limb, VAS, dexmedetomidine, ropivacaine, supraclavicular brachial plexus block

Background: Gallstone disease (GSD or Cholelithiasis) is a significant health problem
both worlds over (in both developing and developed nations). The main objective is
Laparoscopic cholecystectomy has rapidly become established as the popular alternative to
open cholecystectomy, but it should have a safety profile better than of open procedure.
Aims and objectives: The aim of this study was to compare conventional cholecystectomy
and laparoscopic cholecystectomy with respect to duration of procedure, complications,
postoperative pain, analgesic requirement and period of hospital stay.
Materials and Methods: This study consists of 52 patients who have undergone gallbladder
removal in GMC Budaun. 26 patients who have undergone laparoscopic cholecystectomy
and 26 patients who have undergone open cholecystectomy for a study period of one year
have been taken into the study In method 52 consecutive patients below 70 years presenting
with calculous cholecystitis with no evidence of CBD stones were randomized to undergo
open and laparoscopic cholecystectomy.
Results: 9 patients of LC and 10 patients of OC were males. Among LC 16 patients were
females and among OC group 15 were females, 28% of patients who underwent open
surgery had complications and 16% of patients who underwent laparoscopic surgery had
complications. The overall percentage of complications is lesser in laparoscopic surgery
than open surgery, The VAS was median grade 2 in LC group as compared to median
grade 4 in LC group. The NSAID’S were used for more days in OC group compared to LC
group, 23 patients who underwent laparoscopic cholecystectomy were discharged before 5
days. All patients who underwent OC stayed >5 days in hospital.
Conclusion: Herewe conclude in results, the duration of pain, rate of complications and
hospital stay were significantly lower in laparoscopic group. However the main advantages
of LC were reduced postoperative pain with less duration of analgesic intake, more rapid
recovery, reduced hospital stay and early return to normal work.

Background: Cholangiocarcinoma, including intra-and extrahepatic cholangiocarcinoma,
is a rare but highly lethal cancer. Despite effort in finding the risk factors of
cholangiocarcinoma, the causes of most cholangiocarcinoma remain unknown.There are
considerable geographic and demographic variations in the incidence of
cholangiocarcinoma. Although it comprises only 10-15% of hepatobiliary neoplasms, its
incidence is increasing. There are several established risk factors for CC and few are
modifiable which will help in reducing the incidence.
Aims and Objectives: To study the Prevalence and risk factors of cholangiocarcinoma at
GMC Budaun.
Material and Methods: All types of cholangiocarcinoma cases above age of 40 years
admitted to Department of Surgery, GMC Budaun U.P., were studied for risk factors over a
period of two years.
Results: An incidence of cholangiocarcinoma was 0.032% in present study. Peak incidence
of cholangiocarcinoma was 4th to 6th decade of life with mean age of 61.92 years. out of
26 patients 13 patients (50%) were smoker and in those 13 patients 12 (92%) were smoking
for more than 10 years and 13 patients (100%) were smoking more than 10 cigarettes or
bidi per day. 18 patients were using chulha (69%) for cooking meals with coal as a primary
fuel.
Conclusion: In conclusion, we found associations with PSC, smoking and alcohol
consumption; however, further studies are needed to establish the risk factors in our
country Long term exposure to pesticides in patients, who are chronic smoker and exposed
to smoke from chulha are at higher risk of developing CCA than others in this socioeconomic
scenario.

Introduction: Breast cancer is the most common malignancy in women around the world,
accounting for 25.1 % of all cancers among women. Breast cancer are classified in different
molecular subtypes depending on hormone receptor positive or negative and human epidermal
growth factor receptor 2 status. All the three receptors labelled as ‘triple positive’ breast
cancer are rare entity. We herein describe a case series of three patients diagnosed as invasive
ductal carcinoma with Immunohistochemistry (IHC) positive for all three receptors (Hormone
receptors and human epidermal growth factor receptor).
Case presentation: Three patients aged 67, 40 and 34 years presented with breast lump and
were diagnosed invasive ductal carcinoma. There was no history of familial breast cancer, any
other malignancy, or hormonal medication.Modified radical mastectomy was done and
specimen sent to surgical pathology department for histopathology. Modified Bloom
Richardson’s score was 7 and 8 with histological grade 2 for two of the cases. IHC was
performed and was positive for Hormone receptor and human epidermal growth factor
receptor. All the three cases were labelled as ‘Triple Positive’.
Conclusion: Breast cancer with all three receptor positive are rare to find but these cases do
exist. The biological significance and cross talks of their related pathways should be
investigated further for ‘triple positive’ breast cancer to determine intrinsic as this would help
to view the treatment options if these patients receive endocrine treatment in combination with
HER2 blocking agents or a separate therapy.

Introduction: Diabetic foot and diabetic ulcers are common complications of diabetes mellitus.
It affects daily life of patients and lead to amputations. The study was conducted to see the
effect and role of superoxidised solution and gel (microdacyn) in promoting the healing and
treatment of diabetic foot ulcer.
Material &Methods: The wound site was cleaned with normal saline followed by application
of superoxidised solution for 30 seconds and then followed by application of wound care
hydrogel. Observations were made during dressing and examination of the patients/ wounds
was done on the day 7,14,21,28 and at follow-up of 15 days. Rate of contraction of wound is
measured in cm2.
Results: Mean age of patients in the study was 50.0687±11.85 years with equal male to female
ratio. Superoxidised solution provides good wound healing and mean hospital stay was
10.49±4.24 days. Significant reduction of wound is seen in cases with short duration of ulcer
and short duration of diabetes (p<.05).
Conclusion: Superoxidised solution was associated with faster healing of ulcers without any
major complications, proving SOS to be safe and efficient as a wound care product in the
management of lower limb ulcers.

Background: Vitiligo is a condition that causes pale, white patches to develop and affect any area of the skin. Most of the patients with involvement of exposed areas of the body suffer from low self-esteem, embarrassment, emotional stress ultimately leading to social isolation. These factors along with a sense of stigma increase the risk of psychological disorders including depression.
Methods: It was a hospital-based cross-sectional study conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad, Telangana, which is a tertiary care center and serves a large cater of sections including tribal areas. The duration of the study was for 8 months. The total sample size of the study was 80; out of which 40 were vitiligo patients and the other n=40 were non-vitiligo patients. A pre-designed proforma was used to get the basic demographic data and the Zung Self-rating Depression scale was used to assess depression in both groups. Statistical analysis was done using Epi Info 3.4.3 version which is a public domain software provided by the Centre for Disease Control and Prevention (CDC), Atlanta.
Results: Age group ranged from 18-60 years of age. The mean age among the Vitiligo patient group was 36.3±10.53 years and in the control group was 40.8±10.87 years. Sex distribution showed that among vitiligo patients 28 were male and 12 females. The overall prevalence of clinical depression among vitiligo patients was 55% compared to only 10% in controls and this association was found to be statistically significant. Among the patients with clinical depression, nearly two-thirds (63.6%) were male and 36.4% female indicating a high prevalence of clinical depression among males compared to females.
Conclusions: Present study found a high prevalence of clinical depression among vitiligo patients using the Zung Depression Scale. Clinicians should evaluate vitiligo patients for depression and provide appropriate referrals or advice to manage the condition accordingly.

Background:Thyroid dysfunction is common in the general population, especially among
older women. The present study was conducted to assess thyroid function in postmenopausal
women.
Materials & Methods:56 post- menopausal women and equal number of pre- menopausal
women were recruited and classified into group I and II respectively. All were subjected to
TSH estimation in RIA centre with Immunoradiometric assay kit. T3 and T4 were also
estimated if TSH level was abnormal. The sensitivity of TSH estimation was 0.05μIU/ml.
Normal level of TSH was taken as 0.5-4.5μIU/ml.
Results: There were 2 subjects in group I and 4 in group II with TSH level <0.5 μIU/ml, 50
in group I and 46 in group II had between 0.5-4.5 μIU/ml and 4 in group I and 6 in group
II had >4.5 μIU/ml. The prevalence of subclinical hypothyroidism was seen in 2 in group I
and 4 in group II and overt hypothyroidism in 1 in group I and 2 in group II. The
difference was significant (P< 0.05). The mean TSH level in group I was 3.02 μIU/ml and
in group II was 3.86 μIU/ml. The difference was non- significant (P> 0.05).
Conclusion: The prevalence of thyroid disorders especially hypothyroidism is more in
postmenopausal women than premenopausal women

Fuzziness is a type of new incoherence. The fuzzy set theory is said to depict
ambiguity.Fuzzy queuing model with flexible service policy is being investigated in this
work. A parametric programming technique is designed to find the membership functions
of queue length and sojourn time in steady state, in which the arrival rate and service rate
are being pentagon fuzzy numbers. Based on  -cut approach and Zadeh’s extension
principle, the fuzzy queues are transformed into family of crisp queues. The model’s
potency is calculated for various possibilities of -cuts.

Economic Order Quantity (EOQ), an inventory model is ideal to produce cent percent
ordered items. But practically, this assumption becomes invalid as process deterioration,
production processes and other factors pop up. The customer’s expectation and marketing
demands can be satisfied, if only the production rate becomes a function of demand rate.
As the demand and deterioration products are time dependent function, eventually allowed
shortages will be partially backlogged. Rate of backlog is contingent on the waiting time up
to the arrival next lot. To prevail over these sparsities, this paper signifies the application of
EPQ model to contemplate the optimal production run time, production quantity and
shortage period aiming to minimise the total average cost.

Objectives and Introduction
The majority of the predicted value used in Cephalometry which is used in assessing and performing the orthodontic procedure is Caucasian. In India (Delhi NCR), there is growing demand for its treatment, but there is little knowledge available in Cephalometry. So, the question arises, “Should we use Cephalometric norms from other countries?” To find the answer for this question, we have conducted a research in Delhi NCR hospitals for determining the craniofacial morphological characteristics of a group of Indian subjects. 
 
Methodology
The methodology was conducted from the month of January 2019 to June 2019.We have conducted an observational analysis on scout view scan graphic images of patients aged 25 to 45 years at the Delhi NCR Hospitals and remaining work at dental college Azamgarh. The mean score and standard deviations of 15 Cephalometric variables were determined. To calculate the reference values, we used indicator which means 95 percent of confidence interval as the best estimator of our population measures. 
 
Results 
The total number of participants was 1200, with an average age of 31.3 years. The only differences between the sexes in Indian subjects were for SNB and SND tests, which were higher in men. The Indian population had a protrusive Dento-Alveolar system with higher average values compared to Caucasian values, with an exception of inter-incisal angles 118.3º and SND 68.8º, which showed a lower value against Steiner 131⁰ and 79⁰. 
 
Conclusion
The difference with SNB and SND measurements both between men and women in India is that the men in India are having higher SNB and SND values. Just in few measurements, sample statistics differ significantly from the Caucasian averages in India. Taking these differences into account, we were able to propose a map of Cephalometric values, which have given a clear indication of the Indian type.  
 
KEYWORDS: Cephalometric, Indian, Steiner
 

Vitamin D has been associated with various autoimmune diseases. Recently, vitamin D deficiency has been reported in AA [1]. Moreover, topical calcipotriol has been reported to be used successfully in treating AA [2].

 
NECK LESIONS ARE FREQUENTLY ENCOUNTERED IN CLINICAL PRACTICE AND FOUND RESPONSIBLE FOR SIGNIFICANT MORBIDITY AND MORTALITY IN INDIA. SOME OF THE LESIONS OF THE NECK REGION INCLUDE TUBERCULOSIS & OTHER CHRONIC INFLAMMATORY LESIONS, PLEOMORPHIC ADENOMA & CYSTS. MALIGNANT LESIONS-PRIMARY AS WELL AS METASTATIC, COMMON TO THE CERVICAL GROUP OF LYMPH NODES, ARE ALSO FREQUENTLY NOTED. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IS A SIMPLE, ECONOMICAL, HIGHLY ACCURATE TOOL IN THE DIAGNOSIS OF CERVICAL LESIONS. IT IS ALSO IDEAL FOR SAMPLE COLLECTION FOR ANCILLARY STUDIES SUCH AS CBNAAT. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) SAMPLES FROM THE NECK REGION OF PATIENTS CAN BE REVIEWED IN ORDER TO EVALUATE THE EFFICACY OF THIS METHOD
IN THE DIAGNOSIS OF CERVICAL LESIONS. THE MAIN EMPHASIS OF THIS STUDY IS TO DETERMINE DIFFERENT CYTOMORPHOLOGICAL ENTITIES AND PROVIDE THE DETAILS OF BURDEN OF TUBERCULOSIS IN THE TRIBAL AREA.TUBERCULOSIS IS THE MOST COMMON CAUSE OF LYMPHADENOPATHY IN DEVELOPING COUNTRIES SUCH AS INDIA AND SHOULD BE CONSIDERED IN EVERY CASE OF GRANULOMATOUS LYMPHADENOPATHY UNLESS PROVED OTHERWISE.[1]

Alopecia is a Latin word meaning hair loss or baldness and includes many types of hair loss. The
underlying cause of AA is unknown, but recent evidence suggests that it is a chronic inflammatory
disease of the hair follicles. Based on the histological evidence of peripheral follicular fibrosis and an
increase in the number of mast cells - which can increase the synthesis of elastic fibers - it appears that
there may be a link between mast cells and alopecia. The present cross-sectional descriptive-analytical
study was performed on formalin and paraffin-embedded tissues of patients diagnosed with alopecia,
as well as 20 paraffin-embedded scalp samples of "healthy" patients without reporting Alopecia. In
order to evaluate the number of mast cells, Giemsa cytochemical staining was performed. The results
show that the mean number of mast cells in AA and AS patients was 18 and 19, respectively, which did
not show a significant difference. However, this rate was 18.75 in patients with Alopecia and 6.5 in the
control group, which shows a statistically significant difference between the two. Also, the number of
mast cells in the biopsy of patients with alopecia was significantly higher than normal individuals,
which indicates the role of these cells in the pathogenesis of alopecia.

Labor induction rates have more than doubled in the United States over the last two
decades. Indications and risk factors for induction of labor are also gaining in
popularity. Professional organizations such as the American College of
Obstetricians and Gynecologists and The Joint Commission have taken steps to
discourage elective induction of labor prior to 39 weeks' gestation and have defined
new terms such as early-term, full-term, late-term, and postterm gestation to assist
clinicians in determining the appropriate timing of birth for specified indications.
Induction of labor carries the risk of harm to both the mother and her fetus. The
cost of inducing labor and its influence on the health care system are a major
source of worry. Women's education and the shared decision-making process used
to get informed permission are critical elements in lowering early elective deliveries.
The use of scheduling forms, hard stop procedures, induction of labor indication
tools, and informed consents may assist the provider in reducing overdiagnosis,
overtreatment, and disease creep. This article discusses induction of labor trends,
medical indications and criteria, related dangers, cost and health system impact,
and measures to reduce induction of labor.

Background: The value of magnetic resonance imaging (MRI) for imaging the knee was apparent almost immediately after the introduction of this modality in the early 1980s. With the introduction of special closely coupled extremity coils, high field systems, open systems, extremity units and other technical advances, the utility of MRI in the knee has expanded dramatically. MR examination, a non-invasive modality, is now routinely used to assess a wide spectrum of internal knee derangements and articular disorders and has virtually replaced conventional arthrography in the evaluation of menisci and cruciate ligaments, decreasing both morbidity and costs associated with negative arthroscopic examinations. The knee joint is a biggest joint of the human body with complex articulation characterized by the presence of ligamentous and meniscal structures that play an important role in the stability and mobility. MRI due to its excellent soft tissue contrast resolution and multiplanar imaging capabilities provides significant advantages over other imaging techniques in the evaluation of traumatic injuries of knee joint. Study aimed to study the role of MRI in the evaluation of traumatic injuries of knee joint.
Material and methods: Our sample size was of 102 patients referred with history of knee injury were imaged with 1.5 Tesla GE-signa HdxII MRI machine in the department of radiology over a period of 18 months.
Results: Commonest injuries detected in the study are anterior cruciate ligament tear, tear of posterior horn of medial meniscus, bone contusions and joint effusions. Clinical presentation and radiographs of the patient did not help in diagnosis in most of the cases of acute knee injury, especially in multiple ligament and bone injuries. MRI detected soft tissue injuries very well in addition to the bony injuries.
Conclusion: MR examination, a non-invasive modality, is now routinely used to assess a wide spectrum of internal knee derangements and articular disorders and has virtually replaced conventional arthrography in the evaluation of menisci and cruciate ligaments, decreasing both morbidity and costs associated with negative arthroscopic examinations. Magnetic resonance imaging is the excellent non-invasive investigation tool for knee injury due to excellent soft tissue contrast resolution and multiplanar imaging capabilities which provides the most detailed evaluation in cases of various soft tissue injuries of knee joint.
 
Keyword:Non-invasive investigation, traumatic knee, joint injuries, MRI, acute knee injuries

Introduction: As the global severe acute respiratory syndrome corona virus 2 (SARS-CoV-
2) pandemic expands, genomic epidemiology and whole genome sequencing are being
constantly used to investigate its transmissions and evolution.
Aims and Objectives: To ensure that best use is made of the whole genome sequencing
programmes for SARS-CoV-2 results, in improving public health. Analyze and establish a
correlation of demographic features and vaccination status with clinical outcome of
VOC’s.
Material and Method: 478 samples (December 15, 2020- June 15, 2021) were shortlisted as
per state government policy of sample selection criteria for genome sequencing, packed in
triple layer according to standard transportation protocol and sent to the National Public
Health Laboratory (NPHL) for whole genome sequencing.. The data collected by us were
analyzed and correlated with the results of whole genome sequencing, shared by the NPHL
to enhance public health impact of the variant identified.
Observation and Results: In our study we found 92% of B.1.617.2 (Delta) variants and 8%
of B.1.1.7 (Alpha) variant. We found significantly high mortality (25%) in age group > 60
years compared to other age group (20-40years, 40-60years) with Delta variant (p value <
.05). We also found that Delta variant is significantly more transmissible (p value < .05)
than Alpha variant. Mortality was significantly higher among unvaccinated patients
having co-morbid conditions rather than vaccinated patients having co-morbid conditions
with delta variant (p value <0.05).
Conclusion: B.1.617.2 (Delta) variant has emerged as a common VOC among SARS-COV-
2 patients in southern Rajasthan. Vaccination has a very high level of protective role in
decreasing mortality, especially old age patients with associated co-morbidities among
Delta variant.

Discoid lupus erythematosus (DLE) is an autoimmune disorder which encompasses broad
range of dermatologic manifestations. Ocular manifestations are rare and ocular
involvement has been reported in very few cases. They are often misdiagnosed as
blepharitis or eczema. Here we report a case of DLE with ocular involvement

Diabetes mellitus (DM) affects about 400 million adults globally, a number that is predicted
to be doubled by 2035 according to the world health organization (WHO).When cataract
surgery is done on diabetic patient the status of retina and retrieval of vision depends on
severity of diabetic retinopathy and previous treatment received. In diabetic patients,
macular oedema after cataract surgery can be a frequent and complex problem, especially
in the patients with pre-existing diabetic retinopathy. The objective of present study is to
evaluate the status of diabetic retinopathy after cataract surgery. The hospital based
prospective, observational study was carried out. 50 diabetic patients underwent cataract
surgery between October 2017 to September 2018. All were studied postoperatively at 1
month and 3 months.
This study used OCT to evaluate macular oedema in patients which in turn helped to find
out the status of diabetic retinopathy. The present study does not show any progression in
diabetic retinopathy in the operated eyes over the short term follow up of 3 months. None
of the patients who were having no retinopathy pre-operatively developed retinopathy post
operatively.

Introduction: As the global severe acute respiratory syndrome corona virus 2 (SARS-CoV-
2) pandemic expands, genomic epidemiology and whole genome sequencing are being
constantly used to investigate its transmissions and evolution.
Aims and Objectives: To ensure that best use is made of the whole genome sequencing
programmes for SARS-CoV-2 results, in improving public health. Analyze and establish a
correlation of demographic features and vaccination status with clinical outcome of
VOC’s.
Material and Method: 478 samples (December 15, 2020- June 15, 2021) were shortlisted as
per state government policy of sample selection criteria for genome sequencing, packed in
triple layer according to standard transportation protocol and sent to the National Public
Health Laboratory (NPHL) for whole genome sequencing.. The data collected by us were
analyzed and correlated with the results of whole genome sequencing, shared by the NPHL
to enhance public health impact of the variant identified.
Observation and Results: In our study we found 92% of B.1.617.2 (Delta) variants and 8%
of B.1.1.7 (Alpha) variant. We found significantly high mortality (25%) in age group > 60
years compared to other age group (20-40years, 40-60years) with Delta variant (p value <
.05). We also found that Delta variant is significantly more transmissible (p value < .05)
than Alpha variant. Mortality was significantly higher among unvaccinated patients
having co-morbid conditions rather than vaccinated patients having co-morbid conditions
with delta variant (p value <0.05).
Conclusion: B.1.617.2 (Delta) variant has emerged as a common VOC among SARS-COV-
2 patients in southern Rajasthan. Vaccination has a very high level of protective role in
decreasing mortality, especially old age patients with associated co-morbidities among
Delta variant.

Gilo (Tinospora cordifolia) is a plant medicine which is widely used in Unani system of medicine
(USM) for various therapeutic purposes. It has antipyretic, analgesic, anti- inflammatory purpose
and antidiabetic potential. This is a review paper based on published literature which discusses
morphology, habitat, pharmacological actions and ethno-botanical therapeutic uses of this
medicinal plants. It is concluded that, this is one of the best herbal medicine for pyrexia, diabetes
mellitus and syphilis in USM.

Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease, affecting
the joints with varying severity among patients. The risk factors include age, gender, genetics,
and environmental exposure (cigarette smoking, air pollutants, and occupational). Many
complications can follow, such as permanent joint damage requiring arthroplasty, rheumatoid
vasculitis, and Felty syndrome requiring splenectomy if it remains unaddressed. As there is no
cure for RA, the treatment goals are to reduce the pain and stop/slow further damage. Here, we
present a brief summary of various past and present treatment modalities to address the
complications associated with RA.

A diet rich in cruciferous vegetables such as cauliflower, broccoli, and cabbage has long been
considered healthy, and various epidemiological studies suggest that the consumption of
cruciferous vegetables contributes to a cancer-protecting diet. While these vegetables contain
a vast array of phyto chemicals, the mechanism by which these vegetables counteract cancer
is still largely unresolved. Numerous in situ studies have implicated indole-3-carbinol, a
breakdown product of the glucosinolate indole-3-ylmethylglucosinolate, as one of the phyto
chemicals with anti-cancer properties. Indole-3-carbinol influences a range of cellular
processes, but the mechanisms by which it acts on cancer cells are slowly being revealed.
Recent studies on the role of indole-3-carbinol in Arabidopsis opens the door for crosskingdom
comparisons that can help in understanding the roles of this important
phytohormone in both plant biology and combatting cancer.

The coconut, Cocosnucifera L., is a plant that has been cultivated for its many benefits,
especially in its nutritional and medicinal properties. Coconut is an unusual, edible fruit
produced from coconut trees. The coconut tree is a type of palm that has a single straight
stem and has been used for many purposes since prehistoric times. Every part can be used,
including fruit, wood, and leaves. As a result, the trees are widely grown in many parts of
South India for commercial and domestic use. From the coconut tree are found several
products including coconut, soft coconut water, coconut, coconut shell and so on. All
components are used. It is a unique source of various nutrients, so it has many medical
functions including anti-inflammatory, anti-bacterial, anti-plastic, anti-diabetic etc to
maintain good health. And this current review explains the facts of a healthy diet and several
activities of the Cocosnucifera drug.

Corona virus Disease 2019(COVID-19)has become a major health problem causing
severe acute respiratory illness in humans .It has spread rapidly around the globe since
its first identification in Wuhan,China,inDecember2019.Thecausative virus is called
severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), and the World Health
Organization (WHO) named the new epidemic disease Coronavirus Disease (COVID-19).
The incidence of COVID-19 continues to increase with more than three million
confirmed cases and over 244,000 deaths worldwide. There is currently no specific
treatment or vaccine against COVID-19. Therefore, in the absence of pharmaceutical
interventions, the implementation of precautions and hygienic measures will be essential
to control and to minimize human transmission of the virus. In this review, we highlight
the epidemiology, transmission, symptoms, and treatment of this disease, as well as future
strategies to manage the spread of this fatalcoronavirus.

The fruit of Carica papaya Linn (Caricaceae) used in traditional medicine for the
treatment of urinary stones. The present study was undertaken to evaluate
theantiurolithatic effects of the aqueous and alcoholic extracts of the fruit of C. Papaya on
ethylene glycol (EG) induced urolithiatic rats. EG administration resultedin hyperoxaluria
as well as increased renal excretion of calcium and phosphate. Treatment with aqueous
and alcoholic extracts of C. papaya fruit significantlyreduced the elevated urinary oxalate,
showing a regulatory action on endogenous oxalate synthesis. The increased deposition of
stone forming constituents in thekidneys of calculogenic rats was also significantly lowered
by curative and preventive treatment using aqueous and alcoholic extracts of the fruits of
C. papaya. The results indicate that the fruit of C. papaya is endowed with antiurolithiatic
activity and scientifically valid the traditional use of the fruit of C. Papaya in the treatment
of urinary calculi.

Aim: A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery.
Methods: This comparative study was done at the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India for 13 months and patients enrolled for the study were operated at Drishtikunj Netralaya, Patna and Phulwari Eye Hospital, Patna.
Results: 100 patients (mean age 73.5±7.2 years) received topical anesthesia, 100 patients (mean age 70.5±9.4 years) received sub-Tenon anesthesia, and 100 patients (mean age 71.5±8.8 years) received intracameral anesthesia. There was a significant difference in mean age between the topical group and sub-Tenon group (P=0.032). The mean pain score on the visual pain scale in the sub-Tenon group was significantly lower than that in the topical group (P=0.0007) and in the intracameral group (P=0.0051). There were no statistical differences in mean pain score between the topical and intracameral groups (P=0.85). In our study, 70 patients received bilateral cataract surgery and 115 patients received unilateral surgery. The mean pain score was 0.435 in 70 eyes of 70 patients who received bilateral surgery and 0.478 in 115 patients who received unilateral surgery. There was no significant difference in mean pain score between the two groups (P=0.44).50 patients showed high myopia (>-6D). In 50 myopic eyes, there were no significant differences in age, duration of surgery, visual acuity, and mean percentage of corneal endothelial cell loss between the three groups (topical, sub-Tenon, and intracameral). The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0027 and P=0.0022, respectively). However, in 250 eyes without high myopia (<-6D), there were no significant differences in mean pain score between the sub- Tenon and intracameral groups (P=0.15).
Conclusion: Intracameral lidocaine provides sufficient pain suppressive effects in eyes with-out high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia.

Aim: To evaluate the two-dimensional echocardiographic assessment of pulmonary artery hypertension in thyroid dysfunction.
Methods: A prospective double blind randomized controlled study was conducted at ARC Hospital, Bhagalpur, Bihar, India for 1 year. Thyroid function tests were done in all cases using Enzyme immunoassay to confirm the presence of hypo or hyperthyroidism. Electrocardiography was recorded in all the patients. Chest X-rays were done and examined for roentgenographic signs of pulmonary hypertension, i.e. right descending pulmonary artery diameter of >1.5 cm. 2D-Echocardiography was done in all cases and screened for the presence and severity of pulmonary hypertension.
Results: In our study out of the 100 cases, 70(70%) cases were of Hypothyroidism and 30 (30%) cases were of Hyperthyroidism. Unpaired t test is applied. P value is significant if < 0.05 PASP value in patients with hyperthyroidism was 31.06mm Hg while that in the patients with hypothyroidism was 27.17mm Hg. Difference between them was comparable. 80% patients with hypothyroidism and 66.66% patients with hyperthyroidism had normal PASP level. While 20% patients with hyperthyroidism had mild and moderate PASP each, only 16.67% with hypothyroidism had mild PASP. The mean PASP by Doppler Echocardiography was 39.52 mm of Hg in the pre-treatment group. And the mean PASP during the follow up (after 10 months) was 31 mm of Hg. Among the patients in the Hypothyroidism group with PAH, the pre-treatment values of TSH and PASP were high and reduced in the follow-up (after 10 months of treatment) Among the patients in the Hyperthyroidism group with PAH, the mean pre-treatment value of TSH was 0.2 and increased to 2.35 in the follow up. Mean PASP value was 42.6 and reduced in the follow-up (after 10 months of treatment) to 31.7.
Conclusion: The PAH secondary to thyroid dysfunctions may be reversed by restoration of euthyroid state, and hence patients have a good prognosis if diagnosed and treated timely. So every patient of thyroid dysfunction should be screened for PAH, even though further studies are needed to substantiate this.

Introduction:  Guidelines for the prevention of cardiovascular disease recommend the use of risk scores to identify adults at higher risk for whom preventive therapy has absolute benefits. Coronary heart disease (CHD) risk estimation tools are a simple means of identifying those at high risk in a community and hence a potentially cost-effective strategy for CHD prevention. Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient education and management. Aim: 1)To study various risk factors in hypertensive patients according to Framingham criteria. 2)To asses risk of future cardiovascular events in hypertensive patients. Methodology: Study was conducted in 255 hypertensive patients in tertiary care center in south Gujarat, age 18 years or more without any previous history of cardiovascular disease. Framingham risk score was used to assess for estimating 10 years risk of developing cardiovascular disease. Results: In our study 44.70%, 37.25% and 18.03% population had high, intermediate and low  10- year CVD risk. Males had significantly higher CVD risk as compared to females (60% of males & 28.80% of female had high CVD risk). Conclusion:  Higher risk in males was mainly due to history of smoking and diabetes. Significantly higher total cholesterol, low HDL cholesterol in the high risk group as against the low risk one.

Aim: The aim of the present study was to assess the awareness of diabetic retinopathy among Type 2 diabetes mellitus patients in Bihar region.
Methods: This was a descriptive, cross sectional, non-randomized, questionnaire based study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India, for 12 months. A knowledge attitude practice questionnaire was prepared and pretested in a sample group of representative population. The response was analyzed as to whether the questions were understood or not. Social workers were trained in administering questionnaire. Diabetic patients were given questionnaires at primary health centre and filled in the presence of social workers.
Results: Out of the 100 patients, 59(59%) had no knowledge of diabetic retinopathy compared to 41 (41%) who had knowledge. This was statistically significant with p value <0.001. Patients in the upper socioeconomic group had more knowledge about diabetic retinopathy (62.5%) which was statistically significant with a p value of 0.001.There was no significant association between duration of diabetes and knowledge of diabetic retinopathy. About 82.93 % of individuals in knowledge group had right attitude which was significantly higher than non knowledge group (54.24%) with a p value <0.001. Regarding source of information, 44% of patients in knowledge group got information about diabetic retinopathy from physicians, 13% from eye specialists, 11% from reading books, 8% from various media and 24% from other sources like family and friends. About 38.46% in knowledge group had practice of visiting ophthalmologist for eye check-up which was significantly higher than non knowledge group with a p value <0.001.
Conclusion: we concluded that the Increasing knowledge about diabetic retinopathy through awareness campaigns can improve attitude & practice. Early detection & timely intervention can help in preventing sight threatening complications.

Human immunodeficiency virus (HIV) infection has persisted as the world’s leading infectious killer. Most of the women infected with HIV are in the reproductive age group and are capable of passing this infection to their babies. Most (90%) of the infections in children aged under 15 years are from maternally-acquired HIV. The benefits of antiretroviral treatment (ART) in decreasing mother to child transmission (MTCT) of HIV infection. Present study is on HIV infection in Pregnancy  and its outcomes . This is a Retrospective study done in Tertiary care hospital of RIMS, Adilabad , Telanagana state . 255 HIV positive mothers registered in ART Centre were included in study. 215 were diagnosed in ANC and 40 during PNC. 12 mothers developed tuberculosis. 49 babies were HIV positive, out of which 2 died.15 women died and 216 are alive on ART treatment at present. Timely diagnosis of HIV infection during pregnancy is important for preventing MTCT. HIV infected mothers may give birth to HIV negative babies with the help of multidisciplinary teams. With good antenatal care and multidisciplinary approach HIV-infected women can have good pregnancy outcome.

Spinal anesthesia (SA) is considered a safe procedure, but it may have some side
effects including hypotension and bradycardia. Sympathetic fiber blockade and
vasodilation are the main causes of hypotension. SA is performed more frequent in
elderly patients despite the higher risk of hypotension and its consequences. The
percentage of hypotension in elderly patients is estimated to be over 70%[1].
For prevention of hypotensive side effect may have risk of hypervolemia or
myocardial ischemia in elderly population. Hypotension and bradycardia both may
arise from Bezold-Jarish reflex (BJR), spinal anesthesia causes decrease in preload
that stimulates BJR which may be mediated by peripheral serotonin receptors
(5HT-3)[2]. These receptors are located peripherally as cardiac chemoreceptors on
the cardiac vagal afferent and centrally as chemoreceptor trigger zone[3].
Shivering is a common association with spinal anesthesia during intra and
postoperative periods. The causes of shivering are not clearly understood it may be
due to union of some mechanisms including modulation of thermoregulatory
thresholds, decreasing body core temperature, body heat distribution changes and
the cooling effect of the injected fluids into neuraxis[4].
While patients feel very uncomfortable due to shivering, it causes monitors artifacts
and increases the postoperative pain, heart rate,oxygen consumption and metabolic
rate.These effects may lead to myocardial ischemia, hypoxemia, hypercarbia and
lactic acidosis [5].

Effective pain management is critical for women after caesarean delivery, and
significant postoperative pain is related with persistent pain, higher opioid use,
delayed functional recovery, and postpartum depression. Intrathecal morphine is
the standard method for post-c-section pain, offering superior and extended
analgesia. Scheduled non-steroidal anti-inflammatory medications and
acetaminophen should be included in multimodal analgesia, with opioids reserved
for severe breakthrough pain. Wound infiltration and transversus abdominis plane
blocks are critical components of multimodal analgesia for patients who cannot
receive neuraxial opioids or who do not have appropriate pain management. While
analgesics may transfer to breastfeeding infants, transfer could be reduced by
careful drug selection and administration timing.

Laser therapy has proved to be a safe and effective therapy for nail plate psoriasis,
alone or in combination with other therapeutic modalities, being especially
beneficial with topical treatments. Laser can help to improve this resistant form of
psoriasis with high patient’s satisfaction [1]. A positive clinical effect of the laser is
supposed to be caused by its effect on angiogenesis and vascularity within the
psoriatic nail unit. Several case reports and clinical studies have been reported;
however, the results are rather contradictory. While some authors claim effects
mainly on nail bed psoriasis, others report more positive results on nail matrix
psoriasis, or even negative effects on nail bed psoriasis [2].

Background: Renalase is a blood-secreted protein produced only by the kidney; its
blood level approximately 3–5 μg/ml. The Left ventricular hypertrophy (LVH) is
defined by an augmented left ventricular mass that may be measured via
echocardiography or magnetic resonance imaging (MRI). The aim of the present
study was to study whether Renalase is a marker or has a potential role in
developing myocardial hypertrophy in CKD patients under hemodialysis (HD)
treatment.
Patients and methods: To achieve this target, 90 patients on maintenance HD were
incorporated in the present study.
Results: The mean renalase levels were 61.7±67.5 ng/mL in HD patients. The cutoff
value of Renalase was >57.9 ng/ml with a sensitivity of 92.3% and a Specificity of
84.0%. The mean LVMI of the studied dialysis patients was 138 g/m2. The majority
of cases were severely abnormal (60%). There was a statistically significant
difference between the age groups and the LVMI among dialysis patients. The level
of Renalase was significantly increased with the moderately and severely abnormal
LVMI among dialysis patients. The present study disclosed statistically significant
relations between the duration of dialysis and Renalase, HDL, CRP, and LVMI.
There were significant relations between the serum renalase and s. creat, bl. Urea,
Ph, LVMI and dialysis vintage. Also, there were significant positive relations
between LVMI and Hb, CRP, and dialysis vintage.
Conclusion: Renalase could be a novel predictive biomarker in the assessment of
LVH, which is closely associated with the increased risk of death in HD patients.

Introduction: Dengue fever, a mosquito-borne disease that occurs in tropical and subtropical
areas of the world, is considered to be a significant threat for the mankind in both developing
and developed countries.It causes a wide spectrum of illness from mild asymptomatic illness to
severe fatal dengue hemorrhagic fever/dengue shock syndrome. Its impact today is thirty times
>50 years ago. Global incidence of dengue has drastically upped in the last few years.
Materials and Methods: The study was carried out in the department of microbiology at
Government general hospital,siddipet fpr a period of one year , that is from January 2019 to
December 20219. Blood was collected from each patient suspected to be suffering from
dengue, at least 3 days after onset of fever. Serum was tested for the presence of dengue NS1
antigen and antihuman IgM antibodies using Panbio Dengue Early enzyme-linked
immunosorbent assay (ELISA) kit and National Institute of Virology. Results: A total of
samples
2251 were tested over a period of one years i.e. from January 2019 to December 2019. Out of
which 592 (26.29%) were sero-positive for dengue with symptoms of classical dengue fever.
IgM in 349(58.9%) NS1- 243 (41.04%). Conclusion: As vaccines or antiviral drugs are not
available for dengue viruses, the only effective way to prevent dengue is to control the
mosquito vector, Aedes aegypti and prevent its bite.

Background: Patients with Alzheimer disease (AD), the most common form of
dementia. The present study was conducted to assess effectiveness of vitamin D
supplements in the patients suffering from Alzheimer disease.
Materials & Methods:60 patients of Alzheimer disease of both genders were divided
into 3 groups of 20 each. Group I were prescribed memantine alone, group II were
prescribed vitamin D alone and group III were prescribed memantine plus vitamin D
for 6 months. Cognitive change with the mini-mental state examination (MMSE) was
assessed.
Results: Group I had 20 males and 10 females, group II had 12 males and 18 females
and group III had 16 males and 14 females. The mean MMSE score before treatment in
group I was 16.8 and after treatment was 16.4, in group II before treatment was 18.3
and after treatment was 17.5, in group III before treatment was 13.4 and after
treatment was 17.2. The difference was significant (P< 0.05).
Conclusion: Patients who took memantine plus vitamin D had a statistically and
clinically relevant gain in cognition as compared to memantine and vitamin D alone.

Background: The present study aimed to assess the frequency of components of Scored Patient-
Generated Subjective Global Assessment (PG-SGA) in locally advanced head and neck carcinoma
patients (LAHNC) treated with concomitant chemo-radiation. Materials & methods: The present study
was conducted on 60 previously untreated, histopathologically proven patients of locally advanced head
and neck carcinoma who received conventional radical external beam radiation therapy (66Gy / 33
fractions over 6.3 weeks / 2 Gy per fraction) concomitant with Inj. Cisplatin 75mg/m2, 3 weekly. The
frequency of components of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) was
assessed at the time of presentation, at the end of treatment and three months after completion of
treatment. Results: The percentage of patients complaining of loss of appetite at the end of CCRT are
significantly (p =0.01) higher than the percentage of patients having loss of appetite before CCRT. A
decrease in throat pain at the 3rd month of follow up is significant (p = 0.008). At the end of CCRT,
significantly (p ≤ 0.001) higher patients were taking less than usual food and this food intake increased
(P≤ 0.001) in the 3rd month after completing CCRT. The number of patients with normal activities
significantly (P ≤ 0.001) decreases at the end of CCRT and then increases significantly (p = 0.028) at 3rd
month of follow up. At the end of CCRT, the percentage of patients with fairly normal activities
decreased significantly (p = 0.016). There is a significant (p =0.017) increase of patients with a moderate
deficit and there is also a significant (p=0.001) decrease of patients without deficit at the end of CCRT.
Loss of body weight ≥ 5% at the end of CCRT is significant (p = 0.001) then this ≥ 5% weight loss
significantly decreases at the 3rd month of follow up. The gain in weight at the 3rd month of follow up is
significant ( p =0.0004). Conclusion: The outcomes of this study provide a unique patient viewpoint of
using the PG-SGA valuable input for the use of assessing nutrition in the patients receiving concomitant
chemoradiation.

The term “Intra-cranial space occupying lesion” (ICSOL) is used to represent any neoplasm, benign or malignant, primary or secondary, as well as any inflammatory or infectious mass lying within the cranial cavity. It also includes haematomas, different types of cysts, and vascular malformations Magnetic resonance spectroscopy is a simple, easily available, non-invasive, cost effective and easily reproducible investigation modality for intracranial pathologies. After undergoing this study, prompt and accurate diagnosis may help in better management.
Materials and Methods: The present study was conducted at Department of Radio-diagnosis, Basaveshwara Teaching and General hospital attached to M. R. Medical college, Kalaburagi. The study design was a one and half year observational study. The present study was conducted from December 2014 to June 2016.
Result: We found the predominant cause of intracranial space occupying lesions to be neoplasms (64%). Of the neoplastic lesions 65% were intra-axial and 35% were extra axial. Gliomas (14 cases) were the most prevalent intra-axial neoplasms and meningiomas (6 cases) the most prevalent extra-axial neoplasms. Infections comprised 30% of all cases most of which were tuberculomas. The rest 6% of cases were formed by tumefactive demyelinating lesions of multiple sclerosis. Irrespective of cause, the predominant presenting symptoms were headache and neurological deficits, seen in 22 patients each, followed by seizures (20 patients). Even in infections, whether tuberculomas or abscesses, many of the patients did not present with fever or meningismus making the diagnosis difficult clinically.
Conclusion: Magnetic resonance spectroscopy is a newer non invasive modality which provides biochemical information about different tissues that cannot be obtained by conventional MRI alone even after contrast administration. It complements MRI and is particularly useful when the MRI findings are inconclusive. It characterizes lesions based on metabolite patterns and ratios. Choline, N-acetyl aspartate, creatine, lactate, lipids, alanine, amino acids and myoinositol are the major metabolites studied.

The novel corona virus has wreaked havoc in both developing and developed countries. The
respiratory effects of the virus were well reported early on but with each passing day, effects of
covid-19 on others systems came to light. In this report, we bring forward the series of Guillainbarre
syndrome (GBS) cases with the varying presentation in covid infected patients. In our cases,
GBS either occurred during ongoing covid symptoms or within the two weeks of resolution of covid
related pulmonary symptoms. Through this case series, we are reporting one case each of garden
variety, AMAN variety and Miller Fisher variant of GBS. We aim to supplement the already
existing limited data available on other systemic illnesses associated with covid-19 and to make
physicians aware of the potential neurological diagnosis in covid cases.

COVID vaccinations have been developed in the record time frame. But with such rapid
inventions, there comes a risk of potential side effects. Not many serious side effects linked to
vaccinations have been reported to date. Through our case report, we wish to present a 50-
year-old patient who suffered from a NeuromyelitisOptica-like presentation just 2 weeks after
the COVID vaccination. We aim to bring a potential side effect of the vaccine to physicians'
notice so that any patient with similar symptoms does not go undiagnosed. We do not want to
discourage people from taking vaccinations as these side effects are quite rare.

Introduction: Women form the most important part of the family and society, and community health is dependent on the health status of the women. Menopause is biological event occurring in women that indicates the end of reproductive stage to non-reproductive stage. There are several scales for rating the quality of life of menopausal women like Menopausal specific Quality of Life scale [MENQOL], Cervantes Scale [CS], Midlife Women’s Symptoms Index [MSI], The Utain Quality of Life [UQOL], Menopause Rating Scale [MRS].Menopausal specific Quality of Life [MENQOL] is used to rule out common post- menopausal symptoms. It has 4 domains - vasomotor, psychosocial, physical and sexual health. Various studies from several countries have indicated that menopause is negatively related to Quality of Life (QOL) by menopause symptoms based on their severity.
Objectives: To Observe Socio demographic features of post-menopausal women residing in rural and urban areas
To analyse Quality of life among post-menopausal women
Methodology: A descriptive community based cross-sectional study conducted in the urban and rural field practice area of Prathima Institute of Medical Sciences, Karimnagar for period of 18 months (April 2018 - October 2019). 300 study participants were selected for the study. Women of age group 45-60 years, who attained natural menopause were included and Induced Menopause were excluded from the study.
Results: The mean age of the total study population was 54.21 + 4.02 (SD) years. The mean age of study population in urban area and rural area was 53.45 + 4.09 (SD) years and 54.97+3.83 (SD) years respectively. Among all scores of menopausal quality of life for each MENQOL domain ,it was observed that the highest mean score was in vasomotor domain (2.13±1.35), followed by physical (1.94± 0.98) then psychosocial (1.60 ± 0.74) and finally sexual symptoms (1.11± 0.29) which indicates that the quality of life of women was more affected by vasomotor symptoms compared to other symptoms.
Conclusion: Quality of life of menopausal women was significantly affected majorly by vasomotor symptoms followed by other menopausal symptoms. Poor quality of life was observed in rural menopausal women compared to urban menopausal women.

Introduction: A consensus is emerging amongst otologist that obliteration of the mastoid
cavity that result after canal wall down mastoidectomy is sound option to prevent cavity
related problem such as infection, otorrhea, granulation tissue and hearing loss.
Aim:To evaluate the surgical outcome of patients undergoing obliteration of mastoid cavity
with postauricular soft tissue vascular flaps in canal wall down mastoidectomy for chronic
otitis media with cholesteatoma.
Material and Methods: The prospective study (conducted between April2017 to April 2018)
randomly assigned patients with evidence of CSOM with cholesteatoma to two group (25 in
each group, case and control group). After canal wall down mastoidectomy, undergoing
obliteration of mastoid cavity with postauricular soft tissue vascular flap in case group and
left open cavity in control group.
Results: The result was found that healing rate was 100%, 92.30% and 57.14% for small,
medium and large cavity respectively in obliterative group (case), as compared to 100%,
63.63% and 40% respectively in the non-obliterative group (control).
Conclusion: The present study concluded that mastoid cavity obliteration is better for
elimination of cavity problems after canal wall down mastoidectomy.
Ethical consideration: The study protocol was reviewed and approved by institution ethical
committee.

characterise India's population according to the Keros categorization (CT).
Materials and Methods: This study was conducted in our institution over a period of 1 year
(June 2018 to June 2019). Patients >16 years of age undergoing CT scan of paranasal sinuses
(PNS) were included. A total of 1200 patients' PNS CT scan studies were evaluated. The
vertical height of the lateral lamella was used to determine the depth of OF. Independent
samples t test and Chi Square test were used to examine the results by gender and laterality.
Results: OF had a mean depth of 5.16 ± 1.59 mm. The mean depth of OF between males and
females was statistically significant, but not between right and left sides. Keros type I was
discovered on 210 sides (17.5%), type II on 895 (74.6%), and type III on 95 sides (7.9
percent).
Conclusion: Even while the prevalence of the harmful type III OF is modest, it is
considerable, particularly among men and on the right side. To avoid iatrogenic
consequences, a preoperative assessment of depth is required.

Due to the less toxicity, cost effective and eco friendly nature plant derived nanoparticles has been increasingly gain the attention. In this study, prepared the silver nanoparticles using the extract of roots of Calotropis Procera medicinal plant used for the treatment of asthma. This method allowed the synthesis of silver nanoparticles , which was confirmed by FTIR, XRD and SEM. X-ray diffraction characterization of silver nanoparticles indicate that the structure of silver nanoparticles is face centred cubic structure of metallic silver. The topography and surface morphology of silver nanoparticles was examined by using Scanning Electron Microscopy (SEM) and the energy dispersive spectrum revealed that the presence of elemental silver in the sample.SEM images shows that most of the silver nanoparticles are predominantly spherical in shape with close compact arrangement with each otherFTIR evidenced the presence of the functional group and where the reduction occurs and formation of silver nanoparticles which can be studied further to understand the chemical and molecular interaction which could be responsible for nanoparticle formation.
Keywords
Silver nanoparticles, XRD, Calotropis procera, Asthma

Introduction: COVID-19 vaccines have emerged as a key strategy, being the most effective public health intervention in preventing the massive humanitarian crisis. Thus, as a part of preventive measure, government of India had launched COVID-19vaccines on 16 January 2021.Indeed vaccine hesitancy is one of the most significant barriers for success of any immunization drive. Hence, in view of the recent surge in Covid19 cases in our country, this study was planned to assess the awareness, hesitancy and acceptance attitudes ofCOVID-19vaccine among Medical Students (MS) of Maharashtra.
Methodology: This was a cross sectional study. Data was collected using self-reported, structured questionnaire from 356 MS through online Google form. Data were extracted, transferred and analysed using appropriate statistical tool.
Results: The study reported 83.43%vaccine acceptance and 16.57% of hesitancy among MS. Furthermore, the main source of COVID-19 vaccine information was social media followed by government web sites. Majority 91.57% of the students were aware of different types of COVID-19vaccines available in our country. However 62.62% MS among acceptance group were willing to get vaccinated through college or university health centre. Beside the main reason for hesitancy was fear of adverse reactions.  Moreover the hesitant group was uncertain about safety and efficacy of available vaccines.
Conclusion: High acceptance was shown among MS regarding COVID-19 vaccine; however, it is critical to alleviate uncertainties among hesitant MS by continuous education, encouragement and motivation. Consequently, planning and implementation of strategies to further amplify the vaccination rate among medical student is vital to augment the COVID-19 vaccination drive in our country.

Background: This study was undertaken to assess the efficacy and safety of Gemcitabine and erlotinib combination in first line in locally advanced and metastatic (LA/M) carcinoma pancreas patients in Indian population, due to paucity of data.Aims and Objectives: The primary objective was to evaluate efficacy in terms of the objective response rate, progression free survival and overall survival. Safety data was also analyzed.Materials and Methods: In this prospective study, LA/M carcinoma pancreas patients were given standard gemcitabine plus erlotinib till progression or significant toxicities.Results: A total of 50 patients were evaluated. The median age of patients was 59.5 yrs, out of which 28 (56%) were males and 22 (44%) were females. A total of 266 cycles of treatment were administered with a median number of 6 cycles per patient. The CR was not achieved in any patient, PR in 25 (50%), SD in 13 (26%) and PD in 12 (24%) patients. Disease control rate (PR and SD) was seen in (76%) patients. The median PFS was 5.2 months. The median OS was 7.0 months. The main grade 3/4 side effects seen were Rash in 9 (18%), thrombocytopenia in 8 (16%) and Diarrhea in 9 (18%) patients. Overall survival of patients who developed grade 3/4 skin rashes was significantly longer (P = 0.013).Conclusions: Gemcitabine and erlotinib based chemotherapy regimen has good efficacy with reasonable toxicity profile in Indian advanced carcinoma pancreas patients. To the best of our knowledge, this is the first such study conducted in India.

Background: Father and mother as they are regarded as the primary care providers. Father has important role in
child health such as companion, care provider, protector moral guide, teacher, bread earner. Ultimately, the
family will be responsible for shaping a child and developing their values, skills, socialization, and security.
However, there is emerging evidence on the positive outcomes for child nutrition and development of expanding
father’s involvement beyond their traditional roles. Thus, this study explored the knowledge, attitude, and
practices of father’s and mother’s involvement in child care.
Methods: A cross-sectional, community based study was carried out among 400 under five children in field
practice area of rural health training center of Dept. of Community Medicine of Govt. Medical College,
Aurangabad, Maharashtra, India during the period of Jan. 2017 to Dec. 2018. Data was entered in MS Excel
2007 worksheet and analyzed using open Epi version 3.01.
Results: Majority 133(66.50%) of father in urban area think that the father role is important in child health care.
47(23.50%) of father of under five children residing in rural area think that the child health care is the
responsibility of mother only. However 40(20%) of father in rural area think that the father role is also important
in child health care. Father primarily see themselves as providers, not caretakers, a perception widely held by the
larger community as well.
Conclusion: Quite significant proportion of fathers had knowledge about child health and practices of taking
care of child was found but proportionately higher percentage of knowledge and practices were found in
females.

To analyse the clinico-epidemiological profile of acne vulgaris and its relationship with insulin resistance among males and females. Material and method: The present cross sectional observational study was conducted in the department of Dermatology, Venereology and Leprosy at Acharya Shri Chander College of Medical Sciences, Jammu from January 2020-May 2021 among 500 clinically diagnosed patients of acne vulgaris attending the out-patient department. General physical examination including BMI, anthropometry which includes height, weight, triceps skin thickness and waist/hip ratio was done. Investigations comprised of fasting blood sugar and fasting insulin levels. These assess the insulin resistance based on HOMA-IR.

Coronary heart disease resulting from atherosclerosis of coronary arteries. It is the most common cardiac disease found in autopsies. As number of cases of coronary heart diseases are increasing worldwide and it also a huge challenge in India became challenging in India. The study was designed to assess the histomorphological atherosclerotic changes in coronary arteries based on autopsy and to find out the age and sex related prevalence of atherosclerosis in population of mp of which hearts are received in department of pathology, MGM medical college Indore, India. This study will help in collecting baseline information of prevalence of such lesions which will help in framing health care programs to prevent the formation of these lesions

Rashtriya Bal Swasthya Karyakram (RBSK) or ‘Child Health Screening and Early Intervention Services’ Program was launched by the Ministry of Health and Family Welfare in February 2013, an ambitious program that is aimed to cover 27 crore children in India, was launched. 4 D’s identified under RBSK are Defects at birth, Diseases in children, Deficiency conditions and Developmental Delays including Disabilities. Hence the present study was conducted to study the determinants and health status of under 5 children according to 4 D’s of RBSK program in field practice area of rural health training centre

 Burst Abdomen is a preventable condition in which many risk factors play their role and lead to life threatening complications. The aim of the present study is to identify the different risk factors and high risk patients for burst abdomen for decreasing the rate of burst abdomen post operatively. Patients and methods: An observational analytical study included 110 patients and carried out in General Surgery Department, Faculty of Medicine, Zagazig University Hospitals. The patients were divided into 2 main groups: post-midline laparotomy burst abdomen patients and postmidline non complicated laparotomy with burst abdomen patients. Evaluation of different risk factors between the two groups was performed. Results: There is statistically significant relation between occurrence of burst abdomen and both smoking and obesity. There is statistically significant relation between occurrence of burst abdomen and all of direct trauma, diabetes, intraabdominal infection and jaundice. There is non-significant relation between occurrence of burst abdomen and other risk factors. There is statistically significant relation between occurrence of burst abdomen and postoperative ileus, pulmonary complications and wound infection. Diabetes, wound infection, smoking and direct trauma increased risk of burst abdomen by 47.205, 58.547, 40.559 and 39.874 folds respectively. Conclusion: Intra-abdominal infection is the most important factor in predicting burst abdomen. Patient factors like anemia, diabetes, smoking, peritonitis due to bowel perforation act as determinant for wound dehiscence. Postoperatively abdominal burst can be prevented by improving the nutritional status of the patient, early mobilization of the patient and simple investigations like Hemogram, RBS, RFT, LFT, chest x-ray may help to detect predisposing factors

ACS (abdominal compartment syndrome) is a serious condition that affects critically ill people. Because it predominantly affects individuals who are already sick, it may go unnoticed. The aim of study to find a link between IAP and the development of problems in patients with severe acute pancreatitis. We also wanted to see if there was a link between IAP and the development of complications in patients with severe acute pancreatitis (SAP). Patients and methods: This prospective study was conducted on 18 patients with AP hospitalised to the Surgical Intensive Care Unit at Zagazig University's Faculty of Medicine's General Surgery Department (SICU). During the first week after admission, all patients were divided into two groups based on their IAP. Patients with IAP 20 mmHg were assigned to the IAH group, whereas those with IAP 20mmHg were assigned to the normal IAP group. Results: Age, serum Lipase and APACHE were significantly higher among ACS cases and also ACS cases were significantly associated with DM. ACS cases were significantly associated with longer hospital stay also with bleeding, septic shock and mortality.The mean Lipase level was 959.72±103.58 with rang (800-1200). The mean Intra-abdominal pressure of studied patients was 12.94±4.12 and 38.9% of patients had IAH while 2 cases 11.1% had ACS. Conclusion: In patients hospitalised to the ICU with severe acute pancreatitis, IAH and ACS are common findings. IAH could make severe acute pancreatitis worse. Early detection of this possibly treatable aggravating condition could lead to early management and, in turn, a better prognosis. 

: Childhood overweight and obesity remains an important public health concern. The prevlance of obesity and overweight among children and adolescents aged 5-19 years has risen dramatically from 4% to over 20%. The aim of the present study was to assess A803G polymorphism in the NAT2 gene in Egyptian obese children and adolescents and to detect the relation between this gene mutation and impaired lipid profile in them. Patients and methods: this cross sectional study included 100 obese children and adolescents divided into two groups according to their HbA1c results : group 1(pre-diabetic obese children and adolescents) and group 2 (Non- diabetic obese children and adolescents) , both groups are compatible as regard age and sex and had equal numbers (50). Whole blood samples were collected and underwent genotyping todetect NAT2 A803G gene polymorphism using Taqman allelic discrimination assay. Results: There was highly statistically significant higher total cholesterol, triglycerides and LDL among Group 1 than Group 2. But regarding HDL, it was highly statistically significant higher among Group 2 than Group 1. Heterozygous A allele of Group 1 group had the worst lipid profile characteristics (higher cholesterol, triglycerides and LDL and lower HDL) but this difference was statistically significant only regarding LDL while regarding otherpararmeters, they were not statistically significant. While, heterozygous G allele of Group 2 had the worst lipid profile characteristics (higher cholesterol, triglycerides and LDL and lower HDL) but this difference was statistically significant only regarding LDL while regarding other parameters, they were not statistically significant. Conclusion: Our study concluded that Egyptian obese children and adolescents who carrying the NAT2 A803 allele might be at a high risk of impaired lipid profile and consequent increased future risk to develop secondary metabolic diseases.

Infertility is a worldwide health problem among couples with approximately 15% current global infertility rate, translating to one in 6 couples suffering from this condition. The aim of the present study was to find the relation between infertility and pelvic inflammatory disease. Patients and methods: A cross-sectional case series study included 191 infertile women selected from the Outpatient Clinics of the Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University Hospitals. All women underwent general examination, local speculum examination, and abdominopelvic ultrasound. Also, we collected the data about past reports of all investigations, U/S, laparoscopic and HSG reports done during their journey on infertility assessment. Results: There was statistically significant difference between positive and negative PID patient's parity and social class. But regarding other variables, there was no statistically significant difference. There was statistically significant difference between positive and negative PID patients regarding methods of contraception, repeated history of PID and hospitalization due to PID. But regarding other variables, there was no statistically significant difference. There was statistically significant difference between positive and negative PID patients regarding WBCs and bacteruria. But regarding other variables, there was no statistically significant difference. There was statistically significant difference between positive and negative PID patients regarding using IUD as contraception. But regarding others, there was no statistically significant difference. Conclusion: Observed treatment of PID should be initiated in sexually active young women and others at risk for STIs if the following minimum criteria are present and no other cause(s) for the illness can be identified: lower abdominal tenderness or adnexal tenderness or cervical motion tenderness.

Coronary Artery Disease (CAD) is generally characterized by episodes of reversible myocardial demand/supply mismatch, related to ischemia or hypoxia. P wave peak time (PWPT) is a newly introduced electrocardiographic parameter that has been shown to be associated with noreflow in patients with acute coronary syndrome (ACS). This study aimed to evaluate whether there is any association between prolonged PWPT in ECG and the severity of CAD in diabetic patients. Patients and methods: This study included 134 diabetic patients with history of coronary artery disease and were admitted to cardiology department Zagazig University. Patients were divided into group (I) of 40 patients with no evidence of obstructive CADs and group (II) of 94 patients with evidence of obstructive CADs. Results: The difference between both groups was statistically significant regarding the PWPT in lead II and V1. There was a significant difference between both groups concerning the R-wave peak time as the mean value in group I was 21.4 ± 3.7 while in group II was 29.2 ± 7.1. Regarding QRS duration, there was statistically significant increase in group II than in group I. Group II had statistically significant increase in PWD max, PW dispersion and PWTF in the lead V1 than group I. Regarding PWD min, there was no statistically significant difference between the two groups. The cut off value of PWPT in the lead II was 56.5msec with sensitivity (62.8 %) specificity was (80.0 %) and accuracy was 68.6 % .The PWPT in the lead V1, had a cut off value 54.5msec with sensitivity, specificity and accuracy were (66.0 %, 75.0 % and 67.9 %) respectively. the mean value of left ventricular ejection fraction in group I was 63.1 ± 8.3 while it was 53.5 ± 11.6 in group II. There was statistically significant increase in LVEF % among group I than group II. Group II had statistically significant increase in left atrial diameter than in group I (33.4 ± 4.1mm in group I vs 38.2 ± 11.6mm in group II). Conclusion: Prolonged P-wave peak time (PWPT) is a beneficial parameter for detecting high-risk patients with stable coronary artery disease. There was statistically significant older age among patients with obstructive coronary artery disease than those with non-obstructive coronary artery disease. Obstructive CAD group had statistically significant increase in left atrial diameter, left ventricular dilatation. Also, there was statistically significant increase in LVEF % among non-obstructive coronary artery than obstructive coronary artery disease one.

The purpose of hip arthroplasty is to restore function by restoring normal anatomy and thus normal hip biomechanics. The aim of the present study was to evaluate the clinical and radiologic outcomes of young patients with degenerative osteoartheritis who have a total hip arthroplasty (THA). Patients and methods: This retrospective study wasconducted in Orthopedic Surgery Department, Faculty of Medicine, Zagazig University on 18 patients with degenerative osteoarthritis. Patients with significant disabling hip pain and moderate to severe functional limitation of activities of daily living due to osteoarthritis of the hip joint with any of the etiologies. Clinical assessment was done byusing Harris Hip Score at 6 weeks, 3 and 6 months follow up, also we used radiographs in analyzed with reference to signs of loosening at end of 3 months and 6 month. Results: Mean of pain score improved from marked pain (10.1±8.26) to slight pain (38.7±5.04) post- operative. Mean Walk score improved from (1.1±1.02) pre-operative to (9.3±1.53). Post- operative. Mean of Support score improved from (1.9±1.1) pre-operative to post- operative (7.8±2.39). Limping improved from moderate limping (2.2±2.6) pre-operative to (9±1.45) postoperative. Mean climbing upstairs score in most cases improved from (0.55±0.51) pre-operative to (1.9±0.32) post- operative. A statistically significant increase in points of all parameters postoperative. Wear Shoes stocks score improved from (2±0) to (3.1±1.02) post- operative, sitting improved from (1.6±1.53) to sit comfortably to any chair for one hours (4.3±0.97) postoperative. Mean of uses public transportation increased to be postoperative 0.78±0.43 and deformity improved to be 3.1±0.58.Range motion improved to do normal motion range post- operative. Conclusion: Cementless total hip arthroplasty has reassuring results in patients <50 years of age. It is not associated with any significant early or late complications and has outstanding functional outcomes. Patients usually do not experience any pain, limping, difficulty in walking and attain normal limb length. They develop no restriction in the range of movement

Olecranon fractures require open reduction and internal fixation that require anatomical reduction and early mobilization. Many methods have been described for fixation of olecranon fractures including the tension band wiring (TBW) which was the standard treatment. The aim of the present study was to comparing crossing screws fixation to the gold standard, TBW in treating isolated non-comminuted olecranon fractures by functional results as well as to assess the complications and secondary procedures. Patients and Methods: A prospective comparative study concluded 18 patients with displaced olecranon fracture Mayo's type IIA were incorporated in an interventional prospective comparative study. Patients were divided equally into two groups according to the method of treatment. A detailed history, clinical and radiological assessment were performed. The quality of the reduction, union and position of the implant will be measured. The elbow's range of motion (ROM) was measured. The functional evaluation of the surgically treated elbow will be based on the Mayo Elbow Performance Score (MEPS). At the end of the follow-up was done for one year. Results: the mean age was distributed as 30.33±9.83 and 30.88±10.05 respectively between groups with no significant difference between groups, regard sex there was no significant difference between groups. There was no significant difference detected between groups regard side. No significant difference regard follows up duration. Time of union was significantly shorter among group B. No significant difference between groups detected regard any items. Conclusion: Crossing screws for olecranon fractures provide a safe mini-invasive, that enables early healing with excellent functional outcomes and limited complications that appear to be mechanically, biologically and functionally superior to TBW

Chronic Obstructive Pulmonary Disease is a progressive irreversible inflammatory disease that affects the lungs and reduces the airflow. It is a preventable and treatable disease in the worldwide population By the year 2030, COPD will be in top 5th diseases affecting the worldwide population and in top 3, according to mortality rate. [1, 2, 3] Approximately, 30 million people are suffering from COPD in India. According to Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines, a general definition of COPD is “Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with some significant extra pulmonary effects that may be contributed the severity in individual patient”. The pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response in lung to noxious particles and gases. [4,

Background: Red cell distribution width (RDW) is a critical parameter that is reported to have a relation with the incidence and prognosis of cerebrovascular strokes. Altered RDW has been shown to predispose to the development of vascular thrombosis which is the underlying cause of cerebrovascular disease. We in the current study tried to evaluate the relationship between RDW values and stroke severity and prognosis.
Methods: N=50 cases of acute ischemic stroke and age and sex-matched controls were included in the study. The patients were analyzed with a detailed history with the profile of stroke, GCS, NIHSS, mRS, including risk factors such as hypertension, Diabetes mellitus, IHD, and vascular risk factors. All the patients were subjected to 12 lead ECGs, 2D Echo, and CT scans. The sample was sent to the Department of Pathology for complete blood analysis including RDW.
Results: the cases were divided into two groups those with RDW ≥14.5 and those with RDW ≤14.5. We found 62% of cases with RDW ≥14.5 and 28% cases with RDW ≤14.5. We found CRP levels, MCV, Modified Rankin Scale mRS, and Stroke size significantly increased in patients with RDW ≥14.5. Analysis of cases based on RDW in both groups the p-values was found to be 0.0122 considered significant. The diagnostic value of RDW levels at the cutoff value of 13.5 found the sensitivity was 76.5% and specificity was 75.8%.
Conclusion: RDW is an important indicator of the prognosis of ischemic stroke. Although the exact mechanisms underlying it has not been fully elucidated, it may be used routinely in laboratories as it is inexpensive, and when combined with GCS, NIHSS, and mRS parameters it could provide information on stroke severity and increased risk of mortality.

Dermatophytosis is the most common superficial fungal infection also called as ‘ringworm’ or ‘tinea’. Prevalence of dermatophytosis in patients attending dermatology outpatient department (OPD) was 13% in India. Current study was undertaken in view of changing infection trends.
Objectives:
1)      To know epidemiology of adult patients with dermatophytosis.
2)      To know the distribution of clinical types by direct microscopy (Potassium Hydroxide mount/KOH mount) and culture.
3)      To identify the causative fungal agents in various clinical types of dermatophytosis.
Material and methods: Cross sectional study was done in adult patients attending dermatology OPD during September 2019 to January 2020. Sample size calculated to be 102. Purposive sampling method was used. Skin scrapings, nail clippings and infected hair stubs were collected and subjected to microscopy and culture. Hair perforation test and urease test when required were done. Data on sociodemographic profile, clinical type and microbiological finding were recorded. Data analysed using SPSS version 20. Chi-square test was used.

Background: The common modes of suicide were ingestion of agricultural chemicals,
hanging, self-immolation, and drowning. The present study was conducted to assess injury
pattern and analysis of its outcome in patients presenting to emergency department after
near hanging.
Materials & Methods:136 cases of near hanging presenting to emergency department of
both genders were included and injuries diagnosed, inpatient course, mortality, and
functional disability at the time of discharge was recorded. Injury severity was assessed
using the ISS and the abbreviated injury score for each anatomic body region.
Results: Age group 1-14 years had 46, 15-45 years had 70 and 45- 65 years had 30. Base
deficit was 5.4, ISS score was 8.7, GCS 13-15% was seen in 8, 9-12% in 35, 3-8% in 90 and
missing in 13. Mortality was seen among 42 subjects. The injuries reported was abrasions
in 42%, brain in 28%, spinals in 10%, chest in 8%, larynx/pharynx in 5%, extremity in 4%
and vascular in 3%. The mean ventilator days was 3.6, ICU stay days was 3.9, hospital stay
days was 5.4. Functional outcome complete independence (FIMtot=12) was seen in 87%,
complete disability (FIMtot= 3) in 4%, severe disability feeding (FIM<3) in 8%, severe
disability expression (FIM<3) in 10%, severe disability locomotion (FIM<3) in 11% and
discharged to rehabilitation in 18%.
Conclusion: Hanging injuries are associated with a high overall mortality rate. The
majority of survivors have little to no functional disability.

Background: Health care is one of the basic needs of each community. Since considering
to healthcare and investing in this sector increases labor productivity and service
production, therefore, optimal resource allocation and use of resources is very important.
The present study was conducted for assessing the profile of patients reported to emergency
medicine department.
Materials & methods: A total of 500 patients were analysed who presented to emergency
department were included in the present study. Complete demographic and clinical details
of all the patients were obtained. Some patients requiring emergency intubation in the ER
were maintained on ventilator machine. Presenting complaints, personal details, and
medication history were recorded. These patients were followed until the tenth day of
hospitalization and outcome was determined. All the results were recorded in Microsoft
excel sheet and were analysed by SPSS software.
Results: Mean age of the patients reporting to the emergency department was 62.2 years.
Out of these 500 patients, 289 patients were males while the remaining 211 patients were
females. Mean pulse rate was less than 60 in 53 patients (16 percent of the patients).
Breathlessness and chest pain were most common presenting complaints found to be
present in 55 percent (275 patients) and 43 percent (215 patients) of the patients. Out of
500 patients, nature of disease was non-trauma in 483 patients (96.6 percent). Out of 500
patients, 439 patients (87.8 percent) were discharged while mortality occurred in 3 percent
of the patients (15 patients). The remaining patients were left against medical advice
(LAMA).
Conclusion: Medical emergencies are common emergencies and hence a well-equipped ED
and proper training of emergency physicians and paramedical team in are paramount in
saving the lives of these patients.

: Nutrient foramen is a natural orifice into the diaphysis of a bone connecting an oblique conduit (nutrient canal) carrying a nutrient artery and nerves to the medullary cavity. This is the major blood supply during the growing period and in the initial stages of ossification. The knowledge of the topography of nutrient foramen helps the surgeons for more accurate management in the case of fractures, dislocation, tumour resections, and selection of the section of bone for bone grafts and minimizing the vascular insult which may lead to non-union or delayed healing.
 
Aims: The goal of this study is to determine the number, direction, position, and distance of NF in the North Indian population from the proximal end of the completely ossified ulna, as well as to analyse its clinico-anatomical relationships.
 
Material and Methods: The current research was performed on 100 Ulna bones from the Department of Anatomy, Government Medical College Amritsar, Punjab, of unknown age and sex.

The COVID-19 pandemic is a global crisis that caused economic disruptions. India faced challenges like limited resources and increasing demand for essentials, including medicines and supplies. To analyze this, time-series data was extracted to study the impact of the pandemic on India’s major retail pharmaceutical companies. Net sales and total revenue significantly increased post-pandemic and were especially noticeable in the third quarter of 2020. This resulted from a spike in covid cases and price hikes on major drugs needed to treat the disease. While e-commerce has thrived in other areas, rising demand and growth opportunities are leading it to make its way to retail pharmacies. Restriction of movement led to increased users of e-pharmacy. A survey using an electronic questionnaire was conducted on 190 participants across tier 1, 2, and 3 cities to understand consumer behaviour towards e pharmacy. Common age groups were tech-savvy youth aged between 15 and 30 years. 55% of respondents were e-pharmacy users before lockdown restrictions. Other data points including feasibility and delivery time were positive in tier 1 and 2 cities as opposed to tier 3 cities which can be attributed to logistics challenges. 78.3% of the study participants are likely to recommend and use the service post the pandemic. The pandemic has had a small impact on E-Pharmacy, but a shift at its core has begun, which has a promising future as observed through primary research.

The pandemic of COVID-19 disease caused by SARS-CoV-2 continues to be the global public health concern. While nations are taking extensive measures to contain the pandemic, several variants have been identified more recently due to mutations of the SARS -CoV 2 which make it highly contagious and well known source of multiple waves. A retrospective and observational study were conducted on 28,897 nasopharyngeal/ oropharyngeal swabs of patients consulted or hospitalized at tertiary care hospital. The Epidemiological, demographic & clinical details of all patients were recorded and the diagnosis of SARS- CoV 2 was done by real time reverse transcriptase reaction (RT-PCR). A total 4794(16.6 %) patients were tested positive for SARS CoV-2 & maximum cases (38.57%) were in age group 41-60 years ; males (51.48%) were found to be predominantly infected .In year 2020 maximum positivity of SARS -CoV 2 were reported in the months of August & September (14.72%) , then gradual decline from October to Feb 21 and then second wave lead to abrupt rise, 34.42% cases reported in the month of April- May 2021. More than 75% of positive patients were found to be symptomatic and the most frequent symptoms were fever (82.14%), cough (71.69%), and sore throat (43.5%). Severe acute respiratory illness (SARI) was detected in 38.06 % of positive cases & Influenza like illness (ILI) was reported in 11.28%. Fifty one (51) positive samples tested for whole genome sequencing, detected 56.8% B.1.1.7 lineage (alpha variant), (39.3%) B.1.617.2 lineage (delta variant) and 3.9% delta plus variants (A.Y 4 & A.Y 12). As the pandemic continues to unfold, there is need to analyse the epidemiogical & clinical characteristics of the patients infected with SARS CoV 2 and identification of ongoing variants of concern in the presence of new selection pressures such as vaccination. 

AIMS and Objectives: To study the incidence, clinical and histopathological correlation of various types of endometrial lesions in premenopausal and postmenopausal women. To study the clinicopathological spectrum and histopathological evaluation of endometrium in abnormal uterine bleeding in peri-menopausal and post-menopausal age groups. 

Aim: To evaluate the role of Fine Needle Aspiration Cytology in Diagnosis of Thyroid lesion. Materials and Methods: A retrospective research was conducted at the Department of Pathology, Assiut University and Hospital, Egypt. An overall total of 200 patients with a single thyroid nodule who met the inclusion criteria were included in the research. In the case of fine needle aspiration cytology, the sensitivity, specificity, positive predictive value, and negative predictive value were determined based on histopathologic examination, which was the gold standard. Results: There were 120 females and 80 men in attendance, resulting in a female to male ratio of 1.5:1. The patients' ages varied from 14 to 71 years, with a mean age of 43.69 years plus standard deviation (12.49 years). The majority of the patients are between the ages of 30 and 40. Neck oedema was the most common symptom among these patients (100 percent), followed by vocal cord palsy (15 percent), breathing difficulties 11 percent, and dysphagia 9 (4.5 percent), respectively. The thyroid nodule varied in size from 2 to 6.9 cm, with a mean of 4.51 +/- S.D. 1.89 cm and a standard deviation of 1.89 cm. Based on the results of this study, nodular goitre accounted for 52 percent of solitary thyroid nodules, with benign cyst accounting for 32 percent of benign lesions, 33 percent of follicular carcinoma, 17 percent of papillary carcinoma, and three cases being suspicious of neoplasm among the benign lesions. Conclusion: FNAC has key rule in diagnosis of solitary thyroid nodule because it is safe, minimally invasive and cost effective diagnostic tool. 

Aim: to determine the prevalence and clinical profile of patients presented with posterior fossa extra dural hematoma. Materials and methods: This retrospective observational research was carried at the Department of Neurology, Apex Hospital, Jaipur, Rajasthan, India. The data for this research was collected during a 2-year period and was analyzed. The clinical presentation, admission Glasgow Coma Scale (GCS), mechanism of injury, type of intervention, and postoperative prognosis were all examined retrospectively in the data. The Glasgow Outcome Score (GOS) was used to evaluate the outcomes at the time of discharge and at three months after discharge. Results: There were 39 patients in all, 28 of them were men and 11 of whom were girls. There were 29.21 years between the mean ages of the patients. At the time of admission, 24 patients had GCS 13-15, followed by 9 patients with GCS 9-12, and only 5 patients had GCS less than 9. The mean EDH volume was 28.7 milliliters. Thirty-six patients were operated on, and five patients were treated conservatively. Conclusion: Epidural haematomas in the posterior fossa are a rather rare occurrence. Because of the limited volume of the posterior fossa and the presence of critical tissues inside it, mortality may be significant if the haematoma is not detected and treated promptly.

Transition from college life to internship gives freedom to many doctors to eat anything including junk food even though they are aware of the consequences of bad food habits. Intern’s ill health is mainly due to inadequate nutrition. Hospital campuses have canteen facilities, and many interns rely on the variety of food which is provided which could be bad or good. Hence the present study was carried out with an objective to determine the patterns of food habits and the levels of stress amongst interns of Gandhi Medical College, Secunderabad, Telangana, India. Methods: This cross-sectional study was conducted among 188 interns who were working for Gandhi Medical College, Secunderabad, Telangana during the period of May to June 2021. A semi-structured questionnaire and perceived stress scale were used to collect data. Data was entered in Microsoft Excel 2007 worksheet and analysed using open Epi version 3.01. Results: Most of the interns 156(83%) went to have food in fast food restaurants and ordered food online 167(88.82%). Irregular meals were reported by 162(86.1%) interns, only females could do self-cooking after joining. Majority of participants both males and females had meals three times a day. Very few 12(21%) males and 33(24.79%) females were vegetarians and vegans. Conclusion: Perceived stress among interns will lead to change in their food habits and pattern that may lead to further physiological and psychological complications in their life. Behaviour change communication at this point and advocacy of lifestyle modification must be considered and implemented in the internship curriculum.

While countries including India, have taken strong measures to contain the spread of Covid-19 through better diagnostics and treatment, vaccines will provide a lasting solution by enhancing immunity and containing the disease spread. Understanding the adverse effects pattern will help make aware citizens, dismiss false rumours and reduce vaccine hesitancy. Hence the present study describes the pattern of adverse effects reported following COVID-19 vaccination among beneficiaries in Government Medical College, Raigarh, Chhattisgarh, India. Methods: A cross-sectional, observational study of pattern of adverse effects reported following COVID-19 vaccination was conducted among 540 beneficiaries in Government Medical College, Raigarh, Chhattisgarh, India from January 2021 to April 2021. Data was collected through online survey which included questions pertaining to immediate & late post vaccination experience. Results: Majority (33%) participants were 18-30 age group and (58%) were male. Overall (73%) respondents reported atleast one post-vaccination symptom. General weakness & tiredness (73.4%), pain at injection site (62%), bodyache (48%), chills (43%) & fever (39%) were the most prevalent symptoms. The frequency of symptoms among 18-30 age group was (85.9%) & more likely to be reported by women (83.2%) compared to men (65.1%). Around (36.9%) beneficiaries who had one or more comorbidities showed post vaccination symptoms. Around (82.1%) of Covishield beneficiaries developed atleast one or more symptoms post vaccination, while (60.3%) of Covaxin beneficiaries developed the same. Conclusion: Nearly two-thirds of study participants reported mild symptoms following vaccination. General weakness & tiredness, pain at injection site, bodyache, chills & fever were the most prevalent symptoms. Symptoms were more common among younger individuals. More Covishield beneficiaries developed atleast one or more symptoms post vaccination compared to Covaxin beneficiaries

: A pleasant smile not only increases the face value but is also important for improving the quality of life of a person in a variety of spheres. Facial appearance has a long lasting implication on an individual. An unacceptable dental appearance has often been associated with a negative effect on self-image, career advancement and peer-group acceptance. The third most frequent oral disorders, alongside tooth decay and periodontal disease, are dental malocclusions. To confer a treatment plan and to work out on the treatment needs of a community group, it is obligatory to know the trends of occurrence of various malocclusions. With this background the study was planned to determine the prevalence and various preventive and treatment procedures of malocclusion in Aurangabad district of Maharashtra. Methods: A community based cross-sectional study was conducted among 2151 subjects in Aurangabad district, being the capital of Marathwada region by Rural Health Training Center, Paithan under Govt. Medical College, Aurangabad. The standard pro-forma was designed and house to house survey was conducted over a period of 3 months i.e. from June to August 2021. Mouth mirrors, caries explorers and periodontal probes were used for oral examination with proper aseptic precautions. All the findings were recorded in the data sheet after thorough examination. Descriptive statistics and chi-square test were applied using SPSS-17 version. Results: In the present study, prevalence of malocclusion was found to be 28.4%. Epidemiological studies on malocclusion not only help in orthodontic treatment needs and evaluation of dental health services but also offer a valid research tool for assessing distinct environmental and genetic factors in the aetiology of malocclusion. Conclusion: Drastic efforts are being taken by developing countries like India to eradicate many medical and dental diseases. Extensive multi centric studies are required to obtain a countrywide representative data.

: Overall health status of an individual is greatly influenced by the oral cavity. Periodontal disease (PDD) and dental caries are the biggest threats to oral health among the various oral diseases. Despite increasing awareness and improvement in oral health, the global epidemiological data suggests that a worldwide prevalence of periodontal disease is 11.2%. It is a complex chronic disease which can lead to chronic inflammation, destruction of tooth supporting structures, and tooth loss in adults. With this background the study was planned to determine the prevalence of periodontal disease and perceptions towards oral health among the community in Aurangabad district of Maharashtra. Methods: A community based cross-sectional study was conducted among 2151 subjects in Aurangabad district, being the capital of Marathwada region by Rural Health Training Center, Paithan under Govt. Medical College, Aurangabad. The standard pro-forma was designed and house to house survey was conducted over a period of 3 months i.e. from June to August 2021. Mouth mirrors, caries explorers and periodontal probes were used for oral examination with proper aseptic precautions. All the findings were recorded in the data sheet and descriptive statistics and chi-square test were applied using SPSS-17 version. Results: Prevalence of periodontal disease in the present study was found to be 31.06%. It was observed that various factors act as predicators for periodontal disease. Conclusion: For reducing the disease Burdon and its impact on the community, school and community based oral health awareness programs should be implemented.

Background: Chronic colitis, regardless of type, is defined histologically by chronic
inflammation, mainly plasmacytosis, in the lamina propria. Specific diagnosis of chronic
colitides in biopsies can be challenging for practicing pathologists. The present research was
undertaken to study complete clinico-pathology of chronic colitis, pathological pattern and
spectrum of colitis, also study correlation of colonoscopy and histopathology of these
lesions.Method:This study was a retrospective and prospective analysis of 187 cases
ofhistopathologicallyproven colitis on colonic biopsies over a period of 5 years from June 2015
to May 2020. Results:Majority of specimen were rectal biopsies (57.22%) followed by mapping
biopsies (34.22%). Of 85 cases where both colonoscopy and histopathology diagnosis was
available, 61 (71.76%) colonoscopy diagnosis were consistent with histopathology. Among 187
cases, 107 were inflammatory bowel disease (57.22%), they were further sub classified as
ulcerative colitis (UC) (96.26%), Crohn’s (0.93%) and indeterminate colitis (2.8%). Cases of
UC had features of basal plasmacytosis (97.19%), crypt distortion (93.45%), crypt loss
(70.09%) and goblet cell depletion.48cases diagnosed as non-specific colitis. Infectious colitis
comprised 8.56% of total colitis cases. It included tuberculosis 4 (2.14%), CMV colitis
2(1.07%) and 5.35% cases of acute self-limiting colitis. 5(2.67%) cases were diagnosed as
lymphocytic colitis and 2 cases showed focal active colitis. Also, found single case of
eosinophilic colitis and radiation proctitis each.Conclusion:Good clinico-pathological
correlation helps to reduce number of cases diagnosed as non-specific colitis. To improve the
detection rate of microscopic colitis, it is important to take multiple biopsies from normal
looking colon on colonoscopy.

Aim: The aim of the present study to compare the vital parameters and biomarkers in
predicting the outcome of patients in Covid ICU.
Methods: 200 patient were divided in to two groups, Group A of those who expired and
Group B of the survivors. The mean for each parameter was calculated and compared
among the two groups and based on which p value was calculated for each parameter
undertaken in clinical evaluation. Blood reports of investigations assessing the levels of
biomarkers like Procalcitonin (PCT), C- Reactive Protein (CRP), D-dimer, Ferritin,
Lactate dehydrogenase (LDH) and Interleukin-6 (IL-6) sent on first day and last day of
hospitalisation in covid ICU were collected for Group A (Expired) and Group B (Survived)
and master chart was prepared.
Results: The study population comprised of 200 confirmed Covid-19 cases, among which
those expired (Group A) were 103, and those who survived (Group B) were 97. The mean
age difference was statistically significant (p value = 0.003). The mean Heart Rate on day
of admission was statistically significant (p value = 0.005). The mean Heart Rate on last
day of hospitalisation difference was statistically significant (p value = 0.001). The
Median PCT levels along with along with its interquartile range in Group A (Expired)
versus Group B (Survivors) on day of admission the difference was statistically significant
(p value < 0.001). The Median Ferritin levels along with its interquartile range in Group A
(Expired) versus Group B (Survivors) on day of admission the difference was statistically
significant (p value < 0.0003). The Median Ferritin levels along with its interquartile range
in Group A (Expired) versus Group B (Survivors) on last day of hospitalisation the
difference was statistically significant (p value < 0.001).

Aim: To find the level of uric acid in patients of chronic liver disease and its correlation, if any, with etiology
and other parameters.
Materials and Method: This was a prospective study conducted on North Indian population admitted in
Department of Medicine during the period of 2020 and 2021. A total number of 50 patients diagnosed with
chronic liver disease were included in this study. A detailed history was elicited from the patients regarding
their present complaints; associated symptoms; alcohol intake, smoking, previous history of hypertension,
diabetes mellitus, arthritis, hypothyroidism, any cardiac illnesses and chronic drug intake. All patients
underwent an ultrasonogram abdomen and estimation of serum uric acid levels. Waist circumference in males
and females was measured. Glycemic and Body mass index were recorded. Serum uric acid level was sent for
analysis on the day of admission and was followed up.
Results: Out of 50 subjects, 38 (76%) were males and 12 (24%) were females. Mean ± SD uric acid (mg/dl)
among the study subjects was 6.69±2.92. Normal uric acid (3.1-5) was revealed among 24% of the subjects
while higher uric acid/hyperuricemia was reported among 38 (76%) subjects. Mean uric acid was 4.03, 5.17
and 8.94 among the subjects having CTP class A, B and C respectively. Pearson correlation analysis revealed
significant positive correlation between uric acid and total bilirubin, SGOT, SGPT and CTP Score.
Conclusion: Elevated serum uric acid level might be a risk factor for the incidence of chronic liver disease.
Hyperuricemia may act as a surrogate marker for assessing the prognosis of CLD.

Background Covid-19 are an enormous group of infections that are known to cause ailment going from the normal virus to more extreme illnesses like Middle East Respiratory Syndrome (MERS) and severe acute respiratory syndrome (SARS). In mid-2020, after a December 2019 episode in China, the World Health Organization distinguished SARS-CoV-2 as another sort of Covid.
Aim: Study compare demographics, clinical characteristics, comorbidities, baseline lab parameters between survivors and non survivors of Covid 19 who received mechanical ventilation in a tertiary care center.
Method : A comparative cross-sectional study conducted on patients admitted in Covid ICU at the Vedantaa Institute of Medical Sciences, Palghar from  June 2020 to March 202. Patients with age more than 18 years with covid positive status requiring either invasive or non invasive mechanical ventilation included in the study.
Results : Out of 150 patients, 119(79.3)  were male and 31(20.7) were female, with a mean age of 54.005 years (SD ±15.33). The patients were elderly (n = 31) and adults (n = 119). There were 19 (12.66) patients who not survived  and 131(87.64) patients were there who survived from the disease. Median  oxygen saturation of the patients who not survived was  88(84-97) and those who survived was 91 (78-96) but it was not statistically significant. Among the patients not survived found with comorbidity condition like Hypertension (91.17%) followed by Diabetes Mellitus, CKD, CAD. Metabolic parameters showed significantly higher in non-survival group compared to survival group. Increased in Neutrophile was observed in both the group but it was increased more in non-survival group compared survival
Conclusion : From these all overall information and data analysis of Demographic variable, Laboratorial parameters, comorbidity condition it was observed that these parameter were very  helpful in management of severely ill patient, also in priority treatment for patients to decrease morbidity and mortality in population.

Background: Diabetes is a universal problem and is becoming a major concern at old age
especially in obese people and in people with sedentary life style. The present study was
conducted to assess complications and mortality in ST-segment elevation acute myocardial
infarction in diabetic and non-diabetic patients.
Materials & Methods:160 consecutive patients of diabetic (group I) and non-diabetic
(group II) having acute ST-segment elevation myocardial infarction (STEMI) of both
genders were included. Treatment was given to all patients.
Results: Age group <44 years had 15 diabetic and 10 non- diabetic, 45-54 years had 25
diabetic and 12 non- diabetic, 55-64 years had 10 diabetic and 20 non- diabetic and >65
years had 40 diabetic and 28 non- diabetics. The site was anterior in 26 and 20, inferior in
38 and 40, inferior+ right ventricular in 20 and 10 and lateral in 6. Mortality was seen in
those in which streptokinase was given in 7 and 3 and streptokinase not given in 15 and 10
in group I and group II respectively (P< 0.05).
Conclusion: With streptokinase administration there was reduction in mortality in diabetic
as well as in non- diabetic. However, diabetics not on streptokinase had higher mortality as
compared to non- diabetics.

Aim: A Review of literature on Ischemic Heart Disease and Risk of Development of
Cognitive Disorders
Methods: The literature search was conducted in Medline, Embase, PsycINFO, and
CINAHL. The search string consisted of predictor-related terms (e.g. myocardial
infarction, angina pectoris), outcome-related terms (e.g. dementia, Alzheimer, cognition),
as well as some specific limitations. All publications until 2021 were included if they
fulfilled the following eligibility criteria: 1) MI, AP, or a CHD variable that is a
combination of MI and AP (e.g. ischemic heart disease (IHD)) as predictor variable; 2)
cognition, cognitive impairment or dementia as outcome; 3) population-based study; 4)
prospective (≥1 year follow-up), cross-sectional or case-control study design; 5) ≥100
participants; and 6) aged ≥45 years. Reference lists of publications and secondary
literature were hand-searched for possible missing articles.
Results: The search yielded 3500 abstracts, of which (number***) were included in this
study. This resulted in 5 cross-sectional studies, 3 case-control studies, 6 prospective cohort
studies and 1 study with both cross-sectional and prospective analyses (designated as crosssectional
regarding study quality). Quality assessment of all 15 included studies was
sufficient (overall mean NOS score = 6.7, SD = 1.30, range = 3–10). Separate analyses for
each study design showed similar results for prospective (mean NOS score = 6.92, SD =
1.14, range = 5–9) and cross-sectional studies (mean NOS score = 7.23, SD = 0.98, range =
6–8), but the quality of case-control studies was somewhat lower (mean NOS score = 5.9,
SD = 1.93, range = 3–7), mainly due to the effects of one particular study with a score of 3.
Conclusion: We concluded that the CHD was associated with an increased risk of
cognitive impairment or dementia in prospective cohort studies. More mechanistic studies
are needed that focus on the underlying biological pathways (e.g. left ventricular
dysfunction, cerebral small vessel disease, hypoperfusio

Background:Haemodynamic changes occurring during direct laryngoscopy and endotracheal
intubation are well tolerated by healthy individuals but can be fatal in patients with
hypertension, heart disease and intracranial hypertension. Many methods have been tried to
obtund these responses.
Methods: 60 consenting patients were randomised to receive 30 mg/kg of magnesium
sulphate (MgSO4) in 100 ml saline over 10 min before induction or preservative free 2%
lignocaine 1.5 mg/kg diluted to 5 ml with saline 90 secs before intubation. Heart rate,
systolic, diastolic & mean blood pressures and time taken to extubate were monitored.
Results: Hemodynamic parameters showed no significant rise at intubation in both the
groups. Time taken to extubate was similar in both the groups.
Conclusion: MgSO4 30 mg/kg given intravenously as infusionover 10 minutes prior to
induction and lignocaine 1.5 mg/kg given 90 seconds before intubation were comparable in
attenuating pressor response to laryngoscopy and intubation with no clinically significant
prolongation in time taken to extubate in MgSO4 group.

It is the most common and widespread arboviral infection in the world today caused by
Dengue virus. Dengue viruses (DV) belong to the family Flaviviridae and there are four
serotypes of the virus referred to as DV-1, DV-2, DV-3 and DV-4.The course of the disease
has changed in the recent years from milder form to severe form like dengue hemorrhagic
fever & severe dengue fever and with increasing outbreaks frequency.Data was collected by
face to face interview from the parents of the children admitted in pediatric emergency ward
with diagnosis of dengue fever and severe dengue fever in Department of pediatrics. The
presence of bleeding manifestations like melena, epistaxis, hematemesis, petechiae,
hematurias more in DF with warning signs(37.5%) and Severe dengue fever(55.6%). There is
significant association between bleeding manifestations and severity of dengue
fever(p<0.001). Thrombocytopenia was found in 83.8% in dengue fever, 93.8% in DF with
warningsignsand81.5%inseveredenguefeveranditisnotstatisticallysignificant(p=0.308).

Background: Endotracheal intubation is a common mode of securing the airway for
administering general anaesthesia. Direct laryngoscopy and endotracheal intubation is almost
always associated with haemodynamic changes due to reflex sympathetic stimulation caused
by laryngopharyngeal stimulation.
Methods: A prospective, randomized controlled clinical study was undertaken to compare
the efficacy of oropharyngeal lignocaine spray (group L,n=30) and sublingual nitroglycerine
spray (group N, n=30) in blunting of haemodynamic response to laryngoscopy and intubation
belonging to ASA I, posted for surgery under general anaesthesia.
Results: There was statistically significant difference in the mean heart rate between the
groups for the first 3 minutes after intubation. Statistical evaluation between the groups
showed the mean SBP was statistically significant (p=0.036) for initial 3 mins after intubation
and also at 5th 6th & 10th minute. Statistical evaluation between the groups showed that
mean DBP 1st minute after intubation was statistically significant (p=0.008). The difference
was significant at 4, 5, 6 and 9 min after intubation. Statistical evaluation between the groups
did not show any statistical difference in the MAP except at 5th & 6th minute. However,
there was no clinically significant difference in any of the above groups.
Conclusion: Both sublingual NTG & lignocaine group successfully blunted the intubation
response, sublingual NTG spray was better in suppressing the BP response to laryngoscopy
and intubation than oropharyngeal lignocaine spray but lignocaine controlled the HR
response better than NTG.

Dengue virus, a mosquito-borne flavivirus, is the causative agent, currently one of the most
significant emerging disease challenges to global health. The dengue virus are single-stranded
positive-sense RNA viruses with a genome of about 11000 bases that codes for three
structural proteins, C(core protein), M (membrane protein), E (envelope protein); 7
nonstructural proteins, NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5; and short non-coding
regions on the 5' and 3' ends. This was a case control study design in which 201 cases of
dengue fever admitted in the pediatric emergency ward, were enrolled. After taking written
informed consent, data were collected in a predesigned semi structured questionnaire
regarding Socio-Demographic profile, medical history, clinical and hematological profile and
outcome. 8(4%) of cases had positive family h/o dengue fever, 3(1.5%) cases had positive
past h/o dengue fever and 8(4%) cases had positive h/o travel to dengue endemic areas.
201(100%) cases had fever, 94(46.8%) had persistent vomiting,91(45.3%) had
anorexia,78(38.8%) had abdominal pain, 59(29.4%) had headache, 30(14.9%) had rashes, 16
(8%) had facial puffiness, 14(7%) had convulsions and 12(6%) had abdominal distension.

Turmeric(Curcuma logna) is widely cultivated in India and its neighbouring countries and is
also used in the household of of the Indian sub continent as a spice.It has been found
documented that turmeric has been used as a conventional medicine to cure numerous disease
such as cold and cough, diabetes, hepatic disorder etc. Now the researchers from all over the
world have done numerous work to discover the therapeutic benefits of turmeric and its
various extracts. Curcumin being its prime chemical compound has various therapeutic
activities including anti-inflammatory, antioxidant, antimutagenic, antidiabetic,
antibacterial,hepatoprotective, expectorant and anticancerous activity. The main motive of
this article is give an over view on the the various pharmacological activities of turmeric.

Influenza virus is an acute respiratory disease caused by the influenza A or
influenza B virus. These virus show effect mainly during winter season it often occurs in
outbreaks and epidemics worldwide. Influenza virus is respiratory viral disease. Significant
numbers of influenza virus particles are present in the respiratory secretion of infected persons ,
so infection can be transmitted through sneezing and coughing via large particle of droplets. The
duration of influenza virus shedding in immune competent adult patients is around 5 to 10 day or
more and it can be show particularly in children, elderly adults, patient with chronic illnesses,
and immune compromised hosts. If any person infected with influenza they show many
symptoms such as high-grade fever, mayalgia, headache, and malaise. Some symptoms are found
such as nonproductive cough, sore throat and nasal discharge. After that influenza can attack
other organs like that the lungs, brain, heart but mainly it affect respiratory tract and patient can
be admitted in hospital. We can prevent the influenza by using proper annual vaccination. If
sever patient- we can early treatment by antiviral drugs. So, due to disease burden, we reviewed
the currently finding in diagnosis and treatment of influenza.

It has been estimated that in developed countries such as United States, plants drugs comprise
up to 25% of the total drugs, while in fast developing countries such as China and India, it
comprise up to 80%. It is expected that there are 250,000 to 500,000 species of plants on Earth.
Out of these small percentages (1 to 10%) are used as foods and medicine by both humans and
animal. It is possible that rest of plant may be used for foods and medicinal purposes.
Hence, it has turn out to be very important to review on herbal medicinewhich will play
important role in research on plant to find their possible medicinal importance.
Herbal formulations means a dosage form consisting of one or more herbs or processed herbs
in specified quantities to provide specific nutritional, cosmetic benefits meant for use to
diagnose, treat, mitigate diseases of human beings or animals, alter the structure or physiology
of human beings or animals. Herbal formulations contain an active substance or herbal
substance or herbal preparation or herbal substance in combination with one or more herbal
preparations. Herbal formulations are obtained by subjecting herbal substances to treatments
such as extraction, distillation, expression, fractionation, purification, concentration or
fermentation include comminuted or powdered. Whole, fragmented or cut plants, plants parts,
algae, fungi, lichen in an unprocessed, usually dried form but sometimes fresh were used in the
preparations of herbal formulations. Herbal substances are precisely defined by the plant part
used and the botanical name according to the binomial system (genus, species, variety and
author).

Preterm laboris defined as the occurrence of regular uterine contractions after the age of viability and
before 37 completed weeks of gestations with intact membranes [1] . It is the leading cause of neonatal
mortality and a substantial portion of all birth-related morbidity. Preterm delivery accounts for 65% of
neonatal deaths and 50% of neurological disability in childhood. Prematurity rates have not changed in
recent decades [2]

Aim: The aim of this study to determine the epidemiology of ocular trauma in the rural population of Rohtas district of Bihar India.
Methods: A cross-sectional was conducted in the Department of ophthalmology, Narayan Medical College and Hospital, Sasaram Bihar, India from July 2018 to July 2019. 150 cases of the ocular trauma of all age group, due to various causes were included in the study. Demographic data and detailed history were recorded from each participant that includes the mode of injury and place of ocular trauma, the age at trauma and treatment for the trauma was taken from an ophthalmologist.
Results: The data was collected on ocular trauma from 1556 persons. History of ocular trauma was there in either eye of 150 (10.37%) participants in which 10 patients were having bilateral ocular involvement. The mean age at which ocular trauma sustained was 28.1±13.7 years (range 8-69 years) including 73.33% male. The association between gender and ocular trauma was statistically significant (p=0.0001). The place of ocular trauma was significantly associated with blindness (p = 0.03). In this study population, Blunt trauma (92.67%) had been the most important cause of ocular injury. 100 participants had milder trauma with vision impairment (BCVA>6/18). Blinding ocular trauma (BCVA<6/60) was found in 50 persons (3.21% of the total studied population).
Conclusion: The epidemiology of ocular trauma among the rural population of Bihar India, revealing ocular trauma is one of the major causes of blindness and visual impairment affecting mainly the young adults.

Aim: A clinico pathological evaluation of soft tissue tumors in tertiary care centre of North bihar
Methods: This retrospective study was carried out in the Department of Pathology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India, from January 2020 to January 2021. Total 100 patients of all the soft tissue tumors, both benign and malignant   were included in this study.
Results: Total 100 cases of soft tissue tumours were included in this study. It has slightly male preponderance with a male to female ratio was 1.38:1. Benign soft tissue tumours formed 84% of all soft tissue tumours while malignant soft tissue tumours constituted 16%. The commonest benign tumour was Adipocytic (52%) of all tumours of soft tissue followed by vascular tumours (20%), peripheral nerve sheath tumours (17%), fibrous tumours (2%), fibrohistiocytic tumours (2%) smooth muscle tumours (2%) and tumours of uncertain differentiation (1%). The benign adipocytic tumours accounted for the majority of benign soft tissue tumours (47%) followed by vascular tumours (17%) &Benign peripheral Nerve Sheath Tumors (16%),Benign Fibrous Tumor (2%),Benign Fibrohistiocytic Tumors (1%), Benign tumours of smooth muscle (1%) and tumours of uncertain differentiation are nil encountered.
30% benign soft tissue tumours were seen in extremities followed by head and neck 27% and for the malignant soft tissue tumours mainly lower extremities (6%) followed by Head & Neck (5%).
Conclusion: The clinicopathological evaluation is still the gold standard for the proper diagnosis of soft tissue tumors.

Background:Lichen planus (LP) is a common, chronic inflammatory mucocutaneous
disease of unknown etiology and putative autoimmune pathogenesis. The present study
compared different treatment modalities of oral lichen planus.
Materials & Methods: 78 clinically and histopathological diagnosed cases of oral lichen
planus were divided into 2 groups of 39 each. Group I patients were given 0.1% tacrolimus
cream and group II patients were given 0.05% topical application of clobetasol propionate.
Parameters such as pain on VAS and size of the lesion was recorded at baseline, after 3
weeks and 6 weeks.
Results: The mean size (cm2) in group I was 5.8, 3.4 and 1.6 and in group II was 4.7, 3.2
and 1.2 at baseline, 3 weeks and 6 weeks respectively. A non- significant difference was
observed (P> 0.05). The mean VAS was 2.8, 1.4 and 0.6 in group I and 2.9, 1.8 and 0.8 at
baseline, 3 weeks and 6 weeks in group II respectively. The difference was significant (P<
0.05).
Conclusion: 0.1% tacrolimus reduced size of the lesion and pain score efficiently than
0.5% clobetasol propionate in patients of oral lichen planus.

Background:Dry socket (DS), also referred to as alveolar or fibrinolytic osteitis, is a major
complication that follows extraction of tooth/teeth in oral surgery. The present study was
conducted to assess the risk factors for Dry socket.
Materials & Methods: 340 patients requiring extraction of mandibular third molars of both
genders were included. Risk factors such as smoking status, indication of exodontia and
systemic diseases etc. were recorded.
Results: Out of 340 patients, males were 210 and females were 130. Out of 210 males, 20
developed DS and out of 130 females, 24 had DS. The difference was significant (P< 0.05).
Diabetes was seen in 32, smoking in 14, pericoronitis in 22 and systemic disease in 35. The
difference was significant (P< 0.05).
Conclusion: Risk factors for dry socket were systemic disease, diabetes and smoking.

Aim: comparison between herniorrhaphy alone versus hernioplasty in small-sized paraumbilical hernia.
Material and methods: A prospective comparative study was conducted in the Department of General Surgery, SRMS IMS, Bareilly,Uttar Pradesh, India. The study included 120 patients divided into two groups.Group 1 was included 60 patients randomized to paraumbilical hernioplasty with mesh insertion. Group 2 was included 60 patients randomized to paraumbilical herniorrhaphy. Paraumbilical hernia patients aging 20-60 years old with small defect size (less than 3 cm) by preoperative ultrasound. A transverse incision was made, and the sac was dissected all around. Opening of the sac at the neck and exposure of the contents was done then excision of the sac. Suture (anatomical) repair of the defect was done using polypropylene sutures. In group (1), mesh was then inserted and fixed with interrupted polypropylene sutures, while in group (2) and only anatomical suture repair was done without mesh use.
Results: Gender of patients in both groups: In group (1): 25 males (41.67% of group) and 35 females (58.33% of group), while in group (2): 28 males and 32 females with p=0.45. Comparison of age of patients in both groups, it was found that: In both groups the range of age was 24-57 years old with p=0.632. There were significant differences between both groups as regarding operative details. Drain was inserted in only 40 patients of group (2) while all patients of group (1) had drains inserted p≤0.001. Incision size mean in group (1) was about 11.07±1.26 cm. while in group (2) it was only 8.87±0.82 cm with p≤0.001. Also, operation time was reduced in herniorrhaphy group with a mean 31.15±3.11 minutes while in hernioplasty group was 41.23±3.17 minutes with p≤0.001. In comparison between both groups in wound complications, it was found that seroma occurred in 4 patients of group (1) and 2 patient in group (2) p=0.298. Infection occurred in 6 patients in group (1) while only 2 patient in group (2) had wound infection p=0.177. Dehiscence occurred in only 2 patient in group (1) with p=0.336. As regarding recurrence rates, both groups had no statistically significant differences during the 6-month follow-up period; only 2 case had hernia recurrence, which was identified clinically and by ultrasonography after 5 months of operation in group (2) while no cases in group (1) had hernia recurrence during the period of follow-up with p=0.336.
Conclusion: We concluded that the anatomical non-mesh repair of small-sized paraumbilical hernia had significant correlation with shorter duration of operation, smaller incision size and lowered overall costs than mesh repairs.

Typhoid fever is one of the most common bacterial diseases in Indian sub continent. Carriers are
found to be one of the cause of typhoid. A person may hold the typhoid germ asymptomatically
for days to years without showing any signs or symptoms of typhoid fever. The typhoid bacillus
continues to multiply in the gall bladder of such carriers. The bile duct transports it to the
intestine. The silent carriers are the source of typhoid germs that cause infections to recur1. With
over 21.6 million cases and at least 250,000 deaths per year, it remains a global public health
problem. Asia accounts for almost 80% of cases and deaths, with Africa and Latin America
accounting for the remainder. The disease has an incidence ranging from 102 to 2,219 per
100,000 of the population in developing countries like India2

Background:Acne vulgaris is a common inflammatory disorder involving the pilosebaceous unit. The
pathogenesis is multifactorial, involving four key factors with interrelated mechanisms: increased
sebum production, hyperkeratinization of the follicular infundibulum, inflammation, and
Cutibacterium acnes. Botulinum toxin (BoNT)is a potent neurotoxin protein derived from the
clostridium botulinum bacterium. It exerts its effect at the neuromuscular junction by inhibiting the
release of acetylcholine, which causes temporary chemical denervation. At the cellular level,
botulinum toxin functions by cleaving a synaptic protein (synaptosomal-associated protein of 25 kDA
[SNAP-25]) on the internal surface of neuronal membranes, thereby inhibiting vesicle fusion and
release of acetylcholine.

Cancer has manifested itself as one of the most serious health problems facing humanity today. Cervical cancer is one of the most common types of cancer, and the Papanicolaou (Pap) test, often known as a Pap smear, is the most basic test for cervical screening. It involves the microscopic inspection of cervical cells obtained from the cervix, and it is performed by a physician. In order to achieve this, automated detection and classification of cervical cancer from pap-smear images has become a must just because it allows for accurate, reliable, and rapid investigation of the condition's progression. With an emphasis on the history of pap screening, liquid based cytology, and machine learning for cervical cancer detection in recent research publications, this paper provides a summary of the state of the art as stated in several significant recent information sources. For the first time, an evaluation of image analysis and machine learning applications in the growing trends of cervical cancer diagnosis from pap-smear images over the course of a decade has been published. The survey examines 26 journal papers that were obtained electronically through major scientific databases such as PubMed, Google Scholar, Scopus, IEEE, and Science Direct, which were searched using sets of keywords. The papers were obtained from major scientific databases such as Pubmed, Google Scholar, Scopus, IEEE, and Science Direct. Whenever the Pap test is improved through the use of artificial intelligence, the sensitivity for the detection of cervical pathology is improved as well. The general public should be taught about the Pap smear test with AI, including its purpose and the frequency with which it must be performed, through comprehensive programmes aimed at improving disease management in general.

Introduction - Perception of pain by a laboring female is a dynamic process that involves both peripheral and central mechanisms.The ideal technique for labor analgesia should provide rapid, effective, economical and safe pain relief for all stages of labor without compromising fetal vital physiology and wellbeing. It should not hamper the normal process of labor and should be flexible enough to convert to anaesthesia for urgent operative delivery or other intervention. Such an ideal technique would leave the mother awake, alert, and comfortable with preserved ability to ambulate and bear down throughout the labor. Hence the present study was designed to compare efficacy of two different doses of Dexmedetomidine (5mcg vs. 10mcg) when added to Bupivacaine and Fentanyl combination in single dose intrathecal labour analgesia.
Methodology - The study was done as the randomized controlled double blind study with 80 participants. A sample size 72 was calculated anticipating minimum of 20% decrease in VAS Score at the time of delivery considering significance of 95% {α 0.05} and 80% Power of study {β 0.2}, thus we will be undertaking this study in 80 patients, which is clearly larger than 72 patients as calculated.  Double blind randomization was done to allocate. Fulfilling the inclusion criteria, they were allocated into two equal groups of 40 patients using computerized block Randomization Technique.
Results - As intrathecal labor analgesia, also covers the duration of labour from 4-6cm cervical dilation till delivery of baby in maximum number of patients, it is a very good alternative to epidural analgesia in remote and far flung areas where epidural analgesia is not possible.

Background and objective - Seizures are common disorders found all over the world and are encountered frequently during medical practice in variety of settings. Etiological spectrum of acute symptomatic seizures in developing countries is different from developed countries. So this study was done to know the various etiologies of new onset seizures in adults in this region.
Methods - Consecutive 100 Cases of new onset seizures from the hospital attached to Vinayaka Mission’s Medical College, Karaikal, were included in the study. The etiology was determined by neuro imaging and appropriate investigations including cerebrospinal fluid examination.
Results - Of 100 patients 89% were acute symptomatic seizures 40% of SE were caused by neuro infections. Neuroinfection was the leading cause of seizure, which accounted for 34%, followed by Cerebrovascular accidents (29%) and metabolic (9%). Neuro cysticercosis is most common cause in neuroinfection (35%), followed by meningitis (29%) and cerebral malaria (17%). 8% of seizures were because of CNS Tuberculosis. 55% of the CVA were due stroke and 34% due to CVT. 14% of  seizures were pregnancy related. In patients with cerebrovascular diseases, aged under 40 years, cerebral venous thrombosis accounted for79%.

Background Retroperitoneal cysts (RPCs) are uncommon with an estimated incidence of
1/5750 to 1/250,000. In this entity, non-pancreatic pseudocyst are the rarest with only
handful of cases reported in literature, out of which all were found in males. Most of the
time they are discovered incidentally and diagnosis depends in part histologically on
absence of an epithelial lining to the cyst wall, and the patient’s history represents the
cornerstone for diagnosis prediction.
Case presentationA 27 year old, female patient presented to the Gynaecology out patient
department with complaints of amenorrhea for 2 months & lower abdominal discomfort.
On investigation, there was an incidental finding of a large multi-cystic lesion arising from
the pelvis on transvaginal ultrasound scan. The patient was then referred to the General
Surgery department for further management. Correlation of the clinical scenario, imaging
and post- operative histopathological examination of the specimen, revealed
Retroperitoneal Non-pancreatic Pseudocyst.
ConclusionRPC’s are very rare, and probably remain quiescent, until attain considerable
size. Usually, symptoms are non-specific and on examination there may be a palpable,
freely mobile abdominal mass. Sometimes, subjected to one of its classical complications
such as infection, rupture or haemorrhage enforcing the patient to seek urgent medical
advice. In view of potential development of symptoms and complications, the treatment
protocol lines with complete excision of the cyst in order to prevent any recurrence.

Background:Patients of MPDS present with varying degrees of unilateral facial pain, masticatory muscle tenderness, joint crepitation and limitation of mandibular movement. The present study was conducted to assess role of physiotherapy in diagnosis and treatment of the Myofascial Pain Dysfunction syndrome. Materials & Methods: 80 patients with Myofascial Pain Dysfunction syndrome of both genders were divided into 2 groups of 40 each. Group I patients were treated with passive movement and group II with relaxation. Resisted static contraction for opening, closing, protrusion and lateral movement were performed on all patients by instructing the patient to attempt these movements against the resistance of the operator's hand so that temporomandibular joint movement is minimal. This test is positive if pain was reproduced in the muscle being statically contracted. The masseter, temporalis, medial and lateral pterygoid were palpated bilaterally on all patients at both the attachments and muscle bellies for assessment of tenderness. Results: In present study, out of 80 patients, males were 35 and females were 45. Resisted static contractions showed pain in 12% and no pain in 82%, on palpation, 30% had pain and 70 % had no and on EMG, spasm was present in 20% and no spasm in 80%. The difference was significant (P< 0.05). Symptom-free or occasional pain was seen in 65% in group I and 76% in group II. Little or no improvement was seen in 35% in group I and 24% in group II. The difference was significant (P< 0.05). Conclusion: Physiotherapy found to be effective in management and treatment of patients with myofascial pain dysfunction syndrome.

Background:TMD are musculoskeletal disorders characterized by tenderness, pain,
limitations in mandible movements, headache, and clicking within the joint. The present
study was conducted to assess awareness level of dentists about role of physiotherapy in
diagnosis of TMJ disorders.
Materials & Methods:560 dentists of both genders were enrolled. A questionnaire related
to thegeneral knowledge, role of physiotherapy in management of TMDs was recorded.
Results: There were 380 males and 200 females. Year of experience was 0-5 years in 115,
5-10 years in 145, 10-20 years in 120 and >20 years in 180 dentists. There were 150
General dentist, 130 endodontist, 70 prosthodontists, 8-0 periodontist and 40 oral surgeons.
The difference was significant (P< 0.05). Treatment methods for TMDs was splint/occlusal
guard in 56%, braces in 24%, medication in 15% and other in 5%. Dentists’ referral to
other professionals was physiotherapist in 50%, oral medicine in 23%, psychologist in
10%, orthodontist in 7%, speech therapist in 8% and other in 2%. Causes of referral to PT
was masticatory muscle tenderness in 40%, neck postural alteration in 30%, headache in
20% and neck pain in 10%. The difference was significant (P< 0.05).
Conclusion: Most of the dentists has limited knowledge about role of physiotherapy in
diagnosis of TMJ disorders

Introduction: Mental wellness is an important aspect of global health of an individual. Mental health issues not only impact personal and family life of individual but also have a significant impact on work performance. Medical Teaching and training is reported to be challenging and is stressful. Due to their nature of work, mental health of doctors is important not only for their personal front but is a concern for society to which they serve. This study was designed to find the level of stress, anxiety and depression in resident doctors and to find out the correlation between stress-depression as well as stress-anxiety.
Aims & Objective-1) To examine the level of stress, anxiety and depression among resident doctors of a medical college and teaching hospital. 2) To examine the relationship between anxiety and depression as well as stress and depression among resident doctors.
Material & Methods: For this purpose; residents who were pursuing their MD/MS courses in the institute were included in the study. Total number of subjects were fifty. DAS Scale was used for initial screening followed by application of Perceived Stress scale, HAM-A scale and HAM-D scales. The preset questionnaire was filled by resident doctors themselves and data was presented as mean, standard deviation, percentage and correlation was analyzed by using Pearson’s Product moment correlation and partial correlation test.  DAS scale screening results showed depression in 68%, anxiety in 70% and stress in 32% candidates. Final results after application of PSS scale, HAM-A & HAM-D scale revealed stress in 78% residents (low stress-26%, moderate stress-40% and high stress-6%), anxiety in 70% residents (mild -62%, mild to moderate- 4% and moderate to severe in 4%) and depression in 24% residents (mild -20%, moderate-0%, severe-2% and very severe 2%) respectively. Correlation testing found positive however insignificant correlation between anxiety-depression and stress-depression.
Conclusion: This study revealed significant level of stress, anxiety and depression in resident doctors. Considering the impact of issue, preventive and modulating measures can be considered to help resident doctors in dealing with their job expectations and responsibilities.

Aim: The aim of the study to analyze the efficacy and functional outcome between Ponseti and accelerated Ponseti in the management of CTEV.
Material and methods: This was an analytical study conducted in Department of Physical Medicine &Rehabilitation (PMR), Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for the period of 2 years, after taking the approval of the protocol review committee and institutional ethics committee. A total of 100 children (120 feet) were treated. Among these 100 children, 50 children (60 feet) were treated by standard Ponseti method and 50 children (60 feet) were treated by accelerated Ponseti method.
Results: In the standard Ponseti group, 10 children had bilateral clubfoot, 20 were unilateral on left side, and 20 were unilateral on right side. Among 50 children, 33 (66%) were male and 17 (34%) were female. Mean age at presentation was 25.3 days. Total mean Pirani score at presentation was 4.89. Most of the cases required six casts for correction, with a mean of 5.66. Tenotomy was performed in six cases (12%). The mean number of days the child was in cast was 53.4. Eight cases (16%) had a relapse. All relapses were corrected by repeat casting. Mean Pirani score at 6 months follow-up was 0.081. In the accelerated Ponseti group, 10 children had bilateral clubfoot, 21 were unilateral on left side, and 19 were unilateral on right side. Among 50 children, 27 (54%) were male and 23(46%) were female. Mean age at presentation was 27.5 days. Total mean Pirani score at presentation was 5.036. The mean number of casts required for correction was 6.04. Tenotomy was performed in 11 cases (22%). The mean number of days the child was in cast was 40.12. 11 cases (22%) had a relapse, among which two case of equinus was treated with repeat tenotomy and others were corrected by repeat casting. Mean Pirani score at 6 months follow-up was 0.12.
Conclusion: we conclude that accelerated Ponseti method with plaster changes two times a week is as effective as Ponseti method in the treatment of idiopathic CTEV.

Aim: The aim of the present study to determine the association of measles antibody titres with nutritional status in paediatric population.
Methods: This was a cross-sectional study conducted in the Department of Pediatrics, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for 1 year, on 1-10 year old children. Total 300 patients were include in this study for finding out the seroprevalence and anti-measles antibody levels, and studying their association with age, gender, as well as nutritional status of these children. Blood samples were tested for presence of measles specific IgG antibodies.
Results: The relationship between age and vaccination status was not found to be statistically significant (p=0.22). No statistically significant difference was observed in the baseline characteristics of vaccinated and unvaccinated group except for mean weight for age Z score which was significantly lower in the unvaccinated  group (p = 0.023). According to weight for age, in well-nourished children  seropositivity was 67.68% with GMT 889 mIU/ml, moderately malnourished (wasting) 68% with GMT 687 mIU/ml and in severely malnourished (severe wasting) 60.90% with GMT 548 mIU/ml. It was not found statistically significant with p value 0.05 for seropositivity but significant with p value 0.0001 for antibody levels. According to Height for age in well- nourished children seropositivity was 54.32% with GMT 685 mIU/ml, moderately malnourished (stunting) seropositivity was 71.36% with GMT 387 mIU/ml and in severely malnourished (severe stunting) seropositivity 46.67% with GMT 361 mIU/ml. P value noted was 0.005 which is significant. In weight for length/height both seropositivity and GMT were found insignificant in well-nourished, moderately malnourished as well as severely malnourished subject (P value: 0.47)
Conclusion: Nutritional status of children has an association with measles antibody titres as well GMT of measles specific IgG antibody, with those with better nutritional status having higher measles antibody titres.

Background: Typhoid fever is a major health problem in developing countries. It is caused by Salmonella typhi and S. paratyphi. The Clinical & Laboratory profile of these patients is affected by this infection.
Aims: This study was conducted to evaluate the  Clinical & Laboratory Profile of Typhoid Fever in Children in Bihar Region.
Methods: A prospective observational study was conducted in the Department of Pediatric, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 1 year. Total 200 Children aged below 18 years with history of fever of more than 7-10 days duration were included in this study. In each case, age, sex, presenting complaint, laboratory investigations and antibiotic sensitivity pattern are collected and analysed.
Results: Out of 200 cases, 140 (70%) were male and 60 (30%) were female. Most patients were between 6 and 12 years old. Most patients (70%) stayed in hospital for two weeks or more. Fever (100%) was the most prevalent symptom, followed by anorexia (65.5%), vomiting (45.5%), abdominal discomfort (20.5%), diarrhoea (12.5%), headache (9%) and cough (9%) (7.5 percent). Physical observations included toxic look (69.5%), coated tongue (49.5%), hepatomegaly (43.5%), splenomegaly (19.5%), hepatosplenomegaly (14%), and pallor (6.5%). Anemia was identified in 45 (22.5%) instances, while leucopenia and leucocytosis were found in 67 (33.5%) and 33 (16.5%) respectively. Neutropenia was detected in 83 (41.5%) instances and neutrophilia in 58 (29%). 89 (44.5%) had eosinopenia, 15 (7.5%) had eosinophilia, and 31 (15.5%) had thrombocytopenia. SGOT (>200IU/ml) was high in 23% of patients and SGPT (>200IU/ml) in 15%. Blood culture positive for Salmonella typhi in 49 instances (24.5%).
Conclusion: Public health interventions like supply of safe drinking water, appropriate sanitation, awareness of the disease and its transmission, and good personal hygiene practices may be employed.

Aim: To study the hyperhomocysteinemialevels in pregnancy induced hypertension. Methods: A Case control study was conducted in the Department of Obstetrics and Gynecology, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, for 1 year. Total 220 pregnant female subjects in the age group of 16-55 yrs was selected. Out of them 110 were normotensive pregnant women (NPW) in their third trimester and were chosen as control Group 1 and 110 pregnancy induced hypertensive (PIH) patients in their third trimester were chosen as study Group 2.
Results: The Hcy level was significantly increased with a mean and standard deviation (SD) value of 21.77±4.95µmol/l (p- value=0.001) and the uric acid level was also increased with a mean and SD of 5.15±0.87mg/dl (p-value= 0.003) in the PIH. The Hcy level was 9.22 ± 2.43µmol/land the Uric acid level was 3.27 ± 0.92mg/dl in NPW group. . The magnesium level was lower in the PIH compared to NPW (p - value=0.001)
Conclusion: The Hcy and uric acid levels were increased and Magnesium level was decreased in PIH women than the NPW. So these parameters should be part of the evaluation of the pregnant women presenting with hypertension. Thereby, we can reduce the maternal and fetal mortality rate.

Aim: Evaluating serum C-reactive protein level in patients with chronic obstructive pulmonary disease and its correlation with disease severity.
Methods: A prospective study was conducted in the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 13 months. 50 COPD patients and 50 asymptomatic individuals were selected as the control group. COPD patients underwent spirometry tests and the severity of disease was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.
The main inclusion criteria for COPD patients were having symptoms or history of COPD with FEV1/FVC below 70% after using a bronchodilator.
Results: In this study, 100 subjects were investigated (50 patients with COPD and 50 individuals as controls). In the COPD group, 29 subjects (58%) noted cigarette smoking during the study, 9 subjects (18%) reported cigarette smoking in the past, and 17subjects (34%) mentioned a history of baking. In the control group, 8 subjects (16%) noted cigarette smoking during the study; 4 subjects (8%) mentioned cigarette smoking in the past, and five subjects (10%) reported a history of baking. In this study, hsCRP was measured in 49  patients with COPD and 47 control subjects. The mean hsCRP was 7519±417 ng/mL in the COPD group and 2874±393 ng/mL in the control group. In the comparative study of the two groups using t-test, a significant difference was observed (p<0.001). The COPD group underwent spirometry and blood gas measurements, and then FEV1, FEV1%, FVC, and FEV1/FVC parameters were measured. The severity of the disease was determined by the GOLD criteria, where 16 subjects (32%) were GOLD II, 24 subjects (48%) were GOLD III, and 10 subjects (20%) were GOLD IV. There was no case of GOLD I found among the subjects because patients were hospitalized. Mean FEV1 was 1.25 L/s, mean FVC was 2.126 l, and mean FEV1/FVC was 58%.
Conclusion: The findings of the present study demonstrated that plasma CRP is not only effective in the evaluation of inflammation in COPD, but also useful as a marker in monitoring inflammation during COPD treatment. CRP is decreased during treatment by inhaled corticosteroids.

Aim: To determine theIncidence of Acute Ischemic Stroke in Hospitalized Patients with Atrial Fibrillation Who Had Anticoagulation Interruption.
Methods: A retrospective study was conducted in the Department of Geriatrics- Medicine , Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 1 year. The patients of  60 years and above age group were included in the present study or older who were admitted to the hospital with a primary or secondary diagnosis of AF who had anticoagulation interruption without heparin bridge vs. non-interrupted group.
Results: the mean age was 72.1 ± 11.21 years and 50.89% were female. A total of 50 patients out of 450 (11.11%) had anticoagulation interruption in more than 48 h (median interruption of 67 h). Compared to non-interruption group, patients with anticoagulation interruption were older (mean age 76.45 ± 11.52 vs. 72.06 ± 11.88 years, P = 0.001), had slightly higher CHADS₂VASc score (3.98 vs. 3.62, P = 0.01), more likely to have heart failure and less likely to have HTN. Only 10 patients out of 450 (2.22%) had acute ischemic stroke during their hospital stay: 2 patient (4%) in the anticoagulation interruption group, and 8 patients (2%) in the non-interruption group. There was no statistically significant difference in incidence of ischemic stroke between the two groups (1.31% vs. 0.27%, P = 0.27). Short-term interruption of anticoagulation was not associated with a significant increased risk of in-hospital ischemic stroke. CHA₂DS₂VASc score was an independent strong predictor of in-hospital stroke (odds ratio (OR): 7.77, 95% con- fidence interval (CI): 2.99 - 19.03) In terms of secondary outcomes in anticoagulation interruption versus non-interruption groups, results were as follows: mortality (0 vs. 0.68%, P = 1), bleeding (4% vs. 1%, P = 0.04), number of readmissions within 90 days (48% vs. 37%, P = 0.04) and average LOS (7.74 vs. 2.75 days, P < 0.0001).
Conclusion: The patients with AF the incidence of ischemic stroke during hospitalization is low and did not significantly increase with short-term interruption of anticoagulation. The incidence of ischemic stroke in hospitalized patients with AF is strongly correlated with CHA₂DS₂VASc score.

Aim: clinical evaluation of diaphyseal femoral fractures operated in lateral decubitus position with interlocking nail.
Methods: A prospective observational was conducted in the Department of Orthopaedics, A.N. Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year. Total 50 Patients with age group >18 years and diaphyseal femoral fractures (all types of closed/open diaphyseal variants). Assessment at regular intervals was done at 2, 4, 6, 8 and 12 weeks. At each follow-up visit, patient was evaluated clinically, radiologically if needed and complications were noted.
 Results: In our study transverse (46%) was most common fracture pattern followed by Oblique fractures (26%), Oblique- transverse fractures 18%) and spiral fractures (10%). In our study 23 (46%) patients had Fluoroscopy time of 3.5-4 mins followed by 19 (38%) patients with Fluoroscopy time of 2.5-3 mins and 8 (16%) patients with Fluoroscopy time of 3-3.5 mins. The mean Fluoroscopy time was 3.26 mins. There were complications in 4 patients. 1 (2%) patient had limb length shortening by 1.5 cms, 1 (2%) patient had non-union and restriction of movement, 1 (2%) patient had delayed union and 1 (2%) patient had deformity ER and valgus deformity. For evaluation of results in our study Thoresen classification system was used. 58% patients had excellent results with full, pain-free, function of the extremity, 28% patients had good result, 12% patients had fair result and 2% patient had poor result.
Conclusion: Operating in lateral decubitus position significantly decreases operative time, fluoroscopy time and blood loss which further helps in early mobilization and weight bearing also allows resumption of knee range of movement exercises at early stage; so it is possible to give good knee range of movement at the end with decreased hospital stay.

Aim: The aim of the study to analyse the thyroid profile, hs-CRP and lipid profile in newly detected hypothyroid adults in comparison to controls and also to compare the above parameters in subclinical and clinical hypothyroid cases.
 Methods: The study was a cross sectional study which was carried in the Department of Medicine ,Darbhanga Medical  College and Hospital, Laheriasarai, Darbhanga,Bihar,India.  for 1 year. Total 180 patients were divided into 2 groups. Group-1 for newly detected hypothyroid adults and Group 2 as Controls. Blood samples were collected with full aseptic precautions after obtaining informed consent. Clot activator that contains vacuum evacuated tubes for analysis of serum TSH, FT3, FT4, TC, HDL-c, LDL-c, TG, hs-CRP. Then after collection, serum samples were stored at -20⁰ until analyzed. Anthropometric measurements for BMI, height (cm) and body weight (kg) were measured. Results: The mean age of cases and controls in our study was found to be 36.32±12.31years and 35.97±11.16 years respectively (p=0.67). Approximately 83.33% of cases and 71.11% of controls were females depicting a female preponderance. BMI values in the study were higher in cases (26.89± 4.87kg/m2) compared to controls (24.77± 4.56kg/m2) and was statistically significant (P=0.03). The mean TSH levels (14.77 ± 9.8µIU/ml) of cases were high compared to controls (4.2 ± 0.91µIU/ml) and was statistically significant (p < 0.001) The total cholesterol level in cases (183.31 ± 40.77mg/dl) and control (187.32±28.38mg/dl) were within the reference range and there was no statistical significance (p=0.79). HDL-c in cases (48.29±9.37mg/dl) and control (52.57±6.6mg/dl) were found to be lower in cases compared to controls and the difference was statistically significant (p < 0.001). The mean LDLc value in cases (145.14±34.12mg/dl) and control (134.05±31.14mg/dl) was high in cases and the difference was statistically significant (p=0.01). The triglyceride levels of cases (158.27±49.87mg/dl) were significantly higher than that of control (145.24±27.27mg/dl) and was statistically significant (p=0.02). As per the Pearson’s correlation, there was a significant positive correlation between serum TSH and hs - CRP levels in cases (r=0.237, p < 0.001).
Conclusion: The hypertriglyceridemia and at risk hs-CRP levels though seen in hypothyroid cases were more prominent in CH cases than SCH. Dyslipidemia and inflammatory markers were found to be increased in the cases that helped in prediction and evaluation of patients at risk of cardiovascular disease.

Purpose: To study the serum lipid levels of patients with retinal vein occlusion and compare the lipid levels with age matched control group, also correlate with RVO induced macular edema.
Study Design: A comparative study.
Methods: This was a  comparative study. Total 172 patients were included. Among them there were around 86 patients /cases in group1, (26 CRVO, 55 BRVO, 5 HRVO) diagnosed  and 86 controls (selective age matched) in group 2 enrolled into the study. Group 1 cases were those who meet our inclusion and exclusion criteria. After taking informed consent, detailed history taken and thorough ophthalmological examination was done, All patients with retinal vein occlusion in group 1 underwent optical coherence tomography scan to assess macular edema to detect central retinalthickness. Later they were advised for fasting serum lipid levels in an advanced biochemistry laboratory.
Results: Total cholestrol, triglycerides , HDL, LDL levels were elevated significantly in cases with RVO group 1 as compared to age matched controls group 2.
Conclusion: Hyperlipidemia is a common independent risk factor for occurrence RVO in adults. Total cholesterol, Triglycerides, LDL levels were raised (p-value <0.001) and HDL levels were reduced (p value <0.001) in patients with retinal vein occlusion as opposed to age matched comparison control group which was statistically significant. Hyperlipidemia are common risk factors for RVO in adults. It remains to be determined that serum lipid levels can improve visual acuity or the complications of RVO

Background: Glaucoma has been declared to be the second most common cause of blindness in adults in India. Glaucoma was undetected in more than 90 % of individuals identified in the population studies.
Aim& Objective: The aim of this study is to compare the non contact tonometer (the NIDEKNT 510) with the Goldmann applanation  tonometer  (GAT) and to determine the   intraocular pressure readings in healthy and glaucomatous population.
Methodology: This is a Hospital based conducted at tertiary care centre of banaskantha and patan district of Gujarat
Results: Demographic profile of the study showed that males 157 (54%) were more than the females 132 (45.67%) in the normal individual. In glaucoma patients males 91 (67.91%) were more than the females 43 (32.08%). In our study there was linear correlation between age and IOP in both eyes. Higher IOP was found in both > 50 years age group depending on the instrument used.  In our study, in normal patients the IOP mean±SD values of both NCT and GAT was 16.15±4.46 and 15.87±4.58. From these results, IOP readings taken by NCT and GAT readings were found to be in 12-20 mm Hg in normal group.  From the above results, these studies revealed that there were no significant differences in IOP readings taken by both NCT and GAT in normal and glaucoma individual. In the present study, intraocular (IOP) recorded by NCT is slightly higher than the GAT.
Conclusion: From these studies we conclude that both the instruments important for measurement of IOP readings for early diagnosis of Glaucoma. There was a significant difference between the two tonometers if the IOP readings more than 21 mmHg. There was no significant variation in readings of IOP were taken NCT and GAT at <10 and 10-20 mmHg.

Introduction: The Lisfranc injuries are the injuries of one or more metatarsals that are displaced with respect to the tarsus. The incidence of such injuries is rare as compared to other fractures. However, they carry a high risk of morbidity and economic implications. We in the current study tried to evaluate different treatment modalities for Lisfranc injuries reporting to our Hospital.
Methods: This cross-sectional study was conducted in the Department of Orthopedics Mahatma Gandhi Memorial Hospital, Kakatiya medical college, Warangal. The sample size of n=60 patients presented with Lisfranc injury was treated by using K-wires, screws, and plates.
Results: A total of n=60 cases were included and studied during the period. The cases were equally K-wire 33.33%, Screw 33.33% cases, and plate fixation in 33.33% cases. The functional outcomes of the study revealed Excellent outcomes in 46.67% of cases out of which plate fixations achieve better outcomes. Poor outcomes were more commonly noted in the K-wire fixations and no case of poor outcome was noted in the plate fixations.
Conclusion: Percutaneous screw fixation is an effective and relatively simple method of treating TMT trauma specially Myerson type B (partial incongruous) injuries and fracture-dislocation. In our study, we found that both K wire and screw fixation were adequate in allowing an acceptable anatomical reduction until the healing occurred although the overall outcome by dorsal plate was better with lesser complications

Background: An ileostomy is an external opening constructed between the small intestine and the abdominal wall, usually by using distal ileum, Ileostomies can be of various types. The most common has been the end ileostomy, using a technique  popularised by Brooke and Turnbull. Aim And Objective; To compare the morbidity & mortality incidence of early & delayed ileostomy closure.
Conclusion: In conclusion, from reports of our limited experience with both methods early closure of temporary loop ileostomy within 4 weeks shows no significantly increased morbidity except increased wound infection. Routine allocation of patients with temporary loop stomas to early closure could improve patient well being.

Aim: To analyze of shape, amplitude of CMAP of both median and ulnar in normal population and to analyze the anatomical innervations of small muscles of hand in normal cadavers.
Methods: This was retrospective observational study Department of Physical Medicine &Rehabilitation (PMR), Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 1 year. 100  normal  subjects  (32  males  and  68  females)  were include in this study. Motor conduction studies of both median and ulnar nerves were done for the included subjects. NCV machine was used to conduct the tests. Analysis of the shape of CMAP, amplitude and distal latency were performed.
Results: The mean amplitude of median nerve (11.74 mv) was significantly higher than that of the ulnar nerve (10.92 mv).The mean DL of the median nerve (3.92 msec) was significantly longer than that of the ulnar nerve (3.07 msec). Mean DL of median nerve was significantly longer in those with dome shaped CMAP rather than those with double peaked CMAP. Mean DL of ulnar nerve was significantly longer in those with dome shaped CMAP rather than those with double peaked CMAP. The APB received nerve supply from the median nerve in 85% of the specimens and double innervations from both median and ulnar nerves in 15% of the specimens. Flexor pollicis brevis (FPB) received nerve supply from the median nerve alone in 43% of the specimens and from the ulnar nerve alone in 12% of the specimens. FBP received innervations from both nerves median and ulnar in 45% of specimens. Abductor digiti minimi (ADM) muscle received one branch from deep branch of the ulnar nerve in 87% of the specimens and from superficial branches of the ulnar nerve in 13% of the specimens. Simultaneous branches from the deep branch of the ulnar nerve to 3rd lumbrical muscle (77% of the specimens) and to 4th lumbrical muscles (100% of the specimens) and to the palmar interossei in all the specimens.
Conclusion: The configuration of the CMAP of the median nerve is mostly dome, whereas that of the ulnar is mostly double peaked. Variability in the pattern of innervations of the small muscle of the hand could be a possible etiological factor.

Background: Incisional hernia accounts for 15-20 percent of all abdominal hernias. The two operative techniques most frequently used in case of incisional hernia are the onlay and sublay repair. However, it remains unclear which technique is superior.
Aim: To compare onlay versus sublay technique in treatment of incisional hernia in term of outcome.
Materials and Methods: The present descriptive observational study was carried out in patients admitted in surgical wards who are clinically diagnosed to have incisional hernia. The study was carried out for 10 months and follow up continued after that till date. Follow-up was done after every three months. 35 patients were managed by onlay (Group A) mesh repair and 35 patients were managed by sublay (Group B) mesh repair. Data collected in both groups was made in regards to operation time, placement and duration needed for drain removal, wound infection, and recurrence rate.
Results: Wound infection was found in one patient (1.66%) in sublay group while 6 (10%) in onlay group. In onlay group recurrence was found in 4 patients (6.66%) while there is no recurrence in the sublay group. In sublay group seroma formation was found in two patients (3.33%) while 12 (20%) in onlay group.
Conclusion:  In our study, sublay mesh repair was found better alternative for surgical treatment of incisional hernia as compared to onlay mesh repair due to less post-operative complications.

Sixteen patients were included. Direct in-hospital costs were higher for unilateral EH. Direct out-of hospital costs were lower after EH in some studies. Indirect costs were lower for EH. Total costs were higher for EH in three studies and lower in one study. With EH, QoL was better, pain was less, operating time was longer and time return to work and other activities was shorter.
tension-free meshplasty and herniorrhaphy are safe, simple andapplicable even in elderly patients after adequate preoperative assessment and optimization. Although associated with longer hospital stay, the mortality rate is nil and complication as well as recurrence rate is low. Hence, timely repair is necessary in elderly patients even in those with comorbid conditions.

Background:Head and neck cancer, which includes tumours that arise from the oral
cavity, oropharynx, larynx, hypopharynx and sinonasal tract, represents a serious health
care problem in many parts of the world, and ranks as the sixth most common cancer
worldwide.The present study was conducted to assess risk of HPV infection and
oropharyngeal carcinoma.
Materials & Methods: 78patients of oral cancer of both genderswere enrolled. Body mass
index (BMI) was calculated. Frequency and amount of alcohol consumption (ml) were
recorded. 5 ml venous blood sample was obtained for the assessment of antibodies to
HPV16 E6.
Results: Out of 78 patients, males were 58 and females were 20.HPV E 16 E16
serologypositive was seen in 50 and negative in 28, BMI was normal in 26, underweight in
38, poor in 14. Stage I and II was seen in 17, III in 36 and IVin 25. Alcoholism>2 was seen
in 52 and <2 in 26. Smoking >10 was seen in 40 and <10 in 38. Dental carewas good seen
in 15, moderate in 38 and poor in 25.
Conclusion: Common risk factors for oropharyngeal carcinoma was HPV, overweight,
stage III and IV, alcoholism, smoking and poor oral hygiene.

Background: Tinnitus has been shown to be strongly associated with anxiety and
depression. The present study was conducted to assess tinnitus in patients with internal
derangement of TMJ.
Materials & Methods:170 patients with complaint of tinnitus referred for arthrographic
examination of the TMJ were enrolled in the study. Disk positions were diagnosed as
normal superior position, anterior disk displacement with reduction or anterior disk
displacement without reduction. Symptoms such as tinnitus and blockage sensation in the
ear was recorded. Tinnitus was recorded as absent or present
Results: Out of 170 patients, males were 100 and females were 70. Tinnitus was present in
130 and absent in 40. Location of pain was TMJ in 80, lower lateral face in 20, bac of eye
in 10 and temporal region in 20 cases. Other findings were painful chewing in 35, stressful
life in 42, limited mouth opening in 78 and bruxism in 40 cases. The difference was
significant (P< 0.05).
Conclusion: There was high rate of tinnitus in patients with internal disc derangement of
TMJ.

Background: Dermoscopy can act as an alternative diagnostic method to mucosal biopsy for diagnosis of various oral mucosal lesions.
Aim: To study the dermoscopic and histopathological characteristics of oral mucosal lesions.
Methods: The present prospective study was conducted among 53 patients of oral mucosal lesions presenting to the indoor and outdoor facilities in Department of Dermatology, Venereology and Leprosy. After performing routine investigations, dermoscopic evaluation was done in all the cases and recorded in the prestructured proforma. Oral mucosal lesions were evaluated by using non-contact videodermatoscope (AM7515MZT Dino-Lite), polarised mode. It was followed by mucosal biopsy from the same site.
Results: Nonvascular findings were the predominant features on dermoscopy. Structureless grey areas was the most common finding, seen in 72.41% patients of lichen planus. In lichen planus, it is suggested that structureless grey areas on dermoscopy corresponded histologically to hyperkeratosis. Vascular findings in form of light to intense red areas was seen in all patients of pemphigus vulgaris as well as both cases of aphthous ulcer and in each case of actinic cheilitis, bullous pemphigoid, disseminated discoid lupus erythematosus.
Conclusion: Theresultsof this rare pioneer study revealed that dermoscopy of mucosa may prove to be a valuable tool for diagnosis and may obviate need for mucosal biopsy.
 

Background: Testicular trauma and obstructed hernia can be differentiated by taking history from patient. Physical examination adds only a little information. Color Doppler ultrasound (US) is the modality of choice to differentiate testicular torsion from inflammatory conditions and can thus help in avoiding unnecessary surgical explorations. Color Doppler US alone has a limited role in the evaluation of testicular tumours. Gray-scaleultrasonography in combination with color Doppler imaging is a well-accepted technique for assessing scrotal lesions andtesticular perfusion.
Aims and Objectives: To Evaluate the study of Sonography and Colour Doppler in correlation with its histopathology and pediatric non neoplastic scrotal masses and also to compare non-neoplastic and neoplastic scrotal masses by characterization on B-modescan and Colour Doppler ultrasonography.
Material and Methods: The present study was carried out in 100 patients with clinically suggestive scrotal lesions. All cases were subjected to real time sonography examination. Main stress was laid to determine of organ of scrotal lesion to evaluate its nature size and echo texture and to see the results on management of serial Ultrasonography.
Results: Of 56 cases of non-inflammatory scrotal swellings, 5 cases wereneoplastic lesions, remaining 51 cases were non-neoplastic swellings. The 5 cases of neoplastic swellings were three cases of testicular neoplasm, two case of spermatic cord neoplasm which was histopathologically confirmed.
Conclusion: When color Doppler sonography is supplemented with High frequency gray scale US, the sensitivity of diagnosing acute scrotal pathology will be increased.

Laparoscopy has revolutionised surgery and management of the patient with marked decrease in morbidity and post-operative complications. Initially, these procedures were done using only General Anaesthesia. However, now with the introduction of Spinal anaesthesia and after learning its advantages, surgeons are slowly beginning to gravitate towards this mode of anaesthesia. Sixty three patients who were admitted in the hospital for appendicitis participated in this Randomized controlled trial conducted in a tertiary care hospital in India. Thirty three patients were randomly included in Group A (undergoing laparoscopic surgery under Spinal Anaesthesia) and thirty patients in Group B (undergoing laparoscopic surgery under General Anaesthesia). The mean values of Systolic and diastolic pressure was found to be significantly higher in patients who were administered General anaesthesia and no change in the respiratory functions was observed following administration of either Spinal or General anaesthesia. Laparoscopic surgery under Spinal anaesthesia is a viable and safe alternative as compared to General anaesthesia. The recovery rates and the satisfaction reported by patients is also better. Spinal anaesthesia also helps in maintaining better haemodynamic stabilization.

Purpose: Evaluating the efficacy of DWI and Apparent Diffusion coefficient (ADC) value in characterizing hepatic lesions and in differentiating regenerating nodules from HCC in the background of liver cirrhosis.
Methods: In this observational study 40 patients with malignant liver lesions and 19 patients with benign liver lesions were included. Out of these 59 patients, 35 patients had a history of cirrhosis. DWI was used to characterize these lesions. Hepatic lesions in patients with cirrhosis were categorized into hepatocellular carcinomas (HCC) and regenerative nodule. The different ADC values obtained in these proven cases were used to derive a cut off ADC value to differentiate malignant from benign lesions. All these patients were referred to the department of radio diagnosis at Amrita Institute of Medical Science and research centre, Kochi, Kerala, India. Data were collected from June 2019 to June 2021 prospectively.
Results: In the current study we could derive an ADC value which can be effectively applied to categorize lesions into malignant and benign. However there was no significant difference in ADC values between malignant lesions with considerable overlap in ADC values of HCC and other malignant lesion. Therefore, application of ADC value to differentiate between malignant lesions was not useful. ADC value was insufficient to further sub-characterize the malignant lesions into HCC and other malignant lesions even in the background of cirrhosis. However, it is useful in differentiating regenerating nodules from HCC in the case of liver cirrhosis. ADC values of different malignant lesions were nearly same with a decimal difference and hence a cut off to differentiate between these malignant lesions were not possible. Similarly, there was no significant difference between the ADC values of benign solid lesions by which we could subcategorize them. In this study ADC cutoff value of 1.45x10-3 mm2 /s was used to differentiate benign from malignant lesions.
Conclusion: This study showed that application of the derived ADC cut off value of 1.45 was effective to differentiate malignant from benign lesions and it was also useful in differentiating regenerating nodules from HCC in the background of cirrhosis. It was not applicable to further subcategorize the malignant and benign lesions as obtained by histopathology. With the help of DWI, existing gold standard involving liver biopsy and its complications can be avoided in patients having a risk of contrast allergy and severe renal failure.

Background: The novel coronavirus disease (COVID-19) is the most challenging health crisis today that we are facing. Against the backdrop of this pandemic, it becomes imperative to determine the effect of this infection on pregnancy and its outcome. Therefore, this study was aimed to determine to evaluate the maternal and fetal outcome in COVID positive pregnant women.
Method: In this retrospective study we included all pregnant women admitted with COVID-19 over period of 15 April 2021 to 31 May 2021. Clinical features and feto-maternal outcomes were assessed.
Results: The  incidence of COVID positive pregnant women was found to be increased  may be because of increase testing capacities of laboratories. More patients delivered by  LSCS(50.54% ). Admission to ICU relatively increased in mothers(15.38%). Increase incidence of iatrogenic preterm births and caesarean sections due to maternal or fetal compromise. All neonates were tested negative for COVID-19.  Incidence of IUD(17.64%)  appeared to be increased.
Conclusion: There is relatively higher rate of LSCS. Overall preterm delivery and IUD was increased. Maternal ICU admission and death due to COVID-19 complication was also increased.

 
Background: Hypertension is a growing concern in the Indian population with urbanization and developments in work culture and treatment methods.
Aim and objective: To evaluate the influence of serum magnesium levels in gradations of primary hypertension and evaluate its impact on co-morbid conditions.
Methods: Hypertensive patients were screened and included in the study by categorizing them in to grade I and II based on blood pressure levels. Socio-demographic, physical and systemic examination details were recorded with pre-designed questionnaire; electrolyte levels, fasting blood sugar, status of retina and heart were assessed and analyzed using t-test and logistic regression.
Results:Total 100 patients in the study, mean age was 59.3±14.79 years; male predominance (61%); normal retina (83%) and presence of pre-diabetic conditions (67%) was observed, with normal serum magnesium levels in majority (76%). Serum magnesium levels were significantly associated with grade I (P = 0.0173) patients; influencing systolic and diastolic blood pressure values (r = -0.3552, P = 0.003; r = -0.2160, P = 0.0309, respectively).
Conclusion:The optimal values can be further established by evaluation of large sample size, quality of life during treatment, and influence of co-morbidities/complications of hypertension, among others.
 

Background: Nosocomial pneumonia is a common infection with a high rate of morbidity and mortality. It significantly prolongs the hospital stay and associated higher economic burden. We in the current study tried to analyze the clinical and radiological pattern of hospital-acquired pneumonia including the causative organisms and risk factors.
Methods: This cross-sectional study was conducted in the intensive care units of Government Medical College, Mahabubnagar, Telangana. All adult patients who develop nosocomial pneumonia in critical care units as per the definition in inclusion criteria are investigated clinically, radiologically, and bacteriologically to determine the presence of pneumonia, isolate causative microorganisms, and presence of comorbid conditions like DM, COPD, CRF, etc.
Results: Out of n=40 cases hospital-acquired pneumonia was diagnosed in n=22 and ventilator-associated pneumonia was diagnosed in n=18 cases. important radiological findings in HAP of early-onset showed the presence of infiltrates similarly in the late-onset HAP infiltrates were found in maximum cases followed by consolidation and cavity formation. K. pneumoniae was the commonest organism isolated from 40.90% of all cases of HAP. In early-onset HAP the isolation of the organism was in 18.18% of cases and S pneumoniae was the second commonest organism isolated from 13.63% cases of HAP who were not mechanically ventilated.
Conclusion: All 100% cases with HAP of early-onset recovered were as of late-onset HAP 78.5% recovered. In early-onset VAP cases 80% of cases recovered whereas in late-onset VAP only 69.2% cases recovered. Based on the microorganism involved the prognosis was good in cases infected with K. pneumoniae and S. pneumoniae and the worst prognosis was found in cases infected with Pseudomonas Aeruginosa.

Introduction: Intertrochanteric and subtrochanteric fractures are devastating injuries that most commonly affect the elderly, but it is not uncommon in younger age group, have a tremendous impact on both the health care system and society in general. Peri trochanteric fractures mainly comprise of fractures of trochanter and subtrochanteric region. There are various forms of internal fixation devices used for Trochanteric Fractures, of them the most used device is the Dynamic Hip Screw with Side Plate assemblies. This is a collapsible fixation device, which permits the proximal fragment to collapse or settle on the fixation device, seeking its own position of stability.
Objectives: 1) To assess the stable fixation and early mobilization of patients with Intertrochanteric and subtrochanteric fractures. 2) To analyze the anatomical and functional outcome of treatment of Intertrochanteric and subtrochanteric fracturesusing Proximal Femoral Nail.
Methodology: The present study consists of 40 adult patients of intertrochanteric and subtrochanteric fractures, who are treated with Proximal Femoral nail in Mahatma Gandhi Memorial Hospital, attached to Kakatiya Medical College, Warangal, Telangana state between November 2012 and June 2014.
Results: Mean duration of screening was 90 seconds, mean duration of operation 90 minutes and Mean blood loss 130 milli liters. Intraoperative complications were,15% Failure to get anatomical reduction, 15% Failure to put derotation screw,15% Varus angulation and 10% Failure of distal locking. Fracture of lateral cortex, Breakage of guide wire and Breakage of drill bit observed 5% of operations. In our study the average duration of hospital stay was 19.33 days. The mean time for full weight bearing was 12.6 weeks. All patients enjoyed good range of hip and knee range of motion except one who had septic arthritis knee. Post-operative mobility was aided in immediate post-operative period but later all patients were ambulatory independently with or without walking aid after 6 weeks.
Conclusion: The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier and exactly performed osteosynthesis.

Background: Febrile seizures are a common occurrence in children below the age of 5 years. There is a possibility of recurrence in one-third of these cases. We in the current study tried to evaluate the serum sodium and glucose levels in cases with acute febrile convulsions admitted to our hospital.
Methods: This was a cross-sectional study was conducted in the Department of Pediatrics, cases admitted in Pediatrics wards, Bhaskar Medical College and General Hospital, Moinabad, Hyderabad, Telangana State. All cases with febrile seizures were admitted for the first time to our hospital. Febrile seizures (Febrile seizures are defined as a seizure occurring in association with a febrile illness, in the absence of CNS infection or any other defined cause of seizures). Results: Out of n=100 cases studied the most common cause of febrile convulsions in cases of this study was upper respiratory infections in 89% of cases. The duration of convulsion revealed most of the convulsions were lasting for < 5 minutes in 68% of cases. Between 5 – 10 minutes in 28% of cases and > 10 minutes in 4% of cases and the cases were with hyponatremia. No family history of febrile convulsions was recorded in 77% of cases and positive family history of convulsion was found in 33% of cases. Blood glucose levels were found to be normal in 84% of cases and high glucose levels in 6% of cases.
Conclusions:  The study finds that febrile convulsions are more common in males as compared to females. The serum sodium levels in 50% of cases were found to be lower and a greater number of males were with hyponatremia as compared to females. The severity of hyponatremia was also associated with a significantly increased duration of convulsions.

Background: Alopecia in women is generally difficult to diagnose clinically. Trichoscopy may help make the correct diagnosis in doubtful cases. Objective: The aims of the study were to assess the trichoscopic features of different types of alopecia in women, the reliability of trichoscopy vis-à-vis clinical findings, and the validity of trichoscopy in cases with a doubtful clinical diagnosis. Material & Methods: A hospital-based observational, cross-sectional study was carried out on women patients with alopecia. A trichoscopic diagnosis was made and correlated with a clinical diagnosis. The validity of trichoscopy in doubtful cases was evaluated by reporting the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic value. Results: A total of 80 patients were recruited including 38 men and 42 women. The mean age at presentation was 26.84 years (range: 10–59 years). Sixty patients had non‑cicatricial alopecia and the remaining 20 had cicatricial alopecia. The most common trichoscopic findings were  yellow dots (50 patients, 62.5%) and thin hair (33 patients, 41.25%). In patients with alopecia areata, the most frequent findings were yellow dots (92.3%), black dots (68.2%) and exclamation mark hair (72.3%) and Villous Hair (62%). The most common finding in telogen effluvium (TE) was thin hair which was seen in 65.2% of patients.   Conclusion: We conclude that trichoscopy is a relevant investigation in patients with alopecia and has a definite role in the diagnosis of difficult cases. Trichoscopy helped reach a definitive diagnosis in patients in whom the clinical diagnosis was doubtful.

Introduction: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases. Aims and Objectives: To assess the pattern of ACD, and patch test profile of suspected cases of ACD attending of our department. Materials and Methods: It was a cross sectional study in which all the data enrolled in the clinically suspected contact dermatitis patients of our department from January 2021 to August 2021 period were analysed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability. Results: A total of 66 patients were enrolled in the contact dermatitis clinic from January 2021 to August 2021. Hand eczema was the most common pattern seen in 10 cases followed by hand & foot eczema, feet eczema, wrist eczema, Hand & Neck etc. A total of 38 patients (57.6%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix. Conclusion: Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country.

Introduction: The spread of Covid-19 pandemic to India and the pandemic guidelines issued by the government to stop offline classroom teaching posed a big challenge to all educational institutes including medical colleges. Online teaching which was never a part of medical education suddenly assumed importance and was the only viable mode of teaching available during the pandemic. Hence the present study was taken up to assess the perceptions of first year MBBS students aboutthe online teaching.
Aim: To assess theperceptions of first year MBBS students aboutthe online teaching during covid-19 pandemic.
Materials and methods: A cross sectional study was carried out among first year MBBS students of 2019-20 batch of Sri Siddhartha Medical College. A self-structured questionnaire was administered to all study participants and the responses were recorded.
Results: Majority of the students reported that accessibility to record lectures which they can use to revisit any of the lecture classes and clear their doubts as one of the major advantages of online teaching. 84.66% of the students reported their liking to online classes because of the convenience and flexibility to attend classes in a familiar and comfortable environment in home. 30.66% of the students reported internet connectivity issues as one of the problems in distant mode of teaching.42.66% of the students reported less student teacher interaction as one of the major drawbacks of online teaching. 64% of the students reported curriculum content issues like having no practical demonstrations and no clinical visits to hospital as one of the major limitations of this mode of teaching. Majority of the study population displayed adequate knowledge to effectively use the technology to attend online classes.
Conclusion: Improved quality of internet connectivity and enhanced student teacher interaction would improve the learning experience of the students in online teaching.

Background:Hearing is an essential part of how we communicate with others and become
aware of sounds that happen in our immediate environment. The present study was
conducted to assess sensorineural hearing loss in diabetes and hypertensive patients.
Materials & Methods: 120 subjects of both genders were divided into 3 groups. Group I
had diabetics, group II had hypertensive and group II had control subjects. General ear
examination was done using otoscopy. Hearing function, degree, form, and configuration
of any hearing loss, were determined through a general ear examination and Pure Tone
Audiometry.
Results: Group I had 22 males and 18 females, group II had 16 males and 24 females and
group III had 15 males and 25 females. Normal hearing loss was observed in 25% in group
I, 26% in group II and 85% in group III, mild hearing loss was observed in 75% in group
I, 50% in group II and 15% in group III and moderate hearing loss was observed in 24%
in group II. The difference was significant (P< 0.05).
Conclusion: There was more hearing loss in diabetics and hypertensive subjects as
compared to healthy individuals.

Background: Tuberculosis (TB) is a chronic, progressive mycobacterium infection, often with a period of latency following initial infection. The first line and second line of TB treatment show some of the side effects on the individual. Past studies had shown that second line MDR-TB treatment causes an effect in the auditory domain, but there is a shortage of studies related to drugs used in MDR-TB on speech perception in noise.
Objectives: The study aimed to assess the speech perception in noise in individuals with and without tuberculosis.
Material and method: A total of 80 participants in the age rane of 20 to 40 years were included in the study. Further, these participants were categorized into two groups. The first group having individuals without tuberculosis while the second group included individuals with tuberculosis. All the participants were initially undergone for basic audiological evaluation followed by Quick Sin test in Kannada.
Results and discussion: The results showed that there was a significant difference between the groups on speech perception in noise test.
Conclusion: It can be concluded from the current study that individuals with tuberculosis showed poorer performance compared to individuals without tuberculosis on speech perception in noise test.

Lumbar disc herniation is the most common cause of lumbar radiculopathy. Most commonly seen in adult population 20-50 years of age, most common site of occurrence is L4-L5 and L5 and S1evels. Non-operative management of this condition may include physical therapy, anti-inflammatory medications, and epidural steroid injections. After the patient’s informed consent was obtained, 150 patients with lumbar disc prolapse were subjected to epidural steroid infiltration out of which 101 underwent IL procedure and 49 underwent TF epidural steroid injections under the fluoroscopic guidance according to surgeon’s preference. As per our study it was inferred that 83.3% patients had moderate OD score following surgery at the end of 6 months whereas 74.6% patients had mild OD score following only epidural steroid which was also found to be statistically significant.

The etiology of PONV is not fully understood. PONV is multifactorial in etiology and depends on a variety of factors like, age, gender, previous history of PONV, type and duration of operation, anaesthesia technique and postoperative care.¹⁰So as an anesthesiologist it is essential to understand the mechanism involved in nausea and vomiting and the available peri-operative treatment options. After Institutional Ethical Committee approval, one hundred and twenty females aged 18-60yr of ASA I and II who satisfied the inclusion criteria were randomly allocated into four groups of 30 each by a computer generated random number table. There is statistically significant difference in incidence of vomiting among the groups over the study period in total (p value is 0.010), but no significance in the case of nausea among the groups (p value is 0.103).

Introduction: Pneumoperitoneum from Carbon di oxide insufflation will result in increase plasma levels of catecholamines and vasopressin that leads to hemodynamic disturbances. These effects are exaggerated by the steep trendelenburg position. This study was designed to evaluate the effect of Dexmedetomidine and fentanyl on hemodynamics in laparoscopic gynaeconcolgy surgeries which requires steep trendelenburg position.
Methods: After obtaining Ethical committee clearance and patients consent, prospective randomised comparative study was done on 60 ASA I and II patients who were randomly assigned to receive either dexmedetomidine or fentanyl infusion. Patients with ASA III & IV, on β blockers were excluded. Intraoperative hemodynamics, recovery and emergence was assessed. Students ‘t’ test was used
Results: The study included 60 patients undergoing laparoscopic gynaecology oncology surgeries requiring steep trendelenburg positions. Dexmedetomidine group of patients had better intra operative hemodynamics throughout and postoperative recovery when compared with Fentanyl group of patients.
Conclusion: Using Dexmedetomidine infusion in patients will have stable hemodynamics and postoperative recovery also smooth as compared to fentanyl.
 

Spinal cord fills about 50% of the canal in the thoracolumbar segments. The remainder of the canal is filled with Cerebrospinal fluid, epidural fat and meninges. The spatial relationships of grey and white matter structures remain consistent throughout the length of the cord, but the proportions change based on the level. All the patients had routine X-rays of thoracolumbarspine in both Anteroposterior and Lateral views.In all the patients MRI spine and 3D CT ofspine with 2mm thick film uploaded in navigation machine which gives 3D image of the vertebrae. After registration in navigation machine, the pedicle screw trajectory, size and length planned and placed in the center of the pedicle.In our study we had 69.23% males and 30.77% female patients in conventional method and had 84.61% males and 15.39% female patients in navigation method. The average age was 36 years and 29 year in conventional method and navigation method respectively, with male predominance in each group.

The goal of the treatment of the unstable thoracolumbar injuries is optimizing neural decompression while providing stable internal fixation over the least number of spinal segments. Either anterior, posterior or both approaches is less extensive. Pedicle screw device allows immediate stable fixation as the screw traverse all the three columns. Screw passed one level above and one level below the fractured vertebra via posterior approach. All the patients were initially assessed in the outpatient department or casualty according to their presentation and then they underwent a detailed evaluation of their hemodynamic, spine, neurological status and other injuries if associated with trauma. The patients and their attendant were interviewed, their epidemiological, historical, subjective and physical findings were noted. In this study Mean value for total hospital stay was 29.23 days in conventional method and 28.38 days in navigation method. In our study we had 2(15.39%) patients with malplacement of pedicle screw with lateral and medial pedicle cortex breach and  01 (7.69%)  patient with wound infection, were noted in conventional method and had01(7.69%) patients with malplacement of pedicle screw with lateral pedicle cortex breach and  01  patient with wound infection, were noted in navigation method. No neurologic complications were noted in the patient with misplacement of screws.

Background: The Integrated Child Development Services (ICDS) program has been operation for more than three decades in India. The success of ICDS program in tackling maternal and childhood problems still remain a matter of concern. The present study was conducted to assess issues related to Anganwadi Worker (AWW) and Anganwadi centre (AWC) including infrastructure facilities.
Material and methods: A cross sectional study was conducted in 56 Anganwadi centres (AWCs) of Chitradurga district using a predesigned questionnaire containing 42 questions by interns. The details regarding the infrastructure, process indicators and outcome indicators were collected and analyzed.
Results: All the AWCS visited provided 100% PSE and 100% SN coverage among children. A majority of pregnant and lactating mothers (73.3%) & adolescent girls (57.3%) were availing ICDS services. One third of AWCs reported an interruption in the availability of commodities by the government.
Conclusion: The study has reported gaps in terms of infrastructure facilities and safe and continuous drinking water supply. A number of issues pertaining to the ICDS scheme must be identified for the optimized functioning of AWC and it needs to be promptly addressed.
 

assess perceived risk by EPPM(Extended Parallel Processing Model) and the risk of COVID-19 infectionamong general population.
Methods: Cross sectional study was conducted among 185 general population ofChitradurga district. Questionnaire had three parts, 1. Socio-demographic data along with habits and co-morbidities. 2. Risk perception questions (29) with efficacy, defensive response and perceived threats. 3. A predesigned semi-structured questionnaire (24 questions) regarding their attitudes and practices towards COVID 19. Based on which their risk was assessed depending on score.. Chi-square, ANOVA, t-test and binary logistic regression was applied to find significant association.
Results: Among 185 study participants, majority were elders (>60 years) 25.5%, 100 (54.05%) were males, 108 (58.37%) belonged to nuclear family. Perceived risk scores were almost same in all the categories. A total of 106 (57.3%) participants were engaging in danger control processes and 79(42.7%) in fear control processes. Among population, 32.08%, and 44.30% people were in high and medium risk of infection respectively. Everybody is in risk. 85.27% frequently washed hands with soap or sanitizer, 76.8% used mask regularly when they go out, 74.26% do not wash their dress once they come from outside, 70.37% do not wash their shoes, 54.64% use mass transport. Among socio-demographic variables education, type of family and travel history were significantly associated with risk of infection.
Conclusion: Perceived risk was equal in almost all classes. The attitude and practice towards COVID 19 during pandemic was not so impressive.

Background: The physiological changes of pregnancy deem nausea and vomiting infallible complications associated with obstetric anaesthesia, resulting in significant morbidity and longer recovery time. The aim of our randomised control trial was to investigate the efficacy of propofol in addition to the currently accepted regimen of ranitidine and metoclopramide in the prevention of nausea and vomiting in this high risk group undergoing spinal anesthesia during caesarean section.
Methods: Eighty fasted term pregnant women scheduled for elective caesarean section were given ranitidine 150mg and metoclopramide 10mg orally 2 hours prior to spinal anaesthesia following which they received either propofol 200µg /kg IV or placebo as a single bolus dose. Intraoperative and post-delivery emetic episodes experienced were recorded at intervals and the intensity of nausea was assessed using the visual analogue scale (VAS).
Results: The incidence of nausea during the intraoperative period in propofol group was 5 % as compared with placebo group in which it was 32.5%, while that of vomiting in propofol group was 5% as compared with placebo group in which it was 22.5%. Both were found to be statistically significant (p= 0.002, p= 0.023 respectively). The incidence of nausea and vomiting during the entire postoperative period of 0-24 hours between the two groups was found to be statistically insignificant.
Conclusion: The prophylactic administration of a subhypnotic dose of propofol with ranitidine and metoclopramide was effective in the prevention of nausea and vomiting after neuraxial blockade during the intraoperative period but not during the postoperative period.

Aim:The outcome of necrotizing soft tissue infection in Western UttarPradesh-A Prospective Study.
Material and Methods: This study was conducted at Muzaffarnagar medical college Muzaffarnagar UP from Sept 2019to Sept 2021.50 patients with clinical features of Necrotic soft tissue infection were admitted and twice daily dressing and debridement with broad spectrum antibiotics.
Results: 58 patients with features of necrotic soft tissue infection were admitted during study period showed Lower Limb Involvement (57%) followed by perianal region an scrotum(23%). Diabetes (74%) was the most common co morbidity found and was associated with increased risk of mortality, which previous studies also confirmed. In this study mean duration of admission was 24.9days.10patients died during treatment due to severe sepsis. In this study rta is the 3^rd common cause of nsti during this study period(8.9%).with 40% patients healed with no need for grafting(lund and browders chart of burn).
Conclusion: 40-60 years aged were most commonly involved. As the duration of stay increases the mortality tends to increase early debridement with twice daily dressing with antibiotic coverage determine the outcome of the patients with necrotic soft tissue infections.

Background: MRI has been considered as an important radiological non-invasive diagnostic tool in inflammatory demyelinating diseases that helps in early intervention to slow its progression. Lack of data in the current study setting and the fact that, most information on these inflammatory demyelinating disorders come from hospital based cross-sectional studies, this study was conducted.
Aims: To describe the characteristics of inflammatory demyelinating brain lesions on Magnetic Resonance imaging
Methods and Material: A cross sectional study was conducted among fourty clinico-radiologically suspected inflammatory demyelinating diseases i.e. multiple sclerosis (MS), neuromyelitis optica (NMO) and acute disseminated encephalomyelitis (ADEM) in the department of radiodiagnosis in collaboration with the department of neurology, VMMC and Safdarjung hospital, New Delhi. MRI was acquired in different imaging sequences among all the patients and the lesions were described. All the data were expressed in means or proportions based on the type of data and analysis was done using Microsoft Excel.
Results: A total of 24 were having MS, 2 had NMO and 14 had ADEM. Most of the lesions in MS (70.8%) and ADEM (78.6%) were supratentorial. Higher proportions of MS showed hyperintense lesions (84.3% vs 72.7%), contrast enhancement lesions (74.5% vs 54.4%) and false diffusion restriction (76.5% vs 9.1%) compared to ADEM. However, most of the patients with ADEM showed true diffusion restriction (63.6% vs 7.8%) compared to MS.
Conclusions: Hyperintense and contrast enhancement lesions were more common in MS and true diffusion restriction lesions were mostly ADEM lesions.

Background and Aims: Difficult endotracheal intubation is a major challenge for the anesthesiologists. Many parameters assist to predict difficult intubation, hence inter incisor distance (IID), Sternomental distance (SMD) were used to predict the possibility of difficult intubation in patients posted for Head and Neck Oncosurgeries perioperative.
Methods:106 patients, airway was assessed who were posted for head and neck oncosurgeries especially the oral cancer patients. Using Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy and graded difficult intubation as grade 3 and 4.
Results: Difficult endotracheal intubation was found in 20.75% of the said population, which was much higher than general population. Inter incisor distance less than 3 cm, Sternomental distance less than 12.5 cm were the cut off points for difficult intubation. The predicting difficult intubation by inter incisor distance was about 59% sensitivity and 77% specificity with a positive predictive value of 38% and with higher negative predictive value of 88%. The predicting difficult intubation by sternomental distance was about 24% sensitivity and 51% specificity with a positive predictive value of 10 % and with higher negative predictive value of 74% odds ratio of 5.22.
Conclusions: Inter incisor distance had high specificity with significant P value 0.007, hence was a better predictor compared to Sternomental distance in assessing airway in patients posted for head and neck oncosurgeries.

CRC and IBD have been linked to the volatolome, which is a mixture of volatile organic
compounds (VOCs). The volatolome seems to have promise as a non-invasive biomarker
for the identification of CRC and IBD. Multiple researches have been conducted on the
volatolome's potential, utilising either chemical analysis or pattern-recognition approaches
to determine its potential. The existing literature on the potential of the volatolome as a
cancer and inflammatory bowel disease (IBD) biomarker was examined. The survey
examines 23 journal papers that were obtained electronically through major scientific
databases such as PubMed, Google Scholar, Scopus, IEEE, and Science Direct, which
were searched using sets of keywords. The papers were obtained through major scientific
databases such as PubMed, Google Scholar, Scopus, IEEE, and Science Direct, which
were searched using sets of keywords. Publication of the articles was made possible by the
use of major scientific databases such as Pubmed and Google Scholar, as well as the IEEE
and Science Direct. VOC analyses appear promising for future screening of CRC and IBD,
with potentially improved test performances allowing for earlier detection of IBD and CRC
and consequently earlier initiation of treatment, potentially reducing morbidity and
mortality rates as well as lower rates of (unnecessary) colonoscopies, according to the
studies included.

Background: The elbow is the second most commonly dislocated major joint in adults. Simple
dislocations are those where there had been no concomitant fracture apart from small
periarticular avulsions 1 mm or 2 mm in diameter. The present study compared acute
ligamentous repair with functional treatment in patients with simple elbow dislocation.
Materials & Methods:80 patients with elbow dislocation were divided into 2 groups of 40 each.
Group I patients were treated with closed reduction of elbow and group II patients were
treated with closed elbow reduction and subsequent reconstruction of torn collateral
ligaments. Outcome of the treatment was compared.
Results: Side of dislocation was left side in 17 in group I and 14 in group II and on right side
seen in 23 in group I and 26 in group II. Type of dislocation was posterior seen in 15 in group
I and 16 in group II, postero- lateral seen 12 in group I and 11 in group II, postero- medial
seen 7 in group I and 8 in group II and lateral seen 6 each in group I and 5 in group II.
Clinical outcome was excellent seen in 30 in group I and 22 in group II, good in 6 in group I
and 14 in group II, fair seen in 4 in group I and 3 in group II and poor seen 1 in group II.
The difference was significant (P< 0.05).
Conclusion:Closed reduction of elbow repair found to be better than closed elbow reduction
and subsequent reconstruction of torn collateral ligaments.

Introduction - The emergence of ultrasound imaging in regional anaesthesiahas
revolutionizedthepopularityofPNBs.Itprovidesveryhigh-resolutionimages,direct
visualization of structures, avoid accidental vessel or nerve injuries and hence providehigh
safetyprofileascomparedtoblindprocedures.Thisleadstoincreasedsuccessrateduetoreal
timeimagingwhilethedrugisbeinginjected,decreaseddoseneededforlocalanaestheticsand
hence reduced the risk of local anaesthetictoxicity.
Methodology-ThestudywasdoneastheRandomizedSingleBlindedComparativeStudy.
Patientsundergoingunilateralinguinalherniarepairwerechosen.Thepatientswererandomly
allocated into two groups such as group S (Unilateral Spinal Anaesthesia) and groupP
(Paravertebralblock),of25patientseach,usingblockrandomizationwithsealedenvelope
system.
 
Results-Wefoundthatthemeanarterialpressurewasbetterpreservedinthepatientsreceiving
PVBascomparedtounilateralspinalanaesthesia.However,heartratewascomparableinboth
techniques. PVB provides better postoperative analgesia as time to first rescue analgesiawas
significantly higher and total rescue analgesia consumption was significantly less in groupP.
No significant difference was found in adverse effects in bothtechniques

Background:Glaucoma is a disease known since the Hippocrates time. This term indicates a number of neurodegenerative diseases having in common a progressive optical atrophy resulting from the apoptosis of retinal ganglion cells, axon atrophy, and degeneration extending to the visual areas of the brain cortex, finally leading to the characteristic optical-cup neuropathy and to irreversible visual loss.
Aims & Objectives:The aim of this study is to determinechanges in corneal curvature, axial length and IOP reduction  after glaucoma filtration surgery.
Material and Methods:The present study was conducted in the department of Ophthalmology, Ananta Institute of Medical Science & Research Centre Rajsamand, Rajasthan during the period of 1 year from January 2019 to January 2020.25 diagnosed cases of glaucoma who were undergoing glaucoma surgery (trabeculectomy) of either sex, age were included in the study.
Results:TheMean values of keratometry (D) at pre-operative, 1 week, 4 week and 3 months are 1.28±0.744, 4.097±2.915,3.484±1.662 and 2.150±1.051 respectively while the mean value of axial length atpre-operative, 1 week, 4 week and 3 months are 22.537±0.786,22.390±0.783, 22.356±0.782 and 22.402±0.716.
Conclusion: Trabeculectomy is the most common surgical procedure for glaucoma management which may significantly influence ocular biometry. Change in keratometry and axial length can be significant enough to affect visual acuity and the accuracy of IOL power calculation.

Background: This prospective, randomised control experiment was conducted to determine the role of single-dose antibiotic prophylaxis after hernia surgery. This research also provides evidence for determining whether stringent aseptic precautions can reduce antibiotic use.
Materials and Methods: This study included 60 patients with inguinal hernias (direct or indirect) who were admitted to the surgical ward at the Pt. B.D. Sharma Post Graduate Institute of Medical Sciences in Rohtak. Prior to admission, each patient was given a thorough screening as well as a rigorous clinical evaluation that included Haemoglobin, Bleeding time, Clotting time, Urine complete examination, Blood urea, Blood sugar, Serum electrolytes, Chest X-ray and ECG.
Results: The average age of the presenters was 45.88 years old. The majority of the patients, sixteen (26.66 percent), were between the ages of 41 and 50. The youngest patient was an 18-year-old man, while the oldest was an 80-year-old man. Males made up 98.33% (n=59) of the cases, while females made up 1.66 percent (n=1). Lichtenstein's repair was performed in forty patients (66.66%) for indirect inguinal hernias, and Lichtenstein's repair was combined with posterior wall plication in eighteen patients (30%) for direct inguinal and Pantaloons' type hernias. Indirect inguinal hernias accounted for the most occurrences (40), with two having a sliding component.
Conclusion: There is substantial evidence in the international literature to support the claim that prophylactic antibiotic treatment does not reduce the incidence of wound infection. Given the findings of this study, it is possible to conclude that the variations in infection rates are not substantial, and that prophylactic antibiotics do not reduce the rate of SSI in mesh repair of inguinal hernias, and that routine use of prophylactic antibiotics is not indicated.

Background: Good quality multiple choice questions (MCQs) can test knowledge of the students in depth which covers large syllabus in short time. MCQs if post validated accurately can give us items with known difficult index and discrimination index. However not many teaching institutes have provided adequate importance to item analysis.
Objectives: The objectives of the study were to find out difficulty index (P) and discrimination index (d) for each item in a physiology MCQ test paper.
Materials and methods: Physiology MCQ test paper comprising of 20 items, with answer key and answer papers of 250 first Year Physiotherapy students were obtained and item analysis was performed. Choice marked for each item by each student and his scores were entered in Microsoft Excel. Students were ranked & top 1/3rd and bottom 1/3rd were chosen as high achiever and low achiever group respectively. Difficulty index and discrimination index for each item was determined.
Results: 3 multiple choice questions were very difficult with difficulty index (p) <30%. 9 questions were within acceptable range of difficulty index (p- 30 to 70). 8 questions were easy with a difficulty Index (p) above 70%. Discrimination index (DI) of 6 out of 20 questions was below 0.20 and hence unacceptable. DI of 8 questions was between 0.20 to 0.25 and so acceptable. 4 questions were found to have a good discrimination index (DI= 0.25 to 0.35). 1 question was found to have excellent discrimination (DI= 0.35 or more). One item had negative discrimination index.
Conclusion: It can be concluded that difficulty Index (p) and discrimination Index (DI) are very useful tools for the assessment of the quality of an MCQ. An item with known and acceptable difficulty level and discrimination power should be preserved for future exams.

Background: Vernal keratoconjunctivitis (VKC) is an acute on – chronic inflammatory disease of the conjunctiva and cornea,1,2 encountered usually in the first decade of life in children.
Aims & Objectives: To determine the efficacy and safety of Tacrolimus skin cream in the resolution of moderate to severe Vernal Keratoconjuctivitis (VKC).
Material and Methods: A prospective clinical trial was conducted at the Ophthalmology department of Ramkaran Joshi Hospital, Dausa, Rajasthan, from Sep 2019 – Aug 2020. In this study, 54 consecutive cases (108 eyes) with moderate to severe VKC, between the ages of 4 – 18 (mean 7 years) years were included. There were 13 newly diagnosed cases and 41 recurrent. After discontinuing their previous medications, they were treated with Tacrolimus skin cream, 0.03% applied into the lower conjunctival fornix twice a day along with lubricants for a period of 4 – 8 months. Clinical signs and symptoms were recorded at the beginning of the treatment and at all follow-ups which were conducted weekly for one month and then every month for one year.
Results: The duration of therapy was 4 – 8 months (mean 6 months). The patients were followed-up for a mean duration 10 ± 1.5 months. There was marked subjective as well as objective improvement in all cases within one month of therapy. There was no need for any additional therapy. No toxic effects of Tacrolimus were observed in any case.
Conclusion: It can be concluded that Tacrolimus skin cream (0.03%) is an effective therapy for moderate to severe cases of vernal keratoconjuctivitis. It acts as a safe alternative to topical steroids.

Introduction: The spread of COVID-19 pandemic globally has left us with many unanswered questions about the spread, modality of treatment and preventive measures to be taken to reduce its spread. Lack of sufficient knowledge about the virus and the lack of clarity about preventive measures has led to lot of confusion about healthcare practices. First year medical students although not involved in treatment of COVID-19 patients they can act as information providers and sensitize the community about the pandemic. Hence the present study was taken up among first year medical students.
Aim: To assess the basic knowledge about Novel Corona virus disease and its spread and clear the myths among them regarding COVID-19.
Materials and methods: A cross sectional survey was conducted among first year medical students belonging to 2019-20 batch. Data was tabulated using Microsoft office excel sheet and the response were expressed as total count and percentages distribution. Data was analyzed using EPI INFO (Version 7).
Results: Majority of the study participants have good knowledge about the virus, origin of the first case and mode of spread.92.25% of the study participants knew that elderly and people with comorbidities were more prone for coronavirus disease. 100% of the study participants knew that RT-PCR test has the diagnostic test for COVID-19. The entire study participants knew about non availability of a vaccine to prevent COVID-19 infection and some vaccines were in different stages of clinical trials.
Conclusion: The students of first year MBBS have good background knowledge and awareness about coronavirus disease which will help us to use them as the information providers to sensitize community people about various preventive measures one has to take to prevent the spread of COVID-19 pandemic.

Background: Heart failure is one of the major cause of morbidity and mortality in India and worldwide other countries. Its prevalence in the population has increased dramatically over time. Heart failure is a growing health problem . It is been found that the prevalence and incidence of HF are increasing, particularly in individuals aged more than 60 years. Objective: To determine gender difference in heart failure with respect to symptoms at presentation (NYHA), clinical findings, underlying heart disease, risk factors, precipitating factors and prolonged hospital stay. Material methods: This was a cross-sectional study done in In-patients in the department of Cardiology Patna medical college and Hospital Patna Bihar. Patients who presented with symptoms and signs of heart failure secondary to cardiac cause where included in the study who fulfilled the modified Framingham’s criteria for diagnosis of HF. Study duration One and half year.
Conclusion: In this study we proved that gender difference was found with regard to More of presentation of symptoms, even though males and females presented with same set of symptoms and signs, females were found to have worse symptoms at the time of admission. Females were more prone to hae Heart Failure with preserved ejection fraction, mainly at elderly age with LV diastolic dysfunction.

Aim: The aim of the study at comparing the outcome of laparoscopic (TAPP mesh repair) and open hernia repair with respect to the duration of surgery, intra and postoperative complications, postoperative pain, recurrence, stay in the hospital and resumption of daily activities.
Methods: A comparative study was conducted in the Department of General Surgery, IGIMS, Patna, Bihar, India from feb 2020 to Jan 2021 to compare laparoscopic hernioplasty and Lichtenstein’s open mesh repair. The study consisted of 130 patients with unilateral or bilateral inguinal hernia and they were randomly allocated into either group. Various parameters like duration of surgery, intra and post-operative complications, post-operative pain, recurrence, stay in the hospital and resumption of daily activities were compared.
Results: Out of the 130 patients, 30 had bilateral inguinal hernia and the rest 100 had unilateral. 19 patients with bilateral hernia underwent laparoscopic repair and 11 underwent open mesh repair. 46 patients with unilateral hernia underwent laparoscopic hernioplasty and 54 underwent open mesh repair. The mean operative time for unilateral open hernioplasty was 46.45 mins and bilateral was 87.16 mins whereas, for unilateral laparoscopic hernioplasty it was 63.38 mins and bilateral was 121.35 mins. Intra-operative complications like injury to spermatic cord, vessels and bowel were nil in both laparoscopic and open hernioplasty groups. But, post-operative complications, like wound infection was noted in 13.85% (9 out of 65 patients) and 16.92% had seroma formation (11 out of 65 patients) in the open hernioplasty group. In laparoscopic hernioplasty group3.08% (2) had wound infection but, seroma formation was noted in 12.31% (8 out of 65 patients). Urinary retention was noted 18.46 % of open hernioplasty group (12 out of 65) and 61.54% of laparoscopic hernioplasty group (4 out of 65 patients).
Conclusions: Laparoscopic hernia repair is safe and provide less postoperative morbidity in experienced hands compared to open hernia repair.

Aim: Long-Term Morbidity and Functional Outcome of Japanese Encephalitis in Children.
Methods:  A prospective study was conducted in the Department of Pediatrics, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. Children aged up to 12 years admitted with acute encephalitis syndrome (AES) were subjected to laboratory tests for detection of JE. Anti-JE IgM antibody capture (MAC) ELISA was performed on cerebrospinal fluid and serum samples using ELISA kit. Diagnosis of JE was confirmed by detection of anti- JE IgM antibody in cerebrospinal fluid (CSF), or both in CSF and serum samples. Patients with positive results were included in this study. Background demographic and relevant clinical data and results of various laboratory investigations including magnetic resonance imaging (MRI) of brain were noted. Discharged patients were followed up for two years at out-patient department and detailed clinical examination was done to document clinical status.
Results: A total of 300 children with features of AES were screened, and 100 (33.33%) children (55% boys) were diagnosed with laboratory confirmed JE during the study period.  Anti-JE IgM was detected in both CSF and serum in 80 children, and in only CSF in another 20 children.  20 cases (20%) died during the hospital stay.  At the time of discharge, 30 children (30%) had severe sequelae, 9 (9%) had moderate sequelae, 10 (10%) developed minor sequelae, and 32 children (32%) showed full recovery as per LOS. Motor deficit was noted in 40 children (50%) at discharge; quadriparesis in 25, hemiparesis in 8, and monoparesis in 2 child. EEG was performed in 50 children, 35 (70%) were abnormal. Till the end of the study, 20 children (20%) were on AED. Among cases under follow-up, 60 children were school-going. Poor scholastic performance was observed in 10 (20%) children in the long term; another 10 of them became drop-outs due to motor deficits, behavioral problems and apprehension of seizures.
Conclusion: Considering high mortality and long term morbidities, preventive aspects of the disease need to be prioritized.

Background: TB and HIV form a lethal combination, as each fuels the progress of the other in the infected patients. This study assessed the haematological parameters of pulmonary tuberculosis (PTB) patients with and without HIV infection attending the shyam shah medical college, Rewa. Aims: To study hematological parameter namely Hb (Hemoglobin), total RBC count, Total WBC count, ESR (Erythrocyte Sedimentation Rate) and platelets in pulmonary tuberculosis. Methods: To analytical study of all 120 (TB with HIV 60 / TB without HIV 60)  TB patients who were attending Department of Medicine, Shyam Shah Medical College, Rewa (M.P.). And patientsrefered from Anti-retroviral therapy centre, with sputum positivity for AFB (acid fast bacillius).Results: In our study, 83.3% were males and 16.6 % were females in the TB with HIV group. 70% of patients were in the age group of 25 – 45 years in the TB with HIV group, whereas 86.6% of patients were in age group of 25 – 45 years in the TB without HIV. 90% of patients were underweight with BMI less than 18.5, in TB with HIV group, and 73.3% of patients were underweight in TB without HIV group. 80% were anemic in the TB with HIV and 66.6% were anemic in TB without HIV group. 63.4% of patients with TB and HIV had thrombocytopenia, whereas only 10% of patients had thrombocytopenia in TB without HIV group. patients with tuberculosis per se have increased ESR count, whereas TB-HIV coinfection has drastically reduced the ESR count. Among patients with TB and HIV 83.3% of patients had ESR less than 60 mm/hr., whereas 96.6% of TB without HIV patients had ESR greater than 60 mm/hr. since, ESR is a marker of chronic inflammatory states like TB and HIV is a immunosuppressive state, the co-infection of TB with HIV has drastically reduced ESR values in these patients.Conclusion:ESR values are drastically reduced in TB patients with HIV, rather TB patients per se. hence, an ESR less than 60 mm / hr in pulmonary tuberculosis patients should arouse a suspicion of underlying immunocompromised state.

Surgical procedure of the acetabulum especially in total hip arthroplasty it is necessary to evaluate the diameter of the acetabulum as a part of the pre-operative planning in order to estimate the size of the acetabular cup. The purpose of this study was to determine the sex from the acetabulum by using various parameters such as Maximum depth, Maximum transverse diameter, articular and non-articular surface. Before measuring the side of each hip bone was determined. A total of 100 hip bones were taken and individual parameters were recorded. In our study mean values of all the parameters measured were more in males than female bones. In contrast to studies reported by previous works, in our study we observed statistical correlation between acetabular dimensions chilioticline with maximum depth of acetabulum showed statistical correlation of r=0.42 in female bones. Greater Sciatic Notch with maximum depth of acetabulum showed statistical correlation of r=0.42 in male bones. These measurements are of importance during sex determination in medicolegalcases & also important in making prosthesis for hip arthroplasty.

Aim: Evaluate of Shoulder Pain, Depression and Sleep Quality in Hemiplegic Patients
Methods: The cross-sectional study which was carried in the Department of Physical Medicine and Rehabilitation, PMCH Patna, Bihar, India, for 1 year. In the scope of the study, patients with hemiplegia who applied to physical therapy and rehabilitation clinic between 2019-2020 evaluated. Patients 18 years of age or older, having a diagnosis of hemiplegia, and agreeing to participate in the study. Patients who did not agree to participate in the study were not included in the study group. The sleep quality of the patients was evaluated with the Pittsburgh Sleep Quality Index (PSQI).
Results: The study group consisted of 50 patients, 30 men and 20 women, and the average age of the patients was 69.88 ± 10.84 (20–84) years. The frequency of hemiplegic shoulder pain in the study group was found to be 20% (n=10). The median age of patients with HSP (71.5[55.0-85.0] years) and patients without HSP (71.0 [20.0-86.0]) were found to be similar (p=0.37). No significant difference was found between hemiplegia duration in patients with and without HSP (3.1[1.0-29.0] weeks vs. (4.6 [1.0-25.0]) (p=0.82). No relationship was found between having shoulder pain in patients with hemiplegia and gender, education level, family support, CT result, antidepressant use, anxiolytic use and antipsychotic use. It was found that the frequency of shoulder pain among patients with hemiplegia did not change according to ambulation status(p=0.088). The median scores of patients with and without shoulder pain on the PSQI (p=0.44) and BDI (p=0.34) scales were found to be similar.
Conclusion: No relationship was found between having shoulder pain and age, gender, family support, ambulation status, depression, and sleep quality. It was found that patients with shoulder pain had significantly worse motor functions in patients diagnosed with hemiplegia.

Introduction: Adequate pain control remains a major challenge after ambulatory surgery. Midazolam as adjunct to local anaesthetics in caudal epidural analgesia has been found effective with minimal adverse effects.
Objective: The study was carried out to evaluate the analgesic efficacy of caudal bupivacaine and midazolam in children undergoing genitourinary surgeryfor post operative analgesia and to study the side effects and complications of bupivacaine and midazolam.
Subjects and methods: Sixty children, aged2-12 were randomly selected from routine cases of pediatric genitourinary surgery in NSCB Medical college and Hospital, Jabalpur.Group B receive 0.25% bupivacaine 0.5ml/kg [n=30] and group BM receive combination of 0.25% bupivacaine 0.5ml/kg with 50 microgm/kg midazolam[n=30].Throughout the study period heart rate,arterial BP, respiratory rate were monitored. Postoperative pain was assessed by MODIFIED TODDLER PRESCHOOLER POST OPERATIVE PAIN SCALE [TPPPS].Rescue analgesia was given when pain score was 4 or more than 4. Sedation was evaluated by four point sedation score.
Results: Lowest pain score were observed in BM group. The mean duration of postoperative analgesia in group  B was 7.6+1.5hrs and in group BM was 10.43+0.95 hrs’ which was statistically significant[p<0.05]. There was no significant changes in HR,BP and respiratory rate in both groups. The incidence of nausea and vomiting were equal in both groups. No respiratory depression,motor paralysis or urinary retention in both groups during the period of study.
Conclusion- Caudal administration of bupivacaine , midazolam mixture prolongs postoperative analgesia compare to bupivacaine alone without causing any adverse effects and complications.

Introduction: Obstetric anaesthesia and analgesia are associated with many unique and different problems for the anaesthesiologists.Arterial hypotension in pregnant women following  spinal anaesthesia continue to be a matter of concern to the anaesthetist.
Objective: The study was carried out to compare the efficacy ofIVbolusPhenylephrine, Ephedrine and Mephentermine for maintenance of arterial pressure during spinal anaesthesia in caesarean section. To monitor and record side effects, if any.
Subjects and methods: The present study was undertaken on 90 subjects with American society of anaesthesiologist (ASA) type I and II who underwent lower segment caesarean sections under spinal anaesthesia and developedhypotension were selected. Cases were drawn from  obstetrics and gynaecology department of NSCB Medicalcollege and Hospital, in whom the decision was taken to perform caesarean section.The subjects are divided into 3 groups of 30 each to receive Group I -Phenylephrine 100ug, Group II - Ephedrine 6mg and GroupIII-Mephentermine  6mg IV bolus.
Results: The ANOVA test was used to compare the group among the study groups.In group I (Phenylephrine) it was observed that the peak effect was seen between 1-2 minutes,in group II (Ephedrine) between 3-5 minutes.and in group III(Mephentermine) it was seen between 5-6 minutes 
Conclusion- It was concluded that Phenylephrine,Ephedrine and Mephentermine all could be used for maintenance of arterial pressure during spinal anaesthesia for caesarean section.Phenylephrine had an immediate peak,so it may be beneficial for initial control of hypotension. It also shows some advantage over others with regard to reduction in heart rate.

Students in today’s generation used technological gadgets a lot. Engaging these tech-savvy students in the
learning process with their preferred learning style is a daunting task. The differences in teaching and
learning styles result in problems such as disengagement of students, loss of learning aptitude, and loss of
knowledge retention. Recent innovations in visualization technologies such as Virtual Reality (VR)and
Augmented reality (AR) provide avenues that allow these students to engage in a social, collaborative and
active learning environment. AR/VR refers to an immersive digital environment that simulates physical
presence in places in the real or imagined worlds whereas MR represents the merger of real and virtual
worlds to produce new environments and visualizations. Using three controlled experiments these two
emerging technologies are investigated to enhance the educational experience. The results indicated that
these technologies significantly enhance the learning experience and engage students in an active learning
process.

Gall Bladder disease is a very common problem worldwide. According to recent data
of the national registry program of India, northern part of India especially the gangetic belt
has the highest incidence.1The incidence of gall stone disease has increased in Asian
countries owing to change in their food habits, as diet in asian countries are high in calories
and fat.2

Introduction-Chronic kidney disease (CKD) is a condition in which there is structural or
functional damage to the kidneys and they are unable to function properly. Recent studies
have shown that patients with CKD have three times more of depression thanthose in the
general population. Depression in CKD patientsis also associated with poor quality of life
andadverse clinical outcome. Therefore, this study was conducted to evaluate the prevalence
of depression and factors affecting them. Materials & Method-A total of 62 patients of
either gender and aged ≥18 years diagnosed with CKD were enrolled. These patients were
analysed for demographic parameters, stage of CKD, its duration, their co-morbidities and
serum creatinine levels. Diagnostic and Statistical Manual (DSM)was used to screen
depression. Montgomery–Asberg Depression Rating Scale (MADRS) was used to rate
severity of depression. Suicidal ideations were assessed using the modified scale for suicidal
ideation. Result-The mean age of the patients was 52.4 years. Among them 59.6% were male
and 40.3% were females. In age group based analysis, majority (43.5%) of patients were
found to be elderly. The prevalence of depression was more (62.4%) in the age group of 40–
60 years. Among them 45.1 % of them were in CKD stage V and 58% of the patients were
having CKD for ≤ 3 years. Among these patients 46.7% had at least two or more
comorbidities in which 55.1% were suffering from hypertension, diabetes Mellitus &
dyslipidaemia. The level of serum creatinine showed that 51.6% had their levels <5 mg/dl.
Further, we found that 45.1 % of patients among which 37% had severe depression.
However, we found that majority of patients (56.4%) had low suicidal ideations.Conclusion-
The findings of our study suggest that CKD patients should be concurrently evaluated for
depression so that an early diagnosis of depression could be done which may help in
improving the quality of life of CKD patients. Moreover, a standard rehabilitation program
can also be designed which may be important and clinically beneficial for them.

Aims: The main aims were to assess the incidence of prehypertension amongst the medical students in our institution with its correlation with increasing Body Mass Index (BMI) & to see if there was any gender variation.
Materials & Methods: A total of 500 medical students consented to participate in this study, their BP reading were recorded after a demographic questionnaire to assess their socioeconomic status & BMI.
Results: 277 students [55.4%) were prehypertensive out of which 145(29%) students had a high SBP & 132(26.4%) had high DBF. Amongst the 227 students, 33.2% had both high SBP & DBF out of which 64.1% were boys & 35.9% were girls. In the entire study population, out of the 500 students, 25% of the boys & 40% of the girls were overweight.
Conclusions: In our centre we had more than 50% of the study group in the prehypertensive range with a higher incidence amongst boys & about 40% of the girls were overweight these figures are alarming & hence a follow-up study is required for further analysis.

Context: Treatment for lumbar disc prolapse includes conservative, interventional and operative treatment. Controversies exist regarding most effective type of conservative treatment.
Aim: To assess the efficacy of different types of conservative management in low back pain due to lumbar inter vertebral disc prolapse.
Study design: Prospective study
Methods and Materials: 160Adult patients of either sex with low back pain due to lumbar disc prolapse with or without mild neurological deficits visiting or admitted in our hospital were included in the study. 40 patients were treated with bed rest, 40 patients were allowed to continue routine daily activities, 40 patients were treated with back school exercises and 40 patients were treated with McKenzie exercises. The patients were followed for a period of three months with serial neurological examination and outcome measures.
Statistical analysis used: ANOVA and Chi square test.
Results: Back school group and McKenzie group had more favorable scores with respect to VAS, ODI and JOA score which is statistically significant(P=<0.001). Among back school group and McKenzie group, latter had better results with respect to VAS, ODI and JOA score but statistically not significant. JOA post intervention improvement is maximally seen in McKenzie group. Majority of patients from McKenzie group returned to work at the end of 12 weeks.
Conclusions: Back school exercises and McKenzie exercises have better results for low back pain due to lumbar disc prolapse compared to other types of conservative management.

Pain is the most common complaint. Axial back pain is typically present, although some patients do not have this complaint. Radicular pain is more typical and often the more “treatable” ofthe complaints. The pattern of lower extremity radiation depends on the level of the herniation. Lower lumbar or lumbosacral disc herniations can lead to the classic symptoms of pain radiating below the knee. Often pain extends into the foot and can follow a dermatomal distribution. S1 radicular pain may radiate to the back of the calf or the lateral aspect or sole of the foot. L5 radicular pain can lead to symptoms on the dorsum of the foot. Adult patients of either sex with intervertebral disc prolapse with or without neurological deficit, visiting or admitted were taken into the study. Patients with cauda equina syndrome were excluded from study. A total of 160 patients were included in the study. Patients with signs and symptoms of disc prolapse and who come under the inclusion criteria and give informed written consent were selected. Majority of our patients have disc prolapse at more than one level (65%) i.e. disc prolapse involving combination of L4-L5 & L5-S1, L3-L4 & L5-S1 etc. and others have disc prolapse at L4-L5 (23.1%) and L5-S1 (11.9%). No patients had disc prolapse at only level L1-L2, L2-L3 and L3-L4. There is no significant difference in distribution between the groups with respect to level of disc prolapse. (p=0.421).
 

Introduction: Acute Kidney Injury (AKI) following surgery for congenital heart disease
with cardiopulmonary bypass (CPB-AKI) is fairly common. Limited studies have compared
newer definitions of AKI in relation to early non-invasive urinary biomarkers for
prediction of post CPB AKI. We sought to evaluate a) incidence using pediatric RIFLE,
AKIN and KDIGO criteria, b) utility of urinary protein creatinine ratio (UPCR), modified
urine microscopy score and NGAL as predictive early AKI biomarkers and c) risk factors
for post CPB-AKI in children with CHD.
Material & Methods: Serial blood and urine samples were collected for all children (2 mo-
18 y) undergoing congenital heart surgery with cardiopulmonary bypass between Nov
2017 to Apr 2019 at pre surgery,6,24, 48 hrs and day 7, day 30. Incidence of AKI was
calculated as per standard definitions. Urine samples were analysed for UPCR
and NGAL in the supernatant and the sediments were microscopically analysed to derive a
modified urine microscopy score. Risk factors predisposing to AKI were analysed by
multivariate analysis. ROC analysis was done for urinary biomarkers taking KDIGO as
gold standard definition of AKI.
Results: Amongst 76 children with CHD, incidence of AKI was 51% with AKIN/KDIGO
criteria and 55% with pRIFLE criteria. Urinary NGAL rose within 6 hrs of CPB. A cut-off
>84 ng/ml had 95% specificity with only 45% sensitivity (AUC-ROC 0.71). At 24 hrs, urine
PCR was significantly high (AUC-ROC 0.7686) while urine microscopy score was similar
in cases who developed AKI. Ventilation >48 hrs, exposure to multiple antibiotics and
sepsis were significantly associated with AKI.
Conclusion: Combination of pRIFLE with AKIN/KDIGO increased detection of post CPB
AKI by 4%. In our cohort urinary NGAL at 6 hours and UPCR at 24 hours had a moderate
predictive value.

Background: Emotional and social challenges are higher in children with hearing loss
especially during their transition from childhood to adolescence phase. Before the cochlear
implant placement became a routine and widely accepted management modality for
treating hearing loss in children, the children felt more psychosocial issues.
Aims: The present trial was conducted to assess if children with cochlear implants
secondary to hearing loss have similar psychosocial challenges as their peers having
normal hearing patterns by assessing the responses given by children or their parents
concerning the child's health-related quality of life.
Materials and Methods: 62 subjects were divided into two categories of 8-11 years old and
12-16 years (n=31). Independent assessment of children and their parents was done. The
comparison was done of children's responses with their parent's responses, and with
responses of the control children with the normal hearing pattern. The quality of life was
evaluated using the KINDLR survey designed especially for children.The collected data
were subjected to statistical evaluation and the results were formulated.
Results:In 8-11 years old compared to their peers with the normal hearing pattern,
cochlear implants had a less positive quality of life concerning their family and physical
well-being with p< 0.0001. In 12-16 years when compared to their peers with the normal
hearing pattern, cochlear implants had a less positive quality of life concerning their
friends, school, and self-esteem with respective p-values of 0.01, 0.04, and 0.07.
Conclusion:Children with cochlear implants report their quality of life as similar to the
subjects with the normal hearing pattern. In comparison, responses by parents were
reliable and comparable to the children. The quality of life was better in young children
compared to the older children group.

Background: Metabolic and endocrine disorders are related to a significant proportion of
mortality and morbidity seen in the child population globally. The disorders and associated
comorbidities affecting various body organs including inner ear functions include diabetes
mellitus, growth hormone deficiency, childhood obesity, precocious puberty, etc.
Aims: The present clinical trial was carried out to assess high-frequency hearing,
associated tinnitus and vertigo in children with endocrine disorders including growth
hormone deficiency, precocious puberty, type 1 diabetes mellitus, obesity and idiopathic
short stature.
Materials and Methods: 120 subjects having a growth hormone deficiency, precocious
puberty, type 1 diabetes mellitus, obesity and/or idiopathic short stature, and 32 healthy
children were evaluated with a complete otolaryngologic examination followed by
otoscopic ear examination, tympanometry, vertigo, and tinnitus. The collected data were
subjected to statistical evaluation and results were formulated.
Results: PTA˃20dB was seen in 2.5% (n=3) subjects, HFA ˃20dB was seen in 5% (n=6),
PTA and HFA ˃20dB in 5% (n=6) subjects (p= 1.000, 0.465, and 1.000). 18.6% (n=19) had
tinnitus, and 8.82% (n=9) had vertigo. Presence of vertigo and tinnitus in study subjects
with ISS seen in 22.7% (p=0.04). Vertigo with PTA and HFA value ˃20dB was seen in
3.84% (n=1) subject with GHD, 5.88% (n=2) with Type1 DM, 4% (n=1) with obesity, and
3.06% (n=3) subjects in whole experimental group.
Conclusion: Within its limitations, the present study concludes that endocrine diseases
manifested in childhood can lead to alterations in the inner ear with poorly understood
aetiology. However, the study suggests a balance examination and thorough hearing
examination be done in all children visiting endocrinology clinics to detect and treat any
associated abnormality at an early stage.

Background: Severe acute maternal morbidity has long-term ill effects on socioeconomic
condition and health of the females including excessive financial burden post-treatment
which may last lifelong to the desertion of females after hysterectomy considering the
inability to reproduce.
Aims: The present clinical trial was carried out to assess the incidence and various causes
leading to SAMM. Also, the trial was aimed at factors associated with the instance of nearmiss
cases or SAMM.
Materials and Methods: 82 SAMM cases and 4 maternal deaths were evaluated based on
the WHO criteria. The data were maternal deaths, demographic data, complications
encountered, gestational age at the time of SAMM, SAMM event time from admission
time, ICU admission, and associated organ failure/dysfunction. The collected data were
subjected to statistical evaluation and the results were formulated.
Results: Maternal death resulted from abdominal pain in 75% (n=3) and breathlessness in
25% (n=1) female. The disorders associated with SAMM were surgical cause,
haemorrhage, hypertension, indirect causes, and medical conditions respectively in 1.21%
(n=1), 32.92% (n=27), 63.41% 9n=52), 2.43% (n=2), and 18.29% (n=15) females. The
etiology of 4 deaths was due to 50% (n=2) deaths each from cardiac and respiratory
etiology in females with the gestational age of 30.10±2.14 weeks and 25.7±1.3 years of age.
Near-miss cases were 34.14% (n=28) due to compromised transport facility.
Conclusion: The present study concludes that severe acute maternal morbidity affects
significant females and is the leading cause of maternal death. The most common factor
associated with SAMM is in the present study was hypertension leading to morbidity
followed by hemorrhage, whereas, leading causes for morbidity were respiratory and
cardiac causes.

Background: Despite various advancements for screening, detection, prevention, and
treatment of Oral cancer, potentially malignant oral carcinomas remain one of the most
prevalent cancers contributing to significant mortality raising concern. Modifiable factors
identified in oral cancer are immunity and diet.
Materials and Methods: 30 subjects (10 healthy and 20 with oral lesions) from both the
genders and age range of 25-55 years were divided into 3 groups of 10 subjects each.
Group I: normal healthy, group II: oral leukoplakia, and group III: oral carcinoma
subjects followed by blood investigations. The diamine oxide method was used to evaluate
ceruloplasmin and the atomic absorption spectrometer method of Sir Alan Walsh was used
to analyze selenium. Collected data were subjected to statistical evaluation for results
formulation.
Results: On intergroup comparison, it was seen that the mean value for selenium in ng/ml
were 119.935, 109.15, and 99.6228 for Group I, Group II, and Group III respectively,
whereas for ceruloplasmin these values were 31.748, 81.413, and 90.7122 respectively for
group I, group II, and group III.
Conclusion: The present study concludes that the most important defense system to prevent
cell damage by free radicals is the use of antioxidants. Detection of selenium and
ceruloplasmin in the serum of the affected subject can serve as a reliable biomarker in
subjects having precancerous lesion (leukoplakia) and oral carcinomas (squamous cell
carcinoma).

Dengue or break bone fever caused by a RNA virus of arbovirus family is spread by Aedes
mosquitoes. It has wide range of presentations ranging from asymptomatic to dengue
hemorrhagic fever with or without shock.In severe conditions it involves heart, liver and
brain with liver as the most common organ involved. Clinical outcome is related to multiple
parameters including high PCV and low platelet count. The frequency of liver involvement
shows variable results with hepatomegaly found in 4 – 52% of cases. The association
between liver injury with PCV and platelet count is not well studied.
Objectives
1. To study the transaminase level in dengue infections as an evidence of hepatic dysfunction.
2. To study the association of liver transaminases with hemodynamic factors like hemoglobin,
packed cell volume, platelet count in dengue patients with liver dysfunction.
Methodology
This is a retrospective cross sectional study conducted using the patient data of the dengue
outbreak in August to October 2017 at Vinayaka Missions Medical College and Hospital,
Karaikal. All dengue patients (n=201) diagnosed with positive dengue Non Structural-1 or
IgM positive were included. After getting institute ethical clearance, AST, ALT, PCV,
Platelet count and baseline data were collected.
Results
Among 201 dengue infected cases, 62% were males and 38% were females. Among them
31% and 45% were having elevation of AST and ALT respectively. Major proportion of
those with elevated liver transaminases were middle aged and among the transaminases
AST was found to be predominantly raised than ALT. Platelet was significantly decreased
in dengue patient with high ALT and high AST compared to that of normal ALT and AST
counterparts. Platelet count showed statistically significant negative correlation with AST
and ALT levels. PCV showed a significant negative correlation with AST levels.
Conclusion
Increase in AST and ALT levels shows the involvement of liver in the dengue patients. A
negative correlation was seen between liver enzymes and platelet levels implying a common
mechanism for both liver injury and low platelet count. Further studies are needed to find
their basis, which may help in early detection of complications and in applying treatment
regimens for dengue patients.

Background: shifting of the school classes to online format owing to social distancing
norms led to amplification of academic stress, independent learning pressure, dropouts,
everyday life abandonment, less study chance made researchers focus on assessing the
impact of coronavirus on the mental condition of the students. This requires prompt
intervention as stress can further increase in subjects adopting conventional coping
strategies and in subjects with pre-existing stressors.
Aim: The present study was conducted to assess stress, anxiety, and depression in subjects
at a defined geographical area to assess psychological needs in subjects dealing with
causal factors and the pandemic.
Methods: In 156 subjects, DASS 21 scale was used having 21 questionnaires that were
answered by the subjects themselves and were concerned about stress, anxiety, and
depression. The responses were recorded on a scale of 0 to 4 where 0 meant little time/none
and 3 meant most of the time. The responses were recorded based on symptoms severity in
the last week before answering the questionnaire. The interpretation of the DASS 21 scale
was divided into categories of normal, mild, moderate, severe, or very severe. The collected
data were subjected to statistical evaluation.
Results: For gender, only anxiety was statistically significant (p=0.01) which was higher in
females with the value of 1.72±0.993 compared to males with the value of 1.47±0.881. For
the age anxiety levels were significantly higher in subjects of age ≤ 20 years with 1.76±1.01
compared to ≥ 21 years with the value of 1.52±0.883 (p=0.02). For familial history also
significantly correlated to anxiety with p=0.004, whereas for depression and stress the pvalues
were 0.758 and 0.238 respectively and were non-significant. For family history, it
was significantly related to anxiety with a p-value of 0.12, whereas, it was non-significantly
related to depression and stress with respective p-values of 0.753 and 0.297. The
socioeconomic status was also significantly associated with anxiety with the low
socioeconomic group having a strong association having a p-value of 0.25.
Conclusion: The present study concludes that the depression, anxiety, and stress in
students during COVID-19 was seen ranging from mild to severe levels, whereas, majority
European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 08, Issue 04, 2021
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of the students showed normal levels of DASS. Also, positive family history of COVID-19
and family income was associated with increased depression, anxiety, and stress in the
students.

Aim and objectives: The present study assessed the functional outcome with various methods of management of intra-articular fracture of calcaneum.
Materials and method: This prospective randomized clinical study assessed the functional outcome with various methods of management of intra-articular fracture of calcaneum. The study was conducted on acute fracture of calcaneum admitted and treated in Muzaffarnagar Medical College, Muzaffarnagar UP. The student t-test was used for comparing the mean values between the 2 groups whereas chi-square test was applied for comparing the frequency. The p-value was considered to be significant when less than 0.05.
Results: The mean age of the study population was 45.90±20.57 (range = 11-80) years. There were 9 (30.0%) females and 21 (70.0%) males among the study population.
Ankle Society (AOFAS) Ankle Hindfoot scoring system was significantly more among Surgical treatment compared to the Conservative treatment. The mean Bohler Angle 3 months post-operatively and 6 months post-operatively was significantly more among Conservative treatment compared to Surgical treatment. Wound-healing complications were significantly more among Surgical treatment compared to the Conservative treatment.
Conclusion: The reason behind the improved results with open reduction and internal fixation in our series may be due to less traumatic techniques and stronger but malleable implants. Also locking plates for calcaneum decrease the need for bone graft, allow early weight bearing and it provides rigidity especially in osteoporotic cancellous bone.Aim and objectives: The present study assessed the functional outcome with various methods of management of intra-articular fracture of calcaneum.
Materials and method: This prospective randomized clinical study assessed the functional outcome with various methods of management of intra-articular fracture of calcaneum. The study was conducted on acute fracture of calcaneum admitted and treated in Muzaffarnagar Medical College, Muzaffarnagar UP. The student t-test was used for comparing the mean values between the 2 groups whereas chi-square test was applied for comparing the frequency. The p-value was considered to be significant when less than 0.05.
Results: The mean age of the study population was 45.90±20.57 (range = 11-80) years. There were 9 (30.0%) females and 21 (70.0%) males among the study population.
Ankle Society (AOFAS) Ankle Hindfoot scoring system was significantly more among Surgical treatment compared to the Conservative treatment. The mean Bohler Angle 3 months post-operatively and 6 months post-operatively was significantly more among Conservative treatment compared to Surgical treatment. Wound-healing complications were significantly more among Surgical treatment compared to the Conservative treatment.
Conclusion: The reason behind the improved results with open reduction and internal fixation in our series may be due to less traumatic techniques and stronger but malleable implants. Also locking plates for calcaneum decrease the need for bone graft, allow early weight bearing and it provides rigidity especially in osteoporotic cancellous bone.
Aim and objectives: The present study assessed the functional outcome with various methods of management of intra-articular fracture of calcaneum.
Materials and method: This prospective randomized clinical study assessed the functional outcome with various methods of management of intra-articular fracture of calcaneum. The study was conducted on acute fracture of calcaneum admitted and treated in Muzaffarnagar Medical College, Muzaffarnagar UP. The student t-test was used for comparing the mean values between the 2 groups whereas chi-square test was applied for comparing the frequency. The p-value was considered to be significant when less than 0.05.
Results: The mean age of the study population was 45.90±20.57 (range = 11-80) years. There were 9 (30.0%) females and 21 (70.0%) males among the study population.
Ankle Society (AOFAS) Ankle Hindfoot scoring system was significantly more among Surgical treatment compared to the Conservative treatment. The mean Bohler Angle 3 months post-operatively and 6 months post-operatively was significantly more among Conservative treatment compared to Surgical treatment. Wound-healing complications were significantly more among Surgical treatment compared to the Conservative treatment.
Conclusion: The reason behind the improved results with open reduction and internal fixation in our series may be due to less traumatic techniques and stronger but malleable implants. Also locking plates for calcaneum decrease the need for bone graft, allow early weight bearing and it provides rigidity especially in osteoporotic cancellous bone.
 

Aim: To compare the Needle Aspiration vs Incision and Drainage of Lactational Breast Abscess.
Methods: This prospective study was conducted on 100 patients with the primary diagnosis of lactational breast abscess were included in this study. The patients were then divided into two treatment groups A and B with 50 patients in each group.  Patients with abscesses of size < 5cm and lactational breast abscess were included in the study. Patients with co-morbid conditions were excluded from the study.
Results: Our study reported a total of 60 abscesses in the lower quadrant. Even if the abscess was located in more than one quadrant, we had considered that quadrant of the abscess which had the maximum diameter. In the study 54% of the patients were primipara and 46% were multipara. Maximum number of patients (62) had Lower Segment Caesarean Section. In our study more number of patients were presented within the first 6 weeks (86%). In our study we had noticed 64% of the abscesses grow Methicillin resistant Staphylococcus aureus(MRSA).This is followed by Staphylococcus aureus (24%). Other organisms identified in the culture are Corynebacterium diphtheria, S.agalactea and S.epdermidis. The mean duration of healing in group A and group B was 19 days and 30 days respectively. Out of 50 patients in group A only 43 were successfully treated by aspiration. In group B all the 50 patients were treated by incision and drainage. The failure rate of aspiration was 14%.
Conclusion: We concluded that the breast abscess in patients with diameter of less than 7 cm can be treated with needle aspiration successfully and with a good cosmetic outcome.

Aim: To study the outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis:
Methods: 80 patients were included in the study. They were divided into two groups with 40 patients in each group. Group A: (40) patients who underwent laparoscopic cholecystectomy after 48 hours from day of admission. Group B: (40) patients who discharged home after resolution of the acute phase and underwent laparoscopic cholecystectomy after 6 weeks. Both groups were compared as regard: operative time, intraoperative findings and complications, conversion to open surgery, use of abdominal drains, hospital stay, post operative complications, readmission after discharge.
Results:  The mean age of patients in group A was 36.29 ± 10.33 years (range= 20-55 year) while in group B     was 37.58 ± 10.22 y (range= 20- 53 y). The majority of the patients were female. 24 patients (60%) in group A and 32 patients (80%) in group B. In group A the operative time ranged from 46 minutes to 89 minutes with a mean of 67.5±11.69 minutes, while in group B operative time ranged from 39 minutes to 76 minutes with a mean of 57.5±9.98 minutes . P value was significant 0.014. In group A 5 patients (12.5%) have intraoperative finding of acute cholecystitiswhere as none of group B express acute cholecystitisintraoperatively, with no statistically difference (p value 0.069). There was no significant difference in intraoperative complications between both groups. The difference between the two groups is significant (0% vs. 40%, p < 0.0001). 7 patients (17.5%) required hospital readmission due to severity of the symptoms. 10 patients (25%) had biliary colic, 3 patients (7.5%) developed acute cholecystitis, and 4 patients (10%) had recurrent biliary pancreatitis.
Conclusion:  We concluded that the early cholecystectomy in patients with mild acute biliary pancreatitis has no added risk of intra or post operative complications than delayed cholecystectomy. Also it significantly reduces the risk of recurrent biliary problems and length of hospital stay which has a great impact on the patients and health care resources .

Background:Dry eye is a disorder of the tear film which occurs due to tear deficiency or
excessive tear evaporation. The present study compared preserved and preservative-free
hydroxypropyl methylcellulose-dextran-containing eyedrops.
Materials & Methods: 56 patients of dry eyes disease were divided into 2 groups of 28 each.
Group I were prescribed dextran 70, 1 mg/ml and hypromellose, 3 mg/ml hydroxypropyl
methylcellulose (HPMC) and group II 0.3 g HPMC and 0.1 g of dextran 70, with 0.01%
benzalkonium chloride (BAK). The ocular surface disease index (OSDI) questionnaire, tear
break up time (TBUT), corneal and conjunctival staining and Schirmer test were performed.
Results: The mean OSDI score at baseline was 42.6 and 39.4 and at 4 weeks was 32.7 and
28.1 in group I and II respectively, TBUT (sec) at baseline was 7.6 and7.4 and at 4 weeks
was 7.1 and 8.1 in group I and II respectively, conjunctival score at baseline was 6.78 and
7.32 and at 4 weeks was 5.30 and 5.4 in group I and II respectively, corneal score at baseline
was 1.47 and 1.24 and at 4 weeks was 0.52 and 0.41 in group I and II respectively and
schirmer test (mm) at baseline was 6.07 and 6.12 and at 4 weeks was 6.80 and 7.25 in group I
and II respectively. The difference was significant (P< 0.05).
Conclusion: Both preserved and preservative-free hydroxypropyl methylcellulose-dextrancontaining
eyedrops were effective in reducing symptoms of dry eyes disease.

Aims & Objectives: Millions of people have low back pain, which causes more disability
than any other health condition. The present study was planned for comparing the
functional outcomes between pregabalin versus gabapentin in Cases of Low Back Ache
with radiculopathy.
Materials & methods: A total of 100 subjects with presence of low back ache with
radiculopathy were enrolled. Clinical and MRI examination of all the patients was done.
All the 100 patients were divided into two study groups with 50 patients in each group as
follows: Gabapentin group and Pregabalin group. Capsule pregabalin 75 mg one time a
dayorally and tablet gabapentin 300 mg one timea day was given in the respective groups.
Both drugs were given at night time. Pain intensity was assessed at the start of study i.e. at
baseline (0 week), at 1 month and three months using VAS. Complications were recorded
on each visit. All the results were recorded and analysed by SPSS software.
Results: Mean VAS at baseline, one month and three months among patients of group
Pregabalin was 8.91, 6.96 and 3.16 respectively. Mean VAS at baseline, one month and
three months among patients of group Gabapentin was 8.12, 6.43 and 3.58 respectively.
While making intra-group comparison, significant results were obtained. However; while
comparing the mean VAS between the two study groups, non-significant results were
obtained at different time intervals. Sedation as a side effect was significantly more
common in Pregabalin group.
Conclusion: Gabapentin was better in comparison to pregabalin in having fewer side
effects.