European Journal of Molecular & Clinical Medicine

Background: Distal radius fractures shows Bimodal distribution about 25% of the fractures in paediatric age group and 18% fractures in adults. The goals of treating distal radius fractures include articular congruity, radial alignment and length, functional mobility, stability.
Aim: To assess the functional outcome of column specific fixation for intraarticular distal radius fractures with k wire
Material and Methodology: Study was conducted between July 2019 and July 2021 in department of orthopaedics, RMMCH, 23 patients with intra articular distal radius fracture were included in our study. Follow up was done for a minimum of 6 months period, functional outcome was assessed using the Quick DASH scoring system
Results: Of the 23 patients based on our quick DASH scores

Excellent to good results were obtained in 20 patients
Satisfactory results were seen in 3 patients
None of the patients had poor results
Two patients had wrist stiffness attributed to the non compliance with physiotherapy for mobilisation
One patient had mal union due to malreduction attributed to the late presentation to hospital

Conclusion: Column specific fixation with k wire is a less invasive method of treatment of intraarticular distal radius fractures. Although complications like stiffness and malunion were noted it was due to non compliance and late presentation. Hence we would like to conclude that column specific fixation of intraarticular distal radius fractures with k wire shows good long term functional outcome.

Background: Thyroid swelling is a condition commonly encountered by General Surgeons. Some patients need only Medical Management, whereas others need Surgical management in the form of Hemi or Total Thyroidectomy. Compared to RLN the EBSLN is less studied in terms of course and relation to thyroid gland intraoperatively. In our study we observed the course and relation of EBSLN with respect to the thyroid gland during surgery.
Materials and Methods: A prospective analysis of 60 patients who underwent thyroidectomy in General Surgery department in Rajah Muthiah Medical College was done. Intraoperatively, the EBSLN was visually identified and preserved before proceeding to ligate the superior thyroid vessels. The nerve was classified according to the Cernea classification.
Results: In 60 patients, 95 nerves were planned to be identified. The nerve was type 1 in 28/95 (29.5%), Type 2a in 46/95 (48.5%), and Type 2b in 11/95 (11.5%) patients. The nerve could not be identified in 10/95 (10.5%) patients.
Conclusion: The course and relation of EBSLN with respect to thyroid gland varies in different thyroid pathologies.

Aim: To evaluate the clinical and radiological outcome of proximal third tibia fractures managed by intramedullary nailing in knee semi-extended position via the suprapatellar approach.
Methodology: Our study consists of proximal one third tibial shaft fractures which were treated with nailing via suprapatellar approach. The study was done under Rajah Muthiah Medical College and hospital, Duration of the study from May 2019 to December 2021. The patients were followed at intervals of 1 and 6 months and 1 year. Patients were observed for affect in daily day to day activities, union, shortening. The functions were assessed using Lower Extremity Functional Scale (LEFS).
Results: In 20 patients of proximal 1/3^rd fracture of tibia within the study with a mean follow-up of 1 year. On an average of 6-7 months the fractures united radiologically. At the top of 1 year, the typical LEFS was 86%. 4 patients had delayed union in that 1 patient had significant bone loss followed by bone grafting and transpositional gastrocnemius flap was done, one patient pre-operatively had anterior skin discolouration which was debrided. Eventually all the fractures were united. There were no post-operative knee pain seen.
Conclusion: Suprapatellar nailing performed with proper instrumentation, proper surgical technique is a viable option in management of proximal 1/3^rd tibial fractures. Which has excellent radiological and clinical outcomes with lower complications on comparing to other management. This may be a viable option for proximal 1/3^rd (extra-articular) tibia fractures thanks to its inbuilt advantages of placement, perfect nail entry and positioning.

Background: Spinal anaesthesia is the most commonly used technique for lower abdominal
surgeries as it is very economical and easy to administer. Dexmedetomidine, a new highly
selective α2-agonist, is under evaluation as a neuraxial adjuvant as it provides stable
hemodynamic conditions, good quality of intraoperative and prolonged postoperative
analgesia with minimal side effects.
Methods: Prospective double blinded, placebo-controlled study was undertaken in 60
patients allocated randomly by envelop method, divided into 2 groups (30 in each) between
18-50 years of age of either gender belonging to ASA class I and II scheduled for elective
lower segment caesarean section. Group A received 2 mL of 0.5% hyperbaric bupivacaine
and 0.2ml dexmedetomidine and Group B received 2ml of 0.5% hyperbaric bupivacaine with
0.2ml normal saline. The comparison was studied using the Chi-square test or Fisher's exact
test as appropriate, with the P value reported at the 95% confidence interval. P<0.05 was
considered statistically significant.
Results: The addition of dexmedetomidine resulted in a dose dependent prolongation of
sensory regression to S1 segment, prolonged motor block, the time to first analgesic rescue
was significantly prolonged in Group B as compared to Group A and showed Lower pain
scores as compared to placebo group.
Conclusion: Based on study results we recommend addition of dexmedetomidine 5 μg to
intrathecal hyperbaric 0.5% Bupivacaine 9 mg in elective lower segment caesarean section.

Background: Based on well-known properties of propofol over last few years this study was
undertaken to evaluate whether priming principle applied for the induction dose of propofol
would affect the total induction dose requirement and reduce the associated side effects.
Methods: The prospective randomized study was undertaken in 100 patients allocated
randomly by envelop method, between 18-55 years of age of either gender belonging to ASA
class I and II scheduled for elective surgeries under general anaesthesia. In group I Inj.
fentanyl 2 μg/ kg administered over a period of 30 seconds intravenously and then induced
with the calculated dose of Inj. Propofol 2mg/kg until the loss of eyelash reflex. In group II,
30 % of the total calculated dose of Inj. propofol 2mg/kg 30 seconds after the administration
of Inj. Fentanyl 2μg/kg over 30 seconds, which will be followed by the administration
remaining calculated dose till the loss of eyelash reflex. Statistical analysis of the
demographic data was done using chi-square test. Comparison between the groups for the
induction dose and haemodynamic parameters was done using student ‘t’ test.
Results: The average induction dose required was 1.53mg/kg with a mean reduction of
23.89%in the induction dose requirement of propofol was observed in the study group. The
haemodynamic parameters were better in study group II compared to the control group I.
Conclusion: Based on study result we recommend application of ‘priming principle’ for
induction dose of propofol.

A few studies based on published data have indicated patterns of anthropometric variation
along ethnic, geographic, latitude, longitude and altitude, nutrition and several confounding
variables.Many growth studies have been published for the tribal populations of Chhattisgarh.
However, no study, especially with regard to the growth status of the Oraons of Chhattisgarh
has been undertaken. Cases taken in this study were registered cases in government schools
of Jashpur district. 200 boys (100 Oraon and 100 Non Oraon) were included in the study
according to inclusion and exclusion criteria. Age range was 5-18 yrs. At most of the ages
BMI was less for OT boys than NO boys, except at the age periods of 17+ and 18+ where the
BMI of OT boys was more than NO boys. In the age period of 15+ the BMI of OT and NO
boys was found to be same. The difference was statistically significant at age periods of 7+,
8+ and 10+and highly significant in age period of 17+

AIM: Study aimed to assess the burden of psychological morbidity due to lockdown in
the pregnant females.
MATERIAL AND METHODS: It was an observational study conducted in the
department of obstetrics &gynecology, GMC Kathua during the covid lockdown period
from June 2020 to August 2020. 100 antenatal patients attending OPD were included
in the study after excluding those with hypertension, diabetes, heart disease, bleeding
pv,IUGR,oligohydramnios,threatened preterm labour, known psychiatric illness or
taking psychotropic medication, prior sleep disorder. The patients were assessed using a
questionnairewhich was framed using various scales such as PHQ-9 for Depression,
GAD7 for anxiety, Perceived Stress Scale and Insomnia severity index , in addition to
incorporating various sociodemographic and obstetrical details.The arbitrary division
of PHQ‑ 9 scores into ratings of minimal (0–4),mild (5–9), and moderate to severe
depression (≥10) suggested by Reddy et al. was used in this study. Cutoff points of 5, 10,
and 15 were interpreted as representing mild, moderate, and severe levels of anxiety on
the Generalized Anxiety Disorder-7 (GAD-7). Insomnia severity index scored on a fivepoint
Likert’s scale (0 = no problem to 4 = very severe problem). Score of 0–7 depicted
absence of insomnia, 8–14 showedsubthreshold insomnia, 15–21 represented moderate,
and 22–28 showed severe insomnia.

Aim: To evaluate the role of early Vs delayed laparoscopic cholecystectomy in mild and
moderate acute gallstone pancreatitis
Methods:This randomized prospective study conducted in the Department ofSurgery after
taking the approval of the protocol review committee and institutional ethics committee. 100
patients were included in the study. They were divided into two groups with 50 patients in
each group. Patients with mild and moderate acute gallstone pancreatitis were included in this
study.

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.

Aim: To evaluate the fundus changes in patients withGestational
hypertension,preeclampsia oreclampsia.
Methods: All the patients who fulfilled the diagnostic criteria of Gestational
hypertension, preeclampsia or eclampsia(>20 weeks of pregnancy, high arterial blood
pressure of more than or equal to 140/90 , proteinuria more than or equal to
300mg/day or protein creatinine ratio more than or equal 30 mg/mmol or evidence of
maternal organ dysfunction or uteroplacental dysfunction , convulsions or coma) were
included in this study. After taking history for any eyesymptoms, anterior segment was
examined with torch light on the bed itself. Both pupils were dilated with 1%
tropicamide eye drops and fundus examination was done by ophthalmologist with direct
ophthalmoscope in a semi dark room in the ward. Hypertensive retinopathy changes
seen in right or left or both eyes, was taken as positive findings in that patient.
Results: A total of 100 patients were examined. The mean age of patients was 31.2±6.2
years (range 20-50 years). The gestation period ranged between 25 and 41 weeks. 45
(45%) were primigravidas , 33 (33%) were multigravidas and 22(22%) were
grandmultiparas. 41(41%) had mild preeclampsia, 56(56%) had severe preeclampsia
and 3(3%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in
58(58%) patients . There was statistically significant positive association between the
presence of retinal changes and blood pressure (P =0.001), proteinuria (P=0.021) and
severity of hypertensive disorders( P=0.027). However, age(P = 0.44), race ( P=0.89) and
gravida (P =0.37 were not associated with occurrence of retinopathy in our study.
Conclusion: Fundus examination in gestational hypertension , preeclampsia and
eclampsia is important in monitoring and managing cases as it correlates with severity
as it indirectly implies severity of changes in placental micro-circulation that can help to
predict the foetal outcome and ocular morbidity.

common infection. The disease is caused by dermatophytes belonging to genera of
Trichophyton, Microsporum and Epidermatophyton. The present study was conducted
to compare topical amorolfine, sertaconazole and terbinafine in patients with tinea
corporis and tinea cruris.
Materials & Methods: 90 patients with tinea corporis and tinea cruris of both genders
were included. Patients were divided into 3 groups of 30 each. Group I were prescribed
topical application of amorolfine (0.25%) once daily, group II were given sertaconazole
(2%) twice daily and group III were given terbinafine (1%) twice daily. Response to
treatment was assessed after 3 weeks.
Results: Group I had 14 males and 16 females, group II had 17 males and 13 females
and group III had 12 males and 18 females. The mean value of scaling was 0.92 in group
I, 1.14 in group II and 0.78 in group III. The mean value of erythema was 0.94 in group
I, 1.42 in group II and 0.56 in group III. The mean value of pruritus was 1.12 in group I,
1.32 in group II and 0.65 in group III. The response was poor seen in 42% in group I,
22% in group II and 44% in group III. Moderate seen in 40% in group I, 46% in group
II and 48% I group III and good seen in 18% in group I, 32% in group II and 8% in
group III. The difference was non- significant (P> 0.05).
Conclusion: Sertaconazole found to be effective as compared to other agents in
management of cases of tinea corporis and tinea cruris.

Background: Pharmacovigilance relates to the activities concerning the detection,
assessment, understanding and prevention of these adverse drug reactions. The present
study was conducted to asses adverse drug reactions in known population.
Materials & Methods: 250 adverse drug reactions reported in 1 year were recorded.
The data were obtained from the ADR monitoring centre. Each ADR was assessed for
demographic data, relationship to drugs as per causality assessment, and frequency of
ADRs.
Results: Age group 20-40 years had 35 male and 30 female, 40-60 years had 40 male and
55 females and >60 years had 45 male and 45 females. ADRs were reported in oncology
in 12, dermatology in 45, ENT in 30, orthopaedics in 20, general surgery in 50, general
medicine in 43, gynaecology in 35 and psychiatry in 15 cases. Type of reaction was
nausea/ vomiting in 45%, rash in 30%, headache in 12%, abdominal pain in 4%,
diarrhoea in 5% and constipation in 4%. Common drugs leading to ADRs were
NSAIDs in 35%, antibiotics in 20%, anti- hypertensive in 8%, anti- diabetics in 12%,
anti- tubercular in 15% and CNS drugs in 10%. The difference was significant (P<
0.05).
Conclusion: Common drugs leading to ADRs were NSAIDs, antibiotics, antihypertensive,
anti- diabetics, anti- tubercular and CNS drugs.

Background: Vernal keratoconjunctivitis (VKC) is a chronic recurrent non-infectious
allergic disease that generally affects children and young adults. The present study was
conducted to assess efficacy of topical 0.05% cyclosporine in
Vernalkeratoconjunctivitis.
Materials & Methods: 86 patients diagnosed with Vernalkeratoconjunctivitis (VKC) of
both genderswere enrolled. All were prescribed topical 0.05% cyclosporine 4 times a
day. Patients underwent complete ophthalmic examination and symptoms and signs and
intraocular pressure using rebound tonometer. The patients were evaluated at weeks 4,
8 and 12 after the initiation of therapy. Symptoms and signs before and after treatment,
during the four-week intervals, were recorded and scores between 0 and 3 were
assigned.
Results: Out of 86 patients, males were 56 and females were 30. Median of symptoms
score at baseline was 11, at 4 weeks was 4, at 8 weeks was 5 and at 12 weeks was 4. Sign
score at baseline was 6, at 4 weeks was 4, at 8 weeks was 3 and at 12 weeks was 3. The
difference was significant (P< 0.05).
Conclusion: Topical cyclosporine 0.05% help to reduce corticosteroid usage, is an
effective and safe alternative for the treatment of resistant VKC.

Aim: To compared the oxiport laryngoscope blade versus miller laryngoscope blade for
intubation in neonates and infants during general anesthesia.
Methods: This controlled interventional single-blind study conducted in the,
Department of Anesthesiology. 60 neonates/infants in groups of 30 each posted for
surgery in paediatric operation theatre over a period of 6 months were included in the
study. Full-term neonates and infants up to 6 months of age of either sex requiring
general anaesthesia with endotracheal intubation for elective as well as emergency
surgery were included in the study.
Results: Out of the 60 patients 30 patients in Miller group and 30 patients in Oxiport
group were included. Both groups were comparable with respect to age, sex, weight,
mean time to intubation (P = 0.61) and anaesthesiologist performing the laryngoscopy
(P = 0.69).Mean lowest SpO2 recorded was 97.21% ± 3.69% in Miller group and 99.77%
± 2.63% in Oxiport group. This difference was statistically significant (P = 0.039). The
incidence of mild desaturation (SpO2 up to 90%) was 86.67% in Miller group and
93.33% in Oxiport group. The incidence of moderate desaturation (SpO2 between 85%
and 92.5%) was 3.33% in Miller group and 5% in Oxiport group. Incidence of severe
desaturation (SpO2<85%) was 16.67% in Miller group and 0 in Oxiport group.
Correlation between time to intubation and SpO2 in Miller group (Pearson’s R2 =
−0.14) was statistically not significant at P = 0.39. Correlation between time to
intubation and SpO2 in Oxiport group (Pearson’s R2 = −0.38) was statistically
significant at P = 0.001. Both groups were comparable with respect to the type of
surgery (abdominal, thoracic, miscellaneous) (P = 0.68). Abdominal surgeries were
associated with a higher number of severe desaturations (80%) compared to thoracic
(10%) and miscellaneous (10%) surgeries.
Conclusion: we concluded that the apnoeic laryngeal oxygen insufflation with Oxiport
laryngoscope blade decreased the incidence of severe desaturation while intubating
neonates and infants. This was easily done as it was non-cumbersome and did not
increase the overall cost of anaesthesia.

Objectives:

Outlines the necessity of early diagnosing and management of lisfranc injury and metatarsal fracture to avoid chronic instability.
Advantages of plate fixation for (proximal) fifth metatarsal fracture in addition to k-wire.
To assessing the functional outcome and duration of union using MIPPO technique in the management of distal third tibia fracture.

Materials and Methods:
Case Report: We report a case of 32 year old man presenting with multiple injuries to foot and ankle diagnosed as comminuted distal third tibia fracture (with medial malleolus fracture) with panmetatarsal fracture with lifranc dislocation of right lower limb. A single stage procedure done for fixation of all these injuries.
Result; The patient follow up for one year, mean duration union of all fractures noted radiologically by 11±2 weeks. Patient allowed to weight bear after 3 months, Functional range of motion improved from the end of 3 months to 8 months. Prospective functional evaluation of this patient assessed by American orthopaedic foot and ankle society score (AOFAS) 96/100 at the end of 6 months and Pain relief is evaluated periodically by visual analogue scale.
Conclusion: Best results are obtained by immediate anatomical reduction and fixation of lisfranc injuries. In addition to k-wire, plate fixation for fifth metatarsal provides alignment with high union rate, especially when the fracture is comminuted. MIPPO technique is reliable fixation in fracture of distal tibia preserving most osseous (periosteal) blood supply and haematoma  in fracture site and in turn provides  more biological repair.

Introduction: In the overview of literature studies, radiocarpal fracture dislocations are very rare injuries and accounts only 0.2% ¹ of dislocations. The mechanism of injury includes motor vehicle accident, fall from height and work place injuries. These injuries were thought to have poor outcomes and high morbidity.
Purpose of study:-

To enumerate the practical difficulties in fixing a volar radiocarpal fracture dislocations.
To give a functionally mobile joint and prevent the complications of osteoarthritis and arthrosis.

Case report: A 56 years old male, electrician by occupation sustained a self fall from height                (10 feet) while climbing an electric post. He had an open injury to left wrist joint, radius and ulna were dislocated volarly. It was classified as Type 2 radiocarpal fracture dislocation. We fixed it with k-wires and external fixator via dorsal and volar approaches.
Conclusion: Our case study as an adjunct to previous literatures, the outcome came to be good. Radiocarpal fracture dislocation with ulna dislocation needs an earlier intervention with proper preoperative planning. DRUJ instability was common in these patients and required radioulnar pinning.

Introduction: Tympanic  membrane forms a important part of middle ear hearing mechanism .Long standing middle ear inflammation leads to atelectasis of the membrane which gradually results in adhesive otitis media .Material and methods : This is a prospective research was done over 50 candidates of adhesive otitis media to study the outcome of the management of adhesive otitis media tympanoplasty with or without canal wall up mastoidectomy .Results : Both the group showed comparable results with improvement in hearing and state of middle ear on subsequent long term follow up .Conclusions :The outcome of surgical management of adhesive otitis media depends upon patient’s factor and surgeon competency .Moreover it depends patient’s benefit from different approaches

Background: Dry eye is one of the most important causes of ocular
morbidity.Postmenopausal women often present with dry eye symptoms. The purpose of
this study is to assess the pattern of dry eye in post menopausal women attending
ophthalmology OPD in GMCJammu.
Material and methods:A cross-sectional study was conducted on 200 patients attending
ophthalmology OPD in GMCJammufrom June 2018 to December 2018.After the detailed
history,patients were subjected to complete ophthalmic examination,dry eye tests for
example schirmer’s test and tear film breakup time were done, for the assessment of dry
eye.
Results:Out of the 200 patients,most commonly dry eye was seen in the age group 61 to 65
years and mostly in patients engaged in outdoor occupation.
Conclusion: If the symptoms are detected early,patients can be benefitted. The optimal care
includes early detection and adequate use of lubricants in these patients.

Background: Vernal keratoconjunctivitis (VKC) is a chronic recurrent non-infectious
allergic disease that generally affects children and young adults. The present study was
conducted to assess efficacy of topical 0.05% cyclosporine in Vernalkeratoconjunctivitis.
Materials & Methods:86 patients diagnosed with Vernalkeratoconjunctivitis (VKC) of both
genderswere enrolled. All were prescribed topical 0.05% cyclosporine 4 times a day.
Patients underwent complete ophthalmic examination and symptoms and signs and
intraocular pressure using non contact tonometer. The patients were evaluated at weeks 4,
8 and 12 after the initiation of therapy. Symptoms and signs before and after treatment,
during the four-week intervals, were recorded and scores between 0 and 3 were assigned.
Results: Out of 86 patients, males were 56 and females were 30. Median of symptoms score
at baseline was 11, at 4 weeks were 4, at 8 weeks were 5 and at 12 weeks were 4. Sign score
at baseline was 6, at 4 weeks were 4, at 8 weeks were 3 and at 12 weeks were 3. The
difference was significant (P< 0.05).
Conclusion: Topical cyclosporine 0.05% help to reduce corticosteroid usage, is an effective
and safe alternative for the treatment of resistant VKC.

Aim: A comparative study between Nifedipine and magnesium sulfate for treatment of
preterm labor.
Methods: Eligible women with preterm labor between 24-37 week gestations were selected
for the study. Nulliparous and multiparous pregnancies with intact membranes, showing
clinical signs of preterm labor were included in this study. The diagnosis of preterm labor is
based on the presence of 4 uterine contractions or more over 30 minutes, each lasting at least
30 seconds, and documented cervical change (dilatation of 0-4 cm and effacement of at least
50%).
Results: 5 patients (5%) after 24 hours, 9 patients (9%) after 48 hours, 7 patients (7%)
after 72 hours and 54 patients (54%) after 7 days had delivery in the nifedipine group and 11
patients (11%) after 24 hours, 5 patients (5%) after 48 hours, 5 patients (5%) after 72 hours
and 62 patients (62%) after 7 days had delivery in the magnesium sulfate group. This
characteristic was not statistically different between the two groups. In this study, 28 patients
(28%) in nifedipine group and 14 patient (14%) in magnesium sulfate group had a failure
treatment (contractions did not subside) and needed to take other tocolytic medications. This
characteristic was also not statistically different between the two groups.
Conclusion: we concluded that the oral nifedipine is a suitable alternative for magnesium
sulfate with the same efficacy and side effects in the management of preterm labor.

Background- Accessory renal arteries are very common variant in humans, it may be or not
bilateral, vestigial structure that develops during the ascent of the kidney from the pelvis to
the lumbar region. The purpose of this study to evaluate and compare the frequency, Length,
Diameter of Accessory renal artery in male and females of Western U.P. Population.
Method and Material- The data was collected by using CT Scan machine G.E 64 slice with
software Syngo angiography of 100 patients was collected. CT angiography scan was made
and thin slices (0.6 mm) axial images were obtained. The frequency of accessory renal
arteries, Length and Diameter can be evaluated & compared in male and females subjects. A
correlation is considered significant when p < 0.05. For comparing continuous variables, the
t-test was applied. All the statistical analysis was done by SPSS software.
Result- In this study, Ct angiogram more than 50 males and 50 females subjects were
included and 37 ARA out of 100 subjects is present. Accessory renal arteries are present in
31% of cases. 5% ARAs present at Rt side, 20% ARAs present at left side, and 6% ARAs
present Bilaterally. The frequency of accessory renal arteries are present in male cases(21%)
more than female(10%).
Mean length of ARA in RT side in case of male is 41.57±10.41mm and in case of female
39.32±11.7mm. and on LT side length of ARA in male is 48.36±15.44mm and female is
44.33±12.17mm. Diameter of ARA from origin in RT side in case of male is 2.30±0.40 mm
and in case of female is 1.82±0.45mm and on LT side in case of male is 2.26±0.78mm and in
case of female is 2.38±0.78mm.
Conclusion- This Publication highlights the importance of the recognition of the presence of
renal artery variants if surgical procedures are indicated in Western UP. Moreover, CT
Angiography can reveal pathologies of the renal arteries of the kidneys.

Background:Dry eye is one of the most important causes of ocular
morbidity.Postmenopausal women often present with dry eye symptoms. The purpose of
this study is to assess the pattern of dry eye in post menopausal women attending
ophthalmology OPD in GMCJammu.
Material and methods:A cross-sectional study was conducted on 200 patients attending
ophthalmology OPD in GMCJammufrom June 2018 to December 2018.After the detailed
history,patients were subjected to complete ophthalmic examination,dry eye tests for
example schirmer’s test and tear film breakup time were done, for the assessment of dry
eye.
Results:Out of the 200 patients,most commonly dry eye was seen in the age group 61 to 65
years and mostly in patients engaged in outdoor occupation.
Conclusion: If the symptoms are detected early,patients can be benefitted. The optimal care
includes early detection and adequate use of lubricants in these patients.

Background: Vernal keratoconjunctivitis (VKC) is a chronic recurrent non-infectious allergic disease that generally affects children and young adults. The present study was conducted to assess efficacy of topical 0.05% cyclosporine in Vernalkeratoconjunctivitis. Materials & Methods:86 patients diagnosed with Vernalkeratoconjunctivitis (VKC) of both genderswere enrolled. All were prescribed topical 0.05% cyclosporine 4 times a day. Patients underwent complete ophthalmic examination and symptoms and signs and intraocular pressure using non contact tonometer. The patients were evaluated at weeks 4, 8 and 12 after the initiation of therapy. Symptoms and signs before and after treatment, during the four-week intervals, were recorded and scores between 0 and 3 were assigned. Results: Out of 86 patients, males were 56 and females were 30. Median of symptoms score at baseline was 11, at 4 weeks were 4, at 8 weeks were 5 and at 12 weeks were 4. Sign score at baseline was 6, at 4 weeks were 4, at 8 weeks were 3 and at 12 weeks were 3. The difference was significant (P< 0.05). Conclusion: Topical cyclosporine 0.05% help to reduce corticosteroid usage, is an effective and safe alternative for the treatment of resistant VKC.

Background: The five most common transmissible infections in all the blood banks included
HIV, HBV, HCV, syphilis and malaria. This study aims to evaluate the prevalence of prevalence
of transfusion transmitted infections in a tertiary care centre.
Material and methods: The present study was conducted to assess the prevalence of transfusion
transmitted infections in a tertiary care centre. A total number of 1200 donors were analyzed for
the seroprevalence of Transfusion Transmitted Diseases over a period of 6 months. Basic
information was obtained using donor form. Physical examination was done Blood was screened
for HIV, HBV, HCV, syphilis and malaria by ELISA according to manufactures instructions.
Results: A total number of 1200 blood donations were taken in this study. In our study, Males
outnumbered females with 93.33% donations while only 6.66% donors were females. 24 (2 %)
were reactive for blood transmitted infection. In our study, HBV and HCV were the major
infections in blood donors and the seroprevalence were 1.5%, and 0.16% respectively. Only
0.33% was positive for malaria.
Conclusion:The present study concluded that 2 % donars were reactive for blood transmitted
infection. HBV and HCV were the major infections in blood donors.

Background- Variations of renal artery are common in general population and gained
importance because of the wide spread development in renal transplantation surgery. The
purpose of this retrospective study was to evaluate the prevalence of variations in the origin
of right and left Renal arteries at Vertebral level.
Method and materials- The data was collected by using CT Scan machine G.E 64 slice with
software Syngo angiography of 100 patients was collected. CT angiography scan was made
and thin slices (0.6 mm) axial images were obtained. The variation in the origin of renal
arteries at the level of vertebral column can be evaluate by 3-D CT angiography results were
analyzed. A correlation is considered significant when p < 0.05. Most of the possible
correlations were examined. For comparing continuous variables, the t-test was applied. All
the statistical analysis was done by SPSS software.
Result - The most frequent position of RRA origin at vertebral level L1 LP are 32 %, L1 MP
are 16%, L1UP are 8% and also L2 UP are 32%, L2 MP are 10%, L2 LP are 2% cases.
Vertebral levels of left renal arteries L1 LP are maximum in 38 % cases. Others are L2 UP in
32%, L1 MP 20%, L2 MP 6% and L1 UP & L2 LP are 2% in each cases.
Conclusion- In our study, Mostly renal arteries are arising in between upper part of L1 to the
lower part of the L2 vertebrae.

Aim: To evaluate efficiencies of magnetic resonance imaging & ultrasonographyprocedures for various pathologies related to female pelvic region.
Materials & Methods: This study was performed on total sixty patients. All patients reported for various clinical issues of pelvic region. Magnetic resonance imaging & ultrasonography procedures were used as diagnostic imaging modality. Scanning outcomes of magnetic resonance imaging & ultrasonography have been categorized as group one and group two respectively. All suggestive findings of both imaging modalities were correlated with clinical diagnosis. Based on these existences of correlations, Results thus obtained was compiled and sent for basic statistical analysis. P value less than 0.05 was considered significant (p< 0.05).   
Results: Among all sixty studied patients, females were 14 in age group of 25-28 years. 13 patients were seen in age range of 33-36 years. P value was reported to be significant for this (0.01). Magnetic resonance imaging confirmed Inborn Anomalies in 3 patients. Uterine Mutilation was confirmed in 16 patients by magnetic resonance imaging. Pathologies related to Adnexa were noted in 28 patients. P value was reported to be significant for this (0.002). Endometrial Malignancies were noted in 2 patients. P value was reported to be significant for this (0.001). Pathologies related to Adnexa were noted in 25 patients by Ultrasonography. P value was reported to be significant for this (0.010).
Conclusion: Magnetic resonance imaging was able to detect and confirm almost all studied pathologies related to female pelvic region. Ultrasonography procedure was unable to detect few of those pathologies. Therefore, magnetic resonance imaging is superior and accurate option for scanning pelvis region.

This researchdiscovers the epics and characteristics of it in Pashto literature. Epics contains
stories of war, battles, bravery, wrestling and heroism, commemorating the great deeds of heroes
and praising them, killing great animals by heroes and performing extraordinary deeds. The
mystic has supernatural and unseen powers, as well as the ability of a hero in Epic to confront
other heroes, for heroes to remain committed to national values and to accept any sacrifice for it
from various weapons and in certain circumstances. The use of deception, predictions about the
future and so on are the trademarks of Epic. In Pashto literature, Epic is considered to be one of
the earliest, but according to all the standards of writing 11th century was considered the time of
invention of Epic.

The analogue of the parotid gland is the first gland to form in humans. Lesions of the parotid
gland are fairly easy to recognize mainly because of the location and limited number of
structures present here. Tumors of parotid gland are believed to represent approximately 2%
of head and neck tumors. Parotid gland tumors account for 70- 80% of all tumors of salivary
glands. Patients visiting to surgery department with parotid swelling were subjected to careful
history taking, complete clinical examination, and examination of facial nerve integrity.
Clinical diagnosis made was confirmed with USG (ultra sonography) parotid and FNAC (fine
needle aspiration cytology). 14(70%) patients in antegrade group vs. 13(76.47%) patients in
retrograde group had pleomorphic adenoma, 5 (25%) patients in antegrade group vs.2
(11.76%) patients in retrograde group had Warthin’sTumor,1(5%) patients in antegrade group
vs.2 (11.76%) patients in retrograde group had Recurrent Pleomorphic Adenoma.

The antegrade approach is the conventional/standard technique of identification and
dissection of the facial nerve. It is usually the standard procedure for a trainee to master6. The
technique involves identification of the facial nerve trunk as it leaves the stylomastoid
foramen. This is accomplished through identification of the nerve trunk via its relationship
with the tympanomastoid suture, the tragal pointer or the posterior belly of the digastric.
During the study period of 20 month 37 patients with benign parotid disease who underwent
surgery were included in study group. Based on the surgeon expertise and familiarity with the
technique of facial nerve dissection 17 patients underwent retrograde dissection of facial
nerve for parotidectomy and was grouped as retrograde group. In retrograde group, surgeons
with a good experience of retrograde technique performed all surgery. 45% patients in
antegrade group vs. 2 (11.76%) patients in retrograde group recovered completely at 1 month
interval. We tested difference between the groups in facial nerve injury recovery at 1month
by applying Fischer’s exact test p= 0.028 and it was found to be statistically significant.

Urethral stricture disease has always been a challenge for urologists. Different treatment
modalities that are used for treatment of urethral stricture disease are dilatation, urethrotomy,
stent placement. Internal urethrotomy is a safe first line treatment for urethral strictures
independent of etiology and location, with an overall primary success rate of 60-70%.Visual
internal urethrotomy was done in usual manner using cold knife. Injection is prepared by
diluting triamcinolone 40mg, mitomycin 2mg in 5-10mL of saline according to length of
stricture and was injected intralesional at the site of urethrotomy using William’s endoscopic
needle. At every site 1-2mL was injected. After confirming free passage of cystoscope into
the bladder, an 16 or 18 Fr foley’s catheter was left in place for 2-3 days.In our study total of
7 patients lost follow up and among remaining 37 patients total of 10 patients had recurrence,
8 patients in group A had recurrence at end of 6 months, 1 patients at 3 months after
procedure and 7 patients at 6 months after procedure where as in group B only 2 patients had
recurrence 1 at 3 months and 1 at 6 months post procedure, both groups were statistically
comparable with respect to age stricture length,site and etiology.From our study we can
conclude that, Injection of both triamcinolone, mitomycin C at stricture site after VIU can be
considered as safe and effective adjuvant modality compared to VIU alone for short term
management of stricture urethra.

Surgery still has a pivotal role in the management of breast cancer, even though recent
advances in oncology are trending towards more conservative techniques followed by
chemotherapy.The consensus development conference on the treatment of breast cancer in
1979 stated that modified radical mastectomy was the standard of treatment for stage 1 and 2
disease. 60 patients of either sex between age group 30 to 60 years undergoing elective
Modified Radical Mastectomywere divided into two groups of 30 patients each randomly
who fulfilled the inclusion and exclusion criteria. In this study, When we look closer, we
could see that, despite of being statistically significant, the VAS and VRS scores at initial
intervals (1hr, 4hrs) were low in group A when compared to group B. At 8 hours and, there
was a marked increase in VAS and VRS score in group B and thereafter it was akin in two
groups.

The brachial plexus is enveloped by a fascial sheath, formed by prevertebral and scalene
fascia, extending from the intervertebral foramina to the upper arm. The foramina of a sheath,
at any anatomical point, will allow for the spread of local anaesthetics and subsequent
blockade. Each approach to the brachial plexus impacts specific anatomical areas of the upper
extremity. Patients were kept Nil per orally for 6 hours before the time of surgery and on the
previous night premedicated with Diazepam 5 mg and Ranitidine 150mg. 60 patients ASA I
and ASA II were randomly allocated with sealed envelope method into two different groups
of 30 each. Both observer and participant were blinded. GROUP A- received (n=30) 25 ml of
0.5% bupivacaine, GROUP B-received (n=30) 25 ml of 0.5% ropivacaine. There was no
statistically significant difference in heart rate between both groups (p>0.05). There is no
significant difference of heart rate clinically.

Proximal humerus fractures present with different configurations in patients with varying
comorbidities and expectations. Various treatment options are available for treating proximal
humerus fractures. A good functional outcome with context to the early joint mobilisation and
rigid fixation of the fracture can be achieved with PHILOS plate in proximal humerus
fractures.Patients admitted with proximal humerus fractures as inpatient in department of
orthopaedics were included in the study satisfying the inclusion and exclusion criteria.30
patients with proximal humerus fracture were treated by open reduction internal fixation with
PHILOS plate. Improvement of Constant-Murley score at 6 weeks of 47.83 to 64.67 at 12
weeks(p=<0.001), 75.27 at 24 weeks(p=<0.001) and 78.33 at final follow up(p=<0.001).
Most of the patients had excellent (43.3%) followed by good (33.3%), poor (16.7%) and fair
(6.7%) outcome. Varus malunion 6(20%) was the most common complication.Proximal
humeral internal locking system (PHILOS) is the implant of choice for treating displaced
proximal humerus fractures which leads good functional outcome in patients.

Background:Many screening tests are available for predicting adverse pregnancy outcome
and these range from non- invasive to invasive and serum alpha-fetoprotein level
estimation is one of them. The present study was conducted to assess association between
second trimester maternal serum alpha-fetoprotein in 14-22 weeks and adverse pregnancy
outcome.
Materials & Methods: 250 patients of gestational age between 14-22 weeks were included.
Maternal serum alpha-fetoprotein was measured in human serum by microplateimmunoenzymometric
assay by EIA-AFP kit. Maternal serum alpha-feto protein level was
expressed in IU/ml.
Results: 23 (9.2%) participants out of 250 developed preterm labor. 21 out of 23 had raised
value of maternal serum alpha-fetoprotein. 20 (8%) patients out of 250 patients developed
oligohydramnios. 13 out of 20 had raised value of maternal serum alpha-fetoprotein. 14
(5.6%) patients out of 250 developed pre-eclampsia, 11 out of 14 had raised values of
maternal serum alpha-fetoprotein. 7 (2.8%) patients out of 250 developed premature
rupture of membrane (PROM). 4 out of 7 had raised values of maternal serum alphafetoprotein.
Conclusion: There is an increased risk of pre-eclampsia, preterm delivery,
oligohydramnios and premature rupture of membrane with elevated maternal serum
alpha-fetoprotein levels

Background:Laparoscopic cholecystectomy is considered the gold standard for gallbladder
removal and is the most common laparoscopic procedure worldwide. The present study was
conducted to compare high and low-pressure carbon dioxide in patients undergoing
laparoscopic cholecystectomy.
Materials & Methods:86 patients undergoing laparoscopic cholecystectomy of both
genders were classified into 2 groups of 43 each. Group I comprised of high-pressure
carbon dioxide and group II low pressure carbon dioxide. In both groups, abdominal pain,
nausea and vomiting were evaluated on the verbal rating scale (VRS) at 1, 3, 6, 12, and 24
hours.
Results: The mean nausea/vomiting score at 1 hour, 3 hours, 6 hours, 12 hours and 24
hours in group I and II was 5.6, 5.0, 4.5, 3.8 and 3.2 and 4.2, 3.4, 3.0, 2.6 and 2.0
respectively. The mean abdominal pain in group I was 7.5, 6.5, 6.0, 5.4 and 4.6 and in
group II was 6.8, 4.6, 5.2, 3.6 and 2.2 in group I. The mean shoulder tip pain was 6.2, 5.4,
4.6, 3.8 and 2.4 in group I and 6.0, 4.8, 4.4, 3.6 and 1.8 in group II respectively. The mean
pre- operative ALT level in group I was 20.5 and post- operative level was 40.5 and in
group II was 20.4 and 45.6. AST level found to be 21.4 and 38.2 and in group II was 20.4
and 45.3, ALP level was 185.4 and 170.5, BILLT level was 0.62 and 0.70 in group I and
0.61 and 0.69 in group II, BILLD level was 0.21 and 0.34 in group I and 0.23 and 0.35 in
group II respectively. The difference was significant (P< 0.05).
Conclusion: Low pressure group had less pain score and nausea and vomiting score as
compared to high pressure group. Hence, it can be considered as treatment of choice in
patients undergoing laparoscopic cholecystectomy.

Aim:To identify the trend of ocular trauma in pediatric age-group and evaluate final visual
outcome.
Materials and Methods: Prospective interventional study at Government medical College,
Bharatpur from November 2019 toOctober 2020,patients up to age 16 years attended the
casualty department of eye and undergone intervention with follow-up period of 1to3months
or till better recovery.
Results: Total 118 eyes of 115 patients were enrolled. The age-group more affected was
above 5 years (67.80%, i.e.,80 eyes)and below 5years (32.20%, i.e.,38eyes). Boys (62.71%)
were affected more than girls (37.29%). Most of the children reported to casualty within
24hours(80.50%eyes),remaining patients reported later within 2days to 1 week (19.50%eyes).
Most of the ocular injuries occurred by household objects (22.3%), blunt objects(13.56%),
playground/sports (13.56%),accidental fall(11.02%), projectile(7.63%)and others. Best
corrected visual acuity(VA)of more than 6/18 achieved in 61.02%eyes, 6/18-6/60
in18.64%eyes,<6/60-counting finger close face(CFCF)in5.93%eyes, projection of
light(PL)+perception of rays(PR)in5.93%eyes,and noPLin8.47%eyes.
Conclusion: Pediatric ocular trauma is still higher in Rajasthan. It requires early presentation
and intervention so that prognosis can be enhanced and impact of trauma can be reduced as
much aspossible.

Background:Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder
characterized by persistent hyperglycaemia due to relative insulin deficiency, insulin
resistance. This study assessed efficacy of Saroglitazar in patients with diabetic
dyslipidemia
Materials & Methods:120 patients with type 2 diabetes mellitus of both genders were
assessed for serum fasting plasma glucose, post prandial glucose, glycated hemoglobin
(HbA1c), blood urea, serum creatinine, S.G.O.T, S.G.P.T and lipid profile. Patients were
treated with Saroglitazar 4 mg once daily and the follow-up data were available for 12
months.
Results: Out of 120 patients, males were 80 and females were 40. The mean triglyceride
level was 610.4, 208.4 and 224.4, total cholesterol was 312.2, 244.7 and 172.1, non- HDLC
was 274.8, 199.6 and 126.3, LDL- C was 165.6, 116.8 and 104.17, HDL- C was 41.4, 42.1
and 42.5, HbA1C was 8.02, 7.8 and 7.1, FPG was 156.2, 130.5 and 120.4, PPG was
234.6, 172.1 and 160.5, SGOT was 46.6, 42.3 and 40.3, SGPT was 34.2, 38.4 and 37.4, S.
Creatinine was 0.7 and CPK was 74.3, 71.6 and 68.3 at baseline, 12 wees and 52 weeks
respectively. The difference was significant (P<0.05).
Conclusion: Saroglitazar is a very effective therapeutic option in diabetic dyslipidemia with
very high triglycerides level.

Introduction: Osteochondromas (often referred to as exostosis) are usually an incidental finding and are characterized by a benign bony protuberance covered with a cartilaginous surface in the metaphyseal region of long bones. Though they do not affect the patients directly; but cause indirect complications of varying degree of severity such as bursitis, neurovascular impingement, fracture of peduncle or malignant transformation. Imaging studies such as an MRI or CT, are useful aids in the diagnosis; however, biopsy is a mandatory requisite for a definitive diagnosis. Treatment modalities include open surgical or an arthroscopic resection and has good prognosis. Recurrence follows incomplete excision.
Presentation of case: In this report, we present a rare case of a recurrent, symptomatic scapular osteochondroma associated with scapular pseudowinging and snapping scapular syndrome in a 16-year-old female. Radiological findings exhibited by this tumour was highly characteristic. The tumour was then managed with surgical resection thereby resulting in an entire resolution of the patient's symptoms.
Discussion: This case was unique because she presented with recurrence 5 years after her previous surgery as she neared her age of skeletal maturity raising a suspicion of malignant transformation. And also she was having associated pain, pseudowinging and snapping scapula syndrome.
Conclusion: By reporting this rare case of a scapular osteochondroma that presented with scapular winging, we aim to increase the awareness of the unusual manifestations of osteochondroma, particularly atypical sites, signs, and symptoms. Furthermore, we've given a comprehensive description of this case and its management to help other surgeons who face similar cases.

Background:Appendicitis occurs most commonly between the ages of 10 and 20 years and it has a male-to-female ratio of 1.4:1. The present study assessed validation of RIPASA score in diagnosis of suspected cases of acute appendicitis. Materials & Methods:86 patients with right iliac fossa pain and suspected to have acute
appendicitis of both genders were assessed. All were assessed using the RIPASA scoring system on the basis of clinical assessment and hospital protocol, histopathological correlation done with a score. A score of 7.5 was considered a cut-off value for high probability of acute appendicitis. Results: Out of 86 patients, males were 52 and females were 34. RIPASA score <5 was seen in 15, 5-7 in 20, 7.5- 11.5 in 38 and >12 in 13. Emergency appendectomy was performed on 62, positive HPE reports for appendectomy was seen in 54, negative HPE for appendectomy in 8, perforated appendix in 4 and wound sepsis in 7 cases. Conclusion: RIPASA score is a better, easy, safe, and non-invasive diagnostic method for diagnosis of acute appendicitis.

Patients with asthma experience exacerbations due to the airflow obstruction caused by the narrowing of lung passages. The exacerbations vary between simple and lifethreatening, which is unpredictable. As a result, visits to the emergency department and hospitalization incur an enormous health care expenditure. Prediction on the severity of exacerbations is primarily vital to decide on the further course of treatment where conventional tests like spirometry provide mechanical aspects of the lung pathway obstruction. The advent of imaging modalities provides an advanced notion of the severity. Hence, in this review, the epidemiology of asthma, a diagnostic procedure using the different radiological techniques, various factors leading to lung pathway obstruction, and suitable medicines were discussed.

The nomenclature of benign breast disease is very confusing.This is because over the last
century a variety of clinicians and pathologist have chosen to describe a mixture of
physiological changes and disease processes according to a variety clinical, pathological and
aetiologicalterminology. The study includes patient attending surgical out patient department
and admitted to surgical wards with breast lump during the study period. Most of patients
presented in OPD with complaints of breast lump 66 (60%) followed by patients presenting
with lump and pain of 33(30%). Some patient show engorgement of breast 8 (7.2%).Few
Patients also presented with lump, pain and discharge 3 (2.7%).

Benign breast disease is primarily a phenomenon seen in reproductive age group. They are
thought to be largely hormone induced. Benign breast disease is 4-5 times more common then
breast cancer. The study includes patient attending surgical outpatient department and
admitted to surgical wards with breast lump during the study period. Most of the patients
underwent excision-85 patient (77.27%) followed by microdochotomy-4 (3.63%)and I & D-4
(3.63%).Simple mastectomy also done in 4 (3.63%) patients. Wide excision biopsy was done
in 3 (2.72%) patient. Majority of the patients 90 patients (81.81%) did not have any postoperative
complications, whereas 12 patients (10.90%) had discharge from wound and 5
patients (4.54%) had wound gape due to infection.

The normal endocrine function is primarily for the quality of life of people, irrespective of
age, sex, and race. Detrimental thyroid function leads to multiple disorders, including
cardiovascular, renal, neurologic, foetal development, and sexual drive. Moreover, if left
untreated may aggravate the formation of thyroid nodules and subsequently to cancer.
Therefore, periodic assessment of thyroid glandfunction may eliminate these complications
and improve the patients' quality of life. In this review, we have discussed the different
thyroid disorders, their complications, radiological techniques, and invasive procedures for
assessing the thyroid gland.

With increasing life expectancy and prevalence of life style diseases, United States (US) has
seen a 30% increase in prevalence of chronic kidney disease (CKD) in the last decade.
Unfortunately, from India there is no longitudinal study and limited data on the prevalence of
CKD. Chronic Kidney Disease was diagnosed when at least one of the evidence of chronicity
like documented renal failure for >3 months, bilateral small kidneys, histological evidence of
chronicity or GFR < 30 ml/min for 3 or more months was present.A pre informed written
consent was obtained from every case before inclusion in the study. The clinical and
demographic profile was recorded in a specially designed proforma. On ultrasonogram
bilateral kidneys of group A, 12 patients had bilateral contracted kidneys which correspond to
60% of the study patients indicative of ESRD. 6 patients had normal or slightly enlarged
kidney size suggestive of diabetic nephropathy (30%). Findings of ultrasonogram bilateral
kidneys in group B revealed 11 patients had bilateral contracted kidneys which correspond to
55% of the study participants indicative of ESRD. 5 patients had normal or slightly enlarged
kidney size (25%) and 1 patient was having bilateral enlarged kidneys with multiple cysts of
varying sizes suggestive of autosomal dominant polycystic kidney disease (5%).

Chronic inflammation is a common feature of CKD and is a major cause of its associated
morbidity and mortality. Erythropoiesis is inhibited by several pro-inflammatory cytokines
such as interleukin-1, tumor necrosis factor-alpha (TNF-α) and interferon gamma (IFN-γ).12
These cytokines are particularly involved in the inflammatory process as they are directly
produced by macrophages (TNF-α, IL-1) or because their production by another cell is
induced by a macrophage cytokine (IFN-γ). Several studies have shown that markers of
inflammation are associated with a decreased response to erythropoietin. Out of these 52
patients, 12 patients couldn’t complete the study. 5 patients (2 in group A and 3 in group B)
left the study in between due to some unknown causes and 7 patients (4 in group A and 3 in
group B) expired during the study.So finally 40 patients (20 in each group) completed the
study. In group A there was a slight decrease in systolic and diastolic blood pressure from
baseline values of 153.5±12.06 and 92.3±6.06 mm of Hg to 150.4±12.62 and 89.2±5.36 mm
of Hg at 3 months, but the decrease was not significant statistically (p >0.05). In group B also
there was a slight decrease in systolic and diastolic blood pressure from baseline values of
156.2±8.72 and 92.4±6.31 mm of Hg to 149.1±18.20 and 93.6±4.75 mm of Hg at 3 months,
but the decrease was not significant statistically (p >0.05).

Purpose: Proximal femoral fracture is one of the major causes of morbidity and mortality in
elderly group patientswith 11-23% of mortality is reported to occur at 6 months and 22-29%
at 1 year. Despite the huge burden of osteoporosis, there is paucity of data regarding
epidemiology, risk factors and outcome of fragility hip fractures in Indian population. As
most of the published literature are from western world, we conducted the study to look for
risk factors for early-mortality in hip fracture in Indian sub-continent and compare the same
with published literature.
Methods: Total of 174 patients were available for final evaluation. Primary outcome was to
see the mortality in elderly patients undergoing operative treatment and the secondary
outcome measures were predictors of mortality in this age group with regard to age, sex,
Charlson comorbidity index, injury severity score, pre-operative ASA grading, injury-surgery
duration and length of hospital stay. Cox proportional regression hazards regression
modelling was performed to assess the effect of different variables on time of mortality.
Results: Mean age of the patients was 70.56 (± 8.05) years. Mean Charlson Comorbidity
Score was 1.68 (± 1.54; 2SD). Mean time from injury to operation time was 35.59 (±19.02; 2
SD) hours and the mean length of hospital stay was 4.78 (± 1.68; 2 SD) days. Mortality at
one-year after surgery was 18.4%.On univariate and multivariate regression analysis variables
significantly associated (p<0.05) with ‘Mortality’ are: Age, Charlson Index, Charlson Index
Category, Injury to operation time(Hours), Length of hospital stay and pre-operative ASA
grade.
Conclusion: We suggest that, without a dedicated hip-fracture protocol in a resource-poor
set-up, early aggressive management to optimize patients for surgery and surgical
intervention as soon as feasible lead to early return to pre-fracture status and reduces early
mortality.

Many methods have been evolved to combat wound infection during last century. Shortly
after the introduction of the first antimicrobial agent Penicillin alone was shown to reduce the
infection rate in abdominal surgery to 10% from a control rate of 25%.Initially, the antibiotics
were only used post-operatively for treatment of already established SSI. Later, the concept
of antibiotic prophylaxis was introduced. Many studies established the fact that preoperative
prophylaxis with antibiotics reduces wound infection. All patients were given spinal
anaesthesia all patients were painted with 10%povidone and recleaningwith spirit Surgical
field was drappedproperly and aseptic precautions followed group a: prophylaxis by
preoperative intraincisional infiltration of the antibiotic. One gram of cefotaxime diluted in 10
ml of distilled water will be infiltrated along the skin and the subcutaneous tissue in the
proposed line of incision, 20 minutes before surgical incision. In Group 1, wound discharge
was present in 1% on day 5. In group 2, wound discharge was present in 2% on day 5. There
was no significant difference in wound discharge between two groups. At other intervals
there was no discharge in both the groups.

The myelinated A δ (sharp pain, first pain) peripheral nociceptors and unmyelinated C
nociceptors (delayed pain, second pain) respond to strong mechanical, thermal, chemical
stimuli that act as transducers, converting chemical, mechanical or thermal energy at the site
of stimulus to electrical activity, which are conducted to the dorsal horn of CNS. Based on
previous study by Usha Bafna et al., sample size was calculated to be 30 patients, to be
randomly included in each group to demonstrate a 40% difference in duration of analgesia
with a power of 0.8 and type-1 error of 0.05. To allow for study error and attrition, 35 patients
were included in each group. In Group A, 3 (8.57%) patients and in Group B, 4 (11.42%)
showed hypotension that is mean SBP was less than 20% of the base line, were as none of
patients in either group showed hypertension that is more than 20% of the baseline SBP
(intraop and postop). There was no statistically significant difference between two groups P
value (0.6903).

Pregabalin is a structural analogue of gamma aminobutyric acid, substituted at the 3-position;
this facilitates diffusion across the blood-brain barrier. Efficacy of pregabalin has been
proven in neuropathic pain, incisional injury, inflammatory injury. Its mechanism of action is
probably the same as gabapentin but it is more lipid soluble and has superior pharmacokinetic
profile. Due to its sleep modulating effects, it has been used as an anxiolytic. Pregabalin
increases stages III-IV sleep phases and also decreases awakening at night. Patients were
counselled regarding the tablet used in preemptive analgesia its advantages and
disadvantages, the purpose of its use, they were also explained regarding the follow up till
24hr and spinal anaesthesia procedure to be used in the study and consent was taken for the
same. Ramsey sedation score of all the patients was score = 2. None of patients complained
of dizziness in group A. Ramsey sedation score of all the patients was score = 2.2.85% (1
patient) complained of dizziness in group B.

Objective: The aim of study was to ensure supply of safe and efficient blood transfusion to
patient and to prevent Transfusion Transmitted Diseases.
Methods: The present study included data of routine monthly analysis of whole blood and
blood components which was collected from archives of blood bank from the period of 1st
January 2018 to 31st December 2019. Data was collected for the above mentioned period in
which blood was collected from 2520 healthy donors in sterile single, double or triple blood
bags with anticoagulant Citrate Phosphate Dextrose Adenine 1 (CPDA 1) after taking written
consent.
Result: Mean volume was 65.5 mL with range of 50-70 mL. Mean WBC contamination was
1.4×108/unit with a range of 0.15-5.5×108/unit. Mean RBC contamination was
0.077×1012/liter with a range of 0.05- 0.14x1012/liter.
Conclusion: Quality indicators should be well-defined, regularly monitored and properly
documented. Quality Control is an important tool to ensure maximum benefit to patient with
minimum cost and maximum advantage and minimizing requirement of transfusion to patient
and Prevention of risk of Transfusion Transmitted Diseases.

Background: Pain management following caesarean section still remains a challenge in our
environment. Diclofenac suppository is an effective adjunct analgesic for post-operative pain
control. Over the last two decades the number of caesareans being performed has increased
dramatically. High quality postoperative analgesia is important because the new mother has
to recover from major intra-abdominal surgery while also caring for her newborn baby. Many
options are available but tailoring the method to the individual can be problematic because it
has been difficult to predict the severity of postoperative pain or the individual response to a
regimen.

Aim: There is extensive disagreement about the necessity and benefits of routine episiotomy for all. The American Congress of Obstetricians and Gynecologists Committee on Practice Bulletins, 2006 based on good scientific evidence recommends restricted use of episiotomy to be preferred, yet its restricted use is not being practiced. Keeping these in mind, the study was done with the aim to assess the effects of restrictive use of episiotomy during vaginal birth.
Materials and methods: This was a prospective study. Single- ton primigravida term vaginal deliveries over 18 months(June 2020-Dec2021) were included. Under the policy of restricted use of episiotomy, great restraint was observed in giving an episiotomy. Mediolateral epi- siotomy was given in women where expected baby weight >3 kg or perineal tear was anticipated, and in cases of instrumental deliveries. Perineal tears, postpartum status, and satisfaction level of women were compared between patients with or without episiotomy. Data so obtained were analyzed
Results: About 29.8% women delivered with episiotomy, 65.5% had intact perineum; 5.67% women had first-degree perineal tear and only 1.42% women had second-degree perineal tear using a policy of restricted use of episiotomy. None of the women had third- and fourth-degree perineal tear. Patients delivered without episiotomy were more comfortable in terms of less perineal pain, early evacuation of bladder, and ambulation
Conclusion: With the restricted use of episiotomy using precise clinical judgment, the unnecessary episiotomies could be avoided, giving better care and patient satisfaction with minimum maternal morbidity
Clinical significance: The policy of restricted use of episiotomy would result in considerable reduction in maternal morbidity, decreased hospital stay and overall cost, and good patient satisfaction level

Background: Bone marrow is the major hematopoietic organ and is one of the largest organ in human body.¹The causes of bone marrow necrosis (BMN) is varied & diverse. Among these cases, hematopoietic malignancy is the commonest. As it is a potential target organ of various disorders, the examination of blood and bone marrow becomes one of the important component for the evaluation of certain disorders.¹ It is a rare finding accounting for about 0.3 to 2.2%^2,3. Bone marrow necrosis is defined as  necrosis of the medullary stroma and myeloid tissues in large areas of the hematopoietic bone marrow (BM), leaving an amorphous eosinophilic background, poorly defined necrotic cells and preserved cortical bone.⁴
Objectives: The objective wasto highlight these rare phenomenon of bone marrow necrosisand to analyse the underlying disease producing bone marrow necrosis.
Methods: All cases of bone marrow examination performed in the Pathology Department, JNIMS, Imphal Manipur where analysed during the four years period starting  from 1^st November 2017 to 30 November 2021. The clinical details and other parameters of all the cases were traced retrospectively from hospital record section. Archived bone marrow aspirate smears and biopsy sections were reviewed whenever required.
Result: A total of 346 bone marrow aspirations were performed in the department of Pathology during the study period. Five cases of bone marrow necrosis were detected producing a prevalence of 1.4%.
Conclusion: In our series of five cases, 2 cases (40%) of acute myeloid leukemia, 1 case (20%) of MDS-EB II, 1 case (20%) of disseminated tuberculosis and 1 case (20%) of hepatits B viral infection were included. To conclude, in cases of bone marrow necrosis, further investigations including ancillary techniques are strongly suggested to come to conclusive diagnosis as the causes of bone marrow necrosis vary from patient to patient.

Background: Tuberculosis of spine is one of the commonest musculoskeletal TB. It not only causes back pain but also causes functional disability.
Methodology: A cross-sectional study was conducted in the department of Radiology and Imaging, JNIMS, Imphal East in collaboration with the Departments of Orthopedics and Microbiology, JNIMS from March 2017 to June 2021. Fifty patients appeared as tuberculosis spondylitis on clinical and X-ray findings were included in the study. MRI (3 Tesla, Phillips), microbiological tests and preoperative biopsy were done from each patient and 45 of them were confirmed as the patients of spine TB by these procedures. Maximum of the patients were from the age group 31-40 years with a mean age of 36.25±6.33 years. Males were predominant. Results: Multiple and continuous vertebral involvement was seen more common. Conclusions:  MRI should be considered to be the imaging modality of choice for patients with suspected TB spondylitis, because of its high specificity, sensitivity and accuracy as it provides necessary information to the surgeon for proper management by providing vertebral intra-osseous abscess, vertebral disc collapse, skip lesions, dural and intradural diseases and involvement of posterior elements more precisely.

Introduction: Renal failure is a complex disorder that occurs in a variety of settings with clinical manifestations ranging from a minimal elevation in serum creatinine to anuric renal failure. Recent epidemiological studies demonstrate the wide variation in etiologies and risk factors for acute renal disease, describe the increased mortality associated with this disease (particularly when dialysis is required), and suggest a relationship to the subsequent development of chronic kidney disease (CKD) and progression to dialysis dependency Aim: to find out the epidemiological parameters responsible for acute and chronic renal failure in a Government Hospital of Gujarat. Methodology: This was a cross sectional study  done in the department of Pathology, M. P. Shah Medical College, Jamnagar. These patients were above the age of 18 years.  Verbal consent was taken from all patients. 50 patients with acute renal injury were included along with 100 patients with chronic renal failure. Results: maximum incidence of acute renal failure was in the age group of 31-40years (24%) followed by the age group of 41-50 years(18%) . The maximum incidence of chronic renal failure was in the age group of 41-50years (26%) followed by the age group of 51-60 years(24%) followed by the age group of 31-40 years(20%).

Most countries have been struggling in facing the coronavirus. In Indonesia, various proposals and regulations have been introduced as a strategy in handling and preventing the spread of COVID-19, such as the instruction to use masks and for social distancing, travel limitations, area-based restrictions, and vaccination. Unfortunately, COVID-19 has continuedto be an issue since a new variant of concern, known as Omicron (B.1.1.529), was identified. Literature review was conducted in this study, featuring254 cases of Omicron in Indonesia by January 4, 2022. Indonesian government has developed at least fivecriteria to prevent the spreading of the COVID-19 virus,in particular the Omicron variant. Testing rate in Indonesia still below Malaysia, while tracing and treatment control conducted by the Indonesian government is quite similar, and massive in comparison to Malaysia and Singapore, with the PeduliLindungi mobile application launched in 2021. Conducting health promotion has become a necessity, with an understanding of the health belief model, engaging the religious leaders, and providing psychological support for mental health issues.
Keywords: Omicron, COVID-19, Outbreak, Indonesia, Case Record

Background: The optimal duration of maintenance therapy is controversial in proliferative
lupus nephritis. Discordance between clinical parameters of renal remission and histological
findings in immediate post induction phase as well as maintenance phase has made repeat
biopsy a compulsory tool to confirm the histological remission. But timing of repeat kidney
biopsy is debatable. Aim of this study was to find the pattern of repeat kidney biopsy findings
proliferative lupus nephritis.
Methods: Repeat biopsy (biopsy 2) performed on patients of biopsy proven (biopsy 1)
proliferative lupus nephritis (ISN/RPS 2004 class III/IV±V) between November 2011 to
September 2017 on maintenance therapy and in complete clinical remission for at least 2-
years. Clinical and histologic findings at biopsy 1 and biopsy 2 of 29 patients were compared
Results: Average time taken achieve complete remission was 9(2-24) months. Average
duration of follow up, maintenance therapy and complete clinical remission the cohort was
68±17.8, 62.5±14.2 and 58.9±17.3 months respectively. Histological remission was observed
in 93.1%. Other than duration of complete remission on maintenance therapy none of the
variables failed to predict the histological remission.
Conclusion: Majority of patients were in complete histological remission in repeat kidney
biopsy proliferative lupus nephritis following sustained clinical remission on maintenance
immunosuppressive therapy

Antepartum hemorrhage is an obstetric emergency contributing to significant amount of perinatal and maternal mortality.APH is defined as any bleeding from the genital tract between 24 weeks of gestation and delivery of the baby. Maternal consequences of antepartum hemorrhage are grave including shock, postpartum hemorrhage, coagulation failure, preterm labour, and increased rate of cesarean section.
AIMS AND OBJECTIVE-This study was done with the objective of studying the maternal and perinatal outcome in antepartum hemorrhage.
MATERIAL AND METHODOLOGY - A three year prospective observational study was conducted in Department of Obstetrics and Gynecology at MGM medical college and MYH hospital indore in women with antepartum hemorrhage between January 2018 to January 2021 .The study group includes 840 patients antepartum hemorrhage who admitted with complain of bleeding per vaginum in late pregnancy. Record of mode of delivery, associated maternal and perinatal complications were noted.
RESULT - Total 840 cases were admitted, 270 were placenta previa ,510 was abruption placentae, out of which 390 have LSCS, 450 delivered vaginally. In majority of LSCS done the indication was placenta previa240/390. Obstetric Hysterectomy was done in 3 patient and postpartum hemorrhage with severe anemia in abruption placentae was the indication.30 patients landed in AKI due to abruption.
CONCLUSION- In developing countries, like India, APH contributes a major part, there was very high maternal morbidity with increased rates of anemia and postpartum hemorrhage. Hence Universal institutional antenatal care of all women should be targeted to improve their general health, family planning and limitation of births should be encouraged along with focused multidisciplinary approach and facilities can improve maternal and perinatal outcome in APH.

Background: Total knee arthroplasty (TKA) is the best choice for the treatment of end-stage
osteoarthritis, and it can restore knee function, relieve pain, and improve quality of life
(QOL), with 95% of patients achieving a good prosthesis survival rate. The aim of the study
is to determine difference of pain-free range of motion in patient of total knee replacement
with midvastus vs subvastus approach at 6 months.
Methods: 200 patients were included in the present study who were scheduled to undergo
bilateral total knee arthroplasty during a single anesthetic session were followed for 6 months
postoperatively
Result: There were more females than males in the present study. All patients were followed
up for 6 months. No significant differences were found for demographic parameters between
the MV group and the SV group.The VAS, and KSS in the MV group were better than those
in the SV group within 6 months (p < 0.05), but no significant differences were found at 1
month, and 6 months after surgery (p > 0.05)
Conclusion: The better quality of life can be achieved by performing a TKA via the MV
approach. In addition, compared with the SV approach, the MV approach may offer less
postoperative pain and a faster recovery

Background: Bone morphogenetic proteins (BMP) are multi-functionalgrowth factors that
belong to the transforming growth factor beta (TGF-beta) superfamily. The purpose of the
study is to determine difference between radiological and functional outcome in TLIF surgery
with use of BMP 2 vs without BMP 2 in adult patients.
Methods: The present study evaluated data obtained between May 2016 and July 2017 on
patients in whom BMP-2 was used in conjunction with TLIF. 150 fulfilled the study criteria
whose mean age was 54.6 years [range 25–65 years]). Twenty-five patients (33.8%) had
previously undergone lumbar surgeries (discectomy, fusion, and decompression).
Result: Both groups had similar gender distribution and average age at surgery (48.9 ±
12.2years for the BMP group and 44.6 ± 13.7 years for the non-BMP group, p>0.05). As
expected, the BMP group had a shorter median follow-up time of 5.05 ± 7.10 years while the
non-BMP group was followed for a median of years 5.06 ± 12.6.
Conclusion: It is important that clinicians explain these findings to patients so that they can
make informed choices about the type of surgery they would prefer. The use of BMP safe and
effective in the context of TLIF procedures, and thoughtful discussion with patients about the
pros and cons of BMP utilization during surgery is recommended

Background: Diabetes mellitus has a high prevalence globally with rising incidence in the
world. Despite the identification of diabetes mellitus and associated complications for a long
time, the measures to reduce mortality and morbidity in subjects with diabetes mellitus are
focused only for a few decades.
Objective: The present study was conducted to assess the correlation between levels of
glycosylated Hb and serum albumin in subjects with type 2 diabetes mellitus.
Method: The present institution-based observational study included subjects with a
confirmed diagnosis of diabetes mellitus type 2 where levels of glycosylated hemoglobin
(HbA1c) and serum albumin were assessed and correlated.
Result: It was seen that in subjects with glycosylated hemoglobin of <7%, mean serum
albumin level was 3.87±0.88 mg/dl, in subjects with glycosylated hemoglobin of 7-9%, mean
serum albumin level was 2.95±0.53 mg/dl, and in subjects with hemoglobin of >9%, it was
seen that mean serum albumin was 2.46±0.69 mg/dl. A negative correlation was noted where
lesser HbA1C% was related to higher mean values of serum albumin.
Conclusion: The present study concludes that subjects having higher values of glycosylated
hemoglobin have lower serum albumin levels compared to subjects where lower glycosylated
hemoglobin levels in subjects were associated with near-normal or normal serum albumin
levels.

Background: Sepsis is a disease characterized by rapid disease process advancement
needing immediate therapy adjustments. Assessment of disease severity is vital for
appropriate disease management, preventing and decreasing the incidence of complications,
decreasing mortality rates, and attaining a better prognosis.
Aims: The present study was conducted to assess laboratory and clinical parameters in
subjects with severe septic shock and sepsis. Also, the study assessed Acute Physiology and
Chronic Health Evaluation-II score (APACHE-II) with Echocardiographic evaluation of
cardiac functions. Cardiac biomarkers including creatine phosphokinase myocardial band
(CPK-MB)and Troponin-T were also assessed in the present study.
Materials and Methods: The present prospective clinical study was conducted to assess the
cardiac biomarkers, clinical, and laboratory parameters in subjects with severe septic shock
and sepsis.
Result: It was seen that significant mortality was seen in subjects with positive Troponin-T
and high CPK-MB levels. In subjects with septic shock and sepsis, CPK-MB levels were
raised. Increased levels of CPK-MB and Troponin-T were also indicative of myocardial
injury which could lead to coronary insufficiency in subjects with septic shock and sepsis.
Conclusion: The present study concludes that in critically ill subjects, levels of Troponin are
usually raised. However, more data is needed to prove prognostic and diagnostic significance
with its implications in subjects with septic shock and sepsis.

Inductive learning was found to depend on acceptance. The basis of induction research is the
decision tree method . This method uses inductive methods to correctly classify objects based on the quality they
provide. These calculations are very useful for characterizing articles and are often used in the main frame. When
any new quality is added, the ID3 decision tree learning calculation is used to see if there is any progress in the
selection principle currently granted to PUCC (Pollution Treatment Certificate). Three studies were conducted on
the PUCC issuance, each of which added a new feature to the data set, thereby providing decision rules.

Aim: To investigate the relation of vitamin D concentration and parathyroid hormone with insulin resistance in PCOS women.
Methods: In the department of Obstetrics and Gynecology at Dr. Baba Saheb Ambedkar Medical College & Hospital, Rohini, Delhi, a one-year observational study was conducted. The levels of 25, hydroxyvitamin D and PTH, as well as the levels of fasting sugar and insulin in the blood, were tested.
Results: There was a 91.0 percent prevalence of vitamin D insufficiency (<20 ng/ml) in the study, whereas 67.9 percent of participants had an elevated parathyroid hormone level.
According to the study, vitamin D insufficiency (r=-0.64, p=0.01) had a significant negative connection with the HOMA-IR. Increased PTH levels were shown to have a positive correlation with HOMA-IR.
Conclusion: Women with PCOS who have high parathyroid hormone levels or vitamin D insufficiency have a higher incidence of glucose intolerance.
If vitamin D insufficiency and insulin resistance are strongly linked, it may be possible to treat insulin resistance by raising vitamin D levels.

Gallstones are composed predominantly of cholesterol, bilirubin and calcium salts with lesser amounts of other constituents. The most popular classification system uses the relative amount of cholesterol as the main criterion and designates gallstones as being either cholesterol or non-cholesterol. The latter are further classified as black or brown pigment stones. A thorough preoperative anaesthetic evaluation was done and patient fitness for general anaesthesia assessed. A dose of antibiotics (usually a cephalosporin) was given 30 minutes before surgery. A nasogastric tube was inserted routinely. The most common indication for open cholecystectomy was symptomatic cholelithiasis (68%). In the laparoscopic group also cholelithiasis (76%) was the most common cause.

The first open cholecystectomy was performed by Langenbuch in1882 in Berlin. The first laparoscopic cholecystectomy was performed by Muhe in 1985. However the first laparoscopic cholecystectomy recorded in medical literature was performed in March 1987 by Mouret in Lyon, France. The technique was perfected a year later in March 1988 by Dubois in Paris. Preoperatively patient’s history was assessed with special reference to pain, fever, nausea, vomiting, dyspepsia, jaundice, mass per abdomen, weight loss and decreased appetite. A careful emphasis was made to record the physical findings particularly icterus tenderness in right hypochondrium and gallbladder mass. Laboratory testing and USG of gallbladder and CBD was done. CBD stone was ruled out by USG. Mean patient satisfaction score is significantly less in Group OPEN with P =0.009.Significant number of patients responded with good to excellent grading (80%) in LAP group when compared to those patients in group OPEN (44%).For statistical analysis purpose we combined excellent+good as above average, and average+poor as below average satisfaction. Significant numbers of patients are satisfied with laparoscopic surgery when compared with open surgery.

Back ground: Chronic subdural hematoma (CSDH) is a common neurological condition that mainly occurs in the elderly. The minimally invasive procedure-twist drill craniostomy (TDC) is theoretically more suitable to treat CSDH than the traditional procedure-burr hole craniostomy (BHC). Compared with burr hole craniostomy (BHC), twist drill craniostomy (TDC) is getting increasingly popular because of its minimal invasiveness in evacuating chronic subdural hematoma (CSDH) under Local Anaesthesia. However, the TDC technique varies and is continually developing; moreover, no consensus yet exists regarding the optimal protocol and the efficacy and safety of TDC is still controversial.
Methods:A randomized study involving 83 patients with CSDH who underwent surgical evacuation at a single center was conducted, involving 41patients undergoing Twist Drill Craniostomy (TDC group) and 42 patients treated by Bur Hole Craniostomy (BHC group). The neurological outcome was studied to evaluate the efficacy of surgery and the radiological outcome was assessed as a supplement to the surgical efficacy. In addition, complications, recurrence, and reoperation, as well as pneumocrania, duration of operation and length of stay, were studied to evaluate the advantages of the modified TDC compared with BHC. Independent sample t tests or rank-sum tests were used to compare the outcomes between the 2 groups.
Results: There was significant improvement in both Markwalder grading scale and Glasgow coma scale in both twist drill and burr hole group within 24 hrs of intervention.The recurrence rate was 17.1% in the twist drill group and 11.9% in the burr hole group. There were 8 deaths in the twist drill group and 1 death in the Burr hole group but none were attributable to the procedures. All deaths that occurred were attributable to pre-existing co-morbidities.
Conclusions: TDC is a minimally invasive surgical technique to treat CSDH; this procedure isas effective as BHC, but safer and simpler than BHC and should be considered for patients with CSDH, especially the elderly.

NAFLD is a spectrum of liver lesions ranging from simple hepatic steatosis to NASH with progressive fibrosis leading to cirrhosis and liver failure in some patients and eventually hepatocellular carcinoma. The different parts of this spectrum are probably best regarded as parts of a histological continuum. All patients underwent ultrasound (USG) of the abdomen to detect fatty changes in the liver, performed by aexperienced radiologist, using a high-resolution B-mode ultrasonography system, having an electric linear transducer mid frequency of 3-5 MHz.The scanning was done for an average of 20 minutes.
In our study out of 50 patients,22(44%) patients were having diabetic neuropathy on the basis of clinical examination,out of them 10 (45.45%) patients were males & 12 (54.54%) patients were females. There was higher prevalence of diabetic neuropathy in female patients. 28 (56%) patients were negative for neuropathy. Out of total 50 diabetic patients with NAFLD, 31 (62%) patients were having evidence of CAD, out of 31 patients, 17 (54.8%) were male & 14 (45.2%) were female. 19 (38%) patients having no evidence of CAD.

NAFLD may progress through three different stages, from hepatic steatosis to steatohepatitis and finally to cirrhosis. Hepatic steatosis represents simple increase in accumulation of fat in liver, without evidence of inflammation or liver damage. Inflammation and liver damage is however present in steatohepatitis. NAFLD was defined as any degree of fatty liver in the absence of alcohol intake. NAFLD, if present, was classified based on standard ultrasonographic criteria as: Grade 1 (mild steatosis): slightly increased liver echogenicity with normal vessels and absent posterior attenuation. Prevalence of high Waist circumference, which is important marker of central obesity, according to ATP III guidelines for male waist circumference is(≥102 cms) & for female is (≥88 cms) consider as central obesity. In our study,14(58.33%)males patients had waist circumference is ≥102cms &25(96.15%)females patients had waist circumference is ≥88cms. Mean waist cicumference in male were 102.58cms & in female were 96.5cm

Background: Immediate postpartum intrauterine contraceptive device (IPPIUCD) is an effective postpartum family planning method. It provides reversible contraception and also helps in adequate birth spacing. This study examines the outcomes of IPPIUCD and evaluates the reasons for removal of IUCD in the study population.
Methods: This study was done at District Hospital, Koppal from October 2020 to march 2021. Women who underwent IPPIUCD insertion were included in the study. They were followed up for a period of 8months and outcomes in terms of continuation or removal or expulsion of the IUCD were studied.
Results: A total of 548 women underwent IPPIUCD insertion out of which 332 (60.6%) had post placental IUCD insertion and 216 (39.4%) had intra caesarean IUCD insertion. 54 cases (9.8%) had IPPIUCD removed and 30 cases (5.5%) had IPPIUCD expulsion.Reasons for IPPIUCD removal included pain abdomen (7.4%), menorrhagia (29.6%), fear of complications (35.2%), husband refusal (22.2%) and post sterilisation (5.6%).
Conclusions: IPPIUCD is an effective method of contraception for spacing and limiting births. Proper education and counselling regarding this method of contraception and regular follow up and motivation can help reduce the rates of removal and improve acceptance rates.

Background: Hypertensive disorders of pregnancy are known to cause adverse maternal and fetal complications and outcomes. In view of assessing its burden and feto-maternal complications and outcomes in the current study setting, the study was conducted.
Material and Methods: This is a retrospective study conducted among 8941 women with more than 20 weeks of gestation, admitted for delivery under the department of Obstetrics and Gynaecology at Koppal Institute of Medical Sciences during the study period of 2 years from July 2019 to June 2021. The primary outcome was assessed in terms of proportions of hypertensive disorders of pregnancy and eclampsia. Secondary outcomes were assessed in terms of feto-maternal complications and outcomes among those with hypertensive disorders of pregnancy. All the quantitative data were presented in percentages.
Results: The proportions of hypertensive disorders of pregnancy were 10.64% and eclampsia was noted to be 1.9%. Majority (63.1%) of the study subjects were between 18 to 23 years, mostly from rural areas (89.8%) and belonged to lower socio-economic status (95.1%). The highest proportion of them (87.9%) had crossed a gestational age of 34 weeks and also primigravida formed the majority (68.4%). None of them were booked and 41.7% of them underwent lower segment caesarian section. 5.3% of the study subjects had maternal complications with common complications being HELLP syndrome, renal complications, pulmonary edema and cerebral venous thrombosis. 0.7% of them died. 28.9% of neonates had complications viz., low birth weight, preterm and small for date babies. Intrauterine deaths were noted among 8.1%.
Conclusion: 1 in 10 mothers had hypertensive disorders of pregnancy and nearly 2 of such 100 hypertensive mothers landed in eclampsia. Feto-maternal complications were documented among 5.3% mothers and 28.9% neonates. Maternal mortality was reported in 0.7% and 8.1% of fetuses had intrauterine deaths contributing to perinatal deaths.

There are several reports that many co morbidities can both accelerate TB disease and complicate TB treatment. It is therefore important to identify these co morbidities in people diagnosed with TB in order to ensure early diagnosis and improve co-management. When these conditions are highly prevalent in the general populations they can be important contributors to the TB burden. The research students attended ward rounds on a daily basis and collected the cases which are mentioned under the inclusion criteria. All the required parameters were analyzed thoroughly and data was pooled and analyzed. Identified adverse drug reactions and drug interactions were reported to the consultant physician on time and on daily basis. Among 250 patients, majority 182(72.8%) of the patients were found to be without any comorbidities & 68(27.2%) were with co morbidities. Patients with co morbidities were 68, out of which male patients 62(91.2%) were more in number compared to female patients 6(8.82%). There were 55 (80.88%) DM patients followed by COPD-7 (10.29%) and HIV-6 (8.83%).

COPD currently is considered the 11th leading cause of disability worldwide. Current projectionssuggest that by the year 2020, COPD will be the 5^th leading cause of disability worldwide, behind only ischemic heart disease, major depression, traffic accidents, and cerebrovascular disease. The research students will attend ward rounds on a daily basis and collect cases which are under inclusion criteria. The patients will be randomly divided into intervention and control group. The intervention group of patients will be analysed. Majority of the patients came with complaints of dry cough, wheezing and breathlessness, and a very few patients had complained of fever. Most of the patients were admitted for exacerbation of COPD. It was observed that the patients with exacerbation of COPD were more in number in intervention group.

Introduction & Aim:The fibula is a long bone present lateral to tibia in leg. It is used in grafting and reconstructing surgeries in case of large bony tumour resection, grossly fractured mandible, spine surgeries and even stabilizing the tibia. Aim of the study is to describe the relative location, number & course of fibular nutrient foramina and observe any variations by comparing with earlier studies by various authors.
Materials and Methods:Study was done by examining 51 adult dried fibulae consisting of 31 right sided bones and 20 left side bones. Each bone was carefully observed for various parameters as regards the surface anatomy of nutrient foramina present in the shaft. Foramen index was computed and compared with others.
Results:Nutrient foramina were found singly in 82.35% fibulae, 7.84% fibulae showed two foramina and 9.8% fibulae were devoid of any nutrient foramen. 16% foramina proceeded towards the growing end while 84% nutrient foramina were directed opposite to the growing end. 6% foramina were detected in upper zone and 94% were detected in the middle zone. Grossly the total nutrient foramina were placed on the posterior aspect of the fibulae, out of which, 72% surfaced on the medial crest, 20% were present between the posterior border and the elevated medial crest and 8% were sited between the interosseous border and the medial crest. Worked out Mean foramen index of the study was 50.02.
Conclusions: The anatomical knowledge of nutrient foramina aids the orthopaedic and plastic surgeons in planning bone grafting and bone reconstruction surgeries.

Introduction: Head and neck cancer is a common disease worldwide. The prevalence varies among different regions of the world and mirrors the occurrence of risk factors for head and neck cancers. The chronic exposure of risk factors of head and neck cancer to upper aerodigestive tract mucosa leads to cancer or less commonly to field cancerisation, a process of premalignant dysplastic lesions that are at high risk of progression to cancer. Aims: To evaluate the influence of vital pre-treatment variables employed in evaluation and treatment of head and neck carcinomas in predicting prognosis. To assess the feasibility of stratifying head and neck cancer patients into risk groups based on significant variables affecting survival endpoints.
Material and Methods: This is a prospective study conducted in the Department of Surgical oncology at Kidwai Memorial Institute of Oncology over a period of 1 year. Patients attending the cancer OPD were assessed for inclusion in the study. The eligibility criteria were set as given below: Biopsy proven non-metastatic carcinomas of oral cavity, pharynx and larynx, Squamous cell carcinoma-Histology.The protocols included primary chemo RT for the pharyngeal cancers followed by surgery for salvage. For early oral cavity cancers surgery alone or surgery followed by adjuvant CRT and for locally advanced disease surgery followed by CRT was administered.
Result: Regarding site specificity oral cavity cancers were the commonest (59.4%), followed by hypopharynx (20%), oropharynx (11.6 %), and larynx (8.8%)Overall majority of the patients had locally advanced cancers with stage IV (49.5%) and stage III (23.3%) disease. Early head and neck cancers constituted about 27.1% of the study with stage I and stage II cancers contributing 9.4% and 17.7% respectively. Most of the lesions were moderately differentiated carcinomas (63.3%), while poorly differentiated tumors and well differentiated tumors comprised of 9.4% and 27.2% respectively.
Conclusion: Risk stratification of head and neck cancer patients using certain patient, tumor and treatment related variables is feasible. Tumor stage, degree of tumor differentiation, ECOG performance status, treatment related weight loss and treatment interruption are proven prognostic factors affecting survival outcomes.

Introduction: Benign breast condition refers to a lump, cyst, or nipple discharge (fluid) of the female or male breast that is not cancerous. Benign breast conditions are generally caused by a number of factors. Those factors include the makeup of breasts (fatty tissue vs. dense or thick tissue), age, hormone problems.
Methods and Materials: This is a prospective study and observation study conducted in the Department of General Surgery at Prathima Institute of Medical Sciences over a period of 1 year.All patients who underwent surgery for benign breast disease were included. Patients who did not undergo surgery for benign breast disease were excluded. All the data were collected in predesigned proforma by observation of the files and operation notes of patient who underwent surgery for benign breast disease. The files were retrieved from the case sheet and histopathological examination reports were obtained from the department of pathology and relevant information were noted.
Result: In our study, most of the patients were 21-30 years i.e., 38 out of 70 (54.2%), followed by 10-20 years, i.e., 17 out of 70 (24.2%) and least were 1 (1.4%) belongs to 51-60 years.Patients with lump in left breast were more in number (31) than those with lump in right breast (29). Bilateral lump presentation as the least common 10 (14.2%) patients. In our study, 42 was firm 60% followed by 9 were soft while 19 were hard in consistency.Fibroadenoma was the most frequently diagnosed lesion, followed by fibrocystic change. Epidermoid cyst was the third most commonly diagnosed. Other histological diagnoses were fat necrosis, lactating adenoma and tuberculosis of the breast.
Conclusion: Benign breast disorders are a group of conditions that are commonly managed by surgeons. Benign breast pathologic conditions rarely increase the risk of malignancy. As knowledge of benign breast pathologic conditions improves, many conditions can be managed without the need for open surgery. Collaborative care models including nurse practitioners can improve patient experience and education about their breast health.

A direct blow to the eye and the surrounding tissue will result in a contusional injury of
varying severity; from “black eye” to severe intraocular disruption. When the eye is struck, an
anteroposterior compression will result with concomitant stretch in the equatorial plane with
subsequent contusional and tearing damage. A pre-structured and pretested questionnaire was
used to gather information after obtaining an oral informed consent from the study subject
and maintaining confidentiality. The relatives or attendants will be interviewed where the
condition of the victims did not warrant the interview. In our study we found that 68% of the
orbital fractures were unilateral while 32% were bilateral. Out of which the most common
wall to be fractures was the floor 59(59%) patients followed by 34(34%) lateral wall fracture
31(31%) medial wall and 11(11%) had roof fracture.

Trauma can result in fracture of one or more wall of the orbit, floor being most common
affected, followed by combined floor and medial wall fracture, followed by combined floor
and lateral wall fracture, combination floor, lateral wall and medial wall together, isolated
lateral wall and isolated medial wall in decreasing frequency. Pupils were checked for both
direct and indirect light reflex and swinging flash light test was done to rule out any relative
afferent pupillary defect. Slit lamp biomicroscopy and indirect ophthalmoscopy was done to
rule out involvement of Posterior segment. Inspection palpation and auscultation of the orbit
and orbital margins were done Hertelsexophthalmometer was done to check Enophthalmos
and exophthalmos. Extra ocular movements were examined in all nine gazes both ductions
and versions. Forced duction test was done in case of restricted ocular movement. Our study
had 8 patients with diplopia. Out of which 3(37.5%) had floor fracture, 4(37.5%) had
combined medial, lateral and floor, 4(37.5%) had combined medial and lateral and 1(12.5%)
medial wall fracture.

Obstruction of the nasolacrimal duct from whatever source results in stasis with the
accumulation of tears, desquamated cells, and mucoid secretions superior to the obstruction in
a pathologically closed lacrimal drainage system. This creates a fertile environment for
secondary bacterial infection and can result in dacryocystitis which is a constant threat to the
cornea and orbital soft tissue. The study included 50 patients who attended ophthalmology
out-patients and in-patients departments at. The patients were randomly selected and studied
from the clinical and bacteriological point of view. Patients were examined with special
reference to the lacrimal apparatus. Present study shows majority 18 cases (36%) were
suffering from their symptoms mainly epiphora between 6 months-1year, followed by 3-6
months (34%) and 16% had their symptoms between 1-2 years. 6% of the cases had
symptoms since 1-3 months, > 2-5yrs was the duration of the disease in 6% cases. This shows
the chronic nature of the disease which progresses to various stages unless treatment is
instituted.

The studies have shown that bacterial pathogens differ in chronic and acute dacryocystitis.
Acute dacryocystitis is caused by gram negative rods. In chronic dacryocystitis mixed flora is
isolated. The percentage of culture positive was found to be higher in chronic dacryocystitis
with single or mixed growth. All patients included in the study underwent basic evaluation as
mentioned in the standard proforma after obtaining written informed consent. Routine
ophthalmic examination was conducted by the investigator, including slit lamp examination,
paying special attention to the presence of discharge and epiphora. In the present study
bacterial growth was seen in 42 (84%) cases. Gram positive organisms were isolated in 27
(54%) cases and Gram negative organism in 13 (26%) cases. 2 (4%) cases showed mixed
growth pattern. Staph Aureus and CONS accounted for 22% each and Streptococcus 10%
cases. Among Gram negative organisms Klebsiella was isolated in 10% cases. Citrobacter
and Pseudomonas were isolated in 6%.

Background: Determination of age of majority is essential at the time of employment, marriage, fixation of criminal responsibility, judicial punishment, exercise of adult franchise etc. Determination of age forms a major help in solving many medico legal issues. The study of epiphyseal union of bone is considered a reasonable scientific & accepted method of estimation of age by the court of law all over the world. It is the maximum of age estimation that we should combine information from as many epiphyses as possible to provide the most accurate estimate of biological age and therefore chronological age.
Material and methods: The study was conducted at the department of Anatomy with the help of department of Radiology, PMCH, Patna. The material for study consisted of 100 subjects between the age of 11 and 18 years (52 males, 42 females) Source of subjects were from a nearby school. Students of Patna Bihar region were taken for study. The age was verified by checking the date of birth from school admission records. Among these students of 11 to 15 years were students who were in fifth to tenth standards.
Conclusions: There was difference between the age of epiphyseal union of lower end humerus and upper end ulna and upper end radius among the males and females. In general the fusion of epiphyses occurs 3-4 years earlier in females as compared to the fusion in males.

Background: Delirium tremens is one of the severe complications of alcohol withdrawal syndrome which is associated with a high morbidity and mortality.
Material and methods: A prospective cross sectional study was conducted, Department of Psychiatry, at Darbhanga medical college and Hospital, Darbhanga. for a period of one  year , A total of 160 cases that were referred to psychiatry department with alcohol dependence syndrome were assessed and 153 cases were included for the final analysis after taking written informed consent.
Conclusion: The prevalence of DT in cases with alcohol dependence syndrome was 21% in the patients admitted in a general hospital setup for alcohol de-addiction. Occurrence of withdrawal seizures and higher scores on CIWA-Ar predicated the occurrence of DT in the current sample. 

Background: To recognize and understand the short term effects of administration of prophylactic betamethasone, to the mother, on the foetal heart rate pattern.
Material and methods: This study was a cross sectional study. It was conducted over two years in department of Obstetrics and  Gynaecology, at Patna medical college and Hospital, Patna. After admission, a baseline Electronic Foetal Monitoring (FEM) test was done and repeated at 12 hourly intervals for the next 84 hours. Two doses of betamethasone intramuscularly were given at 24 hours interval. Foetal Heart Rate pattern like baseline, beat to variability, acceleration and deceleration were monitored. If FHR pattern showed any non-reassuring findings, EFM was repeated after 1 hour and followed up with Biophysical Profile (BPP).
Conclusion: betamethasone, induces changes in foetal physiology. These changes are not brought about by foetal hypoxia. Knowledge of the transient effects of betamethasone, will avoid unnecessary preterm delivery of babies. This will also reduce the number of caesarean sections in future pregnancies.

Aim: Comparison effect of intravenous tranexamic acid and misoprostol for postpartum haemorrhage.
Methods: This double blinded randomised clinical trial study was done the Department of Obstetrics and Gynaecology, Hi-Tech Medical College, Rourkela, Odisha, India from February 2021 to November 2021. 80 women with PPH (500-1500 ml) diagnosis after caesarean or normal delivery, according to their haemorrhage level after usual therapies for controlling haemorrhage, after getting consent were included in the study. They were divided into two equal intervention and control groups randomly. Patients in group A were treated with intravenous TXA and patients in group B with rectal Misoprostol. Intervention group (group A) which were receiving intravenous TXA (1gr) and if there was relieve in haemorrhage, next TXA dose was repeated after 30 minutes and in patients of control group (group B) after usual therapies, 5 rectal 200 micrograms Misoprostol pills were used. The bladder was emptied before therapy in both groups.
Results: Mean age of all studied patients was 27.7 ± 5.5 years which ranged from 15 to 41 years. As distinct groups mean age of women in group A, was 28.1 ± 5.3 years and in group B it was 27.7 ± 5.8 years. Mean age difference between two groups of under study patients was not statistically significant (P = 0.87). Based on sonography mean gestational age in group A, was 37.8 ± 3.5 and in group B, was 37.5 ± 3.4 weeks. Difference of two groups in terms of gestational age and amount of haemorrhage, was not statistically significant (P = 0.34 and P = 0.47 respectively). In group A, natural vaginal delivery (NVD) was performed, while in group B there in 38 patients (95%) NVD and in 2 patients (5%) caesarean delivery was performed. According to analysis, the difference between two groups was not statistically significant considering mentioned aspects. NVD in 30 cases (75%) in group A and in 36 patients (90%) in group B, was together with episiotomy or laceration and its difference was statistically significant (P = 0.003). Mean massaging time for patients in group A was 25 ± 17.9 minutes and in group B, was 25.5 ± 13.6 minutes. In terms of clinical consequence, 37 patients (92.5%) in group A and 36 patients in group B were discharged without any specific problem.
Conclusions: It is possible to state that misoprostol has no specific preference over TXA, but it is better to investigate its effect with other studies with more sample size and associated with misoprostol.

Aim: Comparison of astigmatism correction following straight and frown incisions in manual small incision cataract surgery
Materials and methods: A prospective interventional cross-sectional study was conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. 100 patients admitted for cataract surgery between the age group of 45 to 70 years were only considered for the study.
Results: The observation of astigmatism in diopters preoperatively revealed 48% had astigmatism -0.25 D, 36% has astigmatism range from 0.26 to 0.50 D, 14% had astigmatism range from 0.51 to 0.75 D, and 2% had astigmatism range from 0.76 to 1.00 D. The course of post-operative astigmatism in relation to preoperative status in patients with frown incision revealed majority showed shift toward WTR astigmatism in the first postoperative week, then the ATR astigmatism increases progressively up to 3 weeks and starts stabilizing at 3 weeks. However, in straight incision, the patients showed a shift toward WTR astigmatism at first postoperative week; then the ATR astigmatism increases progressively up to 3 weeks and stabilizes at 4 to 6 weeks. The best corrected visual acuity at 6 weeks of 6/9 or better following frown and straight SICS were 50 and 37% respectively, 1st week postoperatively; 77 and 53% respectively, 3rd week postoperatively; and 83 and 77% respectively, 6th week postoperatively. In our study, we found that frown incision had significantly better (p < 0.001) mean net astigmatism as compared with the straight incision.
Conclusion: We conclude that small incision size and absence of suture are the most important factors that contribute to less astigmatism and faster stabilization of SICS. The duration for stabilization of postoperative astigmatism in straight incision group is 6 weeks, whereas it is 3 weeks in frown incision.

Aim: Prevalence and risk factors associated with primary open angle glaucoma in diabetic patients in a tertiary care centre.
Methods: This Cross sectional study was done in the Department of Ophthalmology, Narayan Medical College & Hospital, Sasaram, Bihar, India. All documented diabetic cases attending Department of  Ophthalmology giving consent for work up for the study, IOP > 21 mmHg (by Schiotz tonometry) with visual field defects, IOP > 21 mmHg (by Schiotz tonometry) with optic nerve head changes,Optic nerve head changes with visual field defects and Normal IOP with no visual field defects or optic nerve head changes, with asymmetry of IOP in both eyes of > 5 mmHg were included in this study.
Results: The results of the study show clear cut evidence of increased incidence of POAG in diabetic patients, which was 8%. The distribution of age in the study population ranges from 35 to 71 years. The mean age of study participants was 52.69 years and a SD of 10.69 years. There is a significant association between age and POAG. No significant association was found between gender and POAG. No significant association was found between duration of DM and prevalence of POAG. POAG was found to be more in patients with a family history of glaucoma.
Conclusion: Patients with diabetes are at increased risk of open-angle glaucoma. Glaucoma family history and retinopathy are the main risk factors for open-angle glaucoma in the early years of diabetes. Gender of patients, duration of diabetes and medication used for control of diabetes were found to be insignificantly related to glaucoma.

Aim: Clinical profile of ocular injuries following road traffic accidents.
Materials and methods: A retrospective study was conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India. Visual acuity at the time of presentation was recorded using Snellen’s chart. Pupillary reaction, presence or absence of RAPD was noted. Patients who required surgical intervention were admitted and surgery performed after obtaining informed consent. Visual acuity was recorded after the surgery. All these data were tabulated and analysed.
Results: Ecchymosis was the commonest type of ocular injury which was seen in 49% of the patients. Out of 24% patients who had posterior segment involvement,   27%  patients   had   vitreous   haemorrhage. Traumatic optic nerve injury was seen in 16 patients. Eyelid ecchymosis was seen in 49% of patients making it the most common ocular presentation. Lid tear was seen in 28% of cases whereas 5% had lid tear with tissue loss. 2% showed canalicular tear. Orbital fractures were seen in 10% of the cases. 20% had extraocular injuries. Majority of the patients were managed conservatively. Only 36% patients required surgical intervention. Lid repair, canalicular tear repair, corneal tear repair, scleral tear repair, cataract surgery, intravitreal antibiotics, retinal detachment surgery were the various surgical procedures performed. In case of traumatic optic neuropathy intravenous methyl prednisolone was given. Visual acuity was assessed after the surgery. 48% show ed improvement in visual acuity, 36% had no change whereas 16% showed deterioration in visual acuity in the immediate postoperative period. 5% of the patients were totally blind.
Conclusion: It is a preventable public health problem. Henceforth ocular injuries as and when they occur have to be tackled efficiently and methodically.

Aim: Visual outcomes and complications after Neodymium-doped yttrium aluminium garnet laser capsulotomy in Posterior capsular opacification
Materials and methods: A prospective interventional study was conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India. Total 100 patients who were previously operated for cataract by routine ECCE/SICS or Phacoemulsification with or without intraocular lens attending OPD in Ophthalmology department and satisfied the eligibility criteria, were included in this study. After through ocular examination Nd-YAG capsulotomy for PCO was done.
Results: In this study maximum number 43(43%) patients who were having PCO, had a history of cataract surgery >24 month back. 32(32%) patients developed PCO in a period 0f 12 months to 24 months of cataract surgery. In 18 patients duration between cataract surgery and PCO was 6-12 months. In 7(7%) patients PCO developed within 6 months of cataract surgery. As table 2 showed, Capsular fibrosis were found in 61(61%), Elschenig’s pearls in 22 (22%), capsular wrinkling in 15 (15%) and pigmentary deposits on capsule in 2 (2%) of cases.The maximum number of patients were having grade 2 PCO 50(50%), followed by grade 1 with 26 (26%) and grade 3 with 24 (24%) cases. In this study, majority of patients 71(71%) had VA of 6/36 or less before capsulotomy. Among these 71(71%) patients, 43(43%) had VA of less than 6/60 ranging from hand movement to counting of fingers. The VA after Neodymium-YAG laser capsulotomy showed dramatic improvement.
Conclusion: The posterior capsular opacification is a common complication after cataract surgery worldwide and it can be managed safely by Nd:YAG Laser posterior capsulotomy. Nd: YAG laser capsulotomy is a safe and effective method to treat PCO. It is non-invasive and avoids all the complications associated with surgical capsulotomy and local anaesthesia.

HELLP syndrome is  a severe complication of pregnancy with high risk for both fetus and mother , some pregnant women develop just one or two of the characteristics of this syndrome which is called as partial HELLP  syndrome ,Maternal morbidity and mortality are due to consequences such as pulmonary oedema ,renal failure  ,DIC ,this study evaluates the maternal outcome in HELLP syndrome so that  the management is improved  resulting in reduced mortality and morbidity
Objectives: This study was designed to understand maternal outcome in HELLP and  Partial HELLP  syndrome in pregnant women at GIMS hospital kalaburgi
Methodology: This study  is a Prospective analytical study conducted in OBG department in GIMS Kalaburgi from April 2021 to September 2021 (  6 month) .
Inclusion criteria: Antenatal women above 20 week gestation  who fulfilled the criteria for HELLP  and  Partial HELLP  syndrome were included in study
Detailed history , clinical examination, BP measurement  Obstetric Examination , blood investigation were done  and categorized by Missiippi Classification for better evaluation
Maternal outcome were noted and subjected to Statistical analysis .
Exclusion criteria: all antenatal women with mild pre-eclamsipa who does not fulfill the Lab criteria of HELLP syndrome.
Conclusion: Once diagnosis of HELLP syndrome is confirmed management  depends on several obstetric and maternal variables like gestation age , severity  of lab abnormalities, fetal  status , early detection and prompt management of preeclampsia is the most important approach to prevent HELLP and  Partial HELLP  syndrome, we have to increase grass route level antenatal care

Introduction: Chronic kidney disease (CKD) is increasingly being recognized as a global public health problem. The focus in CKD has changed from treating a terminally ill patient, to dealing with a person who has a manageable chronic disease that requires long term care. Hemodialysis (HD) is the most commonly used method of dialysis. Arteriovenous fistulas (AVF) are considered the gold standard for hemodialysis access based on their superior patency, low complication rates, improved adequacy, lower cost to the healthcare system and decreased risk of patient mortality. Aim: to identify the risk factors for failure of Brachio-cephalic arterio-venous fistula (BC AVF). Methodology: This was a single centre, observational longitudinal study done on 98 patients with Brachio-cephalic arterio-venous fistula (BC-AVF). Results: We observed that majority patients were between 51-70 years of age. Two  fistulas that failed during the 15 days follow up were in age group >70 years, 3 fistulas that failed at 30days follow up were in age group between 51-70 years.

BACKGROUND AND OBJECTIVE: Various decompressive and stabilising methods such atlas and axis vertebra (C1 and C2) transarticular screw fixation and posterior screw placement on the lateral mass are used in CVJ surgery. These operations usually target the C1, which is part of the CVJ's bony architecture.Thus, complete understanding of atlas vertebra anatomy is required for surgical planning and fracture analysis. The dimensions of the vertebral artery groove are rare in Indian literature, and even rarer in South Indian literature. This project will gather and give atlas anatomical data that may be useful for surgical planning and assessing C1 fractures.The current study sought to make the following findings:1. Examine and measure atlas vertebra specimens for morphological criteria.2. To offer anatomic data for surgical planning of the CVJ. METHODOLOGY : During 18 months, 120 human dry adult complete atlas vertebrae were gathered from the Department of Anatomy, Kakatiya Medical College.R ESULTS: The mean transverse diameter of the spinal canal was 27.012 mm, and the mean anteroposterior diameter of the vertebral canal was 26.17 mm.In the vertebral artery groove, the midline to lateral most point distance was 23.78 mm on the right and 23.87 mm on the left, while the midline to medial most point distance was 12.98 mm on both sides.The morphology revealed 4 SAF kinds. Oval (45%) and bi-lobed (26%) aspects (13.33 percent right and 7 percent ).ANALYSIS AND SUMMARY :The current research adds to the existing knowledge of atlas vertebra anatomy. Understanding the normal structure of the atlas vertebra is critical for diagnosis and treatment.

Background: Lower limb varicose veins are a frequently encountered medical condition that requires surgical intervention either through conventional procedures or minimally invasive procedures.
Methodology: A case series of 17 patients with lower limb varicosities admitted under the Department of General Surgery at Apollo General Hospital, Film Nagar from September 2019 to December 2021 studied and treated with Endovenous laser ablation without Doppler guidance intra-operatively. Patients were followed up post-operatively after 1week, 1month , 3 months and 6 months to note the regression of symptoms as well as complications of the procedure and recurrence of varicosities.
Results : . Dilated veins and edema have significantly reduced  in all 17 cases within 7-10 days. Pigmentation present in 6 of the 9 patients faded over timeof 6 months. Symptoms like itching, eczema decreased over the same time. No recurrences were noted. No DVT or infections observed.23.5%  of  our  patients  required  Foam  sclerotherapy  for  the treatment of residual varicosities,  immediately after EVLT in  the  same  sitting. 47% complained  of  mild  pain  1  week after  the  procedure, 12%  had  moderate pain  while 41%  had no pain. No patients complained of pain during their subsequent visits. One patient complained of painful palpable superficial vein thrombosis which disappeared by 3rd follow-up visit.
Conclusion: EVLT without Doppler guidance is an efficient treatment modality for varicose veins treatment providing better cosmetic, functional results without radiological expertise.

Introduction: This study aims to study the various outcomes of percutaneous drainage of pancreatic pseudocyst and the factors that favor the successful outcome of this procedure.
Materials and Methods: This longitudinal study was approved by the Institutional Ethics Committee and included a group of 66 patients who were diagnosed with pancreatic pseudocyst with no prior intervention done at the time of admission. The patients were evaluated and underwent radiological image guided insertion of a percutaneous drain and were monitored throughout the course of their treatment and recorded drain amylase levels, complications, length of hospital stay and duration of catheter dwell time. Results were there analyzed to study those characteristics which increased the success of this procedure.
Results: A total number of 66 patients were included in this study out of which 29 were successfully treated with percutaneous drainage. Demographic data collected showed that men and those between the ages of 31-40 were most often diagnosed with a pancreatic pseudocyst. 37 patients did not benefit from this procedure and developed recurrence, complications and required need for surgical intervention. There were no deaths noted. In addition to this it was found that comparatively raised drain amylase levels were associated with a higher rate of failure. Patients were followed up for a period of 2 months after discharge.
Conclusion: This procedure despite being a safe and minimally invasive method of treatment of pancreatic pseudocyst requires proper patient selection to optimize the outcomes and reduce the risk of need for further surgical treatment.

Background: Orthopaedic trauma surgery focused mainly on femoral fragility fractures in the   elderly, since the “lockdown” began on March 23, 2020 in our country. Proximal femur fractures carry a high mortality rate due the age and complications. Thus, orthopaedic surgeons face the daily dilemma of performing life-saving surgery on patients who, have severe respiratory compromise, have a higher risk of peri-operative death. The optimal surgical treatment of displaced femoral neck fractures is still debated. Hemiarthroplasty⁴ contributes to early ambulation and good functional recovery. Determining mortality and risk factors for adverse outcomes for patients with COVID-19 and a concurrent hip fracture is of great importance, as it can improve clinical pathways, perioperative management, and resource allocation.
Methods: This was a retrospective study of 10 patients ≥60 years of age with a neck of femur  fracture and COVID-19 who underwent hip  hemiarthroplasty . Clinical characteristics and early postoperative outcomes were reported.
Results: Seven out of the 10 COVID-positive hip fracture patients in our series were asymptomatic on admission with no clinical signs or symptoms of COVID-19 infection. One of the patient had cough and other 2 patients presented with hypoxia. 7 patients was given supplemental oxygen postoperatively which includes the patient presented with hypoxia . 7 patients required post op blood transfusion .None of the patients were put on mechanical ventilation. There was no case of surgical site infection .Average harris hip score was 80 with good outcome . The average length of inpatient stay was 15 days.
 
Conclusions: Our study  shows  that neck of femur fracture patients who present with asymptomatic or mild COVID-19  who underwent hip hemiarthroplasty had a good functional outcome with few post op complications .

Propranolol hydrochloride is used to treat high blood pressure, thyrotoxicosis, capillary
hemangiomas, performance anxiety, and essential tremors and used to prevent migraine
headaches. In this investigation-controlled release tablet of Propranolol Hcl was prepared
using different polymers such as xanthan gum, tragacanth, sodium carboxy-methylcellulose,
HPMC K4M, Eudragit S100, ethyl cellulose by direct compression method. All the precompression
and post compression parameters of designed formulations of F1-F8 were
evaluated and found to be within permissible limits. The optimized formulation (F7) showed
a maximum percentage of drug release (100%) within 6hrs when compared to other
formulations. From the FT-IR study it was concluded that there were no possible drug and
polymer interactions. The short-term stability studies were carried out at 40±2°C and 75±5%
RH and confirmed no changes in the weight, hardness and friability. Based on study results
it may be concluded that tablets prepared will emerge as eminent candidates in treatment of
hypertension.

Aim:To identify the trend of ocular trauma in pediatric age-group and evaluate final visual
outcome.
Materials and Methods: Prospective interventional study at Government medical College,
Bharatpur from November 2019 toOctober 2020,patients up to age 16 years attended the
casualty department of eye and undergone intervention with follow-up period of 1to3months
or till better recovery.
Results: Total 118 eyes of 115 patients were enrolled. The age-group more affected was
above 5 years (67.80%, i.e.,80 eyes)and below 5years (32.20%, i.e.,38eyes). Boys (62.71%)
were affected more than girls (37.29%). Most of the children reported to casualty within
24hours(80.50%eyes),remaining patients reported later within 2days to 1 week (19.50%eyes).
Most of the ocular injuries occurred by household objects (22.3%), blunt objects(13.56%),
playground/sports (13.56%),accidental fall(11.02%), projectile(7.63%)and others. Best
corrected visual acuity(VA)of more than 6/18 achieved in 61.02%eyes, 6/18-6/60
in18.64%eyes,<6/60-counting finger close face(CFCF)in5.93%eyes, projection of
light(PL)+perception of rays(PR)in5.93%eyes,and noPLin8.47%eyes.
Conclusion: Pediatric ocular trauma is still higher in Rajasthan. It requires early presentation
and intervention so that prognosis can be enhanced and impact of trauma can be reduced as
much aspossible.

Background:Lumber Spinal Stenosis can give rise to several clinical syndromes depending
upon the severity of compression resulting from spinal stenosis. LSS diagnosis is made
through a complete assessment that combines history, physical examination, neurophysiology
and imaging. EMG and NCS play important role in the evaluation of LSR. Present study was
planned to see the extent of functional loss (EPE) by conduction studies associated with the
structural abnormality (MRI) of lumber spinal stenosis.
Methodology: Longitudinal study was conducted in GMCH for four months. MRI was done
of the probable patients of LLS followed by neurophysiological examination. Then
correlation of nerve conduction of lower limb nerve was made with the finding of MRI.
Results:Almost equal male & female were there in study & 70% participants belongs to less
than 60 years of age group. maximum (57%) participants had severe stenosis & 21% had
minimal stenosis.Maximum participants (90%) had lateral left & right compression and only
20% had central compression. Almost 43% participants had compression at L2-L3 level, 70%
had at L3-L4 level, 94% had at L4-L5 level & 63% had compression at L5-S1 level.
Conclusion: The early detection of functional loss by the neurophysiological examination
may provide useful information to the clinician in planning the effective management for the
patient’s favourable outcome

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease
characterized by joint swelling, joint tenderness, and destruction of synovial joints,
leading to severe disability and premature mortality. Early rheumatoid arthritis is
defines as “RA with duration of disease/symptoms of disease < 6 month.”
Aim:To study serum vitamin D level in newly onset rheumatoid arthritis patients.
Methodology: It is a Case-control study, all patients fulfilling revised American College
ofRheumatology criteria/EULAR criteria(2010) for Rheumatoid Arthritis being
attended to in therheumatology clinic, Tools like Oral questionnaire, History &
Clinicalexamination,laboratory equipments will be used.Sample size is 45 cases and 45
controls, complying with inclusion and exclusion criteria.
Result: The study suggested that, mean value of Clinical Disease Activity Index (CDAI)
of RA was 12.24±8.05 in cases and 2.89±0.83 in control, DAS28 Score was 4.24 ± 1.07 in
cases and 3.00 ± 0.37 in control, it showed statistically significant association between
serum Vitamin D3 level with CDAI and DAS28 Score in rheumatoid arthritis patients.
Conclusion: The study results suggest that the inverse relationship between serum
Vitamin D levels and RA disease activity.

Background: Establishing whether patients are exposed to a ‘known cause’ is a key
element in both the diagnostic assessment and the subsequent management of
hypersensitivity pneumonitis (HP).
Objective: The aim of the study is to determine the burden of hypersensitivity
pneumonitis at a respiratory center.
Methods: 100 patients had been enrolled to the study. Demographic, clinical,
radiological and aetiological data were collected with a random identification code for
each patient in view of maintaining the confidentiality during data collection.
Results: Out of 100 patients, there were 65 females and 35 males. Mean age of the
population was 55.50 years (SD = 10.50) years. 50 patients were less than 65 years of
which 30 were aged between 45 to 60 years while 20 were aged <5 years.
Conclusion: In general, patients with acute disease, if correctly and timely diagnosed
and treated, have a good prognosis, and patients usually improve. By contrast, patients
with subacute/chronic HP (in particular those with bird fancier’s disease) often
progress to irreversible pulmonary fibrosis and may die within a few years after
diagnosis.

Objective: The aim of the present study is to determine the association between knee
inflammation and knee pain in patients with knee osteoarthritis.
Methods: A total of 250 patients with knee OA were included in this study. The
diagnosis was based on the American College of Rheumatology (ACR) criteria for knee
OA. The severity of knee pain, stiffness, and disability were measured using the
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results: The mean age of the patients was 50.11 ± 6.34 years. Kellgren-Lawrence
grading scale and age or disease duration were positively and significantly associated,
whereas none of the WOMAC sub-scores were found to be related with Kellgren-
Lawrence grading scale (P > 0.05). On the other hand, WOMAC disability scores were
significantly associated with WOMAC pain and WOMAC stiffness (P < 0.01).
Conclusion: Knee pain, stiffness, and duration of disease may affect the level of
disability in the patients with knee OA. Therefore, treatment of knee OA could be
planned according to the clinical features and functional status.

The thyroid peroxidase (TPO) is a 105 kDa glycoprotein enzyme and the main antigen of the
thyroid microsomal fraction. It catalyses iodine oxidation and thyroglobulin tyrosyl iodination
reactions in the thyroid gland. Anti-TPO antibodies activate complement and are thought to be
significantly involved in thyroid dysfunction and the pathogenesis of hypothyroidism. These
antibodies are significantly present in patientsof Hashimoto's thyroiditis,Gravesdisease and
even in non-thyroidal conditions such as diabetes. In sub-clinical hypothyroidism (SCH),
presence of these antibodies is associated with increased risk of developing overt
hypothyroidism (OH). In the present study, anti-TPO antibodies were tested on 33 individuals,
all of whom reported thyroid stimulating hormone (TSH) levels > 6μIU/mL. These included
18 with SCH and 15 with OH.Anti-TPO ab positivity (levels > 28.4 IU/ml) was observed in 17
patients (51.5%) which included 5 with SCH and 12 with OH. There was greater prevalence of
positivity in OH compared to SCH (80% vs 27.8%). 8 of 33 subjects (24%) had significantly
raised anti-TPO ab (>200 IU/ml). The Billewicz scoring system was used for assessment of
clinical features of hypothyroidism with value ≥25 strongly suggestive of OH. 9 of 33 subjects
had scores ≥25 and out of these, 7 had positive anti-TPO ab.Pearson correlation revealed the
serum TSH and anti-TPO levels to be strongly positively correlated, r(32) =
.7902, p <0.0001.The Billewicz diagnostic score was also correlated with anti-TPO levels, r(32)
= .4107 which was significant at p<0.05.Our results show that higher anti-TPO ab and
TSHlevels are associated with higher symptom scores, indicating underlying
pathophysiological and immunological processes and we suggest that antibodies against TPO
should be routinely assessed in patients presenting with either elevated TSH levels or with
symptoms suggestive of thyroid dysfunction.

Background:Brachial plexus block is a regional technique commonly employed for upper limb
surgeries. The present study was conducted to assess effectiveness of bupivacaine versus
levobupivacaine in supraclavicular brachial plexus block.
Materials & Methods:70 patients of ASA I & II status were given brachial plexus block by
supraclavicular approach for various upper limb surgeries of both genders. Group I patients
received bupivacaine and group B received levobupivacaine. Onset and duration of sensory
and motor block was recorded. Duration of analgesia was considered as the time taken to
reach an NRS score of 3.
Results: ASA grade I was seen in 25 in group I and 18 in group II and II in 10 in group I and
17 in group II. The mean age was 35.4 years in group I and 35.1 years in group II and weight
was 61.2 Kgs in group I and 62.7 Kgs in group II. The mean onset of sensory block was 12.8
minutes in group I and 10.1 minutes in group II, onset of motor block was 14.9 minutes in
group I and 11.3 minutes in group II, duration of sensory block (minutes) was 812.8 minutes
in group I and 1024.6 minutes in group II, duration of motor block (minutes) was 926.2
minutes in group I and 1156.4 minutes in group II and duration of analgesia (minutes) was
910.2 minutes in group I and 1058.0 minutes in group II. The difference was significant (P<
0.05).
Conclusion: Levobupivacaine has a faster onset of both sensory and motor blockade as
compared to bupivacaine.

The rapid spread of the COVID-19virus and related pneumonia has posed a major challenge for
healthcare systems worldwide. The infection was discovered in the city of Wuhan, Central of
China and swept across the world.Theincubation period of the viruscan range from 1–14 days,
and the virus spread can happen in the absence of clinical symptoms as well.The most frequently
reported symptoms are fever, cough, dyspnea, and myalgia or fatigue. Modes for transmission of
virus include direct transmission through coughing,sneezing, and inhalation of droplets and
contact transmission through contact with nasal, oral, and ocular mucosa. Droplet and aerosol
transmission of the virus are the most common causes of COVID-19 infection in dental clinics
and hospitals.COVID-19 virus has lately been detected in saliva of infected patients, thus posing
an alert to health professionals to be customarily vigilant in protecting against the infectious
disease spread. Because of the presence of virus in saliva, it may be helpful as a non-invasive
tool in the rapid detection of the virus.During this pandemic dissemination of COVID-19, dental
treatment must be confined to the procedures that cannot be deferred. All the precautions must be
taken in terms of triaging, personal protective equipment, hand hygiene, pre-procedural
mouthrinse, use of rubber dam, disinfection of the surfaces. Dental professionals are at the
highest risk of COVID-19 infection; hence, dental practicehas to be reorganized in order to
ensure higher safety standards for both dentists and patients.

Background: Polycystic ovarian syndrome (PCOS) is one of the most frequent
endocrine illnesses in women of reproductive age. It affects around 5-10% of the world's
population. Irregular menstrual cycles, prolonged anovulation and hyperandrogenism
are all symptoms of the disease. Hyperinsulinemia, insulin resistance, gestational
diabetes, type 2 diabetes, dyslipidemia and cardiovascular disease may develop over
time.
Aim:To compare the lipid profile and vitamin D levels in women with and without
PCOS in relation to obesity and to determine the Luteinizing hormone[LH], Follicle
Stimulating Hormone[FSH], prolactin[prl] levels in women with PCOS in relation to
obesity
Method: A total of 152 subjects were taken for the study.76 PCOS patients were
identified ultrasonographically and clinically from November 2015 to July 2017, and 76
normal menstruatingwomen served as controls in the study conducted at Deccan
Medical College and Princess EsraHospital, Hyderabad. All the subjects were
categorized as obese or lean based on their BMI.
Results: In comparison to obese participants without PCOS, PCOS obese subjects had
higher TG and TC levels and lower HDL levels, according to the study. When
compared to lean subjects without PCOS, PCOS lean subjects had higher TG, TC, and
LDL values. The HDL levels of PCOS lean patients were observed to be lower than
those of lean subjects without PCOS. Vitamin D levels were also shown to be
considerably lower in PCOS patients (both obese and non-obese) than in healthy
controls.

Objective: To study the Feto maternal outcome of Covid-19 in Pregnancy.
Methodology: This is a retrospective study done on 53 pregnant patients who tested positive
for SARS-CoV-2 and were delivered in D. Y. Patil Hospital, Kolhapur from April 2020 to
July 2020. Maternal and fetal characteristics and the outcome of Covid-19 infection in
pregnancy was studied.
Results: Among the 53 patients, 49 patients (92%) were asymptomatic. Remaining presented
with fever, sore throat, cough. 69% were primigravida and 30% were multigravida. 66%
underwent LSCS while 28% were delivered normally. In majority, LSCS was done for
oligohydramnios and fetal distress. All the patients were discharged after negative swab
report and no maternal death was reported. About 32% of neonates required NICU admission
for hyperbilirubinemia, pneumonia and sepsis. There was no neonatal death and none of the
neonates turned out to be positive for covid-19.
Conclusion: The severity of SARS-CoV-2 was seen to be mild to moderate in pregnant
women. Majority of the women infected with coronavirus disease were asymptomatic. The
risk of vertical transmission to the neonate was also found to be low. Oligohydramnios and
fetal distress were commonly seen in the patients, pointing towards the lack of antenatal
follow up visits due to restricted mobility in the covid era.

Introduction: TAH is associated with significant post-operative pain. Epidural analgesia
with a variety of local anaesthetics and adjuvants is widely used for TAH as it provides both
intra and post-operative analgesia. The aim is to compare the effect of post-operative epidural
analgesia with 0.2% ropivacaine and dexmedetomidine versus 0.125% levobupivacaine and
dexmedetomidine in patients undergoing TAH.
Method: Afterobtaining ethical committee permission and patient consent, 50 women aged
35-65 years of ASA 1&2 were included in the study. We have excluded patients with
hypersensitivity to local anaesthetics, infection at the site of injection. Patients were divided
into 2 groups of 25 each. Group RD-received 10ml of 0.2% ropivacaine and
dexmedetomidine 1 mcg/kg. Group LD-received 10ml of 0.125% levobupivacaine and
dexmedetomidine 1mcg/kg. Using chi-square test and student t-test statistical results were
obtained.
Results: The mean onset of analgesia in Group RD was 11.86min and in Group LD was
8.468min which is statistically significant (P<0.05). Mean duration of analgesia in Group RD
was 210min and in Group LD was 271min which is statistically significant (P<0.05).
Conclusion: We conclude that 0.125% levobupivacaine with dexmedetomidine as adjuvant
was found to have faster onset and prolonged duration of analgesia than 0.2% ropivacaine
with dexmedetomidine.

Introduction: The most common concern associated with TKR is post-operative pain for
both the patient and the surgeon. It is associated with multiple adverse physical and
psychological consequences, which hinder postoperative mobilisation, increase the incidence
of post-operative complications and the overall outcome.A number of modalities have been
recommended of which regional techniques are preferred. Current study aims to compare
post-operative management of pain in patients undergoing Total Knee arthroplasty (TKA)
with epidural analgesia versus femoral nerve block.
Material and methods: Study was done in 100 patients posted for unilateral TKA. After
obtaining written consent and ethical committee clearance patients were randomized in to two
groups. Group “CEA”-8 mL 0.2% ropivacaine was given epidurally and Group “CFB”-bolus
of 20 mL of 0.2% ropivacaine was given through femoral catheter.
Outcomes assessed were
1) Acute postoperative pain (during rest and movement).
2) Postoperative rescue analgesic consumption/rescue analgesia.
3) Quality of early postoperative rehabilitation (functional assessments).
4) Postoperative complications if any.
Results: There was no significant difference in Vas score during rest and activity in both the
groups at 6 hrs,12, 24, 48 and 72 hours. There was no significant difference in both the
groups with respect to rehabilitation indices and adverse events. Only 43.4% of patients
belonging to group CFB, received rescue analgesia which was less when compared to patients
in group CEA(57.6%) which was significant.
Conclusion: CFA have the advantage over CEA in terms of decreased need for rescue.
analgesia with no neuraxial side effects.

In India breast cancer is the 2nd most common cancer in women after cervical
cancer and is associated with high mortality and morbidity. Role of IL-10 in cancer though, well
accepted, is vaguely understood. IL-10 is known to exhibit both pro and anti-tumour activities.
Polymorphism in interleukin genes are thought to influence the expression or function of these
proteins. Hence our study was designed to evaluate the role of low penetrant interleukin-10 (IL-
10) gene and its influence on tumorigenesis.

Aim: To investigate the relation of vitamin D concentration and parathyroid hormone with
insulin resistance in PCOS women.
Methods: In the department of Obstetrics and Gynecology at Dr. Baba Saheb Ambedkar
medical college & hospital Rohini Delhi, a one-year observational study was conducted. The
levels of 25, hydroxyvitamin D and PTH, as well as the levels of fasting sugar and insulin in
the blood, were tested.
Results: There was a 91.0 percent prevalence of vitamin D insufficiency (

tonicclonicconvulsionsunrelatedtoothermedicalconditionsinwomenwithhypertensivedisorderof
pregnancy.Although10%ofpregnanciesarecomplicatedbyhypertensivedisorders,eclampsia
continuesto occur in 0.8% of women with hypertensivedisorders.
Objectives:TocomparetheserummagnesiumlevelsinPritchardregimenandlowdose
MgSO4regimen. To compare the maternaland fetalcomplicationsin both groups.
MaterialandMethods:ThisisaProspectivestudyconductedintheDepartmentofObstetrics
andGynaecologyatTertiarycareteachinghospitaloveraperiodof1yearoneclampticpatients
whogotadmittedindepartmentofobstetricsandgynecology.Standardprinciplesof
managementofeclampsiawillbefollowed.Patientsaredividedintotwogroupsascases&
controlalternatively.Groupsarechosenbasedoninclusion&exclusioncriteria.GroupI
ControlwillfollowPritchardstandardregimen.GroupIICaseswillreceivelowdose
magnesiumsulphateregimen.
Conclusion:Theoccurrenceofeclampsiaintwogroupswasmorecommonintheagerange of 20 to
26yearsamongtheprimigravidaand with previoushistory ofPIH. Thereisnomajor
differenceintheoutcomeofmaternalandfetalinbothgroups.Nonethelessthemagnesium
levelsamonglowdosegrouparesignificantlylowerincomparisonwithstandardregimen group. In
casesand controlsthe magnesium levelsare maintained in normal therapeuticrange.
Lowdoseregimenisbetter alternative tocontrolseizuresin eclampticpatients.

Aim: The aim of this study to determine the Presentation, etiology and viral markers in
children presenting with hepatitis at a Tertiary care hospital.
Methods: 50 cases of acute hepatitis of age 1-13yrs were included in the study. Acute
hepatitis was diagnosed on the basis of history, clinical (Jaundice, pain in upper
abdomen, anorexia, nausea, vomiting, fever, pruritis, tender/non tender hepatomegaly
with or without ascites and without any stigmata of chronic liver disease) and
biochemical evaluation (LFT i.e. serum bilirubin, Alanine
aminotransferase(ALT),Aspartate aminotransferase (AST),alkaline phosphatase(ALK),
serum albumin, PT/INR). Acute liver failure was diagnosed by PT>15sec/ INR>1.5 with
features of encephalopathy or PT > 20 sec/ INR > 2 regardless of presence of clinical
hepatic encephalopathy.. Patients were also tested for viral markers i.e. anti HAV IgM,
anti HEV IgM, HBsAg, and anti HCV.
Results: In our study total number of cases were 50 of which 70% were male and 30%
were female. The most common cause of viral hepatitis was hepatitis A (80%). Hepatitis
B was found in 2 (4%) cases and in 16% cases no viral marker was detected. The most
common clinical presentations were jaundice (96%), fever (94%), fatigue (90%) and
nausea/vomiting (78%). In 80% of cases hepatomegaly was found and splenomegaly
was seen in 2% of cases. SGPT level was increased in all cases with 30% in the range
500 – 1000 units/ml, 22% in the range of 1000 – 3000 units/ml and 12% in the range of
3000 – 5000 range. 48% of cases has total bilirubin of more than 10mg/dl and in 40% of
cases the value was in the range of 5 – 10 mg/dl. In 35cases PT was < 15sec and in 15
cases it was more than 15 sec. The disease resolved in 40(80%) cases,1(2%)had chronic
disease and 9(18%) cases expired.
Conclusions: Majority of cases in children were hepatitis A cases. Most of the cases
were Boys. Those cases with INR >3 at admission has higher mortality. Peak values of
aminotransferase i.e. ALT and AST though reflect hepatocyte damage do not correlate
with mortality.

Background: Degenerative joint disease is a common cause of knee symptoms and
disability. The purpose of the present study is to address the role of arthroscopic surgery in
patients who have degenerative joint disease in the knee.
Methods: The present study included 40 patients from August 2019 to August 2021 who
complained with knee pain in the department of Orthopaedics, IGIMS, Patna. Intra operative
grading of articular cartilage degeneration was done by method described by Noyes – Stabler.
Patient called for follow - up on 1 month, 3 months and 6 months of post-operative day in
OPD, and pain severity score was measured according to knee society pain score8 routine
physical examination of knee was done for other physical signs.
Results: Out of 40 patients in the present study, 15 were females and 25 were males.
The patients showed 65% improvement in grade 2 after 6 months, 30% patients showed
improvement in grade 3 and 5% showed improvement in grade 4 patients after 6 months.
Conclusion: Although Arthroscopy is valuable for the treatment of many knee disorders. The
efficacy of arthroscopic treatment for osteoarthritis of the knee is limited by poor natural
history of osteoarthritis.

Background:Chronic wounds result in significant functional impairment, reduction in
quality of life, and large financial costs for patients and the health care system. This
study intends to establish the efficacy of VAC in comparison with conventional
dressings in wound healing.
Materials & Methods: 65 wound patients of both genders were allocated to VAC and
conventional dressings, considering their diabetic and chronic conditions alternatively.
All patients underwent detailed clinical examination and relevant investigations and the
wounds were thoroughly debrided and the ulcer dimensions as well as the surface area
assessed.
Results: There were 32 patients in group I and 33 in group II. Maximum patients
(40.6%) in conventional dressing and (30.4%) in VAC dressing was seen in age group
51-60 years. Out of 65 patients 12 were females and 53 patients were males. Out of 12
females 8 underwent conventional dressings and 4 underwent vac dressings. Out of 53
male patient 24 underwent conventional dressings and 29 underwent VAC dressings.
There was no statistically significant difference in gender distribution in both methods
of dressings. Diabetic wounds were 25 each and chronic wounds were 3 in conventional
and 4 with VAC method. Accident induced traumatic wounds were 4 each in both
methods. The mean appearance of granulation tissue was 55.2% and 83.3%, wound
contractures in millimetre2 was 46.1 and 97.4 and duration of hospital stay was 16 and
8.76 in conventional and VAC group. The difference was significant (P< 0.05).
Conclusion: VAC dressing was superior to conventional dressing. As majority of our
patients were diabetic, VAC dressings facilitated early wound healing and decreased the
morbidity in our patients.

Background: The proximal humerus fractures are not easy to handle and are the second most
common fractures of the upper extremity. The aim of the study is to analyze the treatment
outcome of proximal humerus fractures using Philos Plate.
Methods: The present study included 40 patients from May 2019 to May 2021 who
underwent PHILOS plate fixation for displaced proximal humeral fractures using the
PHILOS plating system in the department of Orthopaedics, IGIMS, Patna.
Results: Patients were followed up for 6 to 18 months. The mean Constant shoulder score
was 75 (range 28–88). 14 patients had a score exceeding 75,11were scored between 50 and
75, and 10 were below50. Constant scores in 2-, 3- and 4-part fractures were compared.
Conclusion: In the present study, PHILOS plate fixation provided stable fixation with
minimal metal work problems and enabled early range-of-motion exercises to achieve
acceptable functional results. However, the choice of treatment should be based on patient
age, functional requirements, bone quality and fracture pattern.

Background: Diabetes mellitus is a non-communicable chronic metabolic disorder. The
association between sensorineural hearing loss and diabetes has become an important subject
of research. Correlation of hearing loss with genders is not still clear so we have aimed our
study to explore the same.
Objective: To examine the gender-specific association between diabetes and hearing loss.
Methods: This study was conducted on a total number of 150 (78 male & 72 female) selected
diabetic patients from November 2018 to December 2020. The correlation of hearing loss
between male and female diabetic patients was compared by getting a pure tone audiogram.
Results: Out of a total of 150 patients, only 42 patients (28%) were suffered from hearing
loss. Sensorineural hearing loss was present 25.6% in males and 30.5% in females which was
not significantly different (p >0.05).
Conclusion: We concluded that hearing loss has no significant association with genders in
diabetic patients, but early diagnosis and screening of diabetic paints for hearing loss help in a
better quality of life.

Background: The use of anesthetics and opioids leads to motor and behavioral
inhibition, body movements and consequently a decrease in body temperature, which
results in shivering. So, the objective of this study to evaluate the efficacy Of Ketamine
and Ondansetron for prevention of shivering during anesthesia.
Materials and Methods: Total 120 cases were included in this study. We were divided in
to 2 groups. This study was conducted in the Department of Anaesthesia in Pacific
Medical College and Hospital.
Results: We were included 120 cases in this study. Among all 70 were female and rest
were male. We were divided in to three group which were Ketamine (60) &
Ondansetron (60). We were found in this study, the frequency of shivering in the groups
who received Ketamine was significantly lower than the Ondansetron group.
Conclusion: This study concludes that, Ketamine in dose of 0.25mg/kg has been found
to be significantly more effective than ondansetron (4mg) during spinal anesthesia.

Background:Thalassemia also known as “Cooley’s anemia” is an inherited disease of the
red blood cells classified as a hemoglobinopathy. The present study was conducted to
assess prevalence of HIV seropositivity among thalassemic patients in a tertiary care
teaching centre.
Materials & Methods: 80 thalassemic patients of both genders were included. All the
samples for detection of anti- HIV antibodies was done as per the guidelines of National
AIDS Control Organisation (NACO).
Results: Out of 80 patients, males were 45 and females were 35. Age group 0-5 years had
10, 5-10 years had 25, 10-20 years had 40 and >20 years had 5 patients. Seroprevalence of
HIV were 1 case in age group 0-5 years, 3 in age group 5-10 years and 2 in age group 10-
20 years of age.
Conclusion: Authors found lowseroprevalence of HIV among thalassemia patients.

BACKGROUND:Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroidstimulating
hormone (TSH) level with a normal serum free tri-iodothyronine (FT3) & free
thyroxine(FT4) concentration. Hypothyroidism is associated with dyslipidemia and increased
risk of atherosclerosis. SCH can progress to overt hypothyroidism. Lipid profile changes in
SCH, however, are controversial.
AIMS AND OBJECTIVES: To study the lipid profile in patients with SCH.
MATERIAL & METHODS:The present study was a case-control study involving 35 individuals
with newly diagnosed / untreated SCH were studied. 35 age and sex matched adults with
normal thyroid profile were taken as controls. Serum TSH, FT3, FT4, Total cholesterol,
Triglyceride, Low density lipoprotein cholesterol (LDL-C), High density lipoprotein
cholesterol (HDL-C)and Very low density lipoprotein cholesterol(VLDL-C) levels were
measured in all study subjects.
RESULTS: The average total cholesterol and LDL-C in the patients with SCH in our research
were statistically significantly higher than the control group. The mean serum triglyceride,
HDL-C and VLDL-C levels were not statistically different in patients as compared to controls.
CONCLUSION: SCH is associated with dyslipidemia which is a risk factor for atherosclerosis,
with a resultant risk of cardiovascular disease and stroke. Thus, it is important to detect this
condition early so that appropriate steps may be taken to prevent its deadly complications

Aim: To analyse clinico-mycological and therapeutic study of recurrent dermatophytic
infections and determining the right dose and duration of systemic antifungals.
Material and methods: This randomized controlled trial was conducted at the
department of DVL, Acharya Shri Chander College of Medical Sciences, Jammu from
January 2021 - May 2021 among 90 patients with superficial cutaneous fungal infection
coming to the dermatology OPD. Selected 90 patients were assigned to a trial group and
given the standard dose of the drug i.e. Tab. Itraconazole (100mg OD), Tab.
Griseofulvin (250mg BD) and Tab. Terbinafine (250mg OD). Evaluation was done by
clinical assessment in terms of clinical score. The clinical signs and symptoms assessed
were scaling, erythema, and pruritus.
Results: Tinea corporis was the principal dermatophytic lesion accounted for 93.33% of
the study subjects. Pruritus, Erythema, scaling and total scores reduced significantly in
all the drugs i.e. Griseofulvin, Itraconazole and Terbinafine. However reduction was
reported more in Itraconazole drug in our study. Complete clinical cure was reported in
3.33%, 70% and 26.67% of the subjects in Itraconazole drug at 1st visit (3w), 2nd visit
(6w) and 3rd visit (9w) respectively. No cure was reported in Griseofulvin and
Terbinafine drug at 1st visit (3w). 23.33%, 76.67% and 6.67%, 43.33% of the subjects
in Griseofulvin and Terbinafine drug were completely cured at 2nd visit (6w) and 3rd
visit (9w) respectively.
Conclusion: Itraconazole was found to be the best drug for the treatment of
dermatophytes among the tested antifungals.

A by the enzyme citrate synthase.1, 2 Citrate is thought to be freely filterable at the
glomerulurs, in humans, 65 to 90% of the filtered citrate is reabsorbed and 10 to 35% is
excreted in the urine as a byproduct of oxidative pathways in the body.3, 4 It is known to
inhibit precipitation of calcium oxalate and phosphate and growth of their crystals5.
In 1990 Pak has defined normal 24 hour urinary citrates as more than 320 mg for both
genders6. Hypocitraturia is defined as urinary citrate excretion lower than 1.67 mmol
(320mg) per day. However, there are some reports of low urinary citrate output in stone
formers (SF) and renal failure as compared with healthy subjects7-9, while other studies found
no differences10,11.
Prevalence of hypocitraturia varies widely from 8% to 68.3% in patients with renal
stones.6 Furthermore; there are some differences in the range of 24-hour urinary citrate
excretion in normal subjects.10, 12
Urinary pH is also an important factor in stone risk, with higher values favoring
calcium phosphate stones and lower ones uric acid stones13. Although final urine pH is
associated with acid load, it is also influenced by ammonium excretion and the ability of
the distal tubule to acidify the collecting duct. Overall factors that influence urine pH and
citrate are similar, but not identical.
Various studies have evaluated the citrate levels and have conflicted results. Most of the
studies have been done in stone former patients and very limited studies have been done
in normal Indian population. In this study we intend to find out the normal range of citrate
excretion in normal subjects and its relation with various factors.

Introduction: Establishing or ruling out the diagnosis of carcinoma of prostate has been
a challenging task for pathologists for many years .it was an observational study where
patients who underwent TURP procedure were studied. The present study is an attempt
to understand the histopathological spectrum of prostatic lesions and study the
demographic distribution of various prostatic lesions.
Methods: The present study includes 125 cases of prostate specimen from January 2018
to September 2021 received in the post graduate department of Pathology, Tripura
Medical College. H and E stained sections were examined. The relevant clinical details
pertaining to age, clinical complaints and microscopic details are analyzed and
compared with other similar studies.
Result: Total 125 case were studied among which 69 (55.2%) cases were found to be
consistent with BPH and 24 cases were found to be malignant lesion (19.2%). 24 cases
were found to be BPH with associated prostatitis like features, consistent with benign
prostatic lesion. High grade Prostatic Intraepithelial lesions were seen in 8 cases (6.4%).
Out of the 24 malignant cases, majority had Gleason score between 8-10. Perineural
invasion was seen in 10 out of 24 malignant cases (41.6%). All malignant lesions were
adenocarcinoma and 20 were incidental carcinoma which accounted for 16% of all
prostatic lesions. Serum prostate specific antigen levels were available in 24 cases of
prostatic adenocarcinoma cases. 21 out of 24 cases had serum prostate specific antigen
levels greater than 10 ng/ml. (87.5%). Grade Group 4 had the maximum number of
cases i.e 45.8%. Out of 125 cases, 89 (71.2%) cases were from urban areas and 36
(28.8%) cases were from rural areas. All the 24 cases with prostatic adenocarcinoma
were from urban areas.

Background: Anemia is the most common nutritional deficiency worldwide. Anaemia
increases the risk of maternal morbidity & mortality and adverse maternal outcome
such as ante partum hemorrhage, post-partum haemorrhage & puerperal sepsis.
Objective: To find out the prevalence of the Anaemia in antenatal women and to
determine the association with sociodemographic factors.
Materials and Methods: It was a community based, cross sectional study done over a
period of 1 year. The antenatal women with gestational period 12-20 weeks, visiting at
antenatal clinic were registered for the study. The antenatal women were interviewed
by using pre-structured, pre-tested questionnaire. Prior consent was obtained from the
participants. Detailed clinical examination was done at UHTC. Haemoglobin estimation
was done by Sahli’s method. Anaemia was classified as per WHO criteria. Data was
analyzed by using Chi-Square Test to check association. P-value < 0.05 was considered
significant.
Results: 500 pregnant women were included in the study. Majority (93.4%) were urban
dwellers, 227 (45.4%) had attended secondary level of education. Most of them were
Hindu by religion (75.2%), 84.2% had average monthly income <10,000, and 83.6%
were living in the family size >2. Association was found and was significant with age,
socioeconomic status, occupation, education level and family size.
Conclusion: Anemia remains to be a public health problem. Although iron-folic acid
supplementation is available under the national health program to address this issue, it
is important for primary care physicians to consider and address other risk factors
when designing and implementing target interventions for anemia control in selected
populations.

Introduction: Intertrochanteric fractures are common fractures which needs to be reduced
and fixed appropriately for optimum outcome. Poor reduction increases the chances of its
failure by multiple times. Sagitally split fractures are notorious due to the associated flexion
and sagging of distal fragment. Indirect reduction techniques have been used but with less
reliability. Methods: This study tries to evaluate and put forward a technique to fix these
fractures adequately translating into good clinical outcome. the fracture reduction was tried
under traction. A stab incision was put anteriorily to manage the flexion of the proximal
fragment.Conclusion: it is a simple and effective technique. Digital palpation by the
operating surgeon aids in reduction and gets the idea of spatial orientation of the neck and
thus it is easy to direct the guide wire along the direction of the neck which otherwise may
take multiple trials and increased radiation exposure.

Background: Lactate dehydrogenase (LDH, L-lactate, NAD+ oxidoreductase, EC1.1.1.27) is a
family of at least six NAD + -dependent isoenzymes (LD1-LD5 and LD6/LDX). It is recognized
as being one of the most common enzymes in nature. It belongs to the class of oxidoreductases
and it is characteristic for the final stage of anaerobic glycolysis. Aim of the study: To evaluate
the efficacy of lactate dehydrogenase as an indicator of liver tumors. Materials and methods:
The present study was performed in the Department of Biochemistry, Kidwai Institute of
Oncology, Bengaluru, Karnataka, India. For the study, a total of 100 patients were selected. The
age of the patients ranged from 18 to 40 years. Briefly, 20 μL of each patient serum was mixed
first with 1000 μL of buffer (pH 7.35) supplied by the manufacturing company and incubated for
1-5 min at 25 °C. A volume of 250 μL of substrate that composed of nicotinamide-adenine
dinucleotide (0.75 mmol/L) and sodium azide (0.095%) was added to the mixture. After mixing,
the absorbance at 340 nm was read by UV-visible spectrophotometer (CECiL, CE 1021,
England) after 1 min. CK levels were assayedaccording to Humazym M-test as described by the
instructions of the produced company. Results: It was observed that number of male patients
was 45 and number of female patients was 55. The mean age of the participating patients was
31.35 years. High LDH level are observed in large number in females (30 patients) than in males
(24 patients). Increased LDH levels in blood could not be indicator for liver diseases only, but it
may be resulted from damage in muscular tissues. 30 females and 24 males who possessed high
level of LDH were investigated for CK, as monitor for muscular injury. Additionally, 6 male
patients and 9 female patients showed increased levels of LDH and CK in their blood which
means they may sever from muscular damage. Conclusion: From the results of the present study,
this can be concluded that LDH can be used as a good biomarker for diagnosis of liver,
muscular and even cancer diseases. There is little variable between males and females in the
elevated values of LDH. Patients with normal values of CK and high level of LDH suggested to
have unidentified cancer disease, except liver cancer, and for that other specific tests are
required.

Laryngeal mask airways are supraglottic airway devices designed to provide and maintain a
seal around the laryngeal inlet and are effective alternatives to endotracheal tubes. The
relatively newer second generation supraglottic airway devices, LMA-ProSeal, I-Gel & Baska
mask have been safely used in children during spontaneous or controlled ventilation without
complications. A total number of 90 paediatric patients of ASA grade I and II, weighing 10-
25 kg, of either sex, posted for elective surgeries under general anaesthesia and satisfying the
inclusion criteria were enrolled in the study after obtaining informed, written, valid consent
from their parents/guardian. According to our observations, mean insertion time taken for
group B was 15.8 seconds with a standard deviation of 0.9, 10.6 seconds with a standard
deviation of 1.1 for group I and 13.5 seconds with a standard deviation of 0.9 for group P. On
analysis by ANOVA test, p value obtained is 0.001 (significant, <0.05) which implies that
insertion time taken for group B is significantly greater than that of group P and group I.

The cricoid ring, the only circumferentially solid cartilage within the airway, placed
immediately below the vocal cords, is the narrowest part of the paediatric airway, whereas in
adults it is the glottis. Being covered by loosely adherent pseudostratified columnar
epithelium, it can be easily subjected to edema in case of irritation. A total number of 90
paediatric patients posted for elective surgeries under general anaesthesia and satisfying the
inclusion criteria were enrolled in the study after obtaining informed, written, valid consent
from their parents/guardian. Group B (Baska mask) has 30 patients with a mean age of 10.6
years with a standard deviation of 0.9, group I (igel) has 30 patients with a mean age of 9.8
years with a standard deviation of 1.3 and group P (LMA ProSeal) has 30 patients with a
mean age of 9.4 years with a standard deviation of 0.9. ANOVA test was used for comparison
of the three study groups and with p value obtained as 0.43, the three groups are comparable
in terms of age. On comparison of weight of patients in these three groups, group B patients
have a mean weight of 21.6 kg witha standard deviation of 1.2, group I patients have 22.2 kg
with a standard deviation of 1.8 and group P have 20.3 kg with a standard deviation of 2.9.
Based on ANOVA test, p value obtained here is 0.54, hence the groups are comparable in
terms of weight as well.

The novel features of the Baska mask are its integrated bite-block, which prevents airway
block due to patients biting the device and an extended hand-tab attached to the cuff which
helps the operator to manipulate its degree of flexion while inserting the device. Last but not
the least, the device can be inserted in neutral head position. The Baska mask is available in
four sizes, paediatric and adult, in single use and reusable types. Pre-anaesthetic evaluation of
all patients were done on the previous day of surgery by an anaesthesiologist. All patients
under the above-said inclusion criteria, were randomly allocated into following groups after
taking informed, written and valid consent from their parents/guardian:Group B(n=30):
patients receiving Baska mask Group I (n=30): patients receiving I-Gel,Group P (n=30):
patients receiving LMA-ProSeal.Post-operative blood-staining of device on removal was seen
in only one patient (3.3%) in group P and cough in one patient in group B (3.3%) which were
insignificant with a p value of 0.36. Other complications (desaturation, laryngospasm,
aspiration, mucosal/lip trauma, dysphagia, hoarseness) were not observed in any patient.

Background: In the skin, under influence of ultraviolet radiation, 7-dehydrocholesterol is
photoconverted to provitamin D3, which is converted to Vitamin D3 (cholecalciferol). In the
serum, bound to a Vitamin D binding protein (VDBP), Vitamin D3 is transported to the liver,
where it is hydroxylated to 25(OH)D3. In the kidneys, 25(OH)D3 is further metabolized to
1α,25-dihydroxy vitamin D3 [1,25(OH)D3], the biologically active form of Vitamin
D.Vitamin D (Cholecalciferol) is known to contribute to muscular function.
Material and Methods: In this comparative study, Two groups were formed, First group as a
case in which vitamin D was supplemented and second group as control in which Vitamin D
was not supplemented, both the group had 25 number of post- menopausal women who had
Vitamin D level between sufficient range (30-100ng/ml) and were treated with same mode of
treatment (closed reduction and Percutaneous K-wire fixation) for Distal end radius fracture.
Grip strength recovery (in %) was compared in both the group after a period of 6 months.
Results: Final grip strength recovery of all patients came out to be 67%, out of which, in
supplemented group it came out to be 73% while in non-supplemented group came out to be
60% with p value of statistically significance proving major difference in grip strength
recovery in % at 6 months in both the groups.
Conclusion:We concluded with our series that vitamin D supplementation significantly helps
in improving the grip strength recovery in Post-menopausal women after a Distal End Radius
fracture.

Background: Inguinal hernia is a common problem that can be treated only by surgery. The surgeons should improve their technical skills in laparoscopic repair of inguinal hernia (TAPP) with short learning curve. The aim of the present study was to evaluate the safety, effectiveness and feasibility of TAPP inguinal hernia repair. 
Patients and methods: A total of 18 consecutive male patients with inguinal hernias were prospectively randomized to TAPP repair at the surgical outpatient clinics of Zagazig University Hospitals. Postoperative pain was estimated using the visual analogue scale (VAS). Postoperative hospital stay and early postoperative complications were recorded.
Results: The present study showed age was distributed as 44.22±15.7 and majority was manual worker.VAS reduced significantly from 4.16±1.5 one week postoperative to 0.32± 0.31 six months postoperative. During follow-up, no pain, seromaformation were noticed in any patient. Complicated cases were 3 cases (16.7%). 2 cases with scrotal edema (11%) and recurrence 1 case (5.6%). Follow-up was performed at 7 days and at 1, 4, 6 months. When comparing complicated and uncomplicated cases in terms of post- operative pain, hospital stay, return to work and socio-demographic data, only hospital stay was significantly longer in cases that complicated later on.
Conclusion: Laparoscopic transabdominal preperitoneal mesh repair is safe and effective technique in treating inguinal hernia with less post-operative complications associated with and satisfaction and faster recovery.

Background: Infantile Haemangioma (IH)has long been considered as an angiogenic disease because of the tangled disorganized mass of blood vessels
in the tumor. This study aimed to prove the safety and efficacy of medical treatment prior to surgical intervention in management of haemangioma.
Patients and methods: This study was involved patients with infantile haemangioma disfiguring or complaining who admitted to  Zagazig University Hospitals. All patients presented to vascular surgery department were subjected to medical treatment with beta blockers and followed up every 2 months for 6 months for possibility of surgical intervention.
Results: The current study included patients with infantile haemangioma disfiguring or complaining, their mean age was 2.95±1.57. Male patients represent 54.2% and female represent 45.8% of studied group. The majority of outcome were excellent (29.2%), very good (8.3%), good (37.5%) and bad (16.7%). Bleeding reported at 4 cases with 16.7% ulceration and infection 8.3%.  Medical management was in 66.7% and surgical in 33.3% and combined were in 29.2%.  There was significant decrease at all time from pre to 6 month.   The association between basic demographic and hemangiomas characters and type of management were significantly associated with surgical. Surgical management significantly associated with bleeding, and associated with ulceration and infection but not significantly.
Conclusion: Propranolol may be more effective and safer in treatment of infantile hemangiomas (IH) and may also be used as a first-line therapy than previously established therapies, and may be an alternative when more widely accepted treatments for IH have failed. Surgical procedures can keep back for complicated IH in which conservative medical therapy is ineffective or contraindicated.
 

Background: Recognition of the vascular injury is often obscured by the difficulties of examining the painful, swollen extremity that accompanies bone injury. More often than not, however, it is the failure to assess the status of the distal extremity or to appreciate the significance of a large hematoma, recurrent bleeding and distal ischemia that causes delay in recognition of arterial injury. The aim of this study was to evaluate the limb salvage percentage of lower limb trauma with respect to amputation rate.
Patients and methods: This prospective study involved 18 patients with lower limb vascular who conducted at Zagazig University Hospitals. All patients were subjected to clinical examination including general examination for vital signs and local examination to determine site and type of the vascular injury. Laboratory investigations are done including full laboratory tests and radiologic imaging (duplex or CTA). Follow up of patients depended on mangled extremity severity score, linjury severity score and the Gustillo Anderson classification for maximum 2 to 4 weeks postoperatively.
Results: Time interval from trauma to hospital admission was distributed as 7.113.32, major Mechanism of accident was RTA, ischemic limb founded in 77.8%, 66.7% had associated injury, 44.4% had nerve injury, the major type of vascular injury was SFA.  MESS was distributed as 5.05±1.89 and the majority 61.1% had ATA & PTA Pulse post-operative. Concerning the relation between outcome and other demographic and clinical characters, bad outcome significantly associated with higher MESS. There was a significant association between bad outcome and longer interval from trauma till hospital admission
Conclusion: Reduced amputation rates for traumatic lower limb arterial injuries have been achieved with improved revascularization and resuscitative techniques.

Background: Breast cancer is the most common female cancer and the second leading cause of cancer death among women. Seroma is a pocket of clear serous fluid that develops in the body after surgery. Seroma is thought to be caused by the fact that the mastectomy operation leaves a lot of an empty space which can ooze serous fluid causing it to gather up in the space beneath the wound. This study aimed to evaluate the mechanical closure effect of the dead space by suture fixation of the mastectomy flaps to the underlying chest wall on the seroma formation after mastectomy.
Patients and methods: A clinical trial study involved 54 patients with breast carcinoma admitted for modified radical mastectomy at the on cosurgery unit, general surgery department, faculty of medicine, Zagazig University Hospitals. Patients were divided equally into: (a) study group and (b) control group. The  postoperative results have been compared between the two groups and the effect of flap fixation on the amount and duration of fluid drainage and formation of seroma was concluded.
Results: The present study showed a statistically non-significant difference between the studied groups regarding age. There is statistically non-significant difference between the studied groups regarding side of lesion or presence of skin changes. There is statistically non-significant difference between the studied groups regarding pathological type. IDC was the commonest type in each group. There is significant difference between the studied groups regarding days till drain removal which was significantly higher in classic technique group. Regarding postoperative complications, there was 85.2% of flap fixation group had no postoperative complications compared to 59.3% of the classic group.
Conclusion: The flap fixation technique is proving its validity in decreasing the incidence of seroma formation and its subsequent complications, so that it can be introduced as a step in the mastectomy operation.

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection inside ICU. The aim of the present study was to assess the Relation between levels of procalcitonin and C-reactive protein as markers with severity of sepsis and septic shock.
Patients and methods: This observational study was involved 60 patients who diagnosed with sepsis or septic shock and admitted to Surgical intensive care unit, Zagazig University Hospitals, Egypt. Procalcitonin and C-reactive protein levels were estimated in the 1^st, 3^rd, and 5^th ICU day. APACHE II as well as SOFA Scores were estimated on ICU admission.
Results: Patients were classified according to the need for mechanical ventilation (MV group and non-MV group), CRP showed no significant difference between the two groups on the first day (100.51 and 83.21 mg/dl respectively- p=0.108). The remaining readings showed a significant rise in the patients that needed invasive mechanical ventilation. Serum PCT levels showed a significant rise in the MV group throughout the all study readings (p < 0.001). Likewise, SOFA score recordings were significantly higher in the MV patients (p < 0.001). On assessment of the predictors for vasopressor need, the highest sensitivity was reported for 3rd day CRP (84.1% - cut off = 62.01 mg/dl), and 5^th  day PCT (84.1% - cutoff = 0.505 ng/ml). Slight decrease in sensitivity (81.8%) was reported with the application of 1st day PCT and 3rd day SOFA.
Conclusion: PCT and CRP can be used as a  prognostic markers for evaluating the prognosis of patients with sepsis and septic shock.regarding need for vasopressors the highest sensitivity was reported for 3^rd day CRP and fifth day PCT, however the length of stay was found to be highly correlated with 3^rd day PCT, also 1^st day PCT value was better to Predict need for Mechanical ventilation.

Background: Breast cancer is the commonest malignancy in females. Despite the several surgical techniques that have been used to provide the ultimate pathological clearance and cosmetic results, the aesthetic outcome and scarring are not appreciated. Therefore, this current thesis is conducted to study a new technique to reduce this scarring. The single axillary crease approach is not currently used in Zagazig University Hospitals.
Patients and methods: An interventional Study included 30 cases with breast cancer who admitted to Zagazig University Hospitals. All patients were informed regarding this type of breast conservative surgery and the post-operative demands of the follow up.
Results: Patient age range was 35-52and that the mean age was 43.53. The tumor size range was (0.8-4.9) and the mean tumor size was 3.24. The number of cleared lymph nodes ranged from (5-29). About 73.3% of the cleared lymph nodes tested postive by histopathological examination. About 6.7% of the cases were complicated with wound infection, 6.7% with seroma and 6.7% with wound dehiscence. The range of patient satisfaction was (5-10) while the mean patient satisfaction was 8.26. There were no significant difference between complicated and non complicated cases with regard to age, tumor size and number of cleared lymph nodes. There was a significant difference between complicated and non complicated cases regarding patient satisfaction.
Conclusion: The single incision approach in breast conserving surgery has a high success rate in its implementation, for lumpectomy.  Patients operated on using this procedure presented greater satisfaction with both the breast and with the informational process compared with standard surgery.

We here report three cases of boys aged 5, 8 and 10 years with injuries caused by firecrackers. Injuries consist of characteristic burns from explosions or sparks, indicating the injury was caused by firecrackers. The features of this case are discussed along with their implications. Additional measures taken in all three cases were treatment according to the injury suffered by each patient. The first patient was treated with floxa drops 3x a day, polygranate eye ointment 2x, methylpenisolone tablets 2x4mg, meloxicam 2x3mg. The second patient was given endotropinfloxa drops and methylprenisolan tablets 2x4mg. The third patient was given 3x eye drops for the right and left eyes, polygranate eye ointment for the right and left eyelids, bioplacenton ointment for the forehead and nose.
 
 

Introduction : Unstable intertrochanteric femoral fractures are common in the elderly, and the incidence of these fractures is continuously increasing worldwide. The aim of the surgical treatment of these fractures is to achieve stable fracture fixation that will allow early weight bearing. Intramedullary device like the proximal femoral nail antirotation has shown a superior cut-out resistance, which may translate into fewer cut-outs in the clinical setting and better functional outcome.
Methods : A prospective study done between October 2018 to October 2019 which included 30 patients with pertrochanteric fractures and were fixed with cephalomedullary nail with a helical blade.
Results : Twenty(66.7%) females and ten(33.3%) males with majority of subjects were in the age group, 71 to 80 years (40%). Mode of injury was self-fall in 93.3% and RTA in 6.7%. 36.7% were A1, 56.7% were A2 and 6.7% were A3 classification. In the study among those with TAD <25, 60% had excellent, 20% had good, 12% had fair and 8% had poor outcome. The implant related complications in our study was significantly less.
Conclusion: The study concludes that TAD of less than 25mm with centre-centre placement of the helical blade showed an excellent to good functional outcome and early post operative mobilization. From our study we believe that TAD rule <25mm should not apply for PFN-A. Although other studies have shown the importance of the tip-apex distance, our study does not recommend it.

The main reason for this high mortality is the lack of proper diagnosis at the right time. This
is particularly important in patients with HIV and TB co-infection; especially with extra
pulmonary TB as the detection rates are low. There is an urgent need to implement newer
diagnostic modalities for the detection of TB especially in highly HIV prevalent areas.
Patients satisfying inclusion criteria i.e. HIV positive patients clinically and/or radiologically
suspected of pulmonary tuberculosis whose sputum AFB is reported negative were subjected
for CBNAAT. This was done with the intention of identifying yield of CBNAAT over
microscopy. Among patients with abnormal chest x-ray, 84.6% had positive CBNAAT while
in those with normal chest X-ray, 81.1% had negative CBNAAT. Hence majority of patients
with abnormal chest X-ray findings had positive CBNAAT while majority of those with
normal chest x-ray had negative CBNAAT.

Globally, an estimated 10.0 million (range, 9.0-11.1 million) people fell ill with TB in 2018, a
number that has been relatively stable in recent years. The burden of disease varies
enormously among countries, from fewer than five to more than 500 new cases per 100 000
population per year, with the global average being around 130. The sputum samples were
treated with a sample reagent (SR) containing sodium hydroxide and isopropanol. The SR
was added to the sample in a ratio of 2:1 and incubated at room temperature for 15 min. The
treated sample is then manually transferred to the cartridge which is loaded into the
GeneXpert instrument. A printable test result was obtained after 1hour 45 minutes.
Considering the chief complaints at presentation, majority of patients (96%) had cough,
followed by fever in 40% cases, shortness of breath in 22%, hemoptysis in 6% and weight
loss in 6%.

Introduction-Chronic obstructive pulmonary disease (COPD) is a common respiratory
condition involving the airways and characterized by airflow limitation.
According to the Global Burden of Disease Study 2010, COPD is the fourth leading cause
of death in the world and is projected to be third leading cause by 2020. The chronic course of
this disease is frequently accompanied by acute exacerbations, usuallydue to infections.
Materials and methods- A total of 50 patients were included in the study.The data was
collected using structured proforma including demographic data, clinical history and lab
investigations. Descriptive statistical analysis (such as mean, median, standard deviation and
percentage) has been carried out in the present study.
Results-In the present study of 50 study subjects comprised of 46 males and 4 females with
mean age of 70.5 years. In 38% of the patients, bacteria were determined to be the cause of
AECOPD. [ Klebsiella pneumoniae (52.63%), Escherichia coli ( 31.57%) and Streptococcus
pneumoniae (15.78%)]. Among viral etiology, parainfluenza(44.4%), influenza(27.8%) and
Respiratory syncytial virus(22.2%). Among Atypical organisms Mycoplasma, Chlamydiae and
Legionella accounted for 38.46%, 30.77% and 30.77% of the cases, respectively.
Conclusion-
Present study indicates that gram-negative bacteria play a major role in exacerbation of COPD
in our population .Among bacterial infections, Klebsiella was most common organism.
Para influenza followed by influenza and RSV are common viral etiological agents in
exacerbations.
Present study indicates that a good proportion of COPD exacerbations were caused by atypical
bacteria. Mycoplasma was the most commonly isolated organism followed by Chlamydia
pneumophila and Legionella species.

In 2002 COPD was the fifth leading cause of death. Total deaths from COPD are projected to
increase by more than 30% in the next 10 years unless urgent action is taken to reduce the
underlying risk factors, especially tobacco use. Estimates show that COPD becomes in 2030
the third leading cause of death worldwide. Sputum cultureand sensitivity was done
collecting sputum in sterile containers and were incubated on sheep blood agar, chocolate
agar and Mac conkey agar. IgG antibodies against viruses and atypical organisms is done by
indirect immunofluorescent assay(IFA) kit.Sensitivityis 94.6% to 100%and specificity is 90%
to 100%based on micro-organism.Most of them have smoking history with 82% of Exsmokers
and 6% of smokers.Only 12% were non-smokers. Renal failure was seen in 42% of
patients. Chest x-ray showed opacities in only 24% of patients.

Hypertension is one of the leading causes of the global burden of disease. Approximately 7.6
million deaths (13-15% of the total) worldwide were attributable to high blood pressure in
200l.The 2003 global report showed that 7 million people die of hypertension each year and
approximately 4.5% of serious diseases are caused by it. Written informed consent was
obtained from every patient satisfying the inclusion criteria and they were thoroughly
explained in writing as well as orally in English/Kannada about the study, methodology and
possible risks during the study. In Amlodipine with Atenolol group 86% patients had good
quality, and 14% had average physical quality compared to Amlodipine with Enalapril group
which had 66.7% in good and 33.3% in average physical quality.In Amlodipine with Atenolol
group nearly 88% patients had good quality and 12% had average physical quality compared
to Amlodipine with Enalapril group which had 89% in good and 11% in average physical
quality.

Hypertension is one of the leading cause of global burden of diseases and as it is a chronic
condition with significant detrimental effects on the wide range of health outcomes, cost
effective management of hypertension appears to be a great challenge for both developed as
well as developing countries. Even though recently there have been lot of studies on
pharmacoeconomics and outcome research in the field of hypertension globally, but the
results cannot be exactly extrapolated to Indian scenario as the economic status and
socioeconomic factors are different in India as compared to the countries. Hence a study was
undertaken to evaluate the cost effective antihypertensive drugs in our hospital. An
observational comparative study is planned on 100 patients attending the outpatient
Department of General medicine with a follow up period of 6 months. Written informed
consent is obtained from all the patients satisfying the inclusion criteria. Multitherapy was
frequently prescribed (74%), out of that Atenolol with Amlong combination was most
common (54%). Diabetes was the most common co-morbid condition (24%). Multitherapy
was most frequently prescribed, and Amlodipine with Enalapril combination proved to be
most cost effective therapy. HRQoL was not much different in all the treatment groups.

Diabetes mellitus is a non-communicable chronic metabolic disorder. The association
between sensorineural hearing loss and diabetes has become an important subject of research.
Pathophysiology of hearing loss in diabetes is not still well explained. Usually gradual,
bilateral, sensorineural hearing loss at high frequency is seen in diabetes mellitus. Our study
aims to know the prevalence of SNHL in DM and its relation to HbA1c. A total of 300
subjects including 150 healthy individuals age and sex matched as control and 150 patients of
type 2 diabetes between 10-50 years age group including 78 males and 72 females were
included in the study. Fasting blood sugar and HbA1c of all the subjects were taken for the
study and after that pure tone audiometry was performed (PTA). By observing the data
degree, type and correlation with HbA1c of hearing loss was concluded. 28% diabetic
patients suffered with SNHL while 72% were found with normal hearing threshold. Among
42 patients 23 mild, 9 moderate, 9 moderately severe and 1 severe degree hearing loss cases
were found in diabetic group. Hearing loss was found on higher frequencies. Association
between hearing loss and HbA1c was observed and it was highest in the 10-13.9% range but
this correlation was not found significant (p value >0.05) in our study.

Background: Most urologic surgeries are performed in a narrow, limited space with
minimally invasive technique or cystoscope& anaesthesia for these procedures is
administered with the goals of safety, satisfactory procedural condition for the performance
of therapeutic or diagnostic procedures ensuring rapid recovery with minimal post-operative
complications. Therefore, we decided to compare the efficacy & safety of IV Propofol @1.5
mg/kg +Dexmedetomidine @1μg/kg versus IV Ketamine @ 1mg/kg + Dexmedetomidine @
1μg/kg in providing procedural sedation in urological procedures.
Material & Methods: This prospective randomized study was conducted in Department of
Anaesthesiology of Mamata medical hospital. In this study 50 patients scheduled for elective
daycare urological procedures were included and divided equally in two groups. Group Areceived
IV Propofol 1.5 mg/kg, then infusion of Dexmedetomidine@ 1μg/kgand group Breceived
IV Ketamine 1mg/kg, then Dexmedetomidine@ 1μg/kg.
Results: In our study, there is no significant difference in age, weight, gender. The
comparison of mean between two groups after giving dexmedetomidine was statistically
significant (p< 0.05) in heart rate, SBP, onset, duration of analgesia, VAS & Ramsay scores
but DBP & SpO2 was statistically not significant.
Conclusion: Comparison of baseline & intraoperative hemodynamics, showed that the values
were better maintained in Dexmedetomidine + propofol (Group-A) than Dexmedetomidine +
Ketamine (Group B). We have concluded that Dexmedetomidine + Propofol combination was
superior to Dexmedetomidine + Ketamine, providing early onset of sedation, prolonged
analgesia & stable intraoperative hemodynamics.

Aim: Assessment of the prevalence and associated risk factors of post dural puncture
headache (PDPH) after cesarean section delivery under spinal anesthesia
Methods: This Cross Sectional study conducted in the Department of Anesthesia, Madha
Medical College Research Institute, Kovur, Chennai, Tamil Nadu, India for the period of 1
year. The entire procedures were performed at sitting position. The backside of the patients
was cleaned with Iodine and alcohol. Spinal anaesthesia was done using a midline approach
at the L2-3 or L3-4 interspaces by using different size of spinal needles and 0.5 % isobaric
bupivacaine 2.5-3.0ml was injected.
Results: The 100 Patients were included in this study with fulfilling the criteria. 8 patients
had a previous history of spinal anesthesia exposure and 3 of them complained a PDPH like
headache after the procedure. All patients had given spinal anesthesia on sitting position. 23
G needle is the most frequently used spinal needle. There were 1 cases (1%) diagnosed as
failed block which were converted to general anesthesia. Hosmer-Lemeshow test of goodness
of fit was performed to check the appropriateness of the model for analysis. Variables found
to be significant at a binary logistic regression were: needle size and number of attempts.
After analysis with multivariate logistic regression needle size and number of attempts were
found to be significant at p-value<0.05. Size of the needle used to administer spinal
anesthesia is significantly associated with the development of PDPH. In this study PDPH
was present in 43 patients (43%).
Conclusion: In conclusion, the prevalence of PDPH was higher, 43% compared with most
other studies.

Introduction: Chemically, stones are of various types including calcium stones, uric acid
stones, struvite stones and cystine stones among others. Each pathophysiological group has a
predisposition to form certain kind of stones. Hence, knowledge of the chemical composition
of the stone that a patient forms can and does direct the management of the patient.
Objectives: To evaluate if the chemical composition of urinary stones can be predicted with
mean Hounsfield Unit (HU) value on computed tomography (CT).
Methods: This is prospective and analytical study conducted in the Department of Radiology
of a tertiary care teaching hospital in India. Patients diagnosed with urinary stones who had a
non-contrast CT done and had stone retrieved were included in the study. The predominant
chemical composition of the stone was analysed by X-ray diffraction crystallography.
Results: Fifty-one stones of four types were studied. Statistically significant (p<0.001)
differences were seen in the mean HU, maximum HU and median HU values between all the
four types. No significant difference was observed in the difference between periphery and
core HU values. Hierarchy of density among the stone types correlated with previous studies
but absolute measurements varied among different studies.
Conclusion:Mean HU of urinary stones correlates with their chemical composition. Calcium
oxalate monohydrate, calcium oxalate dihydrate, uric acid and hydroxyapatite stones can be
differentiated on their CT attenuation parameters if a database of attenuation characteristics
for stones of known composition is built for given scanner and protocol.

Background:Lipid profile in patients with cerebrovascular disease and to determine
significant correlation between them. To ascertain the effect of age and sex on serum lipid
profile.The diagnosis of diabetes in a stroke patient would change the initial management of
that patient, specifically with respect to other risk factors like lipid and blood pressure
management.
Aims and Objectives: To study lipid profile in diabetic and non-diabetic newly diagnosed
young stroke patients.
Materials and Methods: A total of 138 patients were admitted during study period were
selected by simple random sampling with acute stroke in the study. Fasting total cholesterol,
triglycerides, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein
cholesterol (LDL-C) were measured from venous blood samples.
Results and Observations: The mean HbA1c for group D and group ND were 9.04±1.02
and 4.85±0.45 respectively. This difference in HbA1c among patients in two groups was
statistically significant. The mean values of LDL, VLDL, total cholesterol and triglycerides
showed significant association between two groups. Levels of HDL were significantly lower
in Group D as compared to Group ND.
Conclusion: The lipid profile of LDL, VLDL, total cholesterol and triglycerides showed
significant higher range in diabetic patients as compared to non-diabetics while HDL was
lower in diabetic patients as compared to non-diabetics.

Background: Neonatal sepsis refers to systemic infection of the new born. It is characterized
by a constellation of non-specific symptomatology in association with bacteremia.Neonatal
sepsis is the most common cause of (52%) neonatal mortality in our country, which could be
reduced in large proportion by a high index of suspicion, prompt diagnosis and aggressive
management of this condition. Many studies have come up regarding the usefulness of
procalcitonin in the early diagnosis of neonatal sepsis and have found it to be 87-100
sensitive and also highly specific.
Methods: A prospective clinical study was conducted in Neonatal Intensive Care Unit of
Shimoga Institute of Medical Sciences, Shimoga. From November 2020 to November 2021 to
study role of Procalcitonin in diagnosis of LOS.All intramural neonates admitted to NICU
during this period with clinically suspected Late onset sepsis were included in the study and
were subjected to sepsis screen, blood culture and procalcitonin. Study population was further
divided into 3 group as Proven sepsis (sepsis screen positive and blood culture positive),
Probable sepsis group (sepsis screen positive, blood culture negative) and no sepsis group
(sepsis screen negative and blood culture negative, with alternate diagnosis).Sensitivity,
specificity of Procalcitonin at a level of 2ng/ml in diagnosis of late onset sepsis in neonates
was calculated (Proven sepsis was taken as test group and No sepsis group was taken as
control group).
Results: PCT was found to be >2ng/ml in 58.6% of the enrollees,our study had high PCT of
19.2ng/ml in proven sepsis,our study had sensitivity of PCT as high as 78.57% with
specificity of PCT to the tune of 77.78%.
Conclusion: The procalcitonin values were higher in sepsis proven group than in probable
sepsis and no sepsis group. Sensitivity, Specificity, PPV and NPV of Procalcitonin at value
of.2ng/ml in diagnosis of LOS was found to be 78.57%, 77.78%, 76.74%, 78.57.

Introduction: Vitamin A is required throughout the lifecycle.Vit A deficiency and
Xerophthalmia occur throughout much of the developing world and are linked to undernourishment
and complicated by illness. In developing countries, it is estimated that 5 lakh
preschool children become blind every year owing to Vitamin A Deficiency and many of
them will die because of increased vulnerability to infections, especially measles, diarrhea
&amp; pneumonia. In southern districts of Karnataka, including Shivamogga, the burden of
malnutrition, respiratory infection, diarrhea, measles and post-measles infections are high
leading to significant morbidity and mortality. Majority of the studies related with Vitamin A
deficiency are mostly concerned with clinical signs and symptoms of vitamin A deficiency.
However subclinical Vitamin A deficiency is often missed. The present study is aimed to
detect subclinical Vitamin A deficiency in children at risk, so that supplementation of
Vitamin A in early stage may bring down the burden of preventable morbidity and mortality.

Breast milk is the best milk for premature, sick new-born admitted in NICU, as it has got
innumerable benefits for the growth and wellbeing of the baby. However provision of EBM
to the new-born in resource limited NICU is challenging. We aimed at increasing the
proportion of EBM given to babies admitted in NICU from base line of 20% to 50% of the
total feed on PND5 over a period of 10 weeks. We planned a QI project, analysed the root
cause associated with lesser EBM provision and various change ideas were introduced to
overcome the problems and were tested by 4 PDSA cycles viz. post natal counselling of
mothers, augmenting knowledge and skills of staff nurses in regards to manual expression of
breast milk and introduction of dedicated lactation counsellor to post natal wards. EBM
provision gradually improved from 20% to 72% and sustained above 70% over 10 months.
Thus by doing a simple QI project, EBM provision can be improved and well sustained in a
resource limited NICU.

Background:Dyslipidemia was defined as a combination of high serum triglyceride ≥ 1.7
mmol/L, high serum LDL cholesterol ≥ 2.6 mmol/L and low serum HDL cholesterol <
1mmol/L for men and < 1.30 mmol/L for women. Non-HDL cholesterol ≥ 3.37mmol/Land
atherogenic index ≥ 0.11, were also considered abnormalType II diabetes mellitus (T2DM),
characterized by chronic hyperglycemia, and impaired insulin secretion and insulin
resistance. The objective of the present study was to study the lipid profile among type 2
diabetes mellitus patients.
Materials & Methods: The present study was conducted in the department of general
medicine. It comprised of 62 T2DM patients of both genders. Fasting blood sugar and lipid
profile such as serum cholesterol, serum triglycerides, HDL, LDL and VLDL was assessed.
Results and Observations:There were 31 males and females each. The mean serum
cholesterol level was 228.76 mg/dl, serum TG level was 202.6 mg/dl, HDL level was 39.8
mg/dl, LDL was 142.64 mg/dl and VLDL level was 43.5 mg/dl.
Conclusion: The diabetes has a significant role in alteration of lipoprotein levels. There is
significant alteration in lipid profile levels.

Aims and objective: To evaluate the functional and radiological outcome of antegrade Kwire
fixation in fracture metacarpal.
Material and method: Study includes 25 patients with fracture shaft metacarpal of hand.
These patients were treated with antegrade intramedullary K wire fixation between age group
(20yr to 60yr). Patients were evaluated as per visual analogue scale (VAS) and disabilities of
arm shoulder and hand (DASH) scoring system at 1month, 3 months and 6 months postoperative.
Results: All patients treated in this study had clinical and radiological union by the 10th
week. Patients had good range of movement at MCP joint following K-wire removal, better
DASH score with no joint stiffness and earlier return to work with less complications.
Conclusion: Closed K-wire fixation is a good option for treatment of fracture shaft
metacarpal. Functional outcome in antegrade intramedullary fixation was attributed to entry
from base of metacarpal compared to the conventional retrograde fixation.

Introduction: Acute febrile illness (AFI) is defined as a patient with fever of 38°C or higher
at presentation or history of fever that persisted for 2-14 days with no localizing source. Fever
is the main clinical symptom of various tropical infectious diseases [1].
Materials and Methods: This is a Prospective and observational study was conducted at
Paediatric Department, Gayatri Vidya Parishad Institute of Health Care and Medical
Technology over a period of 1 year. Acute febrile illness (AFI) is defined as a patient with
fever of 38°C or higher at presentation or history of fever that persisted for 2-14 days with no
localizing source. Details of history and results of a thorough physical examination were
entered on a standard data collection sheet.The routine baseline investigations included
complete blood count analysis, serum electrolytes, liver and renal function tests.
Result: In this study typhoid fever was the most common cause of undifferentiated fever
(28.3%) followed by malaria (21.6%), dengue fever (19.1%), Acute gastroenteritis (14.1%),
Pneumonia (9.1%), Bronchiolitis (5.0%), Hepatitis (1.6%) and Pharyngotonsillitis
(0.8%%). Treatment-Enteric fever was treated with Ceftriaxone. Chloroquine was used for
treatment of Malaria. Dengue was treated symptomatically and with fluids according to
Dengue protocol. If fever persisted even after 6 days of antibiotics, then Azithromycin was
added. In the undiagnosed fever category, received empirical antibiotics.
Conclusion: A high prevalence of Typhoid, malaria and dengue in this study. The overlap
probably reflects an undefined level of previous infections, cross reactivity and subclinical
infections in the population, rather than high prevalence of coinfections.

Background:Alpha-fetoprotein (AFP) is the major serum protein in the embryonic
stage and in the early fetal stage.This study assessed association between second
trimester maternal serum alpha fetoprotein in 14-22 weeks and adverse pregnancy
outcome.
Materials & Methods: 152 pregnancies were included in this study. Weight of the fetus
was estimated by the Honarvar 2 equation and compared with real weight. The MSAFP
levels are reported in ng/cc.
Results: Age group 18-22 years had 45, 23-27 years had 60 and 28-32 years had 47
patients. The difference was non- significant (P> 0.05). The mean MSAFP in preeclmpasia
was 76.1, in without pre-eclmpasia was 41.3, in preterm laborwas 55.2, in
without preterm labor was 41.0, in PROM was 42.7 and in without PROM was 43.8.
The difference was significant (P< 0.05). MSAFP level in oligohydramnious was 78.2, in
without oligohydramnious was 40.3, in stillbirth was 36.5, in without stillbirth was 45.2,
in miscarriage was 40.7 and in without miscarriage was 43.1. The difference was
significant (P< 0.05).
Conclusion: Pregnancies with an elevated MSAFP level are associated with adverse
obstetric outcomes.

Background:Psoriasis is a chronic immune-mediated skin disease that affects 125
million people worldwide, which is 2 to 3 percent of total population. Psoriasis is a
common, chronic, inflammatory disease that is associated with an increased risk of
cardiovascular, metabolic, and renal disease in a manner that varies with psoriasis
severity and is often independent of traditional risk factors.
Aim: To study the association of HbA1C and uric acid with psoriasisin the Kashmiri
population.
Method: A total of 70 cases, diagnosed for psoriasis were undertaken during the study
period December 2018 to February 2021 from the department of Dermatology in the
test group. An equal number of age and sex matched healthy individuals with no skin
disease were taken as control group. Blood samples were collected and analysed in the
laboratory of department of Biochemistry, Government Medical College, and Srinagar.
All study participants provided written informed consent prior to enrolment.
Results:Psoriatic patients had higher levels of HbA1c (5.3 ± 0.09 vs 4.9 ± 0.063 mg/dl;
P=0.005) and significantly greater prevalence of hyperglycemia (24.2% vs 12.8%;
P=0.009) than individuals without psoriasis. Prevalence of pre diabetes and diabetes in
patients with psoriasis was 11.1 % and 14.2 % respectively as compared to
controls.Multivariate logistic regression analysis showed that psoriasis can be a strong
predictor of hyperglycemia (odds ratio 2.14; 95% confidence interval 0.939-4.903;
P=0.001). Patients with psoriasis also had significantly higher levels of serum uric acid
than controls. Mean serum uric acid in cases was 6.13 ± 0.187 and in controls it was 5.56
± 0.123 with p value<0.05.
Conclusion: There was a significant increase in Hba1c levels in patients with psoriasis
than control. In addition, we found increased level of serum uric acid in patients with
psoriasis than control. There was a positive correlation between HbA1c values and
higher BMI.

Background: Mucormycosis is a rare disease of immunocompromised adults largely
restricted to the diabetic community with uncontrolled hyperglycaemia. In the second
wave of Covid, in multiple cities over the Indian Peninsula, this much dreaded “black
fungus” has afflicted many individuals who suffered from covid or were recovering
from it.
Aim: To establish the risk factors, clinical presentation, diagnostic sensitivities,
radiological survey of different types of mucormycosis in SARS Cov 2 patients.
Methods: Seventeen patients with covid infection admitted in tertiary care hospital with
diagnosed mucormycosis between Nov 2020 to June 2021 via histopathological or
culture confirmation. This is a cross-sectional observational study where detailed
assessment of clinical profile, biochemical markers and sensitivities of diagnostic
procedures was done. The data then collected and was made into a master chart and
subjected to statistical analysis. Fischer exact test was used for statistical anaylsis.
Result:In total of 17 patients,mean blood glucose levels were compared at the onset of
symptoms of covid and mucormycosis werestatistically significant with (P=0.001). Out
of 17 patients, 11 were rhino-orbital mucormycosis, four had rhino-orbito-cerebral
mucormycosis and 2 had pulmonary mucormycosis.HbA1c >8 had significant
correlation(P=0.009) with rhino-orbital and rhino-orbito-cerebral mucormycosis
whilehigher total dosage of steroids was associated with pulmonary mucormycosis (P=
0.015. Sensitivity of culture was 64.7% in our study while histopathology was
considered gold standard.
Conclusion: Our study shows strong correlation between the long term as well as short
term glycaemic control with the onset of rhino-orbital mucormycosis while dosage and
duration of steroids with pulmonary mucormycosis.

COPD is a growing global epidemic and it is estimated to kill around 3 million people every
year. It is currently the 4th largest killer disease in the world and expected to climb to 3rd
position by the year 2030. WHO has estimated that 600 million people worldwide have
COPD. It affects around 5-10% of population over the age of 40 years but still there is wide
variations in the prevalence between countries. Patients underwent Spirometric analysis and
those with post bronchodilator FEV1 < 40% are asked for willingness to participate in the
study. Those who are willing to participate are screened for inclusion into the study. Informed
Consent was obtained from all the patients. GOLD criteria revealed that majority of the
patients in our study i.e.27(45%) were of Grade 1 followed by 22(36.7%) were from Grade 2,
10(16.7%) from Grade 3 and 1(1.7%) were of Grade 4.

COPD is characterized by chronic airflow obstruction secondary to chronic bronchitis and/or
emphysema. COPD patients reportedly have significant degree of nocturnal sleep symptoms.
Some of the sleep related breathing disorders seen in patients with COPD include Obstructive
sleep apnea, sleep related hypoventilation and REM related nocturnal oxygen desaturation
syndrome. It is a longitudinal observational study. 60 patients both males and females above
the age of 40yrs having COPD were randomly selected and distributed into mild moderate
and severe grades based in FEV1 and FEV1/FVC ratio following pulmonary function testing.
It is found that out of 60 patients following sleep study, proportion of patients with abnormal
Apnea hypopnea index were more among grade 2,3,4 (chi square 26.33, p-0.0001) <0.001
which was statistically significant. Also proportion of patients with abnormal Oxygen
desaturation index was more as the severity of grading of COPD increased. Early CPAP
treatment helped to reduce the severity of sleep disorders and the reduction of AHI and ODI
indices.

Introduction: Prevalence of morbidity and mortality is keep rising in poorly managed stroke
cases. Early detection and proper diagnosis have great potential in management of stroke. The
development of brain imaging modalities (CT/MRI) have led to a milestone that provides a
living autopsy of the brain.
Objective: The goal of this prospective study is to determine the clinical efficacy of CT/MRI
and its benefits over traditional techniques of clinical diagnosis in stroke patients.
Methods: 50 patients in whom clinical signs of stroke i.e., slurring of speech, weakness on
one side of the body, deviation of angle of mouth, and neurological deficits observed were
recruited in the study. CT/MRI was used to diagnosed the stroke.
Results:The NCCT finding have revealed Diffused cerebral atrophy in 14 (28%) patients,
Chronic Infarct in 11 (22%) patients, Subacute Infarct in 7 (14%) patients, Acute Infarct in 6
(12%) patients and Encephalomalacia in 2 (4%) patients whereas 10 (20%) patients
underwent MRI brain.The MRI brain finding have revealed Diffused cerebral atrophy in 6
(6%) patients, Chronic Infarct in 1 (2%) patient, Subacute Infarct in 4 (8%) patients, Acute
Infarct in 3 (6%) patients and Encephalomalacia in 2 (4%) patients whereas 37 (74%) patients
underwent NCCT head.
Conclusion: In both NCCT head and MRI brain finding have revealed diffuse cerebral
atrophy as the most common finding among recruited patients followed by the chronic infarct
(22%), subacute infarct (14%), acute infarct (12%) and encephalomalacia (4%).

Background: The COVID-19 outbreak has been declared as a global pandemic by WHO. It
has placed an unprecedented burden on health systems and authorities.In this complex
context, their knowledge and attitude towards the pandemic can influence their psychological
state and information about their behavioral insights can be valuable to ascertain effective
strategies to reduce overall burden and tackle the crisis better 3.
Aims: To assess knowledge, risk perceptions, preventive behaviors and psychological
variables regarding COVID-19 in Resident doctors.
Methodology: A list of all resident doctors working in New Civil Hospital were informed
about the study and after obtaining an informed consent, they were asked to fill the WHO tool
for Behavioral insight. After collecting data, statistical analysis of the data was done using
appropriate Statistical test like z test, chi-square test.
Results: A total of 110 doctors participated in the study.Depression was very low (14.7%) to
extremely low (38.2%) in majority of doctors. In our study, 9% of the doctors attributed their
psychological burden of worries and fears to losing someone close to them in the pandemic.
Conclusion:Since most participants use almost all sources for gathering information about
covid-19, regular updates should be provided by media and relevant authorities, regular group
meetings, trainings to disseminate knowledge about guidelines and recent treatment protocols
should be organized by the concerned tertiary care hospitals.

Aim: To determine parenchymal thyroid diseases using Ultrasonography (USG) in adult
patients.
Methodology: This study was conducted in the department of Radio-diagnosis, Maharishi
Markandeshwar University, Solan. It comprised of 75 adult patients age ranged 21-70 years
of age. All patients were well informed regarding the study and their consent was obtained.
Particulars such as name, age, gender was recorded in case history proforma. A thorough
clinical examination was performed in all patients. Patients were divided into five groups
such as group I (normal); group II had first detected, early untreated Hashimoto disease (EH);
group III comprised of chronic Hashimoto patients that are under treatment and/or follow up
(H); group IV had multinodular parenchymal hyperplasia (M)and group V had nodular
hyperplasia with Hashimoto (HM). All examinations were performed with the patient in a
supine position with the neck hyperextended. We calculated the thyroid volume with an
automated formula (length £ width £ depth £ 0.52). We categorized the thyroid gland
echogenicity as hypoechoic, isoechoic or hyperechoic relative to the cricoid cartilage. We
evaluated the parenchyma for the presence of nodules, as well as the visibility of tiny
echogenic reticulations.
Results: Out of 75 cases, 35 (46.7%) were males and 40 (53.3%) were females. Each group
included 15 patients each. Mean RI in group I was 0.53, in group II was 0.54, in group III was
0.40, in group IV was 0.49 and in group V was 0.51. Mean AT in group I was 26.0, in group
II was 25.5, in group III was 71.1, in group IV was 46.6 and in group V was 44.8. Mean
SWV in group I was 1.57, in group II was 1.69, in group III was 1.14, in group IV was 1.47
and in group V was 1.60. The difference was significant (P< 0.05).
Conclusion: Real-time ultrasonography can be helpful for accurately diagnosing TD and
ultrasound finding of two or more TD features has good diagnostic accuracy

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using
Ultrasonography.
Methodology: This cases control study was conducted among 50 diabetic patients enrolled
from the diabetes clinic of the Medicine Department of Maharishi Markandeshwar medical
college and hospital Kumarhatti, Solan, Himachal Pradesh and 50 healthy patients (control
group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and
functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in
these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126
mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75gm
glucose. An informed consent was taken from all the subjects in the study and control groups.
All the patients were randomly selected for the study among patients regularly attending
diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in
control group. 46% of diabetics were males and remaining 54% were females, whereas in
control group male to female ratio was equal, means 50% males and 50% females. 90% cases
in control group had no gall bladder disease, while only 66% cases in group with diabetes
had no gall bladder disease. In group with DM type 2, 10% had cholelithiasis, 8% had
cholecystitis and 3% had sludge: while in control group, 4% had cholelithiasis, 2% had
cholecystitis and 4% had sludge. The percentage of contraction of gall bladder had reduced
markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value-
0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than
that of controls (28.45 + 4.26) and the difference of values was found to be highly
significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and
decreased percentage of contraction are observed. Therefore, all T2DM patients should
be evaluated using ultrasonography for the presence of increased fasting gallbladder
volumes to assess the risk of progression to gall stone disease.

Aim: To evaluate fatty liver disease and cardiovascular diseases in type 2 diabetic patients
using ultrasonography.
Methodology: The prospective and observational study was conducted in the Department of
Radiology, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Himachal
Pradesh for the period 9 months. 300 patients diagnosed with type 2 diabetes and ultrasound
abdomen showing fatty changes in liver without any other co-morbidities were included.
Patients were divided in three groups according to the duration of the diagnosis of diabetes.
The distributions of different groups were GROUP A- less than 5 years, GROUP B-in
between 5 to 10 years and GROUP C-more than 10 years. A brief history was taken of the
patient’s complaints and then the patients Random blood sugar and BMI values, as mentioned
in the patient’s case paper were recorded and then ultrasonographic evaluation of the study
subjects was performed by a single radiologist and the following parameters were examined
after obtaining informed consent-Liver echogenicity, Portal Vein Doppler study, Mesenteric
fat pad thickness and Carotid Artery Doppler study. Study method was Interview schedule
questionnaire, OPD records, bedside tickets, physical examination and laboratory
measurements.
Results: Out of the 300 patients, 145 (48.3%) were males, and 155 (51.7%) were females.
Majority (39%) of the patients belonged to 50-60 years of age group followed by 25.7%
patients in the age group of 40-50 years. 18.3% belonged to 60-70 tears of age, 10.7% were
less than 40 years, and 6.3% belonged to more than 70 years of age. Out of the 300 cases, 225
(75%) cases had fatty liver and 75 (25%) cases had non-fatty liver. Out of the included
patients, 33.4% (100) were in group A, 40% (120) were in group B, and 26.6% (80) were in
group C. Out of 300 patients, 70 (23.3%) cases had ischemic changes, but majority of patients
(230, 76.7%) did not have ischemic changes.
Conclusion: Liver ultrasound examination should be considered in every patient with newly
diagnosed type 2 diabetes because the prevalence of NAFLD is extremely high in this group
of patients. It can be said that there was an association between cardiovascular risk factors
and NAFLD in patients with type 2 diabetes mellitus.

Aim: To compare modalities like ultrasonography (USG) and computed tomography (CT) in
the evaluation of suspicious ovarian masses.
Methodology: This prospective comparative study was carried out in the Department of
Radiology, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan,
Himachal Pradesh for a period of 12 months. Total 50 women were included in this
prospective study. All patients underwent abdominal Ultrasonography and CT scan with
determination of the ovarian mass characteristics. Detailed history of allergy and renal
function tests were taken before doing CT scan and if there was history of allergy then nonionic
contrast was used. Site, size, papillary projections, wall characteristics, capsular
infiltrations, the presence of solid areas inside the mass and presence of as cites were
recorded both by US and CT scan.
Results: Out of 50 patients, majority of patients belonged to 40-50 years of age group (19,
38%) followed by 30-40 years of age group (10, 20%). 8 patients (16%) belonged to 20-30
years age group, 7 (14%) belonged to 50-60 years, 60 years of age group included 3
patients each. There are total 29 cases of Pre-menopausal stage and 21 cases of Postmenopausal
stage having ovarian cyst. Out of 29 cases of Pre-menopausal conditions have 7
number of malignant and 22 number of benign type of ovarian masses. In the Postmenopausal
group there are 17 cases of malignant and 4 cases of benign ovarian mass was observed.
Overall, CT was found to have 96% sensitivity, 92% specificity, and an accuracy of 92% in
the differentiation of benign and malignant ovarian masses, while PPV and NPV were 94%
and 90%, respectively. The sensitivity of USG was 90%, specificity was 86% and PPV and
NPV were 88% and 86% respectively.
Conclusion: CT and USG imaging all have approximately similar accuracy in staging
ovarian carcinoma but the sensitivity of CT scan for all ovarian cancer detection greater than
that of US. Among women with ovarian disorders, CT can be primarily in patients with
ovarian malignancies, either to assess disease extent prior to surgery or as a substitute for
second look laparotomy.

Aim: To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography
(MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with
obstructive jaundice.
Methodology: This study was conducted in the Department of Radio Diagnosis, Maharishi
Markandeshwar Medical College and Hospital, Kumarhatti, Solan for the period of 6 months.
60 patients clinically diagnosed as suffering from obstructive jaundice and having total
Bilirubin greater than 5mg/dl were included in this study. Patients who were pregnant and
claustrophobic were not included in this study. All the patients were instructed to fast
overnight prior to examination. Renal functional status, clinical history of all the patients was
noted before undergoing contrast CT. All the patients in the study underwent USG
examination first followed by MRCP and finally CT. Both curvilinear and linear probes were
used in the study. Images of the biliary tree were recorded for later review. Helical CT was
performed on a Philips Healthcare 128 slice CT scanner. MRCP was performed on Philips
Healthcare 1.5 Tesla MRI Scanner. All images were obtained with breath holding and
parameters were individualized.
Results: Of 60 patients, 16 (26.7%) patients were ≤45 years and 44 (73.3%) were >45 years.
32 (53.3%) cases were males and 28 (46.7%) were females. There were 37 (61.7%) patients
with ≤40 days of duration of symptoms and 23 (38.3%) patients with >40 days of duration of
symptoms. In causes of obstruction, choledocholothiasis was responsible
for19(31.7%),stricture16(26.7%),carcinoma ofheadofpancreas11(18.3%),
gallbladdercarcinoma6 (10%), periampullary carcinoma5(8.3%) and cholangiocarcinoma in 3
(5%) of the cases. Taking MRCP as gold standard, 100% (60 cases) had obstructive jaundice.
Whereas 56.7% (34 cases) were diagnosed correctly using USG and 86.7% (52 cases) were
diagnosed correctly using CT. The sensitivity of MRCP is 94% and CT is 92%, while it is
100% for USG. Inspite of the high sensitivity for USG, the specificity for the same is very
low at 70% when compared to that of CT’s 72% and MRCP’s 100%.
Conclusion: The only drawback of MRCP is the cost involved and the availability. From this
study, It is recommended that helical CT can be used as a screening imaging technique to
identify the presence or absence of intrahepatic biliary duct dilatation; thereby shortlisting the
patients for MRCP examination.

Aim: The comparison of diagnostic accuracy for prostate cancer detection between
elastography plus MRI image based TRUS biopsy versus extended core biopsy.
Methods: This Comparative study was carried out in the Department of Radio Diagnosis,
Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal
Pradesh, India for the period of 6 months. 50 Patients with age group of 35 to 75 years, with
Serum PSA greater than 4.0 ng/dl were included in this study. All patient underwent TRUS
biopsy based on the MRI and elastography images, followed by TRUS guided extended core
biopsy (13 cores) done by radiologist randomly. The rate of prostate cancer detection was
compared between the two types of biopsies. Group A consisted of cores from MRI plus
Elastographyguided TRUS biopsy and Group B were cores from extended core biopsy.
Results: The mean age of patients was 63.71. The mean serum PSA for patients was 14.77
ng/dl (6.5 to 40.7). 20 cases presented with AUR and patients were catheterized. The mean
size of prostate in all 50 patients was 51.77 mg (29 to 84 mg). The mean size of prostate and
serum PSA of patients with carcinoma prostate were 14.9 mg and 18 ng/dl respectively.
Prostatic carcinoma detection with extended core biopsy was 42% (n=21). The incidence of
prostate cancer detection by MRI plus Elastography guided TRUS is 41 cases (82%). MRI
plus Elastography guided TRUS biopsy method is considered to be statistically significant as
the p value is 0.0369(since p < 0.05) as obtained by fishers exact test. In our study majority of
the patients had adenomatous hyperplasia (n=30,60%) as the HPE diagnosis, followed by
adenocarcinoma (n==20,40%). The sensitivity of mpMRI plus Elastography image based
TRUS biopsy method in detecting Prostate cancer was 84.5% and specificity was 82%. The
positive predictive value of this method was found to be 80%.
Conclusion: Although mpMRI and Elastography are individually useful for detection of
prostate malignancy, combining both the diagnostic tools for TRUS guided increases the rate
of cancer detection than that of extended core biopsy.

Aim:To assess some quantitative spectral Doppler parameters, resistivity index (RI) and
acceleration time (AT) together to show their reliability for differential diagnosis of
parenchymal thyroid diseases.
Methods: This study was conducted in the Department of Radiology, Maharishi
Markandeshwar University, Solanfor the period of 1 year. Patientsweredivided into five
groups such as group I (normal); group II had first detected, early untreated Hashimoto
disease(EH);groupIII comprised of chronic Hashimoto patients that are under treatment
and/or follow up (H); group IV had multinodular parenchymal hyperplasia (M) and group V
had nodular hyperplasia with Hashimoto (HM). They underwent spectral Dopplerultrasound
usingPhilipsAfiniti 70 G machine by a linear 5-12 MHz probe. Quantitative spectral Doppler
parameters such as resistivity index (RI) and acceleration time (AT) were recorded.
Results: Out of 200, 62.5% were female and 37.5% male most of the patients between 30-40
years 42.5% and followed by 40-50 years was 30%. The distribution of patients was done
based on diseases. The mean RI in group I was 0.57, in group II was 0.60, in group III was
0.45, in group IV was 0.51 and in group V was 0.53. Mean AT in group I was 25.9, in group
II was 24.8, in group III was 69.5, in group IV was 45.8 and in group V was 44.5.The
difference was significant (P< 0.05).
Conclusion: The resistivity index and acceleration time together are reliable for differential
diagnosis of parenchymal thyroid diseases.

Aim: To evaluate the diagnostic accuracy of ultrasonography in detecting nasal bone
fractures compared with CT as the reference standard.
Methodology: A cross-sectional study was conducted in the Department of Radiology,
Maharshi Medical College & Hospital, Kumarhatti, Dist. Solan, Himachal Pradesh, pin code
173229 for the period of 1 year. The study group consisted of 100 patients with nasal bone
fracture who were investigated by physical examination. These patients were then examined
by conventional radiography and sonography. Physical examination was considered as the
gold standard for the diagnosis of nasal bone fracture. All patients were investigated
radiographically by a lateral and a Waters view X-ray at the beginning. The results were
evaluated by a radiologist. The reports were then recorded as either “positive” or “negative”
according to the existence of nasal bone fracture. Then, patients were examined by
sonography. Soft tissue edema and subperiosteal hematoma was also examined as a possible
predictor to differentiate an acute from a chronic fracture. The negative and positive
likelihood ratios (LR- and LR+), NPV and PPV were calculated and used for determining the
diagnostic accuracy. The LR-of ultrasonography was lower than radiography. The LR+of
sonography for the diagnosis of nasal bone fracture was 65.20 [9.28-390.10] which represents
a large and conclusive increase in the likelihood of the fracture in the presence of positive
findings. Furthermore, LR of sonography was 0.14 [0.10-0.21] which proposed a large to
moderate decrease in the likelihood of the fracture, in the presence of negative findings. LR+
of radiography was 6.20 [2.87-6.27] which showed a small increase of the likelihood of
fracture in positive results and the LR¯ of x-ray was 0.36 [0.21-0.42] which proposed a small
decrease in the likelihood of the fractures when the findings were negative.
Results: In this study, 100 patients who had nasal bone fracture in their physical examination
were investigated by sonography and radiography. Of these patients, 31 were women and 69
were men. The mean age of patients was 24.7 years. 37 (37%) patients were between 20-30
years and 28 (28%) were between 30-40 years, and 5 (5%) patients were < 20 years of age
group, while 7 (7%) were > 50 yearsand 23 patients were between 40-50 years of age group.
The youngest patient included in the study was a 12 year old male child and the oldest
patientwas a male of 60 years of age. Of the 100 patients, 78 had nasal bone fracture
(according to physical examination) and 22 patients were found normal but were investigated
due to legal issues. Out of the 78 clinically proven nasal bone fracture cases, conventional
radiography showed a fracture line in 65 cases.

Objective: The aims of the study were determination of the range of CTHFN in different
categories of FLD by USG and to compare CT Hounsfield Numbers with ultrasonographic
categorization of the FLD.
Material and Methods: It was a cross sectional analytical study. By purposive sampling 186
patients of FLD were sampled from Department of Radiology, Maharishi Markandeswar
Medical College and Hospital Kumarhatti, Solan, Himachal Pradesh, The data was collected
for 9 months. Patients of both gender of age between 20-80 years, who underwent both CT and
USG scans of abdomen and with Ultrasonographic diagnosis of diffuse FLD were included.
The USG categories of FLD were compared with mean liver CTHFN. Statistical analysis was
done by ANOVA; p value of CTHFN was found significant for each Ultrasonographic category
of FLD.
Results: Total 186 patients of FLD were observed. The mean age of population was
51.25±15.32 years and range was 18-72 years. The mean Values of CTHFN of liver was
37.85±13.52 HU and range was-10.65-54.62 HU with significant p value. The frequency of
male population was 113(60.8%) and female was 73 (39.2%). The mild, moderate and severe
FLD was found in 138 (74.2%), 32 (17.2%) and 16 (8.6%) patients respectively. The mean
values of liver CTHFN in mild moderate and sever FLD categories by USG were 41.74±4.88
HU, 23.77±3.89 HU and 3.05±6.79 HU respectively. These values along with P values and
95% Confidence Interval (CI) were analysed. In multiple comparisons the Least Significant
Difference (LSD) of USG categories of FLD with mean liver CTHFN, p value was significant
when mild FLD was compared with moderate and severe FLD, moderate FLD was compared
with mild and severe FLD and severe FLD was compared with mild and moderate FLD.
Conclusion: USG is a reliable and sensitive modality for the grading of FLD

Aim: To evaluate the sonographic morphology of pelvic masses and to correlate with the
histopathological diagnosis of the patients who underwent surgical intervention.
Material and Methods: A cross-sectional prospective study was conducted in the
Department of Radiology Maharishi Markandeswar Medical College and Hospital
Kumarhatti, Solan,Himachal Pradesh for the period of 1 year. Total 100 female patients with
Gynecological masses using high resolution ultrasonography and findings correlated with
histopathology or serial sonographic examination.
Results: Majority of the patients were in the age group of 40-50 years with mean age of 36.3
years. The minimum number was in the age group of below 20 years. The most common
chief complaint of female patients enrolled in our study was pelvic pain 36 (36%) followed
by pain and palpable mass 16(16%).Menstrualirregularity, menorrhagia, post-menopausal
bleeding, infertility, and amenorrhea were the other less common complaints in the female
patients of our study. Out of 100 patients evaluated by ultrasonography 25 (25%) were having
ovarian pathologies and 45(45%) were having uterine pathologies. Eleven patients presented
with localized collection in the fallopian tube pathologies. Few cases there were involvement
8(8%) of vagina. Fibroids were the most common uterine masses.
Conclusion: The USG is most commonly preferred imaging tool to evaluate gynecological
masses. It’s important to differentiate gynecological and non-gynecological masses on
sonography for accurate management of the patient.

Background: Appendicitis is the most common cause of acute abdominal pain,
requiring surgical intervention. The present study was conducted to assess efficacy of
postoperative antibiotics after appendectomy in non- perforated appendicitis.
Materials & Methods: 76 patients undergoing appendectomy of both genders were
divided into 2 groups of 38 each. Group I patients were not given any postoperative
antibiotics and the group II patients received a single dose of cefuroxime sodium and
metronidazole, 8 hours postoperatively. Open appendectomy was performed by the
standard operating technique through right lower quadrant incision. Parameters such
as duration of symptoms, duration of surgery and hospital stay was recorded.
Results: There were 26 males and 12 females in group I and 20 males and18 females in
group II. Duration of symptoms was 1.9 days in group I and 1.4 days in group II,
duration of surgery was 52.3 minutes in group I and 54.8 minutes in group II. The mean
hospital stay was 2.31 days in group I and 2.42 days in group II and surgical site
infections was 10 days in group I and 5 days in group II. The difference was significant
(P< 0.05).
Conclusion: Both groups were comparable in terms of surgical site infection.

Background: The risk factors for the development of incisional hernia include obesity,
diabetes, emergency surgery, postoperative wound dehiscence, smoking and
postoperative wound infection. The present study was conducted to compare different
treatment modalities of management of incisional hernia.
Materials & Methods: 80 patients of incisional hernia of both genders. The consent was
obtained from all enrolled patients.
Data such as name, age, gender etc. was recorded. Routine investigations such as CBC,
bleeding time, clotting time etc. was done. Patients were divided into 2 groups. Group I
was treated with inlay and group II were treated with sublay technique.
Results: Group I comprised of 28 males and 12 females and group II had 16 males and
24 females. Common complication reported was seroma formation 3 in group I and 1 in
group II, wound dehiscence 2 in group I and recurrence 2 in group I and 1 in group II.
Risk factors was diabetes was seen in 7 and 5 in group II, obesity was seen in 4 in group
I and 2 in group II and smoking was seen in 10 in group I and 13 in group II.
Conclusion: Both techniques were comparable in terms of risk factors and
complications.

Background: Dengue fever is a major public health problem with morbidity and mortality and the recent epidemic showed variable clinical presentations with unpredictable clinical progression and outcome. Increasing work is being done to identify a biomarker that may predict the various clinical phenotype or complications.
Materials and Methods: This was a prospective study conducted in the department of Pediatrics in a tertiary care hospital. Patients with clinically suspected dengue fever underwent dengue serology tests. Patients were followed till 48 hours post defervescence of fever or settling of any other ongoing concern. Data analysis was done using Windows SPSS software version 20 and P value less than 0.05 was considered statistically significant.
Results: A total of 200 patients were enrolled in the study. Maximum number of cases (48%) was in the age group of 11 to 15 years. Commonest symptom was fever in 100% cases. NS1 antigen was positive in 96% cases. Severe dengue patients were significantly more in age group of 6 to 10 years (58.2%) Children with dengue with warning signs had significantly raised levels of SGOT, SGPT and CPK.
Conclusion: Biochemical markers may help to identify and appropriately manage the high risk children of dengue fever with warning signs thus reducing morbidity and mortality due to dengue fever.

Aim: The aim of this study to evaluate the microflora in the post-chemotherapy patients of oral cancer.
Methods: The present study was conducted in the Department of Dentistry Ananta Institute of Medical Sciences and Research Centre, Tehsil Nathdwara, Distt. Rajsamand, Rajasthan, India, from July 2020 to June 2021. We enrolled 24 patients (15 men and 9 women, aged 20–55years) with solid malignancy that had no previous adjuvant radiotherapy or recent antimicrobial or antiviral treatment. Sampling was done at the same time of day, approximately 2 h after breakfast. Microorganisms were identified by standard procedures as well as the production of a set of metabolic enzymes (as tested with Rapid ID 32A and Rapid ID32 Strep). With regard to bacterial counts, the results were expressed in MCF, equivalent to 1.5 × 108 cells/ml.
Results: Oral mucositis, according to WHO scores, involving nonkeratinized sites developed in 8 patients (33.33%) in the test group: 7 with Grade 1 and 1 with Grade 2. No ulcerations on the keratinized mucosa were scored. No mucositis developed in the control group. 12 patients (50%) who developed plaque that consisted predominantly of saprophytic Gram-positive cocci (Streptococcus spp., Leuconostoc spp., Granulicatella spp., and Gemella spp.). The other 12 patients (50%) developed periodontal pathogens (F. nucleatum, P. gingivalis, Actinobacillus spp., and P. micros). Actinobacillus spp. was the least frequently found periodontal pathogen in the test group (8.33%), while F. nucleatum was the most frequently found (16.67%). No significant differences were found in bacterial changes between t0, t1, and t2 in the test group. In the control group, the bacterial count remained unchanged during the observation period. At t0, t1, and t2, differences in qualitative and quantitative variations between the two groups were not significant.
Conclusion: No changes occur in microflora in dental plaque in cancer patients within 7 days from the first course of chemotherapy. No correlations between oral mucositis and specific microorganisms were assessed

The prevalence of cardiac autonomic neuropathy (CAN) in type 2 DM patients increases with
the duration and poor glycemic control. Patients with CAN are at increased risk for
autonomic dysfunction like resting tachycardia,abnormal systolic and diastolic function
leading to syncope and dizziness, prolonged QT interval, silent ischemia/infarction, lethal
arrhythmias and sudden death.Usage of 5 simple and cheap bed side tests for autonomic
function and corrected QT interval from ECG are helpful in early diagnosis of CAN. Early
recognition of CAN is helpful in delaying effects of CAN by strict control of blood sugar and
following healthy life style. Our study was conducted on100known and newly diagnosedType
2 Diabetes Mellitus patients<60 years whopresentedto Medicine OPD and admitted in IPD
wardsin Maharani LaxmiBai Medical College.Out of total 100 patients,49% had normal
score(0,1); 25% had borderline score(2,3,4); rest 26% had abnormal score ≥5; the prevalence
of CAN was 51%.Among 100 patients 47% patients were foundwith poor glycemic control
(HbA1C ≥ 8),in these 17% had early and 21% had definite CAN. Out of 100 patients of the
study, 55% patients had QTc>440ms out of which 17% had early and 23% had definite CAN.
The CAN also increased with older age group. So it is important to diagnose CAN early in
asymptomatic diabetics. There is significant correlation between CAN and QT prolongation.
QT interval in ECG can be used to diagnose CAN with reasonable sensitivity and specificity.
Usage of 5 bedside autonomic function tests are very helpful in early diagnosis of CAN.Strict
control of blood sugar can delay the early development of CAN. Intensive control of blood
sugar can delay the early development of CAN.

Context: Polycystic Ovarian Syndrome (PCOS) is a heterogenous chronic endocrine disorder commonly diagnosed in women of reproductive age. The disorder itself and its associated Co-morbidities increase healthcare costs and contribute to reduced quality of life. Global Prevalence of PCOS is estimated to be between 6% and 26%. Early diagnosis of PCOS and Its prompt treatment will help girls to improve quality of life and prevent further health hazards.
 
Objectives: To estimate the prevalence of PCOS among female medical students, To assess their knowledge regarding PCOS and source of their knowledge.
 
Materials and Methods: A Cross sectional descriptive study was conducted from October to December 2021among female undergraduate medical students in Government medical college, Kurnool. After obtaining Institutional Ethical committee (IEC) clearance and informed consent from students, Data was collected by self-administered closed ended questionnaire through Google forms. Data analysis was performed using IBM SPSS version 21. Results were expressed interms of mean, percentage.
 
Results: All participants had some knowledge about PCOS but only 66.1% (244) were aware of long-term complications of PCOS and only 76.2% (281) had knowledge regarding role of life style modification in prevention and treatment of PCOS.
 
Conclusions: Even though the female medical students have some knowledge regarding   PCOS, their awareness about the risk factors and complications of PCOS is significantly less. Effective educational intervention can significantly increase their knowledge on PCOS.
 

Aims & objectives:
To determine the incidence of urinary tract infections in catheterized patients admitted in the hospital and to identify uropathogens and their antibiotic sensitivity patterns in our hospital.
 
Methodology:
This is a prospective study on patients with Foley’s catheter more than 48 hours in situ. Urine sample is collected from the catheter following CDC urine sampling guidelines, cultured, antibiotic sensitivity is identified. The results are analyzed and susceptibility patterns are observed.
 
Inclusion Criteria: Patients of ages 14 to 80 years are included. Patients with catheter in situ for more than 48 hours. No prior history of urinary tract infections before insertion of catheter. Patients who are catheterized in the hospital.
Exclusion Criteria: Patients on prolonged antibiotics usage. Patients denied consent for study. Chronic and prolonged catheterized patients.
 
Results: Total of 745 patients are analyzed, 525 patients showed sterile cultures despite having symptoms suggestive of UTIs. 220 patients developed positive cultures confirming urinary tract infection. The most common isolate is E.coli followed by Klebsiella, Enterobacterecia and Pseudomonas. S.aureus, Acinitobacter, candida are uncommon pathogens isolated. E.coli, Klebsiella showed resistance to Fluroquinolones, Beta lactam group and sensitivity to 3rd and 4th generation Cephalosporin, Imipenem group and Colistin. Pseudomonas showed maximum resistance to all higher antibiotics with susceptibility to Aminoglycosides group of antibiotics.
 
Conclusion: The study showed the incidence of infections in catheterized patients despite adhering to sterile procedure. It is of utmost importance to maintain strict aseptic conditions, early diagnosis and appropriate diagnosis and proper antibiotic regimen to effectively control UTIs. Empirical antibiotics and non-judicious usage leads to multi drug resistance and can pose a serious threat to the patient’s recovery and lead to emergence of resistant strains which may pose a threat in near future.
 

Introduction: Obesity and type 2 diabetes mellitus have emerged as new drivers of CVD risk
as a result of our contemporary overconsumption of processed and energy-dense food
products with low nutritional value, paired with our sedentary lifestyle. Increased oxidative
stress is a well-known contributor to the onset and progression of diabetes,
as well as its consequences.
Material and Methods: This is a prospective and observational study conducted at
Department of Biochemistry. Students and apparently healthy cases in the age of 18-30 years
who accompanied DM patients in were included for the study (n = 50). Individuals who are
taking any medications for a health issue that prevents them from conducting sub-maximal
exercise, as well as those who engage in regular physical activity, yoga, or other biofeedback,
were excluded from the research. For the control group (n = 50), age and gender matched
seemingly healthy adults with no family history of diabetes were recruited.
Results: The cardiovascular parameters of controls and cases individuals are shown and
Heart rate (p <0.001), blood pressure (SBP p< 0.001, DBP p <0.001, MAP p <0.001)and rate
pressure product (p 0.001) all showed statistically significant differences, but PP (< 0.135)
did not. The body fat distribution, cardio respiratory fitness as determined by the Cooper 12-
minute run test, and blood glucose readings of controls and patients. Body fat percentage
(p<0.001), visceral fat (p<0.001), Cooper 12-minute run test (p<0.001), and FBS (p<0.001)
were all significantly different. The differences in oxidative stress parameters across groups.
Between controls and cases participants, there was a significant difference in TAOS
(p<0.000) and MDA (p<0.000).
Conclusion: In our study, we found that both groups had similar age, height, and waist-hip
ratio (WHR), but FDRDM had a considerably higher body mass index (BMI). Fasting
percentage body fat and blood glucose levels were significantly higher, and the 12-minute
walk distance was much shorter in FDRDM. Visceral fat levels were marginally elevated, but
not statistically significant alteration during the early stages of illness significant differences
in oxidative markers were observed among the subjects.

Introduction: Although there was a weak positive link between inflammatory indicators and
serum lipid levels, assessing both of these parameters combined may aid in the early
detection and treatment of people who are at high risk for metabolic disorders like type 2
diabetes mellitus and other cardio vascular diseases.
Materials and Methods: This experiment was carried out at the Department of Biochemistry
research lab in India. The sample size was determined to be N=100 based on a 0.56
connection between visceral fat composition and oxidative stress and inflammation. The
study included students and apparently healthy cases between the ages of 18 and 30 who
followed DM patients in (n = 50). Individuals taking any medications for a health condition
that precludes them from performing sub-maximal exercise, as well as those who participate
in regular physical activity, yoga, or other biofeedback, were excluded from the study. Age
and gender matched ostensibly healthy persons with no family history of diabetes were
recruited for the control group (n = 50).
Results: Significant difference was noted in the inflammatory markers & the lipid profile
parameters except for the HDL. In individual with type 2 diabetes, worsening dyslipidemia
and inflammation over time raises concerns about the early onset of atherosclerosis. In the
absence of glycemic control, insulin treatment is of poor effect. Efforts to improve glycemic
control are required.
Conclusion:Lipid profile of an individual is associated to obesity, inflammation, vascular
function, and diabetes. Appropriate lifestyle adjustments may be performed to lower the
inflammatory markers and metabolic disorders. A greater understanding of the causes of
inflammatory markers and lipid profile aid in the development of specialized therapeutic
approaches for treatment of type 2 diabetes mellitus.

Background: Dexmedetomidine and midazolam both affects duration of spinal
analgesia by different mechanisms, and yet, no studies are available to compare them
for postoperative analgesia after neuraxial administration. We investigated the addition
of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of
effective analgesia.
Materials and Methods: The patient posted for elective procedure under spinal
anaesthesia were randomly allocated in to three group of 20 patient and each group.
Group D- Patient in the group receiving 3 ml of 0.5% hyperbaric Bupivacaine with
5mcg Dexmedetomidine the total volume is 3.5ml. Group M - Patient in the group
receiving 3 ml of 0.5% hyperbaric Bupivacaine with 1mg of Midazolam, the total
volume is 3.5 ml. Group B-: Patient in the group receiving 3 ml of 0.5% hyperbaric
Bupivacaine with 0.5 ml of normal saline, the total volume is 3.5 ml. The groups were
compared to the regression time of sensory block, duration of effective sedation score,
and side effects.
Results: The mean duration of sensory and motor block was quite prolonged in group D
patients The results were, statistically highly significant (P<0.0l) There
is significant difference between all the three groups in group D the sensory duration
block is 226 minutes while in group M is 158.7 minutes, In group B this Is 134.8 minutes
which is much less than the above groups. The motor block in group D 202.35 minutes,
in group M is 110.5 minutes and in group B is 96.8 minutes.
Conclusion: Dexmedetomidine (5mcg) when used as an adjunct to 3 ml of 0.5%
hyperbaric bupivacaine and prolongs the duration of effective analgesia in the
immediate postoperative period without any significant hemodynamic instability in
comparison to 1 mg midazolam.

Background:
Reaction time (RT) is a measure of the response to a stimulus. Reaction time provides an indirect index of the processing ability of Central Nervous System and also a simple means of determining sensory-motor performance. It is the time interval between the onset of stimulus and the initiation of appropriate voluntary response under the condition that the subject has been instructed to respond as rapidly as possible and is a simple and non-invasive test for peripheral and central neural structures with a physiological significance. Factors that can affect the average human RT include age, sex, left or right hand, central versus peripheral vision, practice, fatigue, fasting, breathing cycle, personality types, exercise, and intelligence of the subject.
Aim:
The aim was to compare visual Reaction time (VRTs) and auditory Reaction time (ARTs) on the basis of gender of nursing staff.
Materials and Methods: The present study was conducted in the SMS Medical College & attached hospitals, Jaipur. The study was done after getting approval from institutional human ethical committee. The study was conducted on 80 healthy normal nursing staff [males& females] of 20-35 years old. Reaction Time was recorded with the help of Audio-visual Reaction Time apparatus, supplied by Medi system, Yamuna Nagar. It had display accuracy of 100% and resolution 0.01 second. Statistical analysis was done.
Results: In both the sexes’ Reaction time to the auditory stimulus was significantly less (P < 0.001) as compared to the visual stimulus. Significant difference was found between Reaction time of male and female nursing staff(P < 0.001)
Conclusion: The effect of night shift duty stress on auditory reaction time in males and females shows that males have significantly better auditory reaction time than females. Similar results were found for Visual reaction time indicating that males can tolerate night shift duty stress better than females. Females are unable to adjust to shift duties due to the family problems, resulting into shift work intolerance and thus prolongation of audio-visual reaction time. The ART is faster than the VRT in nursing staff. Furthermore, male have faster RTs as compared to for both auditory as well as visual stimuli.

In India, the incidence of the disease is on the increase due to the change in diet patterns and
the greater awareness of the problems. A gallstones survey limited to railroad workers
conducted in 1966 utilizing oral cholecystography had suggested that gallbladder stones
occurred 7 times more commonly in North Indian workers than in South Indian workers.
Patients were selected according to inclusion and exclusion criteria after taking informed
consent and reassuring them keeping confidentiality of their data. In all the 200 patients,
patients diagnosed as cholelithiasis and who underwent laparoscopiccholecystectomyor
converted to open-cholecystectomywere included in the study. After explaining complete
details of the procedure and complications to the patients, the surgery was performed under
general anesthesia. In our study out of 200 patients, majority of patients, both male and
female had pain as their chief complaints with total percentage of (62%).Next to pain
majority of patients including males (10) and females (16) Nausea as major complaint
constituting (13%) of total average. Dyspepsia 21 i.e., (10.50%), pain + nausea 15 i.e.,
(7.50%) and pain + jaundice 14(7%) as their chief complaints in decreasing order.

The common etiology of conversion from LC to open cholecystectomy is uncontrollable
bleeding, adhesions, inflammation, anatomical variations, trauma of bile duct, presence of
malignant pathologies and technical failure. The conversion rate to OC remains
approximately 2-5% in most series. Patients were selected according to inclusion and
exclusion criteria after taking informed consent and reassuring them keeping confidentiality
of their data. In all the 200 patients, patients diagnosed as cholelithiasis and who underwent
laparoscopic cholecystectomy or converted to open-cholecystectomy were included in
the study. After explaining complete details of the procedure and complications to the
patients, the surgery was performed under general anesthesia. In our study out of 200
patients, age from 21-60(n=102) years have difficulty in operation with >40mins of duration
of operation with P value <0.001 and the difference is statistically highly significant by
Fisher’s exact probability test.Incidental Carcinoma of gallbladder in 1 (0.5%), Gallbladder
polyp in 1 (0.5%), CC in 136 (68%), AC in 46 (23%), AGC in 5 (2.5%) & MGB in 11
(5.5%).

Background: Blood glucose and electrolytes have a complicated relationship that is
influenced by a number of other factors such as age and concomitant conditions. As
there is paucity of such studies in India, so present study was to determine the most
prevalent electrolyte disturbances among diabetic in-patients and to explore an
association between blood sugar and electrolyte imbalances.
Materials and Methods: The present cross-sectional study was carried for a duration of
two years among 271 adult patients with diabetes mellitus admitted to the wards and
ICU in a tertiary care centre. Patient-specific information was collected in a structured
schedule and blood sample was collected for laboratory investigations after obtaining
written informed consent. All tests were performed at a 5% level of significance; thus,
an association was significant if the p value was less than 0.05.
Results: In present study (Table 1), the mean age of study subjects was 58.92 ± 13.15
years, with nearly equal representation from males (49.4%) and females (50.6%). The
mean duration of diabetes among subjects was 9.72 ± 6.57 years. The mean HbA1C was
7.65 ± 1.23 % which reflect uncontrolled diabetes. The most common electrolyte
imbalance among enrolled subjects was hyponatremia (33.6%). The mean levels of
serum sodium (group A: 132.82 ± 3.99 vs group B: 135.62 ± 5.12), were statistically
different (p<0.05).
Conclusion: The importance of evaluating serum electrolytes in patients with type 2
diabetes was presented in the study. Electrolytes, particularly sodium, chloride, and
potassium, become significantly disturbed as fasting blood glucose rises.

Background: Treatment of distal radius fractures is difficult due to comminution and
joint involvement. Plating is now the standard treatment method for distal radius
articular fractures because of higher rate of complications after conservative
management.Aim: The aim of the study was to evaluate the usefulness of volar locking
plate fixation method of distal radius fracture and to compare it with other results.
Materials and Methods: We evaluated 28 patients from volar locking plates from
December2012 to March 2017, treated for distal radius intraartiular fractures by using
a volar locking compression plate. Standard X-ray and clinical assessment after 1year
were measured and final outcome were assessed using modified Gartland and Werley
score.
Results: At the end of 12 months, 17 cases out of 28 cases in which most of the excellent
results in AO type B fractures (excellent outcome in 13 patients out of 16 patients i.e.
81.25% cases) as compared to type C fracture where it was 33.33% cases (excellent
outcome in 4 patients out of 12patients). One case developed of superficial wound
infection which resolves with antibiotics.
Conclusion: The distal radius fixation volar locking plate restores anatomy, helps in
speedy movement of wrist and function, prevents postoperative collapse of fracture and
hence is an excellent treatment method for distal radius fractures.

Background: Saphenous nerve is the largest cutaneous nerve in the lower limb. It
usually arises from the dorsal division of femoral nerve and innervates skin over
patellar ligament, tibial side of leg, medial side of foot and ball of great toe. Saphenous
nerve also responsible for mechanosensor functions in the knee joint. Evidence based
research reported that saphenous nerve is prone to injury during interventional
procedures. Knowledge about Aberrant saphenous nerve anatomy is essential for
clinicians to perform interventional procedures in patients without complications. So
the author of the present study aimed to explore the aberrant saphenous nerve anatomy
in cadaveric lower limb specimens.
Materials and Methods: In the present study 50 (27 Right side and 23 left side)
formalin-fixed embalmed cadaveric lower limb specimens were dissected in the
Department of Anatomy, Mahatma Gandhi Medical College, Pondicherry, from 2019 to
2021. The saphenous nerve origin, course and branches were observed in all the
specimens and any variations in the same were documented and analyzed.
Results: Out of 50 specimens, the saphenous nerve took origin from the anterior
division of the femoral nerve along with the intermediate and medial cutaneous nerve of
the thigh in 9 (18%) specimens. Aberrant course in the thigh was observed in 6 (12%)
specimens. No variations were observed in the branching pattern of the saphenous
nerve except Infrapatellar branch of saphenous nerve originated as 2 branches in 3
(6%) lower limb specimens in this study.
Conclusion: Variations in origin, course and branches of saphenous nerve observed in
the present study had left side supremacy. Clinicians should be aware of such variations
to perform procedures like femoral artery catheterization, saphenous nerve blockade
and knee surgeries without complications.

Background: Stroke is the top cause of death and one of the leading causes of long-term
disability all over the world. hsCRP levels evaluated shortly after a stroke have been
demonstrated in studies to predict complementary elements of outcome. There's a
chance that high hsCRP levels are linked to the severity of cerebral tissue damage. We
wanted to see how high hsCRP levels were in people who had a cerebrovascular
accident. The goal was to see if there was a link between the level of hsCRP and the
severity of the stroke and the outcome.
Material and Methods: Patients hospitalised to a tertiary care hospital's (Narayana
Medical College Nellore) medical ward and medical ICU were studied. It was a crosssectional
investigation. The study involved a total of 100 patients who had a stroke and
met the study's inclusion and exclusion criteria. hsCRP levels were tested in all patients
within 48 hours of admission. Data was entered into a Microsoft Excel database
prospectively.
Results: The average age of the patients in the study was 59.12 years. Eighty-eight
percent of the patients were between the ages of 40 and 80. Also, values were found to
be higher in haemorrhagic stroke (value) than ischemic stroke (value), with a significant
difference. In both types of stroke, there was a significant association between hsCRP
levels and GCS, with lower GCS scores linked with greater hsCRP levels.
Conclusion: We concluded that hsCRP levels are elevated in both ischemic and
hemorrhagic strokes, implying an inflammatory response in acute stroke. Increased
hsCRP levels were linked to the degree of the neurological impairment and a worse
prognosis.

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.According to WHO, Natural menopause is defined as the permanent cessation of menstruation resulting from the cessation of ovarian follicular activity.
Objectives:
To observe epidemiological profile of post-menopausal women in urban and rural area.
To describe symptomatology of post-menopausal women.
Material &Methods:
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:
Majority of the study population of menopausal women in rural area experienced vasomotor symptoms (65.3%), psychosocial symptoms (82%), physical symptoms (93.3%) and sexual symptoms (27.3%) compared to the menopausal women in urban area, who experienced vasomotor symptoms (52%), psychosocial symptoms (36%), physical symptoms (53.3%) and sexual symptoms (6%). Significant statistical difference was observed between the residing area with the vasomotor symptoms (p=0.01), psychosocial symptoms (p<0.001), physical symptoms (p<0.001) and sexual symptoms (p<0.001).
Conclusion:
Majority of the menopausal women experienced mild degree of vasomotor, psychosocial, physical, and sexual symptoms. Vasomotor symptoms were commonly observed in the initial duration after attaining menopause whereas psychosocial, physical, and sexual symptoms were common in the later stages of menopause.

Background: Inspite of its importance there are not many studies on maternal morbidity and mortality with perinatal outcome in patients undergoing elective or emergency caesarean section, Most of the literatures available are either maternal morbidity or perinatal outcome and of other states. The present study was undertaken to know the effect of caesarean section on maternal and perinatal outcome. Caesarean section is the surgical intervention in case of serious delivery complications. This surgical procedure has been saving lives for a long period of time. The concern for the caesarean rates is due to its rapid increase over the period. Methods: This is prospective study was carried out on 300 patients undergoing caesarean section, both elective and emergency and their newborns in the Department of Obstetrics and Gynaecology in Darbhanga medical college and Hospital, Darbhanga. The procedure of the study was explained and required consent for the study was taken. Examination of the patient was done and all relevant data was obtained. Details of indications for caesarean section, nature of operation,
Conclusion: Caesarean section rate can be reduced by combined efforts at all levels and by encouraging hospital vaginal deliveries of all the primigravida, grand-multiparous pregnant women and those who had previous caesarean section, provided adequate fetal monitoring and operative facilities are available.

Background: Meconium stained amniotic fluid has been considered a sign of fetal distress and associated with poor fetal outcome but others considered meconium passage by fetus is physiological phenomena and produce environmental hazards to fetus before birth. Such magnitude of different opinion was the object behind taking up of this study and aim was to find out incidence of meconium aspiration syndrome and effect of meconium in terms of morbidity and mortality.
Methods: Two hundred babies born with meconium stained amniotic fluid considering the inclusion and exclusion criteria, in the Department of Paediatrics, Mahavir Vatsalya Aspatal Patna Paediatrics. Study duration of two years. Fetal monitoring, mode of delivery, Apgar score, birth weight, resuscitation of baby are noted.
Conclusion: Immediate airway management, need for suction and intubation should be guided by state of newborn rather than presence of meconium. Timely diagnosis and management of meconium stained amniotic fluid may improve fetal outcome.

Background: Chronic Kidney Disease (CKD) is a progressive loss of kidney function and is a worldwide public health problem both for the number of patients and for the cost of treatment. Trace elements such as copper (Cu) is altered in CKD. We assessed 100 subjects of both sex with different age groups, among them 50 are normal healthy controls (group 1) and 50 are CKD patients (group 2) from dialysis ward (medicine) S.R.G. Hospital, Jhalawar Medical College, Jhalawar (Raj.) Serum copper was estimated using Flame Atomic Absorption Spectrophotometer (AAS).
Results: Serum copper level was significantly low in CKD patients, mean ± SD (1.2041 ±0.46360) (p<0.05) when compared with the healthy control group (1.3823 ± 0.25259) (p<0.05). Gender had no significant effect on serum copper level, in males, (1.1992± 0.41431) and females (1.2146± 0.56946) (p>0.05).
Conclusion: This study shows that in CKD patients, trace elements derangement is important in the primary diagnosis of trace element dysfunction and medical management of CKD.

Background: Acute onset seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes and its outcome from developing countries. Seizure is a commonly encountered problem in pediatric practice. Convulsive disorder constitutes a heterogeneous group with a varied etiology. Arriving at the cause of seizure is important as it plays a vital role in managing the child. Chances of recurrence to be analyzed, after the first episode of seizure for management. The aim was to study the etiology and the causes of recurrence after a first episode seizure.
Methods: A prospective observational study was done on 142 children for a period of six months admitted in tertiary care center. Proper history, complete neurological and other systemic examinations was done. Blood investigations and imaging with EEG was done when indicated. All children were classified according to International League against epilepsy and followed up for recurrence rate and history leading to recurrence. Co- relation between recurrence and risk factors was analyzed.
Results: Electroencephalogram tracing was abnormal in 65 out of 107 children. 20 out of 65 had recurrence while only 2 among 42 normal EEG had recurrence. This was statistically significant (P value 0.001). Children with remote symptomatic etiology constitutes the majority in those with abnormal EEG tracings. In children with remote symptomatic etiology, only one child had normal EEG. Remote symptomatic had higher number of abnormal EEG when compared to others and was found to have more recurrence.
Conclusions: Children with EEG abnormalities after the first episode of afebrile seizure have more chance of recurrence. Children with seizure secondary to remote symptomatic etiology had more recurrences.

Introduction: Anemia is a common finding in patients with heart failure (HF). The cause for anemia is multifactorial, with iron deficiency being the most common cause. Anemia with HF is an established predictor of morbidity and mortality. Iron deficiency in systolic HF, even without anemia, has been associated with increased mortality, increased hospitalizations, and decreased functional capacity and quality of life measures.
Methods: The current study was done  at the sri jayadeva institute of cardiovascular sciences hospital, Kalaburagi, Karnataka  over a period of 2 years from march 2016-2018. We evaluated ID in heart failure patients. ID was defined as absolute (ferritin < 100 μg/L) or functional (transferrin Saturation index < 20% and ferritin between 100 and 299 μg/L). We evaluated if ID was a predictor of death or hospitalization due to heart failure or any cause using univariate and multivariate cox regression analysis.
Results: There were 67.5% (27/40) patients who had ID with a mean serum ferritin level of 76.4 μg/L. Of the 27 iron deficient patients, 22 (55%) had an absolute ID, and 5 had a functional ID. Eight out of 27 of the iron deficient patients were anemic (20% of the total cohort, 30% of the iron deficient patients). Anemia was seen in 6 other patients, which was possibly anemia of chronic disease. There was a trend for more advanced New York Heart Association (NYHA) class (NYHA III and NYHA IV) patients with ID (37.4% vs. 30.77%, P = 0.697).
Conclusion: Anaemia is a very common comorbid condition in patients of HF. The pathophysiology is diverse and includes nutritional deficiencies, loss of blood through GI tract, decreased iron absorption, and decreased release of stored iron. It is an independent predictor of reduced exercise capacity, quality of life, and recurrent hospitalizations.

Background: The key to early diagnosis is the detection of disorders in labour progression specifically by following the evolution of characteristic patterns of cervical dilatation and fetal descent using the partogram. Although labour is a natural physiological process characterized by progressive increase in the frequency, intensity and duration of uterine contractions, resulting in effacement and dilation of the cervix with descent of the fetus through the birth canal.
Methods: This is Prospective study of Carried out total 400 patients conducted in the Department of Obstetrics and Gynaecology.  Darbhanga  medical  college and Hospital Laheriasarai,  Darbhanga.  All the patients were primigravidae with term gestation, cephalic presentation without any complications who presented with both spontaneous and induced labour. WHO partogram was used for all patients.
Conclusion: Use of partogram is a simple, safe, inexpensive and highly effective means of monitoring progress of labour. Hence it identifies the abnormality early and deliver them safely in time by active management of labour.

Background: The modern era has witnessed a vast change in the field of medicine. With the advances in science and technology and better access to a variety of services, The purpose of this study was to investigate the effect of laparoscopic surgeries on liver function in humans and the possible mechanisms behind such effect.
Methods: The department of General Surgery at DMCH, Laheriasarai, Darbhanga. Blood samples were collected from 60 patients undergoing various types of   laparoscopic procedures preoperatively once and post operatively on day 1 and day 7. They were tested for liver function by comparing the level of serum bilirubin, serum alanine amino transferase (ALT), serum aspartate aminotransferase (AST) and serum alkaline phosphatase. The time of CO insufflation was also measured.
Conclusion: Transient elevation of hepatic enzymes occurs after laparoscopic surgery. CO pneumoperitoneum.is the major causative factor.

Background: Liver is one of the important target organ for insulin and its counter regulatory hormones, such as glucagon. Chronic liver disease (CLD) is often associated with glucose intolerance and diabetes. Glucose intolerance and frank diabetes are seen in a lot number of patients with chronic liver disease. The number of CLD patients continues to increase in INDIA because of alcohol (ethanol) consumption and epidemics of obesity and non-alcoholic fatty liver diseases (NAFLD).
Methods: This is a observational, study (descriptive study) of 60 patients admitted in the wards of, Department of General Medicine, Jawaharlal Nehru Medical College and Hospital, Bhagalpur. Study  period of June  2020 to  Sep 2021 who matched the inclusion criteria. Data was collected after obtaining informed/written consent from patient. Detailed  history, clinical examination, general physical and systemic examination and relevant laboratory investigations were done.
Conclusion: The occurrence of glucose metabolism disorder in chronic liver disease was high. OGTT helped in unmasking diabetes in many patients. The number of impaired glucose tolerance and diabetics were more in Child Pugh B and C compared to Child Pugh A.

Background: Better understanding of the clinical characteristics of Hemolytic Disease of the Newborn due to ABO incompatibility helps to optimise care. ABO incompatibility is complex because anti-A and anti-B antibodies are composed mainly of Immunoglobulin M.
Material and methods: This is  cross sectional study conducted in the neonatal unit of narayan medical college and Hospital Jamuhar Sasaram Rohtas. A total of 50 neonates with blood group A or B born to mothers with blood group O; with jaundice and or anemia were enrolled during the Study period of two years, The various maternal and neonatal parameters and their association with development of jaundice and or anemia was studied. Conclusion: Early identification of high risk neonates with ABO Incompatibility, diagnosis and early intervention can reduce morbidity and mortality.

Background: Present clinical study was conducted to study the effects of intravenous Magnesiun Sulphate on spinal anesthesia with Bupivacaine and Buprenorphine,
Methods:  After thorough pre anaesthetic evaluation , Pre operative vitals para meters in the form of baseline pulse, blood pressure pulse were recorded. A good venous access was taken. Patient connected to ecg, pulse oximetry, non invasive blood pressure monitoring. Patients randomly allocated into two groups: Group M-50 received 50mg/kg intravenous MgSO₄ in 500ml Ringer lactate over 20 mins. Group C-50 received intravenous 500ml Ringer lactate over 20 mins. Both the groups received intrathecal 15mg of Inj.Bupivacaine (0.5%) and 30 mcg of Inj. Buprenorphine.
Conclusion: We conclude that IV bolus dose of magnesium sulfate of 50mg⋅kg−1 in 500mL of Ringer Lactate solution dose not prolongs the duration of anaesthesia and analgesia when given in combination with intrathecal bupivacaine5% and Buprenorphine 30mcg. but it reduces the analgesic consumption and incidence of nausea and vomiting associated with intrathecal Buprenorphine.

Background: The multimodal analgesic drugs act at all four levels of pain pathway, as it having  synergistic effects, it is effective in preventing and treating acute pain.
Methods: This is  prospective, double blind, randomized clinical trial involving 42 patients belonging to the American Society of Anaesthesiologists Class I and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Group A (study group) received injection diclofenac sodium, paracetamol, clonidine, and skin infiltration with bupivacaine adrenaline and Group B (control group) received paracetamol and skin infiltration with saline adrenaline. Pre-emptive analgesia was practiced in both the groups. BIS guided induction was done with incremental doses of Inj propofol. Two 2 ml blood samples were drawn; one just before tracheal tube placement and another one 3.
Conclusion: Pre-emptive MMA when judiciously administered targeting all the four elements of the pain pathway reduce consumption of anaesthetic drugs and provided optimal surgical conditions by ensuring intense analgesia with minimal adverse effects.0 min following skin incision for random serum cortisol and random blood sugar.

Background: Hysterosalpingography is a gold standard and cost effective method of assessing the integrity of the female genital tract. Two important indications for obtaining HSG are evaluation of tubal patency and congenital uterine anomalies. Hysterosalpingography is a safe relatively inexpensive, simple and rapid diagnostic test, when performed properly provides valuable information about the uterine cavity and tubal architecture.
Methodology: This study was conducted in the Department of Obstetrics and Gynaecology, at Darbhanga medical college and Hospital Laheriasarai, Darbhanga. Study duration period of two years. A total of 60 women infertile women, anxious to conceive, coming for infertility work-up in hospitals underwent Hysterosalphingpography.
Conclusion: Hysterosalpingography is highly sensitive and specific in diagnostic work-up of patients with infertility. It is also cost-effective and can be used as a sole radiologic evaluation tool for female infertility or complimentary with other radiological and non-radiological investigations such as pelvic sonography, laparoscopy, magnetic resonance imaging. 

Introduction and objective: All types of cleft-associated anomalies do not occur with equal frequency. It has not been well-known if specific types of anomalies are commonly related with clefts, or which organ is most commonly affected. Cleft lip and palate (CL and P) could be associated with many other structural abnormalities of the adjacent vital structures of the face.
Methods: Three hundred seventy consecutive syndromic and non-syndromic children with CL and P patients in Department of otolaryngorhinology ,Banas Medical college and research institute ,Banas Kantha, District and adjoining area of Gujrat and Rajasthan India, from Dec 2018- Dec 2020 were studied. Data were analysed using Statistical Package for Social Sciences (SPSS) version 16.
Results: A total of 370 cleft lip and palate patients were managed. More than fifty-five percent were male and 44.3% were female. 9.7% patients had ocular anomalies. Out of 36 CL and P patients, 41.7% patients had bilateral cleft lip and palate, 22.2% patients had unilateral cleft lip and palate.
Conclusion: The present  study of Cleft lip and palate are the most common facial deformity and clefting may involve lip only, lip and palate and palate only

Introduction: Thyroid lesions are of great importance because most are amenable to Medical or Surgical management. The Medical diagnosis of Thyroid lesions is crucial as Malignancy necessitates Surgery while follow-up is important just in case of Benign lesions. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was introduced in 2007 to standardize terminology utilized in reporting thyroid cytology.
Material and Methods: A retrospective observational study of already diagnosed cases of Thyroid in FNAC was performed in the Department of Pathology at Late BRKM Medical College, Bastar over a three years period from January 2017 to December 2019. The FNAC smears were reclassified according to the 6 diagnostic categories of TBSRTC.We could pursue follow up Histology for 160 cases. The diagnosis offered in FNAC was compared with that observed on Histopathological examination.
Results: On cytology out of 386 cases, 21(5.44%) categorized as Non-Diagnostic/ Unsatisfactory Samples, 338 (87.56%) cases as Benign Follicular Nodule, And 10 (2.59%) as Atypia of Undetermined Significance/Atypical Follicular Lesion of Undetermined Significance (AUS/AFLUS), 3 (0.78%) as Follicular Neoplasm/Suspected Follicular Neoplasm (FN/SFN), 4 (1.04%) as Suspicious For Malignancy, and 10 Cases (2.59%) as Malignant. Histopathological follow-up of 160 cases. The malignancy rate for the Non-Diagnostic category was 0%, Benign category was 1.44%, AUS/FLUS category was 33.33%, FN/SFN category was 50%. Suspicious for Malignancy category was 66.66%, malignant category was 100%.
Conclusion: The Bethesda system is the most suitable reporting system for cytopathology of Thyroid lesions. It minimizes the surgical procedure for benign lesions.

Background: The aim of the study is to compare the treatment outcomes of surgical repair in
inguinal hernia with classic versus preperitoneal methods on reduction of postoperative
complications.
Methods: The present study included 100 patients out of which 60 were males and 40 were
females. Both the techniques were explained to the patients.
Results: The rate of recurrence was 4 in the classic group and 3 in the preperitoneal group.
The frequency of postoperative pain was 12 in the classic group and 7 in the preperitoneal
group. This difference was significant according to Chi-Squared test
Conclusion: It can be concluded that the preperitoneal method is a more suitable method for
inguinal herniorrhaphy than the classic one because of fewer complications, according to the
findings of this study.

Aim: To measure the tibial and femoral footprint of ACL in Indian patients (with and
without ACL injury) using MRI of normal patients, during (ACLR) and during TKR.
Materials and Methods: The present prospective study was conducted at PD HINDUJA
hospital and medical research center, Mumbai from March 2015 to November 2015
among 100 patients of Indian origin undergoing arthroscopy, TKR and MRI in our
hospital. We have taken three separate patients group undergoing different procedure
related to knee i.e. Group 1 (Arthroscopic ACL reconstruction), Group 2 (Total knee
replacement) and Group 3 (Diagnostic MRI). As MRI are done in extension of knee,
femoral footprint was in vertically oval plane, so calculating length of maximum
Supero-inferior measurement on MRI sequence of femoral footprint was giving us
length of femoral footprint. All above-mentioned readings were added in tabular form
in excel sheet master chart and was statistically analyzed using SPSS software version
24.

Purpose: This study investigated correlations between findings on panoramic
radiographs and cone-beam computed tomography (CBCT) to assess the relationship
between the maxillary sinus floor and the roots of maxillary posterior teeth. In addition,
radiographic signs indicating actual root protrusion into the maxillary sinus were
evaluated on panoramic radiographs.
Methods:A total of 250 maxillary posterior teethwho underwent panoramic
radiography and CBCT were enrolled. The relationship between the posterior teeth and
the maxillary sinus and panoramic radiography signs associated with protrusion of root
apices into the sinus were evaluated.
Results: There were differences between the imaging modalities about the positioning of
the root apices regarding the sinus (p<0.05). Only the projecting of the root apices and
the interruption of the sinus floor on panoramic radiography were predictors for the
root protrusion (p<0.05).
Conclusions:Knowledge of anatomical relationship between the maxillary posterior
teeth and maxillary sinus guides not only in proper preoperative treatment planning
but also avoids the possible complications encounter while performing the minor oral
surgical procedures involving maxillary posterior teeth, which are close to the maxillary
sinus.

Background: Phase-contrast MRI (PCMRI) with cardiac synchronism is a dynamic technique used to visualize cerebrospinal fluid (CSF) movement. The present study was conducted to assess Cerebrospinal Fluid Hydrodynamics Using Magnetic Resonance Imaging in Postcraniospinal Surgery Patients.
Materials and Methods: The present case-control study comprising 30 patients and 30 controls, conducted over a period of 2 years in a tertiary-care hospital in India. Healthy subjects formed the control group. Conventional magnetic resonance imaging of the brain was performed before PCMRI. Assessment of clinical signs and symptoms was done pre and postoperatively. Statistical Analysis of data was done in terms of mean (±standard deviation), frequencies (number of cases), and percentages. The p-value of < 0.05 was considered significant. All the analysis was performed on SPSS 16.0 version (Chicago, Inc., United States).
Results: The present case-control study comprising 30 patients and 30 controls. Postoperative imaging follow-up was done in 30 patients after an interval of 1 month. Postoperatively, a majority (17) of the patients showed improvement in clinical symptoms. 7 patients showed no change, while six patients showed deterioration. Phase-Contrast Magnetic Resonance Imaging Quantitative parameters measured at cerebral aqueduct, foramen magnum, C2–3, and D12–L1 vertebral levels, in controls, showed no significant difference in peak CSF velocities. In group I and group II mean change CSF velocity was noted in improved patients was more than the other patients.
Conclusion: The present study concluded that PCMRI can effectively evaluate changes in CSF flow noninvasively both pre- and postoperatively.

Introduction: The identification of sex from skeletal remains of great medico-legal and
anthropological importance. Hip bone in this feature plays a very important role, especially
its large sciatic notch that can be detected early in embryonic development.
Materials and method: It's a cross-sectional investigation.
Results: In our study mean value of width was found as 4.49+0.44 in male while in female it
was 4.84+ 0.48. Mean depth of the sciatic notch was found as 2.78+0.38 in male and 2.96+
0.39 in female.
Conclusion: The sciatic notch was found deeper in males compared to females. Higher
reference value compared to female.

Background: This study was intended to assess the effectiveness of percutaneous needle
aspiration (PNA) and pigtail catheter drainage (PCD) in the treatment of liver abscess.
Methodology: A prospective randomized comparative study conducted at the Department of
Surgery. The inclusion criteria are patients with liver abscess who were older than 16 years
with a cavity size of more than 5 cm or more than 60mL in volume. The study was conducted
after getting the approval from the institutional ethical committee and 510 patients with liver
abscess were included for the study. The patients with the signs & symptoms of liver abscess
were admitted and detailed history and physical examinations were carried out. Certain
laboratory investigations include – complete blood counts, renal function test, liver function
test, prothrombin time, viral markers, blood culture and amoebic serology were taken. All the
patients were randomly assigned into two groups using computerised randomisation method.
Results: The PCD group had statistically significant rate of duration of antibiotics need, days
for clinical improvement and time for 50% reduction in abscess cavity and treatment success
rate with comparable long-term outcomes.
Conclusion: PCD is more efficient than PNA and can be used primarily in the treatment of
both amoebic and pyogenic liver abscesses along with systemic antibiotics. PNA can be
considered as an effective alternative when PCD cannot be performed due to unavoidable
situations.

Background: Myelopathy can refer to any form of spinal cord pathology whereas myelitis
refers to an inflammatory or infectious process. The present study was conducted to assess
etiological Spectrum Of myelopathy in a tertiary care institute of Eastern India in Dept. of
Neurology.
Material and methods: The present study was conducted to assess etiological Spectrum of
myelopathy in a tertiary care institute of Eastern India in Dept. of Neurology. The number of
patients included in the study was 50 patientsof non-traumatic compressive myelopathy.
Patients were clinically evaluated and relevant routine biochemical analysis and appropriate
neuroimaging studies were carried out in all.
Results: In the present study 50 patients of non-traumatic myelopathy were included.
Various etiologies of compression myelopathy in 50 patients were Tuberculosis Potts with
paravertebral abscess in 34% patients, cervical spondylosis in 24% patients, Benign neoplasm
in 12% followed by CV anomalies in 6% patients.
Conclusion: The present study concluded that Tuberculosis Potts with paravertebral abscess
was the most common etiology of non-traumatic compressive myelopathy.

Background: Hysteroscopy is a direct and definitive method of assessing intrauterine
pathology. The present study was conducted to evaluate Pre-ART hysteroscopic findings and
clinical outcomes post ICSI in infertile women who underwent controlled ovarian stimulation
for IVF cycles.
Material and methods: It was a prospective observational study conducted among 80
women posted for pre-ART hysteroscopy in Nowrosjee Wadia Maternity Hospital. Detailed
history followed by general and gynaecological examination of the patient was done. ICSI
procedure was then performed and the fertilization check was done.

Background and objectives: Subclinical hypothyroidism is an asymptomatic condition
with normal thyroxin and raised thyroid stimulating hormone (TSH) level. It affects 3-
15% of adult population. Large scale population based studies on the prevalence of
subclinical hypothyroidism in India are scarce. So this study was done to estimate the
prevalence of subclinical hypothyroidism in patients attending OPD in ANMMCH,
GAYA and find out the relationship of TSH level with age, sex, family history, body
mass index, and other co-morbid conditions.
Subjects and methods: An observational study was carried out on adult persons visiting
OPD at ANMMCH GAYA. TSH, T3, and T4 levels were measured. Data about
demography and other parameters and co-morbid conditions were collected during
routine visits. Analysis was carried out on all variables in the study, and relationships
were explored. Serum TSH above 5 μIU/ml(with normal T3 and T4) was considered as a
case of subclinical hypothyroidism
Results: A total of 1457 participants (1042 females and 415 males) in the study gave
consent for study and blood samples. subclinical hypothyroidism was seen in 113
(10.84%) females and 27 (6.5% males). No significant relationship were noted in TSH
levels with dyslipidemia and increasing blood pressure. 5 cases of overt hypothyroidism
(all females) was found in our study sample. There was a trend of raised TSH among
perimenopausal women in our study. No patient presented with thyroid enlargement.
Conclusion: Subclinical hypothyroidism has a prevalence of 9.6% of adults visiting
OPD. TSH levels tends to be higher in the perimenopausal women, which warrants
particular attention to the females aged 40 years and above.

Background: The purpose of the present study is to evaluate the accuracy of TNAB for the
diagnosis of benign and malignant lung lesions.
Methods: The present study included 50 patients from June 2020 to June 2021. Our
retrograde study on CT- guided or ultrasound guided lung biopsy on tertiary care center of
Bihar Indira Gandhi Institute of Medical Science.
Results: Out of malignant lesions, most were adenocarcinoma 71.87% followed by
squamous cell carcinoma 15.63%, poorly differentiated carcinoma 9.38% and non-hodgkins
lymphoma 3.12%. In the benign lesions, most of the cases were non-specific inflammatory
lesion 44.45% followed by granulomatous lesion 27.78%, A-V malformation 11.12%,
neurofibroma 5.55%, spindle cell lesion 5.55% and necrosis 5.55%.
Conclusion: The ability to diagnose only malignant lesions by TNAB would markedly limit
the efficacy of that technique, since surgery would be performed on most malignant lesions
diagnosed by TNAB as well as on the lesions not diagnosed by TNAB.

Background: Preeclampsia is considered a systemic syndrome of pregnancy and may show hepatic and renal involvement. Serum electrolytes play important role in development of hypertention.
Objective: To study serum electrolytes and biochemical parameters under liver function tests and renal function tests of pre-eclampsia patients in comparison to normal pregnant women.
Method: A case control study was conducted during one year, on 50 cases of pre-eclampsia and 50 controls who were normotensive pregnant females. Their demographic and clinical details were obtained and laboratory analysis of serum electrolytes, liver function tests and renal function tests was done.
Observations: Serum sodium, potassium, calcium, chloride, bicarbonate, Albumin, total protein levels and Aspartate aminotransferase levels were significantly lower in pre-eclampsia cases than in normotensive controls. Alanine Transaminase, Alkaline phosphatase and Uric acid levels were significantly higher in cases of pre-eclampsia as compared to controls.
Conclusion: Close monitoring of pre- eclampsia patients is must as it has deleterious effect on liver and kidney along with electrolytes which may increase maternal and fetal morbidity and mortality.

Chronic Suppurative Otitis Media (CSOM) is one of the common hearing problems which can cause many complications if not treated properly. Hence, the aim of the study is to identify the bacterial isolates causing CSOM and to study their antimicrobial susceptibility pattern. The study was carried out in a Dept of E.N.T & Dept of Paediatric J.L.N.M.C hospital in Bhagalput from August 2018 to july 2019 for a period of 12 months. 100 patients of CSOM with unilateral or bilateral discharge attending the ENT Out Patient Department were included in the study. Swabs were taken and sent immediately to the microbiology laboratory and processed. Bacterial isolates were identified using standard methods and antibiotic susceptibility testing was done. Staphylococcus aureus was the most predominant organism isolated followed by Pseudomonas sp., Escherichia coli, Klebsiella sp.. The present study helped in knowing the bacteriological profile of the cases of CSOM. Empirical treatment may not be successful in all cases because of emergence of resistant organisms. Hence it is advisable to do antibiogram before starting the treatment.

This research project is conducted between March2019 To August 2021 in the
Department of Microbiology. A total of 1000 various clinical samplesreceived in the
microbiology laboratory from the OPD & IPD Patients. Out of 1000 various clinical
samplesculture, were found total 500(50%)gram negative bacilli (Escherichia coli). But, were
found total 45 (09%) E.coli from pus swab culture

Introduction: A high blood pressure that doesn't have a known secondary cause is called as essential hypertension, is a leading cause of death worldwide. Calcium supplementation known to reduce the blood pressure in normal healthy individuals.
Objective: The present study aims towards analysing the correlation between serum calcium level with the blood pressure among patients with essential hypertension.
Methods: 30 cases of essential hypertension patients as cases and 30 suitable healthy age sex matched individuals with normal blood pressure as controls, as per JNC-8 guidelines were recruited in study. Serum calcium level and blood pressure was analysed in all patients.
Results: Systolic Blood Pressure in control group was 111.1 ± 7.570 and in cases was 158.1 ± 9.066. Diastolic Blood Pressure in control group was 72.80±6.183 and in cases was 92.33±6.456. Serum calcium in control group was 9.207 ± 0.7249 and in cases was 8.130 ± 0.4843.
Conclusion: Patients with lower calcium level tends to have raised blood pressure and vice versa. Thus, routine dietary restriction salt in hypertensive individuals can help in better management of hypertension.

Background and purpose: Stroke is one of the leading causes of death and disability
worldwide. It imposes a major physical mental and financial burden over the patient,
family and the country. Despite increasing burden of stroke in developing countries,
population-based data are scarce. An event of stroke can be caused by a number of risk
factors, some of which are nonmodifiable and some are modifiable. Hypertension,
diabetes mellitus, heart diseases, hyperlipidemia and smoking belong to the modifiable
group and their prevalence shows diversity worldwide The aim of the study was to find
out the prevalence of different risk factors of strokes.
Methods: This observational study was carried out on 215 patients of stroke admitted
in different medicine units of ANMMCH GAYA. Only patients having diagnosis of
stroke, confirmed by CT scan or MRI, were recruited. Patients were grouped into
ischemic or hemorrhagic stroke. Patients with subarachnoid hemorrhage, bleeding into
an intracerebral space occupying lesion or intracerebral hematoma due to head injury
were excluded from the study. Proper history was taken regarding presence of various
risk factors and measures taken to control or prevent them. Enquiry about proper drug
compliance was also done.
Results: A total of 215 patients were included in the study. 143 were males and 72 were
females. Mean age was 62.7 years. 135 patients were of ischemic stroke (87 males and 48
females) and 80 patients were of hemorrhagic stroke (56 males and 24 females). 70.7%
patients were hypertensives and 48.8% were diabetics. 36.7% had CAD and 36.2% was
current or ex smokers. 56.7% patients were either overweight or obese. 102 patients
had 2 risk factors, 33 had 3 and 10 patients had 4 risk factors. 13 patients had no
identifiable risk factors.

Vitamin D deficiency is now recognized as a worldwide health disease . The major cause of vitamin D deficiency is the lack of appreciation that sun exposure in moderation is the major source of vitamin D for most humans. Very few foods naturally contain vitamin D, and foods that are fortified with vitamin D are often inadequate to satisfy either a child’s or an adult’s vitamin D requirement. Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, osteoporosis, and fractures in adults. Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases. Vitamin D can be easily assessed in patients by measuring serum 25-hydroxyvitamin D. The aim of this study was to estimate vitamin D3 levels in patients coming to medicine and orthopaedic OPD with various symptoms related to vit D deficiency such as tiredness and fatigue, muscle pain, bone and joint pain, mood changes, low immunity (recurrent respiratory infections), hypertension . Both male and females 70 adult subjects were included in this study. Serum Vitamin D3 levels were estimated in all subjects. 35.71% subjects  had severely deficient vit D3 levels. 42.85% were deficient. 14.28% had inadequate vitamin D3 levels. 4.28% had adequate levels of Vitamin D3 . Vitamin D deficiency can be managed with pharmacological or non-pharmacological approaches depending on the severity. The goal of the treatment is to raise serum vitamin D to normal levels to relieve the symptoms and reduce the adverse health outcomes such as rickettsia among infants, osteomalacia among adults, and osteoporosis among the elderly.

Background: Allergic conjunctivitis is a common allergic ocular disorder that leads to itching and discomfort. The current study is aimed to compare the clinical efficacy and therapeutic effects of 0.1% olopatadine hydrochloride to that of 0.5% ketorolac tromethamine ophthalmic solution with different pharmacological mechanisms in the management of seasonal allergic conjunctivitis.
Methods: Based on the inclusion and exclusion criteria a total of n=100 cases were selected by convenient sampling; they were randomly and equally allotted into two groups. Group I (received 0.1% Olopatadine hydrochloride) and group II (received 0.5% Ketorolac tromethamine). All the patients underwent thorough ocular examination that included visual acuity, slit-lamp Bio-microscopy to evaluate conjunctival and corneal involvement. IOP was measured with a non-contact tonometer. Fundus examination was done using indirect ophthalmoscopy.
Results:  The comparison of improvement of itching scores at different intervals was done and the p-values were found to be significant at the interval of 30 minutes and 2 days. This shows that rapid improvement of symptoms was found in group I (Olopatadine) as compared to group II (Ketorolac). For improvement of hyperemia scores at different follow-up visits was done and the p-values were found to be significant at the interval of 30 minutes only and the values were not found to be significant at the 2^nd day and at the 7^th day. Both drugs are equally effective for hyperemia management at follow-up intervals.
Conclusion: The present study found 0.1% Olopatadine eyedrops were more effective and elicited quicker response as compared to 0.1% Ketorolac eye drops. The efficacy of both was similar at the end of 14 days of treatment. Minor side effects were observed in two patients of the Ketorolac group and no side effects were observed in the olopatadine group. Therefore, while choosing treatment for seasonal allergic conjunctivitis due consideration must be given to costs, side effects, and patient compliance.

Background: This discussion on technology as a possible solution to difficulties such as a lack of competent personnel and an increasing demand for long-term care necessitates an examination of digital technology in nursing care. We opted to conduct this research since there aren't many good empirical overviews of current technology in the literature. With this project, researchers wanted to map the field of digital technologies used in informal and formal healthcare settings that had already been studied for acceptability, effectiveness, and efficiency (AEE). They also wanted to show how widely these techniques have been applied and which populations and settings they have been used on. Methods: A complete literature search was conducted using Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit, and CareLit. In addition, relevant articles on project websites were personally examined

Background: Vocal cord paralysis (VCP), defined as the loss of normal adduction/abduction
caused by a lesion distant from the cords, result from neural injury to the recurrent laryngeal
nerve. Present study was aimed to study various etiologies of vocal cord paralysis at a tertiary
hospital.
Material and Methods: Present study was hospital based, retrospective observational study,
conducted patients with vocal cord palsy confirmed with endoscopy.
Results: In present study, 52 cases were of vocal cord paralysis were evaluated in detail.
Majority were from 41-60 years age group (53.85%) followed by 41-60 years age group
(28.85%).Male patients (57.69%) were more than female (42.31%). Common symptoms
noted in present study were dyspnoea (75%), hoarseness of voice (55.77%), dysphagia +
dyspnoea (30.77%) & dysphagia (25%). Majority of cases had unilateral vocal cord palsy
(92.31%) as compared to Bilateral (7.69%) vocal cord palsy. Among cases left (61.54%) side
involvement was common than right (30.77%). In present study, various neoplasms (thyroid,
bronchogenic, esophageal) & post surgical (thyroidectomy, esophagectomy) were most
common etiology in 26.92% patients each. Other etiologies were idiopathic causes (17.31%),
neck nodes/cervical metastases (11.54%), mediastinal masses/lymph nodes (5.77%), CNS
causes (5.77%), cardiovascular (3.85%) &blunt Trauma (1.92%).
Conclusion: Vocal cord paralysis was common in males, at 5th& 6th decade & it was
unilateral in majority of cases. Common causes of vocal cord paralysis are neoplasm, postsurgical
& idiopathic.