European Journal of Molecular & Clinical Medicine

Introduction: Neonatal hyperbilirubinemia is the most common clinical finding noted during
the first seven days following birth. Amongst all the modalities available for management of
neonatal hyperbilirubinemia, phototherapy is proven to be the safest. However, like any other
intervention, phototherapy too has some of its own side effects.
Aim & objectives: To estimate and compare alterations in serum electrolytes of healthy term
neonates before and after phototherapy.
Material & methods: A hospital based prospective observational comparative study was
conducted over a period of 18 months in the department of Pediatrics on 110 healthy term
neonates with unconjugated hyperbilirubinemia who were subjected to phototherapy as per
American Academy Pediatrics guidelines. Electrolytes including sodium, potassium, chloride
and calcium were analyzed from serum using standard laboratory techniques.
Results: The mean sodium, chloride, potassium and calcium levels before phototherapy was
141.3±2.69 meq/L, 102.2±2.98 meq/L, 4.43±0.52 meq/L, 9.14±0.46 mg/dl and after
phototherapy was 140.5±2.70 meq/L, 102.0±2.93 meq/L, 4.23±0.48 meq/L and 8.09±0.55
mg/dl respectively. All were found to be statistically significant (p-value <0.05); although none
were clinically significant and conveyed no symptom of dyselectrolytemia in this study.
Conclusion: This study shows that neonates exposed to phototherapy are at a risk of
developing electrolyte imbalances and consequently their complications. Hence, close
monitoring of such babies are needed to prevent imbalances and their untoward consequences.

Aim: To assess the outcome after internal fixation of floating knee.
Materials and Methods: Hospital based single center cross sectional descriptive type of
observational study among 80 patients in the department of Orthopedics in teaching hospitals
attached to S.M.S Medical College and hospital. After obtaining clearance and approval from
the institutional ethical committee and patients detailed history was obtained using the study
proforma with special attention to mechanism of injury. Examination of other associated
symptoms was based on history and clinical examination. Open reduction internal fixation of
floating knee under spinal anaesthesia under c-arm guidance. Routine antibiotics and
analgesic/anti-inflammatory drugs were administered. Post-operative evaluation was carried
out by clinical examination and X-ray. Functional assessment and final outcome were measured
according to the Karlstrom criteria.
Results: Male (85%) prominence was higher than females (15%). Mean age of male and female
was almost same. In the study, 17 (21.3%) patients did not have any associated injuries while
63 (78.1%) patients have any associated injuries among them, 52.5% patients have
Contralateral Limb Injury, 15% patients have head injury and 11.3% patients have pelvic
injury. In the study, 55% patients have grade I type, 20% patients have grade IIa type, 10%
patients have grade IIb type and 15% patients have grade IIc type. Right side (65%) most
common affected than left side (35%). RTA (80%) most common cause of trauma than FFH
(15%) and assault (5%). Close (60%) type of injury recorded higher than compound (40%).
Interlocking nail femur (70%) was most common treatment for fixation of femur fracture than
plating (20%) and external fixation (10%). Interlocking nail tibia (50%) was most common
treatment for fixation of tibia fracture than plating (30%) and external fixation (15%). Excellent
results was found in 40% patients, good results was found in 30% patients, fair results was
found in 20% patients and poor results was found in 10% patients.
Conclusion: The most important factors which determine the functional outcomes were the
type of fractures (open or closed), pattern of fracture, intraarticular involvement, and treatment
modality used. Fraser’s classification effectively classifies the injury and helps to determine
the eventual outcome of injury. Karlstrom criteria are an effective scoring system to grade the
functional outcome of floating knee injuries.

Background: The prevalence of renal dysfunction has been reported to vary from 14-50% in
patients with cirrhosis. The prevalence is estimated to be approximately 50% among patients
with cirrhosis and ascites and 20% of patients with advanced cirrhosis admitted to the hospital
3,4. The wide range in prevalence is likely due to different study populations and varying
definitions of renal dysfunction. Patients with HRS who fail to respond to medical therapy or
those with severe renal failure of other etiology may require renal replacement therapy.
Simultaneous liver kidney transplant (SLK) is needed in many of these patients to improve
their post-transplant outcomes. However, the criteria to select patients who would benefit from
SLK transplantation are based on consensus and lack strong evidence to support them. Heath
care system has evolved over the last decade and newer drugs are available for the management
of complication of cirrhosis. We attempt to study its impact on course and outcome of acute
kidney injury. Also few of the patients could possibly be on the antiviral drugs for hepatitis B
and hepatitis C. If these patients are admitted they will be included in study and we would study
the effect of the effect of this drug on acute kidney injury and vice versa. Hence, the present
study was conducted to study clinical profile of patients with acute kidney injury in liver
cirrhosis.

The purpose of this research is to develop training scenarios on environmental education using Science, Technology, Society, Environment (STSE) model integrated into scientific thematic lessons, particularly for prospective early childhood teachers. In addition, product efficiency on the positive attitudes of the trainers towards the environment was examined. The above-mentioned objectives are possibly achieved with the following activities: 1) initializing the Borg & Gall model (1999) and 2) assessing the resulting product value using t-test, termed pre-test and post-test. Therefore, the applied simulations were declared suitable for use after series of  developmental events.
The results involved three expert assessments in the field of early childhood, environmental education, and educational technology, although further analysis is required. Subsequent investigation conducted on the subject user group, indicating a positive value of 83.3%, in support of the product.
Therefore, the efficiency test results showed the training on environmental education using the STSE model and integrated with scientific thematic lessons, were known to enhance 32.44% of all aspects of the prospective teacher's positive attitudes on the environment.

Background: Rocuronium bromide, a mono quaternary amino steroid with a short onset and an intermediate duration of action, is currently one of the most commonly used neuromuscular blocking agent. In common with vecuronium, hepatic uptake & biliary excretion have been suggested to be the main mechanism of rocuronium metabolism with renal elimination accounting for 10-20% of its overall excretion. This study was conducted to investigate the neuromuscular effects of 0.6mg/kg rocuronium under general anaesthesia in patients with and without renal failure.
Methodology: This prospective observational study includes 110 patients (pts.) divided into two groups, Group ‘S’ (n=55) pts. with renal failure and Group ‘C’ (n=55) without renal failure. Neuromuscular transmission was monitored, parameters recorded were onset, time to maximal block, time to recovery of first twitch response to 25%, 50%, 75% and 90% of base line, time to recovery of train-of-four (TOF) ratio of 70% and recovery index 25% - 75%.
Results: In both the groups demographic data were similar. Both onset time and maximum block for rocuronium were comparable in group S and group C, found not significant. Time to recovery of first twitch response to 25%, 50%, 75% and 90% of baseline, time for recovery of TOF ratio to 70% and recovery index were significantly prolonged in group S compared to group C.
Conclusion: Rocuronium can be used with caution in patients with renal disease and monitoring of neuromuscular block in this group of patients is essential.

Introduction-uric acid production is a normal phenomenon in normotensive pregnancy, however in preeclampsia and eclampsia uric acid production exaggerated may result in greater potential for endothelial oxidative damage. It has been reported that higher UA is indicative in women with preeclampsia and eclampsia.
Material and method-Prospective study was done for duration of 16 months i.e. may 2019 to Sep.2020 in the department of Biochemistry of central research laboratory of Magadh Medical College, Gaya, India. A total no.100 women in which 50 cases (30 Preeclampsia & 20 Eclampsia) and 50 control (30 were normal pregnant & 20 normal non- pregnant women with reproductive age group)
Result-The mean serum UA , 24hours urinary protein  were higher in preeclampsia and eclampsia compared to control.
Conclusion-A significantly increased serum UA in preeclampsia and eclampsia than control group indicate the significant role in pathogenesis of PIH. Total serum Protein levels are reduced in preeclampsia and eclampsia compared to control.

Aims and objective: To compare efficacy of pain relief function of therapeutic transforaminal vs interlaminar epidural steroid injections and to assess improvement in functional outcome in lumbar disc disease patients after treatment.
Methodology: Patients with back pain documented with lumbar disc disease treated initially with rest, analgesics and physiotherapy for 6 weeks, will be analyzed clinically and radiologically. All the patients selected for the study be examined according to protocol, clinical and radiological investigations. Patients will be subjected into two groups by simple random sampling containing 30 members each. Group A will be given transforaminal epidural steroid injection and Group B will be given epidural steroid injection by Interlaminar route. Post epidural steroid injection  patients were followed up for 6months and post injection disability and pain was assessed using Roland morris low back pain disability questionnaire, visual numerical score, finger floor distance, patient satisfaction score.
Results: Pre procedure Roland Morris Disability mean score was compared with post epidural steroid injection. Reduction of 5 score or more after procedure considered significant. In a group receiving transforaminal epidural steroid, among 30 patients 24 patients had relief at end of 1month, 16 patients had relief at end of 6 months, and in other group receiving epidural steroid through interlaminar technique in that 12 patients had significant relief at 1 month, 8 patients had significant relief at the end of 6 months. On comparison of both the groups Roland morris disability mean score was statistically significance at 1month, 3 months and 6 months  in  TFESI group compared to ILESI group (p<0.05). On comparison of pre and post procedure Finger floor distance  of both the groups it was significant in TFESI group compared to ILESI group at 1 month and 3 months (p<0.05)  and was not significant at 6 months. Comparison by Patient satisfaction group was significant at 3 months in TFESI group compared to ILESI group (p<0.05)  and was not significant at 1month and 6 months. On comparison by Visual numerical score both the groups did not show any statistical significance.  Post procedure the complications, such as dural puncture, excessive bleeding or infection were not reported in both groups. But headache was reported in 2 patients in ILESI.
Conclusion: Patients with radicular pain from disc herniation or lumbar canal stenosis obtain significant relief from a TFESI. Transforaminal epidural steroid therapy has better outcome with respect to Roland Morris disability assessment, Visual Numeric Scale, Finger Floor Distance. Patient Satisfaction and Pain Relief - majority of the patients have a significant improvement which lasts for 6 months.

Introduction: Laparoscopic cholecystectomy may be performed using spinal anaesthesia instead of
general anaesthesia (LC). In-depth investigation on the feasibility of laparoscopic cholecystectomy
Spinal anaesthesia is administered. Aside from general anaesthesia, regional anaesthesia has been
documented as a solo approach for executing LC (spinal/epidural/combined spinal epidural).
Material and Methods: The American Society of Anaesthesiologists anesthesiologists provided SA to
12 patients who had elective laparoscopic cholecystectomy with physical status I or II. Throughout the
perioperative phase, only drugs for anxiety, pain reduction, nausea/vomiting alleviation, hypotension
therapy, and adverse event management were administered. The operating table tilt was kept to a
minimum and the CO2 pneumoperitoneum pressure was less than 10 mm Hg during the LC procedure.
Several studies were undertaken to examine postoperative complications as well as the duration of
hospitalisation and patient feedback.
Results: Everyone had a successful spinal anaesthetic procedure and the maximum degree of sensory
blocking was reached at T4. Only one patient had GA for surgery, and that patient was not able to have
surgery with SA. Four patients (33.33%) complained of right shoulder discomfort after surgery, and
Fentanyl was administered to two of them. There was no additional discomfort during or after the
procedure. Midazolam was prescribed to two individuals for anxiety. One patient needed ephedrine
because she was hypotensive, despite intraoperative crystalloid infusions of 1460 (SD 138) ml.
Conclusion: As a standard technique, a laparoscopic cholecystectomy may be performed under spinal
anaesthesia. This is both feasible and safe. In hospitals with limited resources, such as those in developing
countries, laparoscopic cholecystectomy may be done under spinal anaesthesia

Introduction: Despite careful antenatal surveillance involving scrupulous examination, an issue of
considerable disappointment is that a majority of low-birth-weight infants are not diagnosed until
delivery. Low birth weight infants are susceptible to hypoxia and fetal distress, long-term handicap, and
fetal death.
Objectives: The present study will be undertaken in our institution to study the correlation of placental
thickness, measured at the level of the umbilical cord insertion, with the ultrasonographic gestational age
in normal women and fetal weight and outcome.
Methods: Present study was a single centric, observational, cohort, follow up, hospital-based study in
which 100 pregnant women who will come for ultrasound in third trimester during the study period was
recruited in the study. The relationship between placental thickness with fetal parameters, birth weight
and fetal outcome at delivery was investigated in this study. Correlation between placental thickness with
the fetal parameters, average gestational age, gestation at delivery, neonatal birth weight & APGAR
score, and placental weight was investigated during this study.
Results: Significant positive correction of placenta thickness was found with the gestation age, estimated
and actual fetal birth weight, and placenta weight. APGAR score showed negative correlation with the
placenta thickness. Positive correlation of placenta thickness was also found with the Biparietal diameter
(BPD), Head Circumference (HC), abdominal circumference (AC) and Femur length (FL).
Conclusion: Ultrasonography serves a significant role in estimating foetal weight, which is a crucial
component of prenatal care. Because of its linear association, placental thickness evaluated at the level
of umbilical cord insertion can be utilised as a reliable sonographic indication in the evaluation of. As a
result, it can be utilised as a secondary sonographic method for determining foetal weight.

Introduction: Elevation of serum ferritin levels can result in major health issues. Increased oxidative
stress, inflammation, and endothelial damage are all linked to elevated serum ferritin levels, which in
turn raises the risk of hypertension.
Aim: Serum ferritin levels in patients with high blood pressure and a healthy control group were
measured and compared in this study.
Material and Methods: The present study was a hospital-based observational and analytical study. The
study was conducted over a period of 1 year on 60 patients. The study group comprised of 30 patients
(not diagnosed with hypertension or on any treatment) and the control group comprised of 30 (age and
gender matched) individuals. The levels of serum ferritin were analysed by the chemiluminescent
method.
Result: The results of the present study showed that, the mean value of serum ferritin was 313.17 ±
173.86 ng/ml in study group and 169.50 ± 105.66 ng/ml in control group. The mean SBP was 137.53 ±
14.32 mm/Hg in study group and 121.60 ± 8.09 mm/Hg in control group. The mean DBP was 87.73 ±
8.83 mm/Hg in study group and 71.03 ± 9.56 mm/Hg in control group. The results of the present study
indicate that the difference between the mean serum ferritin and mean SBP, mean DBP among the study
group and control group was found to be significant statistically (p=<0.005).
Conclusion: The current study found a positive association between the mean serum ferritin levels and
high blood pressure among the study participants

Introduction: Hyperbilirubinemia is the most common morbidity in normal term healthy
newborn. There is evidence that cord blood albumin (CBA) level can act as a potential marker
for the prediction of hyperbilirubinemia in neonates. The present study was therefore designed
to establish a correlation between the level of cord blood albumin (CBA) and total serum
bilirubin (TSB) so that albumin level could be standardized as a prediction marker for the
neonatal hyperbilirubinemia.
Methods: CBA and TSB levels were analysed in 500 normal term healthy newborns with birth
weight ≥2500 grams and APGAR score ≥ 7/10 at 1 min and 5 mins, after obtaining consent
from their parents. Albumin levels were analysed from the cord blood at the time of birth and
TSB levels were analysed from venous blood. Pearson’s correlation coefficient was used to
analyse the correlation between CBA and TSB levels.
Results: The mean CBA was 2.94 ± 0.34 g/dl and mean TSB was 11.17 ± 2.52 mg/dl. The
relationship between CBA and TSB values was statistically significant on further analysis of
CBA with the modality of treatment, the results were again statistically significant. The
correlation between CBA and TSB was also observed with negative correlation of r = - 0.43
with p value of <0.0001 which was highly significant.
Conclusion: Newborns with high CBA levels have low risk of developing neonatal
hyperbilirubinemia and can be discharged early from hospital. Whereas low CBA is an
indicator for developing neonatal hyperbilirubinemia in the first week of life.

Candida is ubiquitous in nature and is found on inanimate objects, in foods and on animals.
They are commensals of humans. Most Candida infections are endogenous in origin. They
inhabit the gastrointestinal tract including the mouth and oropharynx, the female genital tract,
and the skin. Health care workers do show carriage on the skin. The transformation of
Candida from a commensal to a pathogen depends on the decreased host resistance, local
ecology or increased virulence of the organism. The samples received for routine culture and
sensitivity like, pus, sputum, Urine, blood, vaginal swab, endotracheal aspirates, endotracheal
tube tips, CVC tips, IJC tips, Lumbar drain tip and sterile body fluids like CSF, pleural fluid,
ascitic fluid etc. at the Microbiology laboratory were subjected to standard culture and
sensitivity tests. The AUX method could not detect C. kefyr identified on WB method.
Instead C. kefyr was identified as C. tropicalis. Similarly one of the isolates of C. parapsilosis
was identified as C. tropicalis by WB method. None of the species of Candida except C.
krusei were resistant to fluconazole. While a majority of the C. krusei isolates (78.1%) were
resistant to fluconazole, there were no resistant strains observed for voriconazole in any of the
112 isolates.

Background: Accurate placement of tibial and femoral tunnel has significant effect on
functional outcome after anterior cruciate ligament reconstruction (ACLR). Anterior cruciate
ligament tear is one of the common sports injuries, and arthroscopic reconstruction is now a
day’s popular surgery. Its failure is rare but not uncommon. Despite advances, failure rate
after ACL reconstruction (ACLR), ranges from 0.7% to 10%1. Slight anterior placement of
femoral tunnel can lead to restriction of knee flexion and, similarly if tibial tunnel is anterior,
it leads to impingement of graft, surgical failure and also the need for a revision surgery.
Post-operative CT scan provide a reliable and valid way for the assessment of anatomical
tunnel position and obliquity after ACLR.
Materials and Methods: 31 patients with complete ACL tear with or without the meniscal
injury are treated with single bundle arthroscopic reconstruction using hamstring graft tendon.
With common post-operative rehabilitation protocol all patient are followed up clinically and
radiological for next 2 year. Femoral, tibial tunnel positions on sagittal plane. Were measured
interpreted with the clinical parameters. Radiological parameters were summarized as mean
standard deviation and proportions as applicable.
Results: Total no of patients with the age averaged 27.13± 5.89, pre op lysholm score
averaged 64.26±8.93. At 24 months follow up position of the tibial tunnel was found to be at
an average of 31.55%±4.79posterior from the anterior edge of the tibia. The femoral tunnel
was found at an average of 28.54±3.18% anterior to the posterior femoral cortex. 32.2% and
35.5% of patients showed grade 1 anterior drawer and lachman test positive respectively. And
mean lysholm score averaged to be 86.58±5.32.
Conclusion: The location of femoral tunnel in the mid sagittal section from the posterior
cortex 28.54±3.18% of anteroposterior length showed no significant correlation the lysholm
scoring. Locating the tibial tunnel positioning on the tibial plateau from the anterior cortex of
Showed significant p value with functional outcome.

Background: Tunnel expansion in anterior cruciate ligament reconstruction (ACL-R) is a
well-accepted phenomenon, still its effect on functional outcome is little known.
Purpose: To study prospectively the effect of change in the tunnel volume as observed with
computed tomography (CT) on functional outcome after ACL-R.
Materials and Methods: This study conducted for a follow up of 24 months of time period
between June 26th 2017 to 31st December of 2019, after approval from ethical committee 31
patients with complete ACL tear with or without the meniscal injury were treated with single
bundle arthroscopic reconstruction using hamstring tendon graft. With common postoperative
rehabilitation protocol, all patients were followed up clinically and radiologically
for two years. Tibial and femoral tunnel volume were measured and correlated with the
clinical parameters. Radiological parameters were summarized as mean, standard deviation
and proportions as applicable.
Results: Total number of 31 patients with the average age 27.13±5.89 and pre-operative
lysholm score average of 64.26±8.93 were included in the study. At the end of 2years follow
up of each patient, 32.2% and 35.5% of patients showed grade 1 anterior drawer and
lachman test positive respectively and mean lysholm score averaged to be 86.58±5.32.
Significant difference of tunnel volume noted at the end of 2 years with a 0.837 cm3 and
0.545 cm3of tibial and femoral tunnel volume respectively.
Conclusion: Noted a significant expansion of both tibial and femoral tunnel volume
postoperatively when compared to the intra-operative tunnel volume. Both the femoral and
tibial tunnel volume showed negative correlation with the functional outcome.

Objective: To evaluate the use of Pap smear screening method for detection of precancerous
lesions.
Methods: Women working in police department and female family members of men working
in police department were screened for Ca cervix. A total of 67 women were recruited for the
study. A clinical examination per speculum and per vaginal examination were performed and
a history taken for all women. A pap smear was used for all women to see for cervical cancer.
The smear was obtained using Ayer’s spatula and spread over a marked glass slide which was
placed in 95% ethyl alcohol and sent to department of Pathology for cytopathological
examination. All data were recorded using a predesigned proforma.
Results: Most women were in age range of 30-50 years. The common complaint was white
discharge per vagina occurring in about 30% of individuals, abdominal pain was in 8.95% of
them, irregular menstrual cycle in 12.78% and 40.29% of them did not have any complaints.
Out of 67 ladies 61 (92.1%) pap smears were taken and 6 were not taken due to post
hysterectomy status or because they were menstruating. The test was negative for malignancy
in 68.6% of individuals and 11% of individuals had inflammatory smear due to infections
with trichomoniasis, bacterial vaginosis or candidiasis. Atypical cells were detected in 2.98%
women and they were advised colposcopy and guided biopsy. 5% of individuals had
unsatisfactory smear due to inadequate sample.
Conclusion: A Pap smear is simple, noninvasive, cost-effective, and easy to perform for
detection of precancerous lesions in a gynecological patient. Awareness about screening in
general population is needed. Women with an abnormal Pap test should undergo a
colposcopy and guided biopsy.

Background: Menstruation is generally considered unclean in the Indian society though its a
physiological process indicating beginning of reproductive life. Several prohibitions and the
negative attitude of parents in discussing the related issues openly have blocked the access of
adolescent girls to the right kind of information. Various studies indicate that a huge
information gap exists among rural and urban adolescent girls regarding menstrual hygiene.
The data about the level of knowledge and practices which are followed by them with respect
to menses are beneficial in planning a program for improving the awareness level with
respect to their quality of life.
Materials and Methods: A community based cross sectional study was conducted from July
2018 to September 2018 on 708 school going adolescent girls of Gadag district, Karnataka.
Girls between age group 11 to 18 years were included. Data was collected by a predesigned,
pretested questionnaire.
Result: Awareness of menstruation was only among 12.07% of rural school girls and 38.09%
among urban school girls. The first source of information regarding menstruation was mother
in 8o% and only 17% from friends in both urban and rural girls. 18% of urban school girls
always missed school and 35% of urban girls missed sometimes. Only 5.39% girls in rural
areas always missed and 15.57% in rural areas missed sometimes. 76.22% girls from rural
schools used sanitary pads and 68.31% of girls used in urban schools. Around 50% of girls
both in rural as well as urban schools changed their pads twice a day. It was found that among
the urban school girls 70.45 % of them disposed the sanitary pads by wrapping it in a paper,
10.82% flushed it in the toilets. In the rural schools, surprisingly 71.53% of them buried the
sanitary pads, 7.56% flushed it and only 20.83% of them wrapped it in a paper. 40.93% of
urban girls and 34.52% of rural school girls still practiced in the social taboos like diet
restrictions, not attending religious functions or places of workshop.
Conclusion: There a need for adequate information both in rural and urban school girls. The
knowledge about hygienic practices is lacking. There is also a need to address social taboos in
both the groups. There is a need to emphasise on significance and physiological implications
of menstruation.

Caudal block can be performed as a single shot caudal or a continuous caudal using catheter
techniques. Single shot caudal blocks are used for ambulatory and minor procedures while continuous
catheter techniques are used for in-patients undergoing more extensive procedures. This study included
72 children, of both genders, coming for various elective infra-umbilical surgical procedures such as
herniotomy, orchidopexy, circumcision etc. Ethical clearance from institutional ethical committee was
obtained. Informed consent was obtained from the parents before including the children in the study. In
group A, the mean baseline heart rate was 122.67±9.08 per min which decreased to112.97±8.70 at 5
mins. The heart rate gradually decreased to 93.03±5.33 per min at 30 mins and 90.43±5.80 at 60 mins.
The mean baseline heart rate in group Bwas 121.92±8.52 per min which decreased to 112.19±9.79 at 5
mins and gradually decreased to 90.17±6.96 at 30 mins and 90.82±5.53 at 60 mins. However, there was
no significant difference in the heart rate between the two groups at any time interval.

The benefits of regional anaesthesia in children are well documented. These include attenuation of the
stress response, reduced opioid requirement and therefore reduction in associated side effects,
improved postoperative analgesia, and earlier extubation. Caudal epidural block is one of the most
common regional techniques in paediatric anesthesia. Caudal block is safe and reliable technique, easy
to perform and has been found to be very effective in children, especially in infra-umbilical surgeries
when combined with general anaesthesia. This study included 72 children, of both genders, coming for
various elective infra-umbilical surgical procedures such as herniotomy, orchidopexy, circumcision etc.
Ethical clearance from institutional ethical committee was obtained. Informed consent was obtained
from the parents before including the children in the study. Optimal calculated needle angle for
successful caudal block was 28.14±4.03 degrees in Group A, 19.22±2.78 degrees in Group B, which
was statistically significant. Needling time or procedural time for successful caudal block was
5.97±1.32 seconds in Group A, 14.25±2.93 seconds in Group B, which was statistically significant.

Background: Nonunions of the tibia may be associated with low-density bone tissue, bone loss, adjacent
soft-tissue damage, limb shortening, limb deformities and joint contractures. There is no gold standard
for the treatment of nonunions of the tibia.
Aims and Objectives: The purpose of our study was to assess the results of treatment with the Ilizarov
method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies
and surgical techniques. To achieve union at nonunion site with correction of limb length discrepancy
and correction of deformity with early function and mobilization.
Materials and Methods: Our study has been taken place, Department of Orthopaedics, Maharaja
Agrasen Medical College, Agroha, Haryana, India. The operators used one of two treatment strategies:
neutral fixation without compression or continued compression. The following were assessed: rates of
union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of
hospital stay. It is prospective study of treatment of aseptic nonunion of shaft tibia. As we have taken 35
patients of tibial nonunion. All relevant pre and perioperative information and complications were
recorded. Also assessment of functional outcome was made.
Results and Observations: In our study we have evaluated the differences in time to union in the
subgroup of patients with at least one risk factor for disturbances in fracture healing. The following risk
factors were considered: diabetes mellitus, corticosteroid therapy, smoking, advanced lower extremity
vascular disease, and alcohol dependence. Sample size in our study was of 32 out of 35 cases has united,
about 91% success rate. The average duration of nonunion was about 14.5 months, average union time
(fixator removal) is about 6.2 months. Two of our patient were showing poor tolerance to Ilizarov
external fixator changed to other modality.

Background: Aging is an undefiable process and as the population ages, the incidence of hip fracture is
anticipated to increase exponentially. Prolonged bed rest further worsens the morbidity and mortality
after a hip fracture. Intertrochanteric femur fracture management in elderly needs more attention to
reduce malunion and increase early mobilisation to reduce mortality and morbidity. Ideal choice of
treatment is internal fixation by intramedullary or extra medullary devices. Intramedullary devices
provide more stable proximal femoral anatomical fixation. Between PFN and PFNA; helical blade in
PFAN provides more stability, better compression and rotational control with lower cut-out rate.
Aims and Observations
a) To assess the factors for functional outcome of PFNA2.
b) Evaluation of effectiveness and stability of PFNA2.
Material and Methods: In our study, we have taken 32 patients with unstable Intertrochanteric femur
fracture between Nov 2020 to Oct 2021 fulfilling inclusion and exclusion criteria were included in this
study and underwent closed reduction and internal fixation by PFNA (n=32). Assessment was done in
terms of demography, preoperative and intraoperative variables, postoperative parameters mainly
functional outcome till 1 year postoperative.
Results: In our study Preoperative variables, AO fracture type were assessed preoperatively. Duration
of surgery, blood loss and fluoroscopy imaging were significantly lower in PFNA as compared to PFN.
Postoperative complications like cut-out rate, shortening, varus malalignment, return to pre-fracture state
were also lower in PFNA group than PFN. Postoperative functional assessment done by Harris Hip Score
shows better outcome in PFNA than other fixation devices.
Conclusion: PFNA reduces duration of surgery, blood loss, fluoroscopy imaging as compared to other
implants. PFNA also offers better postoperative functional outcome.

Background: Many anesthetic pre-medications are used to relieve this stress response. Of these premedications,
midazolam and dexmedetomidine are effectively used as sedatives. The present study was
planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Many anaesthetic pre-medications are used to relieve this stress response. Of
these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present
study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Fear of unpleasant and painful procedures, separation from parents and
unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in
unpremeditated patients. Because of this premedication should be an integral part of paediatric
anaesthetic practice.

Background: Substance abuse is increasing in young population of India at alarming rates. Younger
generation abuse the substance to gain temporary pleasure, to relive stress and under peer pressure.
Medical students are more prone to substance abuse because of longer working hours, high pressure
working environment and stress.
Objectives: Present study aims towards finding a correlation between stress and addictive behaviors, so
as to recognize the extent to which stress affects the medical students. Present study also focusses on
establishing comprehensive measures to manage stress among medical students.
Methodology: Total 200 undergraduate medical students were recruited in present study. The stress level
was analysed using perceived stress scale (PSS) and perceived academic stress scale (PASS). Substance
abuse was analysed using drug abuse screening test (DAST-10) and alcohol use disorders identification
test (AUDIT).
Results: A significantly high correlation was found in the stress level and substance abuse among
undergraduate medical students. PSS exhibit correlation of 0.3589 with AUDIT and 0.3194 with DAST.
PASS exhibit correlation of 0.4760with AUDIT and 0.3775with DAST.
Conclusion: Stress was found to be a significant problem among medical students and this leads to
consumption of alcohol and other illicit mind-altering psychoactive substances in an attempt to cope with
various academic and other life stressors.Awareness creation about the adverse effects of substance use
and academic counseling in the first 2-3 years of course and putative stress reduction interventions are
recommended and needed.

Breast cancer is the one of the most commonly occurring cancer in women and is among the top five causes of mortality due to cancer. Early detection of breast cancer plays leading role in reducing mortality rates and improving the patient’s prognosis. The factors related to women´s awareness, knowledge and perceptions about breast cancer may contribute significantly to medical help-seeking behaviours. Thus, practice of breast self-examination among female undergraduate students will be essential in acknowledging targeted interventions through the provision of guided educational training programs.
Material & Methods: A cross sectional study on female students of an engineering college in Karimnagar were studied between January - April 2020 using a pretested structured questionnaire regarding awareness of breast cancer, its risk factors, clinical features and preventive measures. Data collected was analysed using SPSS v16.0.
Results: Knowledge regarding - risk factors for breast cancer was 36.8%, regarding clinical features was 51.5%, BSE as a preventive measure was 83.8%. Major source of gained knowledge was the Internet (75%).
Conclusion:  Most students know about breast cancer but their overall knowledge about its risk factors and clinical presentation is inadequate. Only one third of them were aware of BSE as a means to detect Breast cancer.

Fracture of Intertrochanteric region has been successfully fixed since years with the use of dynamic hip
screw and proximal femoral nail, however life-threatening complications associated with these methods
are not unknown to the orthopaedic fraternity. We present a report of two cases of pseudoaneurysm of
profunda femoris artery which were operated for intertrochanteric fracture elsewhere and then referred
to our hospital when during follow up for the index surgery, the course got complicated.

Ankle fractures are amongst the commonest type of fractures treated by orthopaedic surgeons. The
incidence of such fractures has increased since the last three decades in both the younger and elderly
population, as well as due to increased vehicle accidents. Pre-reduction and pre-operative radiological
assessments, extrapolated on long term clinical results, have helped to improve the management of these
fractures. Without mentioning the nature of contouring to be done, restoration of proper tilts/rotation and
malleolar lengths, especially in comminuted fractures can be very challenging. The current study has
been carried out to ascertain the various anthropometric parameters to help in designing of such implants.
Radiographs of Twenty Cadaveric ankle specimen were obtained and Anthropometric measurements of
the lateral & medial malleolus of twenty cadaveric fibula & tibia of same specimen were carried out and
the radiographs of ankles of 500 volunteers formed the material for the study. The length and width of
lateral & medial malleolus in coronal and Sagittal planes, the angles subtended by various bends of the
medial surface of medial malleolus and lateral surface of lateral malleolus in radiographs of cadaveric
tibia and volunteers were measured. The data collected has been recorded and analyzed. It is hoped that
the measurement of the various parameters will be of value for scientific designing of implants for
fixation of malleolar fractures.

Introduction: Supraclavicular brachial plexus block could be an alternative and provide comparable
effective anaesthesia and postoperative analgesia for shoulder surgery. Interscalene brachial plexus
blockade is the standard nerve block for analgesia after arthroscopic and open shoulder surgery.
Material and Methods: This is a Prospective, observational and descriptive study conducted in the
Department of Anaesthesia at Nimra Institute of Medical Sciences (NIMS) over a period of 1 year. These
patients were divided into two groups by simple random method; the patients were divided into group
IRD (interscalene block using 30 ml of ropivacaine 0.5% + 50 μg of dexmedetomidine) and another
group (supraclavicular block using 30 ml of ropivacaine 0.5% + 50 μg of dexmedetomidine). The
procedure was conducted using nerve stimulator technique.
Results: The mean time of the onset of sensory block in supraclavicular group was 3.50±0.83, in
interscalene was 3.1±0.62 and onset of motor block (min) was 3.60±0.62 in supraclavicular group, in
interscalene was 3.21±0.54. The duration of sensory block was 495.53±49.41 min and 759.42±84.15 min
in supraclavicular group and interscalene block respectively. Moreover, duration motor block (min) in
supraclavicular group was 438.52±47.32, in interscalene was 659.23±38.74.
Conclusions: The onset of sensory and motor block was significantly faster in interscalene techniques
then supraclavicular. Prolonged duration of sensory and motor block followed by interscalene and
supraclavicular approaches, respectively.

Introduction: In India, there is a high frequency of ALD, with alcohol being responsible for roughly
half of all instances of cirrhosis. However, not everyone who consumes alcohol develops the condition,
and the total chance of acquiring the disease in a person is determined by a number of variables. The
length, amount, and kind of alcohol ingested, as well as nutritional state, comorbid illnesses, sex, race,
and hereditary variables, may all have a role. Multiple investigations on the impact of drinking patterns
in the development of illness have shown conflicting conclusions.
Objectives: Present study aims towards analysing the clinical profile of patients with alcoholic liver
disease. Present study also aims to perform psychiatric screening using CAGE criteria and alcohol use
disorder identification test (AUDIT) scale for assessing the severity of alcohol dependence.
Methods: Present study was a single centric, prospective, observational and hospital-based study. 50
patients with clinical/investigational evidence of alcoholic liver disease were include in study. CAGE
Criteria to screen and alcohol use disorder identification test (AUDIT) scale was used for assessing the
severity of alcohol dependence.
Results: The mean age of the recruited patients was 50.80 ± 12.74 years. Among total 50 patients, 96%
patients were males and 4% of patients were females. Total 26% patients have CAGE score of four, 34%
patients have CAGE score of three, 40% patients have CAGE score of two whereas no patient had a
CAGE score of zero. AUDIT scoring indicate that 96% patients exhibit alcohol dependence, 4% patients
presented with harmful or hazardous drinking levels whereas no patient presented with Low-risk
consumption. A total of 96% patients were alive whereas mortality occurs in 4% patients in present study.
Conclusion: Our findings show a link between the type, amount, and duration of alcohol consumption
and the development of alcoholic liver disease.

Macrovascular complications of diabetes mellitus include cardiovascular diseases, cerebrovascular
accidents and peripheral vascular disease. Macrovascular disease is a significant cause of mortality in
diabetic patients. Diabetic individuals have a multitude of risk factors for atherogenesis and the odds of
developing coronary artery disease and ischemic strokes are 2 to 4 times and 2 to 3 times more,
respectively, than non-diabetic individuals. This is a prospective observational comparative study in
which 60 patients with type 2 diabetes mellitus in the age group of 35-65 years were included and
results are compared with 60 Normal Individuals. The study design was approved by the Ethical
Committee of the institution. In NN group, 12(85.7%) patients were on OHA, 02(14.3%) patients on
insulin. In NH group, 19(82.6%) patients were on OHA, 04(17.4%) patient was on insulin. In HH
group, 16(69.6%) patients were on OHA, 7(30.4%) patients were on insulin. The distribution of BMI
among all the three groups was equal. P value was 0.215 which shows that the groups were similar to
each other in the distribution of BMI.

The triglyceride levels in serum generally remain elevated for about 3 to 6 hours after a meal. This
postprandial hypertriglyceridemia (more than 2.72 mmol/l or 201 mg/dl) is exacerbated by the next
routine meal and thus the lipemic milieu persists throughout the day. Therefore, measuring and
documenting postprandial dyslipidemia in diabetic patients is vital in addition to measuring the fasting
lipid levels. Blood samples were drawn before and 4 hours after the standardized test meal. The
HbA1c, fasting and postprandial lipid profile levels and glucose levels were estimated. Fasting and
postprandial triglycerides, total Cholesterol, HDL, VLDL were measured by standard laboratory
technique. The mean serum HDL cholesterol in the NN group was 40.57 ± 5.23.The mean serum HDL
cholesterol in the NH group was 35.43 ± 6.33.The mean serum HDL cholesterol in the HH group was
32.87 ± 6.30. The mean serum fasting triglyceride in the NN group was 107.29 ± 20.69.The mean
serum fasting triglyceride in the NH group was 132.57 ± 7.52.The mean serum fasting triglyceride in
the HH group was 230.13 ± 48.96.

Introduction: Early detection and compliance to prescribed treatment is important to avoid life threatening complications among those with non-communicable diseases (NCDs). The present study aimed to assess adherence to prescribed medications and associated factors among patients with NCDs.
Methodology: This was a cross-sectional survey done among patients with diagnosed with NCDs attending outpatient clinic of Medicine department to determine the prevalence of non adherence. To assess medication adherence, the Morisky Medication Adherence Scale (MMAS-8) was used. Patients were divided into two groups for the purposes of analysis: those with poor medication adherence (MMAS-8 score less than 6) and those with moderate to high medication adherence (MMAS-8 score more than 6). (MMAS-8 6 or above).
Comparison of patient related variables was done using chi-square test
Results: Out of 232 patients, 22% had low compliance to drug therapy. Mean age of the patients was 48.5 years, ranging from 30 to 78 years. Increasing age and female gender were found to be significantly associated with low medication compliance. Literacy, employment status, alcohol and tobacco consumption were not found to be significantly associated with low medication compliance. In addition, having only one non-communicable disease, disease duration more than 5 years and having to take five to six medications were found to be associated with low medication adherence.
Conclusions: Approximately one-fifth of patients adhered poorly with their medications. Patients must be sufficiently motivated and counselled in order to adhere to their medication regimens. Further study is required to assess the efficacy of different educational techniques for promoting patient medication adherence.

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia accounting for one- third of all arrhythmia related hospitalizations. AF is major risk factor for stroke. Atrial fibrillation is hyper coagulable state in both paroxysmal and chronic atrial fibrillation, AF related stroke can be effectively prevented with oral anticoagulant therapy with vitamin K antagonist or non vitamin K antagonist. The present study was done with objective to detect prevalence of use of anti coagulants in treatment of non-valvular atrial fibrillation.
Methods: This was a descriptive cross-sectional observational type of study done at Narayan medical college and hospital Jamuhar, Sasaram, department of Medicine on 200 patients of non-valvular atrial fibrillation. Non-valvular atrial fibrillation patients were defined as atrial fibrillation without rheumatic valvular disease predominantly mitral stenosis or mechanical heart valves. Data regarding patients’ demographics, co-morbidities, diagnosis of AF were recorded; CHA2DS2_Vasc and HASBLED scores were calculated for each patient.
Results: In this study out of total 200 study subjects, 50 study subjects had CHA2DS2_Vasc score less than 1, whereas 150 study subjects have score more than 1. Out of 150 eligible patients only 15 were on anticoagulants.
Conclusions: In this study, it was found that the majority of patients with non-valvular AF were not anti-coagulated (90%), the type of anticoagulant most commonly used was vit K antagonist and most common risk factors for bleeding are hypertension (72%) followed by heart failure (36%).
 

Introduction: In India, a large proportion of women with an unmet need for contraception are within their first year after childbirth. It is major obstacles for nation social and economic development. The present study concentrates to educate postpartum women for contraception and to study  the acceptance and compliance of medroxyprogesterone acetate (DMPA) in Bihar women .
Methods: This is retrospective study with cross sectional data collection from 210 patients for a period of 14 month , from JANUARY 2019 TO FEBRUARY 2020.
Results: The study concluded that DMPA is highly effective contraceptive with low failure rate .
Conclusion: It is available as a first line method to all who wish to opt reversible method of contraception.

Background: clinical study fifty cases of intracapsular fracture neck of femur in elderly patients above the age of 50 years irrespective of sex treated by hemiarthroplasty using unipolar (Austin moore’s / Thompson’s ) or bipolar endoprosthesis, in the Department of Orthopedics, were followed up and functional results were analysed with the objectives, to study the age  and sex incidence of fracture neck of femur, quality of life after hemiarthroplasty, morbidity and mortality associated with the procedure.
Methods: Fifty cases of fracture neck of femur in elderly patients above the age of 50 years treated by hemiarthroplasty using either unipolar or bipolar prosthesis in the Department of Orthopaedics at All india institute of medical sciences, Patna. Study duration period of two years, were selelected on the basis of purposive sampling or judgement  sampling method. Conclusion: The success of hemiarthroplasty no doubt depends on preoperative planning and proper attention to surgical details to achieve the optimum biomechanical stability. The poor results (11.1%) were due to moderate to marked pain in the hip or thigh after hemiarthroplasty. We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients.

A thorough understanding of clinical spectrum of chest injury, management and its outcomes shall help
in better patient management and decrease the mortality and morbidity associated with chest injury.
Total of 150 patients with chest trauma reported to casualty, Emergency Department, were included in
study. Patients of age group 15-65 years, with no pre-existing cardiopulmonary disease were enrolled
in the study. Patients treated on OPD basis and brought dead were excluded from the study. Blunt chest
injury was seen in 80.07% and penetrating injury was found in 19.3% of cases. The main reasons for
the chest injury were RTA (57.3%), fall from height (16%), assault (22%), industrial injury (2.7%),
animal attack (0.7%) and fall of objects on chest (1.3%).

Introduction: The pandemic disease COVID-19 has varied presentations clinically and even
radiologically. Early diagnosis and treatment help in containment of the disease. Therefore, assessing
the radiological patterns in order to contribute to the diagnosis COVID-19 is the aim of this study.
Materials and method: A cross-sectional descriptive study from January 2021 to June 2021 was
carried out on 165 patients suspected of COVID-19 with delayed RT-PCR report or in cases with initial
RT-PCR negative, but having high clinical of suspicion of COVID-19. HRCT pattern in such cases
were documented and correlated with the repeat RTPCR and other laboratory parameters such as
Interleukin IL-6, serum ferritin, C-reactive protein, Lactate Dehydrogenase.
Results: Most common HRCT pattern was bilateral multifocal peripheral ground glass opacities
predominantly involving posterior segments. Other common patterns were crazy paving and
consolidation.
Conclusion: Specific patterns on the HRCT can be used in diagnosis of COVID-19 when there is high
clinical likelihood, however the study should be used judiciously only when indicated.

Background: Floating knee injuries are frequently part of polytrauma. The outcome of this injury
pattern when compared to only femur or tibia fracture is less satisfactory. The outcome is even worse
when there is presence of other associated injuries. We hypothesized that not all associated injuries
have similar bearing on the outcome thus tried to find out the impact of commonly associated injuries
on the final outcome of these complex fractures.
Methods: Study was conducted including the patients of floating knee injury operated between
September 2016 and January 2019. Total of 42 eligible patients were operated, 4 patients were
excluded to due to lack of adequate follow-up. Data relating to demography, Fraser subtype,
compounding, associated injuries and clinical outcome were collected. Statistical analysis was
performed to see the association of associated injury, Fraser subtype and presence of compounding
with clinical outcome.
Results: Mean age was 33.5 years (17-63 years) with a male preponderance. Mean follow up was 1.6
years. Twenty-seven patients (71.1%) had excellent/good outcome while outcome of 11 patients
(28.9%) was acceptable/poor. Seventeen patients (44.7%) had compound fractures. Injuries which were
significantly associated with Acceptable/Poor outcome were ligament injuries, popliteal artery injury,
abdominal injury and patella fracture. Chest injury with a p value of 0.05 was also very close to being
statistically significant.
Conclusion: The clinical outcome of these patients not only depend on proactive and optimum
management of tibial and femoral fractures but also on the management of associated injuries.

Introduction: In this genre of AO principles, most of the fractures are fixed surgically unless it's a
hairline fracture or a very high risk patient with co-morbidities.
Material & methods: Our study involves 23 patients visiting a remote government medical college
with hip intertrochanteric fracture (IT) which were managed non-operatively due to co-morbidities
and/or patients not willing for operative management. All those patients were applied de-rotation boot
cast and applied 10% traction of their body weight over it. Clinical and functional outcome was
measured by Harris hip score at admission, 6, 12 and 18 months follow-up. Radiological evaluation
done by radiographs of hip-AP and lateral views.
Results: Statistical analysis was done using SPSS software for descriptive data. Paired ‘t’ test was
applied to see improvement in functional & clinical outcome (Harris hip score), first between 6 month
follow up and 12 month follow up & 18 month follow up and results were tabulated. The ‘p’ value was
< 0.01 for Harris hip scores analysis by ‘t’ pair test between 6, 12 and 18 months follow-ups and was
significant.
Conclusion: Operative treatment of intertrochanteric fractures though gives early mobilization and less
hospital stay, after one year of injury both non-operative and operative management are of less
significance with respect to mortality, functional outcome and medical complications.

Primary objective of the use of grafting in a subarticular defect associated with tibial plateau fractures
is to prevent the collapse of articular defect. Autogenous iliac bone graft has been the most frequently
recommended treatment for defects associated with unstable tibial plateau fractures. Despite the wide
acceptance of autogenous iliac bone graft as the so-called gold standard, complications of graft harvest,
ranging from temporary pain and numbness to long-term functional impairment are well documented.
Twenty acute, closed, unstable tibial plateau fractures (Schatzker's types II through VI) that required
open reduction and internal fixation with Computerized Randomization for the type of grafting of the
subarticular defect was done at the time of surgery. The age, weight, height, and sex of the patients and
the fracture patterns were comparable in the two groups. All fractures united in both groups within the
same time period (an average of three months); Union was determined by the treating surgeon
clinically as the ability of the patient to bear full weight without pain and, radio graphically, as the
disappearance of the fracture lines on the three-month follow-up anteroposterior and lateral
radiographs.

Reduction and fixation of articular surfaces followed by attachment to humeral shaft. Reduction and
fixation of Medial and Lateral condyles to shaft, then reconstruction of articular surfaces. 8 patients
(25%) had excellent, 9 patients (30%) had good and 9 patients (30%) had fair outcome according to
MAYO performance score. Nonunion is not encountered superficial infection in 5% cases treated by
daily dressing and IV antibiotics. A high rate of union can be achieved in complex intra-articular
fractures of distal humerus if the proper principle of stable fracture fixation are followed i.e. a posterior
trans-olecranon approach and dual fixation of both columns and restoration of continuity of articular
surfaces.

Background and Aim: Since the onset of the 2019-nCoV disease (COVID-19), many skin
manifestations have been reported in COVID-19 patients. This study aims to analysis of various skin
manifestations among patients with COVID-19.
Methods: An observational study was conducted in department of dermatology, Bharatpur Medical
College & Hospital, Bharatpur.
Results: Among Covid positive patients 47% had maculopapular eruptions, 19%, 19% each had
urticarial and pseudo chilblains, 9% had pedicular eruptions and only 6% had necrotic lesions and they
present within 1-4 week. There is a significant association between gender and skin lesions, co morbidity
and skin lesions.
Conclusion: Infection with 2019-nCoV may lead to skin manifestations with various clinical symptoms.
These clinical features combined with clinical symptoms of COVID-19 may aid in the timely diagnosis
of patients with COVID-19.

Introduction: A Cochlear implant (CI) is surgically implanted electronic device that provide a sense of
sound to a person with severe to profound sensorineural hearing loss. It helps in social rehabilitation of
the patient with hearing loss. Cochlear implants, like the human hair cell, receive mechanical sound
energy and convert it into a series of electrical impulses. The brain adapts to the new mode of hearing,
and eventually can interpret the electric signals as sound and speech.
Aim: The present study aims to evaluate the outcomes of cochlear implant in terms of hearing and speech
gain, The Department of Otorhinolaryngology of R.N.T. Medical College, Udaipur with patients who
will undergo CI surgery.
Materials and Methods: The prospective study (conducted between June 2016 to December 2018), the
study population in our study were patients attending the Department of ENT in RNT medical college,
Udaipur. A detailed history, including prenatal and perinatal history to assess for risk factors include
TORCH infection and the various parameters that were analyzed like Audiological assessment (BERA,
Otoacoustic Emission testing) duration of deafness, age, sex, type and degree of deafness, lack of benefit
with hearing aids, radiological analysis (HRCT & MRI) of temporal bone and cochlear anatomy for
feasibility for implantation.
Surgically cochlear implanted through Veria technique under all aseptic precautions.
Results: In our study mean age of implantation was 4.851+/-1.265. The mean revised CAP score at pre
op-, 6months, 12months of surgery was 0.5+/-0.5,3.8+/-0.6 and 7.875+/-0.6 respectively; the mean SIR
score at pre-op 6 months, 12 months of surgery was 1.0+/-0.0, 2.2+/-0.4 and 2.5+/-0.5 respectively; the
mean MAIS score at pre op-, 6 months, 12 months of surgery was 1.9+/-1.92, 25.3+/-1.27 and 32.25+/-
0.66 respectively.
Conclusion: Intelligible speech and auditory performance of children who underwent prelingual
cochlear implantation was improved compared to their pre-operative status. Cochlear implantation
appears to be beneficial for pre-lingual deaf children in term of quality of life.

Background: The aim of the study was to compare multi-modal approach with Tramadol suppository
and Ultrasound guided Transversus Abdominis Plane (TAP) Block with Bupivacaine versus Tramadol
suppository alone in providing adequate post-operative analgesia after Caesarean section.
Method: 158 patients, aged between 18 to 40 years with ASA physical status I-II scheduled for elective
caesarean surgery, were enrolled in this prospective randomized comparative study. 79 patients (of Group
A) were given Ultrasound guided Transversus Abdominis Plane Block with Bupivacaine and Tramadol
suppository as post-operative analgesia. The remaining patients were given only tramadol suppository as
post-operative analgesic (Group B). They were observed for 12 hours or till the patient requested for
rescue analgesic. Pain (VAS score), satisfaction (Likert scale), sedation (Four-point sedation scale),
nausea & vomiting (PONV Impact scale) and adverse effects at 3hours, 6hours, 9hours and 12hours postoperatively
were observed and compared in both the study groups.
Results: Both groups were comparable in demographic data. There was a statistically significant
difference between the VAS scores and satisfaction scores with a p < 0.001 between the two groups. No
statistically significant differences in the sedation, PONV or adverse effects were found between the two
groups. In our study, Group A patients who received ultrasound guided TAP block remained painless for
longer period (23hours) than Group B (6.5hours).
Conclusion: In conclusion, our study suggests that Ultrasound guided TAP block significantly improved
postoperative analgesia in women undergoing Caesarean delivery patients.

Background and Objectives: Adjuncts to local anaesthetics for brachial plexus block enhances the
quality and duration of analgesia. The purpose of this study was to compare the effects of
dexmedetomidine, when added as adjuvant to bupivacaine, in respect to onset, duration of sensory and
motor block along with duration of analgesia.
Materials and Methods: After informed consent, 60 ASA I and II patients scheduled for
elective/emergency upper limb surgeries under supraclavicular brachial plexus block (under ultrasound
guidance) was randomized were divided into two equal groups-Group A & B. Group A-received
bupivacaine 28 ml (0.25%) & dexmedetomidine 1μg/kg, and Group B-received bupivacaine 28 ml
(0.25%) & 2ml normal saline. Onset and duration of sensory and motor block, duration of analgesia were
studied in both the groups.
Results: Both groups were comparable with regard to age, sex distribution & duration of surgery. There
was no statistically significant difference. Onset of sensory and motor blockade was 9.2±1.6min
and12.8±1.6mins, respectively in group A, while it was 17.7±2.6min and 23.5±1.7min respectively in
Group B, which (p value˂0.001) is statistically significant. Duration of sensory block and motor block
was 648±49.1min 600.2±45.9min, respectively, in group A, while it was 250.5±26.8min and
206.0±19.0min respectively, in group B, which (p value˂0.001) is statistically significant. The duration
of analgesia in group A was 720.8±44.2 min, while in group B, it was 268.9± 23.1min which (p
value˂0.001), is also significant. There were no adverse events noted in either group. All patients were
haemodynamically stable.
Conclusion: Dexmedetomidine when added to bupivacaine in supraclavicular brachial plexus block had
faster onset, greater duration of sensory and motor block and also longer the duration of analgesia, than
in bupivacaine alone.

Background: Chronic Dacryocystitis is an inflammatory condition of the lacrimal sac most commonly
associated with partial or complete obstruction of the nasolacrimal duct. It usually presents with watering
and sometimes purulent discharge, but some may progress and cause severe ocular and extra ocular
complications.
Objective: To compare the study subjects and the outcomes between the External vs. Endoscopic
Dacryocystorhinostomy.
Methodology: The present study was a retrospective, observational, nonrandomized, comparative
clinical study done by Reviewed medical records of 48 patients who underwent DCR at Kodagu Institute
of Medical Sciences from January 2018 to December 2021. Data regarding the intra-operative course,
surgical outcomes, and postoperative complications were analyzed. Anatomical success was defined as
patency confirmed by intranasal endoscopic inspection of the ostium and successful lacrimal sac
syringing whereas functional success was defined as complete resolution of epiphora assessed and
documented post-operatively.
Results: Primary acquired nasolacrimal duct obstruction (NLDO) is a common cause of epiphora in
adults, and it is 4-5 times more common in females. Of the 48 cases, 47 were primary cases and 1 case
was a revision External DCR and only in this patient stent was placed and in all other cases in both
Endoscopic and External DCR we have not used stents. Both External and Endonasal DCR had
comparable outcomes. In the Endonasal DCR group it was seen that out of the 34 patients operated, 2
patients had continued epiphora. Thus the success rate stands at 94%. It was noted that both patients who
continued to have epiphora after Endonasal DCR had lot of pus in the nasolacrimal apparatus with thick
sac wall noted intraoperatively.

Background: Psoriasis is chronic inflammatory dermatosis with genetic background. Topical therapy
alone is effective in localized psoriasis
Objective: Study was conducted to compare the efficacy and safety of topical calcipotriol and dithranol
in mild chronic plaque psoriasis with less than 10% BSA involvement
Methods: Study duration was 6 weeks. Thirty patients each were included in two groups. In calcipotriol
group, patients applied calcipotriol ointment (0.005%) twice daily. In dithranol group patients applied
1% ointment in 1st week, 2% ointment during 2nd week, 3% ointment from 3rd weeks onwards. Duration
of application was 60 minutes, once daily.
Results: Patients responded to both the treatments satisfactorily. However, calcipotriol was superior in
efficacy. Patients in both the groups tolerated the treatment.
Conclusion: Both calcipotriol and dithranol (short contact therapy) were effective in the treatment of
mild chronic plaque psoriasis. Even though, dithranol is less potent, it is cost effective.

Objective: To study the efficacy of 50 μg of Misoprostol tablet for induction of labor, oral v/s vaginal
route.
Methods: 100 women, at term gestation, with various indication for induction of labor with Bishop’s
score of ≤4 were included. After deciding, 50 women received 50 μg orally and 50 women received 50
μg vaginally every fourth hourly (maximum of 6 doses) or till they went into active labor.
Results: After statistical analysis it was found that in vaginal misoprostol route the induction to delivery
interval was significantly less compared to oral misoprostol group (9.5 v/s 160).
It was also found that the required dose of drug in vaginal route is less compared to oral route (40% of
women need only 2 doses in vaginal group compared to 35% of oral group were 6 doses required).
Conclusion: For induction of labor vaginal misoprostol is always more effective compared to oral rout

Background: Vitamin D is essential for calcium absorption, bones strengthening, hemopoiesis,
protection against heart failure, prevention against upper respiratory infection, acts as anti-oxidant and
strengthening immunity. Its deficiency has turn out to be epidemic globally, but still majority of
population is unaware about the problem. The prevalence can be appreciated in all age groups in both
the genders, such as, youngsters, adult, pregnant women and geriatric group. As vitamin D functions in
bone remodeling and its normal growth, the deficiency leads to retarded growth and skeletal deformities
in infants and adolescents, whereas, muscle weakness and fractures are common in adults. Present study
was carried out to sensitize the medical undergraduates regarding deficiency, prevention and treatment
of vitamin D.

Context: Intubation through LMA CTrach™ involves manipulations with the LMA and tracheal tube.
Thus there is a possibility of postoperative sore throat and hoarseness of voice as with any other methods
of tracheal intubation.
Aims: To compare the incidence of postoperative sore throat and hoarseness of voice with water based
lubricant when betamethasone gel is used for lubrication during intubation.
Settings and Design: Prospective observational study commenced after approval from hospital ethics
committee and was conducted over a period of one year.
Methods and Material: Patients fulfilling the inclusion criteria were grouped into 2 groups depending
on whether betamethasone gel 0.05% was used as a lubricant (Group Betamethasone) or water soluble
lubricant was used for lubrication (Group Water based lubricant) during intubation with LMA CTrach™.
Patients were assessed for sore throat and hoarseness of voice after 24 hours of surgery.
Statistical analysis: Parametric data were analysed using independent samples t-test. Nonparametric
data were analysed using chi-square test or Fisher’s exact test. P value less than 0.05 was considered
significant.
Results: The incidence of postoperative sore throat in Group Betamethasone and Group Water based
lubricant was 26.82% and 26.82% respectively. Similarly the incidence of hoarseness of voice was
14.63% and 21.95% respectively.
Conclusion: We conclude that betamethasone gel does not reduce the incidence of postoperative sore
throat and hoarseness of voice compared to water based lubricant for intubation with PVC tracheal tube
through LMA CTrach™.

Facial anthropometry is very important for the study of human growth and variation in different races
and also for clinical diagnosis and treatment. A study was conducted in the Department of Paediatrics,
Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan to make a database of
various anthropometric measurements, especially craniofacial anthropometry of normal full term
newborns born in the hospital.
Objective: To measure craniofacial anthropometric parameters of normal full term newborns, make a
database and to statistically analyze the correlation (comparison) between male and female neonates with
respect to the above-mentioned parameters.
Material & Methods: Study was conducted from the month of February 2020 to October 2020 on 453
newborns. All the facial parameters were measured with the help of vernier caliper and were taken twice
and final value was taken as the average value of the two measurements.
Statistics: Mann-Whitney U and Wilcoxon Rank Sum tests were used to compare 2 groups.
Findings: The mean value and range for all the parameters was determined. A statistically significant
difference in Face Width (p<0.038), weight (p<0.019), Foot Length (p<0.030), Crown Heel Length
(p<0.049) and Nasal Width (p<0.046) between male and female newborns was seen.
Conclusion: The local values have been derived from well-defined populations to make and expand the
normative database of various craniofacial anthropometric parameters. Pediatricians can be benefitted by
this study for screening and diagnosis of various craniofacial abnormalities as a part of complex genetic
disorders and for craniofacial surgeries.

Introduction: Thrombocytopenia is a common condition seen in clinical practice. A wide range of
etiologies and variation in clinical presentation often pose a challenge in its diagnosis. Early recognition
of thrombocytopenia and its causes can avoid critical bleeding.
Aim: This study aimed to assess etiology and clinicopathological profile of thrombocytopenia in a
tertiary care center.
Materials and methods: Of all patients whose blood samples were received for complete blood count
analysis, 500 patients with thrombocytopenia were included. Blood samples were run in Sysmex XP-100
and PCi 20 fully automated, three-part differential hematology analyzers. Leishman-stained peripheral
blood smears were also studied.
Results: Mild thrombocytopenia (platelet count 60,000-1,50,000/μl) was seen in majority (84.8%) of the
patients followed by moderate thrombocytopenia (platelet count 20,000-60,000/μl) in 10.8% and severe
thrombocytopenia (platelet count <20,000/μl) in 4.4% of the patients The most common cause of
thrombocytopenia was found to be infections (50% patients) followed by chronic liver disease (14.8%
patients), macrothrombocytopenia (10.6% patients), hematological disorders (8.6% patients), gestational
thrombocytopenia (7.8% patients), drug intake (4.4% patients) and chronic kidney disease (1.8%
patients). Among infections, acute febrile illness (nonspecific) was the most (23.2%) common cause
followed by COVID 19 infection (19.4%) and bacterial sepsis (5.4% patients). Four distinct patterns of
platelet histogram in patients with thrombocytopenia were seen.
Conclusion: Similar to most previous studies, infections were the most common cause of
thrombocytopenia in the present study. The present study also highlights two novel entities- suspected
asymptomatic macrothrombocytopenia and Covid-19 infection.

Introduction: Chronic kidney disease (CKD) is associated with a complex array of cutaneous
manifestations caused either by the disease or by treatment. Cutaneous manifestations in chronic kidney
disease are polymorphic and diverse. Most patients with severe CKD progress to end stage renal disease
(ESRD) with significant morbidity and mortality. The Aim of our study was to evaluate the prevalence
and pattern of cutaneous disorders among patients with chronic kidney disease.
Materials and Methods: One hundred patients of chronic kidney disease above the age of 18 years with
dermatological manifestation were enrolled in the study. A detailed physical examination and
dermatological examination was done and findings recorded. Relevant investigations including complete
haemogram, diabetic profile, ANA, renal function tests, Liver function tests, electrolytes, viral markers,
serum calcium, phosphorous and PTH (parathormone) levels, KOH mount, culture & sensitivity, woods
lamp examination, biopsy was done if indicated.
Results: In our study we included 100 patients of CKD with cutaneous manifestations. The most
common cause of CKD in our study was found to be diabetic nephropathy which was seen in 47% (n=47)
patients. Pruritus was the most common dermatological manifestation seen in 73% (n=73) of the total
study population followed by xerosis in 68% (n=68). More than 50% of the study population had more
than one dermatological manifestations. Nail and hair changes was seen in 43% and 58% respectively.
Conclusion: Patients with end stage renal disease (ESRD) may present with variety of skin abnormalities
and the most common being pruritus and xerosis as seen in our study. An inter-disciplinary approach
involving dermatologists and nephrologists is essential to improve the quality of life of patients with
ESRD.

Introduction: Complete blood count (CBC) by the automated hematology analyzers and microscopic
examination of peripheral smears have traditionally been used in the diagnosis of anemias. The advent
of automated hematology analyzers has improved accuracy and precision of test results and has reduced
subjective errors. This study aimed at
i) Comparing anemia characterization between automated CBC analysis and conventional peripheral
blood smear assessment.
ii) Studying RBC histogram patterns in various categories of anemia.
Materials and methods: Blood samples from 500 adult anemic patients were run in Sysmex XP-100
fully automated, 3-part differential hematology analyzer. In all patients, blinded peripheral blood smear
examination by two observers was done. Anemia categorization by peripheral blood smears and
automated red cell data was compared.
Results: The number of patients with normocytic normochromic anemia on automated CBC was 280
and on peripheral smear examination was 269. On automated CBC, 137 patients had microcytic
hypochromic anemia whereas 107 patients had microcytic hypochromic picture on microscopy.
Significantly higher number (p<.05) of patients (76) with microcytic normochromic morphology was
diagnosed on blood smear compared to automated counts (17). When RBC volume and hemoglobin
content were considered together, a Kappa value of. 447 was obtained indicating moderate agreement
between the automated and manual (peripheral blood smear) assessment of anemia.
Conclusion: Patients with most anemia types can be accurately diagnosed by automated CBC analysis.
The peripheral blood smear has limitations in cases with borderline MCVs and mild hypochromia which
may be missed. It, however, still remains the cornerstone in the identification of abnormal RBC
morphology seen in hemolytic anemias.

Background: The Asthma Guidelines of the National Asthma Education and Prevention Program
(NAEPP) published by the National Institutes of Health (NIH) emphasize the need to evaluate asthma
control as a key component for asthma treatment and management. Well-controlled asthma is associated
with improved health status, and fewer physician visits, hospitalizations and emergency room visits
among children and adults. In contrast, poor asthma control is directly linked with increased school
absenteeism and loss in work productivity among asthma children and adults/caregivers, respectively.
Unfortunately, studies report that asthma remains uncontrolled in many asthmatic patients, despite
receiving appropriate treatments. Present study has been designed to update the knowledge regarding
factors affecting asthma control and factors responsible for frequent exacerbations in children so that
corrective measures could be taken.

Background: Sex assignment and subsequent corrective surgery, if required, can occur without delay – effectively reducing the psychological trauma inflicted on the parents, the child and the community. In view of gross psychological trauma and social stigma associated with these situations we undertook a community intervention to identify further cases of extreme perineal hypospadias, being raised as girls, in this region and undertook necessary investigations and management.
Materials & Methods: a grass root community intervention was undertaken. It was made mandatory to examine the external genitalia of all girls between 0 and 6 years of age, presenting and enrolled to anganwadi centres.
Results: Data was collected from January 2019 to December 2019. A total 9828 girls were examined, out of these 72 were suspected cases of ambiguous genitalia. Out of these suspected cases 22 cases were clinically confirmed as having ambiguous genitalia.
Conclusion: Given our experience we believe examination of genitalia should be mandatory for such or any other screening program especially given the potential psychological and social harms that can result to the child and the family from missing such conditions.

Introduction:
Background: Inguinal hernia repair without mesh by Desarda Technique. To study the short-term postoperative mean pain-score, return to normal gait, recurrence among adult patients with primary inguinal hernias compared to other conventional methods.
Methodology:  It’s an observational study with 30 patients of age group 20-40 years with primary inguinal hernia. Study was conducted in Government wenlock hospital, Mangalore. Results: Out of 30 patients included in the study, 21 right sided and 9 were left sided hernia. 28 patients were pain free by 3^rd day, 2 of them were pain free by 7th day, 2 patients developed seroma collection, and 1 patient developed
wound gapping and required secondary suturing, all the patients returned to normal gait by 2^nd day, no foreign body sensation, and no recurrence till now.
Conclusion: Desarda’s no mesh repair is a physiologically sound, easy to learn and simple method. It is more comfortable for the patient as pain intensity and duration is less, early return to gait and normal activity, less hospital stay, also cost beneficial (without mesh) for the patient.

Introduction: Chronic obstructive pulmonary disease causes significant mortality and morbidity
worldwide and in India. It is characterized by airflow limitation that is not fully reversible. Better health
care seeking behaviour may halt the progression of disease and improve their quality of life. This study
assesses health care seeking behaviour of chronic obstructive pulmonary disease and factors affecting it.
Material and methods: All 205 patients diagnosed with chronic obstructive pulmonary disease using
spirometry in a large community based study were enquired about their health care seeking behaviour.
Chronic lung disease severity index was used to assess the severity of symptoms. Sociodemographic data
was also recorded. Factors affecting their healthcare were enquired of using a semi-structured
questionnaire.
Results: Large number of patients were under diagnosed and untreated. Public sector was preferred with
being asymptomatic or few symptoms and high cost being major barriers for not taking treatment. Severe
symptoms, later stages of disease, lower standard of living & those living in rural areas had a significantly
lower treatment seeking behaviour.
Conclusion: Chronic obstructive pulmonary disease patients were having poor health care seeking
behaviour.

Objective: Knowledge of pseudo constipation behaviour in exclusively breastfed infant’s 0-6-month age
is sparse. This benign temporary condition creates anxiety among parents and health care providers so as
infants are put to diagnostic tests and treatments not required. Mothers self-introduce early add on feeds
as of anxiety which may hinder the optimal infant feeding. The study aimed to:
1. To determine prevalence of pseudo constipation or infrequent stools in 0-6 months healthy
breastfeeding infants.
2. To draw correlation of pseudo constipation and its impact on exclusive breastfeeding.
Methods: 100 mothers fitting into inclusion criteria were put to a set of questionnaire. Babies born with
normal birth weight, passed meconium within 48 hours and predominantly breastfed, having satisfactory
weight gain and no illness history in past 6 months were included. Babies with functional constipation,
infant dyschezia, history suggesting of organic causes of constipation, failure to thrive, congenital
anomalies or associated illness were excluded.
Results: The prevalence of pseudo constipation in 0-6months predominantly breastfed infants was 42%.
All these infants had mean peak time duration of defecation ≥2days and mean duration the symptom
lasted in weeks was 5.43 weeks (SD-4.52, median-5). All infants had reduction in frequency of stools in
second month of life (median-45 days). Among the infants who had pseudo constipation behaviour
64.3% of mothers had started early complimentary feeds <6month age. The comparison between the
cases and control group showed to be highly significant with χ 2 =21.23, df =1, p <0.001.
Conclusion: Prevalence of pseudo obstruction behavior in exclusive breastfed infants is as high as 42%.
Nearly 64.3% of mothers intervened this by adding complimentary feeds early <6-month age. We would
like stress that knowledge of this temporary condition requiring no interventions would be a great benefit
for pediatricians, pediatric surgeons, nurses and parents.

Introduction: Congenital Hypothyroidism is one of the most common causes of preventable mental
retardation with an estimated incidence of 1:2500-2800 live births in India. The need for neonatal
screening for CH is essential as the majority of signs and symptoms are not exhibited in the neonatal
period.
Aim: To use TSH values as a marker for screening for Congenital Hypothyroidism in neonates in an
iodine deficient endemic region and to find normative values of Serum TSH for the study group.
Material and Methods: A prospective observational study was conducted over a period of 18 months.
A total of 500 newborns who fulfilled inclusion criteria were enrolled. Umbilical Cord Blood samples
(2ml from placental side) were taken for TSH values for all Term neonates with birth weight ≥ 2.5 Kgs
whereas Serum TSH values at 48-72 hours of life were taken for Preterm (<37 completed weeks) and
Low birth weight neonates. All babies who had a cord blood TSH value of >20 mIU/L were sampled
again for TSH and T4 and if repeat TSH was >20 mIU/L and/or T4 < 10 mIU/L they were subjected for
further examination and treatment if required.
Results: The mean cord blood TSH was 7.26 mIU/L in our study, with 7.28 mIU/L in term neonates and
6.94 mIU/L in preterm neonates. Nine babies had TSH values >20mIU/L in the initial screen but all were
<20 mIU/L on repeat sampling. Hence none of the 500 neonates who were screened for CH in our study
were detected to have congenital hypothyroidism. TSH values corresponding to the 5th, 10th, 25th, 50th,
75th and 95th percentile were 3.08, 4.71, 5.39, 13.18, 21.65 and 39.22 respectively. The babies born to
mothers with hypothyroidism, had higher TSH values compared to those without risk factors.
Conclusion: In our study, none of the 500 newborns screened had congenital hypothyroidism. We
observed that neonates born to mother with hypothyroidism had higher cord blood TSH which was
statistically significant. According to our normogram, the 50th centile corresponded to 13.18 mIU/mL
which is <20 mIU/mL while neonates above 75th centile had TSH values above 20 mIU/ml.

Background: Thyroid diseases are endemic in India with around 42 million people suffering from them.
Hashimoto’s thyroiditis is the most common autoimmune pathology of the thyroid gland. Papillary
carcinoma thyroid is the most common thyroid cancer. The objective of this article is to study coexistence
of Hashimoto’s thyroiditis with papillary thyroid cancer.
Methods: Our study was prospective study carried out on 123 patients in the age group 14-65 in the
department of surgery Sree Gokulam Medical college and research foundation Venjaramoodu during the
period November 2011 to February 2013.A history was taken followed by clinical examination. They
were then investigated by thyroid function test, ultrasound neck X-ray neck, X-ray chest, indirect
laryngoscopy, fine needle aspiration cytology (FNAC) and anti-thyroid antibody tests. The patients were
taken up for surgery and histopathology reports were correlated with the findings of FNAC and antithyroid
antibodies.
Results: Out of the 123 patients who enrolled. For our study 115 were females. All patients presented
with a swelling in the neck. FNAC showed 70(56.9%) colloid goitre, 14(11.4%) had Hashimoto’s
thyroiditis, 11(8.9%) follicular neoplasm and 4(3.3%) papillary thyroid cancer. 60(48.8%) of patients of
123 had abnormal Anti- TPO antibodies and 70(56.9%) had positive Anti- thyroglobulin antibody. Of
the 123 patients 38(30.89%) had thyroiditis. 19(15.44%) patients had papillary thyroid cancer and 5(4%)
had papillary thyroid cancer and thyroiditis at the same time. All patients with papillary carcinoma
thyroid and thyroiditis were females.
Conclusion: In a country like India were thyroid diseases are endemic, benign thyroid diseases are very
common. Papillary thyroid cancer is the most common thyroid cancer and according to our study has a
26.3% coexistence with Hashimoto’s thyroiditis which is the commonest auto immune thyroid disease.
From this study we conclude that careful workup and surgery are recommended when dealing with
patients with thyroiditis especially women.

Introduction: Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP, with growth factors up to 8 times that of normal serum, has been shown to be safe  and effective in promoting natural processes of wound healing. Our study aims to examine the effect of combining the fat graft with PRP in myringoplasty procedures indicated for TMP secondary to chronic suppurative otitis media (CSOM) and whether it can significantly promotes Tympanic membrane (TM) healing.
Methods: This prospective study included forty patients, presenting with dry tympanic membrane secondary to tubo-tympanic CSOM. Half the patients underwent fat graft Myringoplasty with PRP application (group A), while others served as control and received the fat graft only, without PRP (group B).
Results: In group A, eighteen cases (90%) significantly showed an intact tympanic membrane, while Eleven cases (55%) were successful in group B. P=0.044.
Conclusion: Topical autologous PRP application during fat plug Myringoplasty is highly successful with no reported postoperative infections and minimal morbidity.

Introduction: Early diagnosis of hypertension is an important strategy in its control which is usually
missed in OPD practice. Kumarhatti, Solan, was selected as the place of study based on the new AAP
2017 criteria to find the prevalence of elevated blood pressure and hypertension at an altitude of 4000-
5000 feet.
Objective: To measure blood pressure of school going children and to classify BP measurements into
normal BP, Elevated BP and Hypertension.
Methods: 600 children between 10 to 17 years of age were selected from urban and rural schools. The
final diagnosis of HTN was made if a child or adolescent had auscultatory confirmed BP readings
≥95thpercentile on 3 different visits. Data collected was analyzed using SPSS20.
Results: Prevalence of EBP, stage 1 and stage 2 hypertension was found to be 15, 8%, 4.5% and 1%
respectively in the study. Prevalence of EBP and stage 1 hypertension was higher in urban population
(17.2% and 5.3% respectively) whereas stage 2 hypertension was almost equal in both population
(P<0.05). Prevalence of EBP, stage 1 and stage 2 hypertension was maximum in obese category as
38.6%, 13.63%, 6.8% followed by overweight 24%, 11.25%, 2.5% respectively (P<0.05). The prevalence
of positive family history among study subjects was 15% (N=90) with P value<0.05.
Conclusion: Prevalence of hypertension was 5.5% in the study subjects. Prevalence of EBP and stage 1
hypertension was higher in urban population. Our study revealed that prevalence of elevated blood
pressure and hypertension was significantly more in overweight and obese children and with positive
family history compared to normal children proving obesity and positive family history as an important
risk factor for hypertension in children.

Introduction: Pulmonary Function Tests (PFTs), especially spirometry is an established mode of
assessing chronic lung diseases especially Asthma. Spirometric reference values are essential in assessing
pulmonary function. Normative values of these tests differ from population to population and with
difference in methods and apparatus used. The normal standards for pulmonary function measurements
among the hilly areas of Himachal Pradesh is not reported yet.
Aim: To measure the normative values of spirometry (FEV1, FVC, FEV1/FVC, PEFR) in children of 5-
18 years age range living in and around Solan district of Himachal Pradesh, India.
Material and Methods: This cross-sectional study was carried out at M.M Medical College and
Hospital, Kumarhatti, Solan, HP, India and comprised school-going children and nearby community aged
5-18 years. After noting their gender, age, height and weight, the pulmonary function test measures,
Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC%, FEF 25-75%
and peak expiratory flow rate were taken. Simple and multiple regression models were used for the
prediction of pulmonary function test values. SPSS 20 was used for statistical analysis
Results: Of the 200 participants, 110(55%) were boys and 90 (45%) were girls. The mean age was
12.47±3.27 years. The means height, weight, forced expiratory volume in 1 second, force vital capacity,
peak expiratory flow rate FEV1/FVC% and FEF 25-75% were 147.39±16.07cm, 41.30±12.38kg,
2.54±0.70, 2.90±0.8, 5.42±1.30, 87.41±3.85% and 2.90±0.84 respectively. All the three variables - Age,
Height and Weight-had significant linear relationship and positive correlation with the pulmonary
function test values (p0.7). Among these three variables maximum correlation was found with height
(r=>0.8).

Etomidate has been widely used in western countries has now become available in India. Etomidate is
preferred in patients with CAD, especially with poor left ventricular (LV) function as it provides stable
cardiovascular profile but it has less inhibitory effect on pharyngolaryngeal reflex thus may cause less
blunting of response to laryngoscopy and intubation. After getting approval from institutional ethics
committee, study was carried out in all patients fulfilling the inclusion and exclusion criteria during the
study period. Patient diagnosed or known case of CAD either from history, investigations were
included in the study after obtaining written valid informed consent. There was no hypertension or
hypotension in group A (EF<45%) but in group B (EF>45%) hypertension was noted in just 1 patient
and no hypotension noted. Statistically they were non-significant (p value-0.077). There was no
occurrence any arrhythmias or significant ST changes in either group at any point of time from
induction to 10min after intubation.

CAD and stroke are the predominant causes and are responsible for >80% of CVD deaths. The Global
Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100000 populations
in India is higher than the global average of 235 per 100000 populations. In India of particular concern
is its accelerated buildup, the early age of disease onset in the population and the high case fatality rate.
After getting approval from institutional ethics committee, study was carried out in all patients
fulfilling the inclusion and exclusion criteria during the study period. Patient diagnosed or known case
of CAD either from history, investigations were included in the study after obtaining written valid
informed consent. 2D Echo of patient diagnosed or known CAD was routinely done in our institution
mainly to know the ventricular function. The number of patients having DM was comparable in the two
groups (p value-0.644). The percentage of DM patients in group A and group B being 40% and 35%
respectively. The time taken for intubation in two groups was comparable, with the mean duration
being 19.5s in group A and 19.4s in group.

Background: At the end of 2019 a new viral disease namely covid-19 has occurred which was highly
contagious within a few months it spreads to more than 100 countries. A poor understanding of new
infections and lack of knowledge leads to compromised patient health benefits as well as psychological
stress to front-line health workers. This study aimed to assess the knowledge and level of perception of
health care workers about covid-19.
Methods: A cross-sectional web-based survey was carried out among front-line health care workers who
work at tertiary health care centers the survey instrument constituted a semi-structured pre-tested
questionnaire. The 29-item questionnaire was divided into two sections. Statistical tool chi-square test
used to investigate the stress, anxiety, and depression with significance set to p<.05.
Results: Out of 100 participants 30 front-line health care workers have minimal depression, 25 mild
depression, 14 moderate depression, 13 moderately severe depression, maximum participants belong to
age group 26-35 (P-value .001). The participant with a child is a total of 67 out of 100 participants who
show a variety of depression, Maximum number of participants is 21 having mild depression P (value is
.010). There total of 57 participants who confident caring covid-19 patient, maximum of 22 participants
who have mild depression (P-value is .000).
Conclusion: As the entire world faced the covid-19 thread and continued to emerge, most frontline health
care workers have a varying degree of depression but according to PHQ-9 no one has severe depression.
Definitive or effective treatment of covid-19 including prevention of this by vaccination is mandatory.
Education intervention, personal protection equipment and appropriate knowledge are urgently needed
to reach frontline health care work beyond the international border and future studies are warranted.

Background: Incisional hernia continues to be one of the common post-operative complication of
abdominal surgery. Newer techniques have been added for hernia repair including prosthetic mesh repair
and the laparoscopic repair, which have been reported to produce better results. This study aimed to
compare on-lay mesh repair and retro-rectus mesh placement.
Material and Methodology: The current study was a prospective study conducted in the Department of
General Surgery, J.L.N. Medical College & Attached Group of Hospital, Ajmerwith an aim to evaluate
and compare the efficacy of on-lay mesh repair and retro-rectus mesh placement for repair of incisional
hernia in terms of VAS score for pain post-operatively, to compare the duration of the surgery, hospital
stay between the two repair techniques and to compare the early and late complications between the two
repair techniques on a total 50 patients (25 patients of onlay and 25 patients for retrorectus repair).
Results: There is significant lower complication i.e. blood loss, pain, seroma formation, surgical duct
infection, sinus formation and recurrence in sublay mesh repair and blood loss is also significantly lower,
while operative time and blood loss during surgery is higher in comparison to onlay mesh placement.
Conclusion: In our study there are significant lower complication in sublay repair than onlay repair.
Thus, proved the sublay repair a better approach for the ventral hernia repair than the onlay repair.

Background: Bupivacaine, the commonly used local anesthetic agent in spinal anaesthesia having
duration of sensory and motor blockade of 90 to 200minutes limits its use for short duration ambulatory
surgery with delayed ambulation and risk of urinary retention. But 2-Chloroprocaine (2-CP) has
duration of action of 70 to 150 minutes. With Clonidine, an α2-adrenergic agonist, as an adjuvant has
been shown to prolong both the sensory and motor blockade when combined with spinal Bupivacaine.
In our study, we compared the effectiveness of intrathecal 1% 2-Chloroprocaine with clonidine vs.
intrathecal 1% 2- Chloroprocaine for infraumbilical surgeries in terms of their onset of blocks, duration
and offset of blocks along with the hemodynamic variations.
Methods: A prospective and omised controlled double blind study was conducted in 60 ASA I and
ASA II patients in the age group 18-60 years, posted for elective infraumbilical surgeries under
subarachnoid block. They were randomised into 2 groups of 30 patients each and Group CC (n=30)
received intrathecal 3.0 ml of 1% 2-CP with 30 mcg Clonidine and Group CS (n=30) received
intrathecal 3.0 ml of 1% 2-CP with 0.2ml Normal Saline. Hemodynamic parameters, onset of sensory
blockade, time for highest sensory and motor blockade, total duration of sensory an motor blockade,
two dermatome regression time, time for rescue analgesic, time for ambulation and first micturition,
sedation score were recorded. Side effects werenoted.
Results: Demographic data as well as operating data were comparable between the 2 groups. Group
CC showed faster offset and prolonged sensory and motor blocks compared to Group CS. Time for
ambulation and micturition were less in Group CS compared to Group CC. No side effects were note
din both the groups.
Conclusion: Addition of clonidine to Intrathecal isobaric 2-chloroprocaine decreases the onset time for
sensory and motor blockade, produces higher level of sensory blockade, prolongs postoperative
analgesia, prolongs sensory blockade and motor blockade, prolongs ambulation and voiding time and
has less haemodynamic changes which could be easily managed. Hence it may be proposed for day
care surgeries.

Background: Midazolam and propofol by virtue of their antiemetic effect were found
individually to reduce the incidence of intraoperative nausea and vomiting. This study
compares the effects of midazolam and propofol in decreasing the incidence of nausea and
vomiting in pregnant women undergoing lower segment caesarean section (LSCS) under
spinal anaesthesia. It also assesses maternal sedation, neonatal outcome and other side effects.
Aim: To compare the effects of subhypnotic dose of midazolam and propofol in prevention
of intraoperative nausea and vomiting in lower segment caesarean section under subarachnoid
block.
Methods: With ethical committee permission the 60 pregnant women were randomly
allocated into 2 groups after taking informed consent. Group M received 0.03mg/kg
midazolam immediately after cord is clamped, Group P received 10 mg propofol immediately
after cord is clamped. Incidence of nausea and vomiting was not according to Bellville
scoring system (0-novomiting, 1-Nausea, 2-Retching, 3_vomiting). The degree of sedation,
hemodynamic changes were noted baseline, after induction, after drug administration, 30
mins after drug administration, 60 mins after drug administration, neonatal out come and side
effects were recorded.
Results: Statistically significant decrease in intraoperative nausea and vomiting in patients
undergoing LSCS under spinal anaesthesia with 10 mg propofol compared to 0.03 mg
midazolam is observed. Degree of sedation, respiratory rate, mean mephentermine
consumption were comparable between two groups and no difference found.
Conclusion: Propofol significantly decreases incidence of intraoperative nausea and
vomiting inches are in section under spinal anaesthesia as compared to midazolam.

Although measurement of amylase and lipase is useful for diagnosis of pancreatitis, serial
measurements in patients with acute pancreatitis are not useful to predict disease severity,
prognosis, or for altering management. Routine abdominal computed tomography (CT) scan
is not recommended at initial presentation because there is no evidence that CT improves
clinical outcomes and the complete extent of pancreatic and peripancreatic necrosis may only
become clear 72 hours after the onset of acute pancreatitis. This was a prospective
observational study conducted in HIMS, Hassan from July 2020 to July 2021. Modified
Glasgow score showed Mild Acute Pancreatitis in 93 and Severe Acute Pancreatitis in 47
Patients. Using the modified CT severity index, the observers graded severity of the acute
pancreatitis as mild in 66, moderate in 31, or severe in 43 of the 140 patients with CT scans.

Background: Candida causes urinary tract infections in persons with conditions such as
diabetes, prolonged hospitalization, instrumentation, prior antibiotic therapy etc. Mere
presence of Candida in urine is not indicative of true infection and it requires other evidence
such as pyuria, symptoms suggestive of urinary tract infection, repeated isolation of same
organism etc.
Objective: The study was done to estimate prevalence of Candiduria in the hospital and to
know the predominant species causing the same. The study also determined antifungal
susceptibility pattern of the isolates
Materials and methods: Routine urine samples suspected of urinary tract infection sent to
laboratory for culture and antibiotic sensitivity testing were analyzed. Culture on routine
media were done, followed by speciation using Auxanography method of sugar assimilation.
Antifungal susceptibility testing was done following CLSI guidelines using fluconazole and
voriconazole discs.
Results: Prevalence of Candiduria was estimated to be around 2.2% amongst urine samples.
C. tropicalis was the predominant species (51%), followed by C. albicans (26%). Other
Candida species isolated were C. glabrata (11%), C. guelliermondi (6%), C. parapsilosis
(4%) & C. krusei (2%). All isolates were susceptible to voriconazole. Two isolates of C.
tropicalis was intermediately sensitive to Fluconazole, whereas one isolate of C. krusei was
resistant to fluconazole.
Conclusion: The prevalence rate of 2.2% of Candiduria was similar to few studies observed.
Pyuria was noted in 80% isolates highlighting the non-reliance of pyuria in cases of
Candiduria. Majority of the isolates had colony count of >104cfu/ml, which is significant in
diagnosis of urinary tract infection. Non-albicans Candida (NAC) were the predominant
group (74%), which is in consonant with global trend of increasing prevalence of NAC
species in Candida infection. Certain species are developing resistance to routinely used
antifungals like Fluconazole, notably C. krusei. It was also noted in the study. The study
highlights the importance of knowledge of various Candida species causing Candiduria and
their antifungal resistance pattern.

Objective: Active chronic suppurative otitis media (CSOM) is the bacterial chronic infection
of middle ear cleft mucosa and treated with antibiotics empirically, which may cause resistance
to bacterial strains. In this study, we studied the bacteriology and susceptibility pattern in
CSOM for efficient empirical treatment especially in central India.
Methods: Clinically proven 160 patients with CSOM with otorrhea, were included in our
study. Ear discharge samples were collected with the asepsis method and bacterial culture and
antibiotics sensitivity patterns were obtained.
Results: Bacterial growth was present in 76.1% of ear samples with Staphylococcus and
Pseudomonas being most prominent. Vancomycin and Rifampicin were most effective for
staphylococcus and amoxicillin and quinolones were most resistant. Meropenem and
Piperacillin/tazobactam were the most effective antipseudomonal antibiotics. Ciprofloxacin
and Levofloxacin were least sensitive antipseudomonal quinolones.
Conclusion: Amoxicillin with quinolones were highly resistant for bacterial growth in-ear
samples so used cautiously as empirical therapy in CSOM. For effective treatment of CSOM
and prevention of resistant strain emergence, all ear samples must be sent for culture sensitivity.

Introduction: Surgical treatment of patellar fractures has evolved over the years. It ranges from partial
or total patellectomy to open reduction internal fixation using tension band wiring and constructs.
Previous studies have documented conflicting results regarding clinical and functional outcomes after
surgical treatment of patellar fractures.
Aim: To assess the functional outcomes of surgical intervention in patellar fractures and make a
comparison between tension band wiring and partial patellectomy.
Methods: 46 patients with patellar fractures were included in this prospective longitudinal study.
Depending on the fracture type surgical intervention in the form of tension band wiring of the patella in
24 patients and partial patellectomy in 22 patients was done. Postoperatively, the functional outcomes
were measured at three months, six months, and the latest follow-up. The outcome variables used were
Knee Injury and Osteoarthritis Outcome Score (KOOS), extensor lag, range of knee flexion, thigh
circumference, Medical Research Council (MRC) grading of quadriceps and hamstrings strength and
complications in treated patients. Levene’s test, T test and chi-square test were used to compare the
these outcome variables.
Results: KOOS score was significantly better (P value of 0.001) and thigh wasting was less (P value of
0.09 and 0.412) at three and six months in the tension band wiring (TBW) group. Knee flexion (P value
of 0.001) and extensor lag (P value of 0.02) had significantly better outcome in the TBW group at three
months, but a similar outcome to the partial patellectomy group at six months (P value >0.05). All the
patients had regained their full quadriceps/hamstring muscle strength at six months. Fracture union was
assessed at six months and showed a significantly better union rate in tension band wiring when
compared to partial patellectomy (P value < 0.05).
Conclusions: Operative management of patellar fractures gives good to excellent functional outcomes
at short to midterm follow-up with minimal complications, irrespective of the type of procedure.
Comparable functional outcomes can be expected following patellar osteosynthesis and salvage
procedure. However, future studies with bigger sample size and longer follow-up are needed.

Background: Traditionally Open Z-Plasty lengthening is the choice of the procedure for
treating Achilles tendon contracture seen in equinus deformity of the foot, which is
commonly seen in club foot, spastic cerebral palsy, polio myelitis, post traumatic and post
burn contractures etc. Percutaneous Achilles tendon lengthening by triple level tenotomy
technique is based on sliding of partially cut tendon preserving its biology, strength and
biomechanics. This study aims to evaluate the efficacy and safety of this new surgical
therapeutic method.
Methods: A retrospective analysis of the Achilles tendon contracture cases in our hospital
between 2015 and 2020 was conducted. Fifty-one cases of equinus deformities treated with
percutaneous triple level Achilles tendon tenotomy. Operative time required, hospital stay,
wound healing, Achilles tendon rupture and equinus recurrence were recorded and
statistically analysed. American Orthopaedic Foot & Ankle Society (AOFAS) scoring system
was used to assess the Foot and ankle function.
Results: The mean follow-up period was 20 months. The mean operative time was 6 minutes
and mean hospital stay was 2 days. No cases had infection or wound healing complications.
One patient had equinus recurrence which was minimal. The mean AOFAS score increased
from 53% points before procedure to 96% at final follow-up.
Conclusion: This method of Achilles tendon lengthening by Triple level percutaneous
tenotomy significantly reduces operative time, hospital stay and thus expenses. Also this
technique is much better in maintaining soft tissue biology, strength and biomechanics thus
helping in preventing rupture of the tendon and recurrence of the deformity.

Dexmedetomidine the S-enantiomer of medetomidine a highly sedative and potent α2-
adrenergic agonists has a potentially useful role as a sedative agent. In healthy volunteers
dexmedetomidine increases sedation, analgesia and amnesia and decreases heart rate, cardiac
output and circulating catecholamine in a dose dependent fashion. Anaesthesia workstation
was checked. Appropriate size endotracheal tubes, working laryngoscope with medium and
large sized blades, stylet and working suction apparatus were kept ready before the induction
of general anaesthesia. Emergency drug tray consisting of atropine, adrenaline and
mephentermine were also kept ready for any eventuality. Post extubation Ramsay sedation
score was significantly higher in group D compared to group S at 30th, 60th and 90th minute
with p value = 0.001, 0.001 and 0.051 respectively. However no patients in group D required
intervention for sedation and were easily arousable. There was no statistically significance
between the groups immediately after extubation and at 120th minute postoperatively. 3
patients in group D (8.57%) and 3 patients in group S (8.57%) had vomiting immediately
following extubation which was statistically not significant (p = 0.721). 1 patients in group D
(2.86%) and 2 patients in group S (5.71%) had vomiting after 30 minutes of extubation which
was statistically not significant (p = 0.555).

Etomidate is a popular intravenous induction agent because it has a stable haemodynamic profile and
results in minimal histamine release. Myoclonus is observed in 50%–80% of patients who did not
receive pretreatment before etomidate administration, which increases the risk of regurgitation and
aspiration in emergency conditions. Various drugs were used in the treatment of myoclonus but the
results have been inconclusive. Dexmedetomidine, a new alpha-2 agonist has been tried by several
authors to suppress the myoclonus induced by etomidate. A prospective randomized controlled double
blind study was conducted in seventy patients aged between 18-55 years belonging to ASA I and II
scheduled for elective surgery under general anaesthesia. After obtaining informed written consent, a
detailed preanaesthetic evaluation was done and investigations were obtained as indicated. The patients
were randomized into 2 groups with 35 patients each, received either 0.5 μg/kg of dexmedetomidine in
10 ml saline (Group D) or 10 ml of Saline (Group S) over a period of 10 minutes prior to etomidate
induction. The incidence of severe myoclonus was significantly less in group D compared to saline
group with p = 0.031 (8.57% in group D and 28.5% in group S). However there was no change in the
incidence of myoclonus (P = 0.237) and pain on injection (p = 0.309) in both groups. Recovery profile
was comparable in both groups. Our study shows that pretreatment with dexmedetomidine 0.5 μg/kg
IV is effective in reducing the severity of etomidate induced myoclonic muscle movements without
however dexmedetomidine does not have any significant effect on the incidence of myoclonus
following etomidate induction.

Background: Nasal polyposis is a prevalent condition that is said to affect between 1 and 4% of the general population. The aetiology of nasal polyps is largely unknown and has long been a topic of debate. Although historically have believed polyps to be a manifestation of allergy.
Objective: To find out the prevalence of nasal polyposis among patients with chronic recurrent rhinosinusitis.
Materials and Methods: This is a Cross-sectional study, was conducted in MYH a tertiary care hospital, Indore, M.P. A total of 338 patients presenting with symptoms of chronic rhino sinusitis and giving consent were recruited for the study. All patients with chronic recurrent rhinosinusitis were included in the study.
Result: The mean age of participants was 34.5-9 years. There was a preponderance of male gender among all the patients. The most common symptom was nasal discharge, followed by nasal obstruction, followed by headache, among all the participants, 46.1%.
Conclusion: From our study, we conclude that the chronic recurrent rhinosinusitis patient has a chance of developing a nasal polyp if left untreated.

Femoral shaft fractures are one of the common fractures in paediatric age group. They represent approximately 1.6% of all bony injuries in children. The preference of treatment of femoral shaft fracture in each child depends upon age of the child, the location and type of the fractures. Elastic stable intramedullary nailing is the minimally invasive technique, the short operation time, and the preservation of the growth plate.
The purpose of the present study is to analyse the result of titanium and stainless-steel elastic nail in paediatric femoral fractures in 5-12 years of age group. No statistically significant difference was found in stability of fractures treated with both the methods. Both methods have their own advantages. Stainless steel nails are much cheaper as compared to titanium elastic nails which is important aspect in Indian scenario.

Diaphyseal femur fractures in children account for 1.4-1.7% of all fractures, and 7.6% of those involving the long bones. Diaphyseal femur fractures ratio between males and females is 2.6:1.Non-operative treatments such as Pavlik harness, traction, and Spica casting, and operative treatments such as sub muscular plating, elastic nails, rigid nails, as well as internal and external fixation. Elastic stable intramedullary nailing is getting popular for management of femoral fractures for children 5 years and older.
In this study, 35 children aged between 6-15 years with diaphyseal femur shaft fractures were treated with elastic stable intramedullary nailing (ES1N). All patients successfully completed one-year follow-up and were included in the analysis. All the patients were managed with titanium nails. We based on our experience and results thus conclude that Titanium elastic nails can be considered better method of treatment regarding lesser rate of surgical wound complications.

Background: The various types of post-menopausal symptoms progressively worsen the well-being of
women and affect, consequently, their quality of life (QOL) on a daily basis.
Objectives
1. To determine the prevalence of poor quality of life among post-menopausal women of rural area.
2. To assess the factors responsible for the poor quality of life among post-menopausal women of rural
area.
Methods: A community based cross sectional observational study was carried out among 100
postmenopausal females aged between 40-60 yrs of age. The standardized Menopause-Specific Quality
of Life Questionnaire (MENQOL) and the International Physical Activity Questionnaire (IPAQ) were
used.
Results: Among the study participants, the most common symptoms in the physical domain were
“decrease in physical strength” (88%), “decrease in stamina” (81%) and “feeling tired and worn out”
(81%). Urinary incontinence was seen in 26% of women. In the psychosocial domain, “the feeling of
having the ability to accomplish less than previously” was the predominant one (78%). Among the
symptoms of sexual domain, “decrease in sexual desire” was the most common complaint (67%). Among
vasomotor symptoms, hot flashes were present in only 35% of participants. Those having low physical
activity were exposed to more postmenopausal symptoms as compared to those having moderate and
severe physical activity.
Conclusion: Menopause is associated with decrease in QOL. Awareness regarding menopausal
symptoms will lead to improvement in QOL by early recognition.

Background: The aim of this study is to evaluate the per se effect of cinnamaldehyde which
is obtained from bark oil of cinnamon tree and its interaction with ondansetron on catalepsy
in Swiss albino mice.
Methods: Haloperidol induced catalepsy model was used. A group of 36 healthy mice of
either sex weighing 20-30 grams were divided at random into six groups (n=6).
Cinnamaldehyde with 98 percent purity was obtained. Catalepsy was induced by haloperidol
(1mg/kg, i.p). Control group received tween-20 20% (10ml/kg, p.o), standard groups were
administered ondansetron (0.5mg/kg and 1mg/kg, p.o ), test groups received cinnamaldehyde
in strength of 100mg/kg, and 200mg/kg and combination group of ondansetron plus
cinnamaldehyde (0.5mg/kg + 100mg/kg) per oral, respectively.
Results: In this acute study, from 60 min onwards after haloperidol administration,
ondansetron at both doses (0.5 mg/kg and 1 mg/kg), showed significantly lower cataleptic
scores as compared to all groups. Cinnamaldehyde at both strengths did not show any
significant effect as compare to control at any point of time (P>0.05). Combination of
ondansetron 0.5 mg/kg with cinnamaldehyde 100mg/kg, showed significant increase in
cataleptic score as compared to ondansetron 0.5 and 1mg/kg alone (P>0.05). Which suggest
that cinnamaldehyde abolishes the protective effect of ondansetron in haloperidol induced
catalepsy.

Aims and Objectives: The aim of the study was to study serum lipid profile and compare
their levels in patients with oral sub mucous fibrosis (OSMF) and oral squamous cell
carcinoma (OSCC).
Materials and Methods: This study was done in two groups of patients ‑ OSMF and OSCC.
There were forty five participants in each group. Serum obtained from centrifugation of 12
hour fasting blood samples was analyzed on fully automated analyzer Beckman coulter AU-
680 for estimating the lipid levels (cholesterol, triglycerides [TGL], and high‑density lipids
[HDL]) by colorimetric method. Low‑density lipid [LDL] values were obtained by calculator.
Results: The comparison of lipid profile between Oral Submucous Fibrosis and Oral
Carcinoma cases shows statistically significant results for TC, HDL and LDL.
Conclusion: The change in lipid levels may have an early diagnostic or prognostic role in
oral premalignant and malignant lesions.

Background: Dentine hypersensitivity is a common complaint among dental patients.
Recently, a novel stabilized calcium sucrose phosphate dentifrice was introduced that offers a
desensitizing benefit. The primary aim of this study was to compare the in vivo efficacy of
this novel dentifrice with Calcium sodium phosphosilicate and a non-desensitizing dentifrice,
on dentin hypersensitivity in a four-week period.
Methods: Sixty volunteers with tooth sensitivity were recruited, and a double-blind,
randomized, parallel, controlled clinical trial was conducted in a hospital setting. Clinical
evaluation for dentin hypersensitivity by 0-10 VAS score was done using air blast, and cold
water methods. Following baseline measures, subjects were randomly divided into three
groups and treated as follows:
Group A: Dentifrice containing calcium sodium phosphosilicate (NovaMin).
Group B: Dentifrice containing Calcium sucrose phosphate.
Group C: Dentifrice containing no desensitizing ingredients. Clinical evaluations were
repeated after two and four weeks of product use.
Statistical analysis used: Mean VAS scores were compared among groups at different time
points (baseline, and 2 and 4 weeks) and among groups at each time point using one-way
analysis of variance.
Results: Compared to baseline, there was a clinically significant decrease in dentin
hypersensitivity in Groups A and B following four weeks use of the dentifrices containing
calcium sodium phosphosilicate and calcium sucrose phosphate, respectively. The Group A
dentifrice, however, was found to be significantly better in reducing the VAS score compared
to the Group B and Group C dentifrice at any time point for both measures of sensitivity.
Conclusion: The results suggest that the dentifrice containing 5% NovaMin provides rapid
and significantly more relief from dentin hypersensitivity in four weeks compared to a
dentifrice containing calcium sucrose phosphate or a non-desensitizing dentifrice.

Background: The Anterior cruciate ligament (ACL) is among most commonly affected
ligaments, and surgical treatment is chosen for most patients who present pain and instability.
Aims and objectives: The aim of this study to assess the correlation of patient’s height,
weight and BMI with autologous harvested hamstring graft size.
Material and method: This study is Experimental study design. In this study a total of 50
patients, selected cases were operated for the primary ACL reconstruction utilizing hamstring
tendon autograft at the Department of Orthopedics at Dr. Baba Saheb Ambedkar Medical
College, Delhi, India from 15th August 2020 to 15th Jan 2022.
Result: The correlation and p-value of height and weight was with respect to harvested graft
length (semitendinosus and gracilis) respectively. The other variables which include BMI do
not correlate with harvested graft length (semitendinosus and gracilis).
Conclusion: We found that there was slight correlation between weight and height of male
patient. We would suggest that: Height and weight could be successfully used as an
anthropometric measurements for evaluating graft length.

Aim: To assess the serum Vitamin D levels and Kellgren-Lawrence grading in patients of
Primary Osteoarthritis.
Materials and Methods: The present observational study was carried out on the patients
coming to the OPD of the Department of Orthopedics, SMS Medical College and Hospital,
Jaipur. All patients complaining of Osteoarthritis of the knee joint and willing to participate
in the study were interviewed for age, sex, history of inflammatory arthritis or any rheumatic
disease, complain of celiac disease & malabsorption syndrome or any history of intake of any
drug that might affect serum Vit D levels. After the successful running of Quality Controls
the clear serum obtained from patient’s serum was analyzed on Advia Centaur XP (for
Vitamin D & PTH) & fully automated chemistry analyzer Beckman Coulter AU 680 (for
routine biochemical parameters). Based on the serum biochemistry results, patients with
deranged RFT & LFT were excluded from the study & the Serum Vitamin D, PTH, Calcium
and Phosphorus levels of the patients with normal RFT & LFT were documented.
Results: In our study maximum number of patients (109, 41.44%) fell in the age group 51-60
years with age ranging from 37-70 years. Mean age is 55.37 ± 8.04 years. Male female ratio
was 0.81:1. Mean serum Vitamin D level is 18.27±8.34 ng/ml with range from 4.2-44.34
ng/ml. Maximum no. of patients were in the Vitamin D deficient group (148, 56.27%), 96
(36.5%) patients were Vitamin D insufficient while only 19 (7.23%) patients had Vitamin D
levels above normal range. Maximum number of cases were of grade 3 (90, 34.22%).
followed by grade 2 (82, 31.18%). Minimum no. of cases are of grade 0 (7, 2.66%) followed
by grade 1 (22, 8.36%). The mean Kellgren- Lawrence grading for the cases is 2.68 ± 1.01.
Conclusion: There is high prevalence of Vitamin D deficiency in Osteoarthritis patients. But
this prevalence needs to be compared with the prevalence in general population by including
age & sex-matched healthy controls. The present study could be further taken in this
direction.

Background: There is a debate around the existence, anatomy, and role of the so called
―anterolateral ligament (ALL). This study was conducted with a primary aim of finding out
and comparing the prevalence of the presence of anterolateral ligament and it’s three portions
(femoral, meniscal and tibial) in knees with and without ACL tear.
Methodology: This is a cross sectional study conducted in which A total of 96 patients
undergoing MRI knee for clinically evident ACL injury or history of chronic knee pain were
included in the study. Out of 96 patients included in the study, 48 patients had ACL tear
(Group A) and 48 patients did not have an ACL tear (Group B). Demographic data and
clinical information were noted for all patients. Descriptive variables were expressed as mean
and standard deviation for quantitative variables and frequency and percentages for
qualitative variables. The data was analyzed using SPSS® version 21.0. Categorical variables
were analyzed using Chi square test and for normally distributed data - t test was used. p
value <0.05 was considered as statistically significant.
Results: ALL was visualized in 65% of the patients included in the study. Its femoral
component was visualized in 56%, tibial component in 63% and meniscal component in 57%
of the patients. The three components were viewed together in 30% of the patients. We found
a significant association between ACL tear and the presence of ALL (p <0.001), with ALL
visualized in around 81%of knees with an ACL tear and only 48% of knees without an ACL
tear. Meniscal tears were significantly associated with the presence of ALL as out of the 62
patients in which ALL was visualized, 24 had an associated medial meniscal tear, 7 had
lateral and 3 had tear in both the menisci.
Conclusion: Our study demonstrated radiological evidence of the existence of the ALL.
Furthermore, we found presence of ALL to be significantly associated with ACL injury and
meniscal tear. Age, gender, or affected side was not found to be associated with the presence
of ALL.

Background: Surgical site infections are among the most common hospital acquired
infections. They make upto 14-16% of inpatient infections. Objective of present study was to
evaluate the risk factors associated with surgical site infections in caesarian cases, the bacteria
causing wound infections in obstetric operations, the antibiotic sensitivity and resistance
pattern of the pathogens isolated.
Methods: 100 women with wound infection during hospital stay or within 30 days following
caesarean section were taken for the study. These case records were thoroughly studied and
noted. Pus samples were collected from the wound site with help of sterile swabs under
aseptic precautions and immediately transported to microbiology laboratory for culture and
sensitivity.
Results: Most of the patients belonged to the age group of 21-25 years, contributing to 55%
of the cases. Majority of the women are from rural areas (71%). 57% of the cases were
unbooked. 90% of the SSI were seen in emergency surgeries and 10% in elective surgeries.
Anaemia (48%) was the most common medical risk factor followed by hypertensive disorders
25%. The risk of post-operative infection has been found to be proportional to volume of
blood loss during cesarean section and duration of surgery. Staphylococcus aureus was found
to be predominant organism of wound infection of which 21% were MRSA followed by
Klebsiella and E. coli.
Conclusions: Proper assessment of risk factors that predispose to SSI is critical for the
development of strategies for reducing the incidence of SSI and for identifying high risk
patients requiring intensive postoperative surveillance. We can conclude that reduction in
intraoperative blood loss and duration of surgery can reduce the incidence of Postoperative
infections. Also Pre-operative antibiotics should not be made mandatory in all lower segment
caesarean section as no significant difference has been found in the infection rate in spite of
giving preoperative antibiotics.

Electrophysiological studies revealed that Esmolol causes an increase in sinus cycle length
and sinus node recovery time. Electrocardiographic parameters like 'PR' 'QRS' and 'QT'
intervals were not prolonged. In contrast to other beta blockers, electrophysiological values
return to baseline values within a period of 30 minutes after withdrawing the drug. When
infused at a dose of 200 micrograms/kg/minute, Esmolol can significantly reduce the namely,
resting heart rate, Systolic blood pressure, rate pressure product, cardiac index. Esmolol can
also attenuate isoprenaline induced tachycardia. After obtaining clearance from the
Institutional Ethical Committee and informed written consent, a prospective randomized
double-blinded study was conducted on sixty patients scheduled for various elective surgical
procedures belonging to patients physical status American Society of Anesthesiologists
(ASA) Classes I and II were included in the study. In esmolol group the basal heart rate was
97.8bpm. During reversal heart rate increased to 102.7bpm. During drug injection and
subsequently heart rate decreased as shown in table. At 15min post extubation heart rate was
84.6bpm which was less than basal.
In labetalol group the basal heart rate was 97.5bpm. During reversal heart rate increased to
103.1bpm. During drug injection and subsequently heart rate decreased as shown in table. At
15min post extubation heart rate was 69.9bpm which was much less than basal.

Complications after trachea extubation are three times more common than complications occurring
during tracheal intubation and induction of anaesthesia. Hypertension and tachycardia are well
documented events during extubation. These hemodynamic responses reflects sympatho-adrenal reflex
stimulation (epipharyngeal and laryngo pharyngeal stimulation) with concomitant increase in plasma
level of catecholamines and activation of alpha and beta adrenergic receptors. A routine preanesthetic
examination was conducted assessing the general condition of the patients on the evening before
surgery. From all patients, informed consent was obtained. All patients were kept nil per oral for 8 h.
On arrival in the operating room, i.v. line was established, and fluid dextrose with normal saline was
started. Patients were connected to multichannel monitor which records HR, noninvasive blood
pressure, end-tidal carbon dioxide, and oxygen saturation. Statistical evaluation between the group
showed there was no significance of SBP between the group at basal, extubation upto 1th minute post
extubation (p>0.05). At 2th min (p=0.034), 3rd min (p-0.023) and 15th min (p=0.024) post extubation
there was significance esmolol> labetalol at 2nd and 3rd, labetalol >esmolol at 15th min.

Background: Distal tibial fractures are one of the most complex injuries around the ankle joint, accounting for approximately 7% of all tibial fractures. Fractures of the distal tibial metaphysis with or without intra-articular extension can present a management challenge because of their inherent instability, scarcity of soft tissues, subcutaneous nature and poor vascularity of bone
Methods: This was a retrospective study of 30 patients to evaluate the functional and radiological results of Locking Compression Plate (LCP) osteosynthesis in distal tibial fractures using Minimal Invasive Percutaneous Plate Osteosynthesis Technique (MIPPO) .
Results: There were 30 patients in the study including 10 males and 20 female of mean age 45 years. The mean follow up period of our patients varied ranging from 10 months to 24 months (average– 18 months). All fractures united at an average of 18 weeks (range- 16 to 24 weeks) except two cases of delayed union(>20 weeks) .There were 2 superficial wound infections  and one case of deep infection which were treated with oral antibiotics and progressed to union and there were no failures of implant.  No other complications like deformities, compartment syndrome, non-union, implant irritation/skin impingement or implant failure were seen in our study. There was full range of motion patient except for two patients with restriction of plantar flexion. Two patients had mild pain on walking. 
Conclusions: The above study shows that MIPO technique is a safe, effective method to treat distal third tibia fractures with good radiological and functional outcome . The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections

Background: Vaginal discharge is one of the commonest problems faced by women. Syndromic management is a benchmark in management of vaginal discharge.
Objectives:
1. To evaluate the efficacy and tolerance of one day combination kit therapy in syndromic management of vaginal discharge in present scenario.
2. To find etiological cause in patients who do not resolve from vaginal discharge after 14 days.
Material and Methods: It was a prospective study done on 100 women in gynaecological opd of a tertiary hospital for a period of 3 months. Patients were evaluated before and after single day AFS kit therapy.
Results: There was excellent response in vaginal discharge(90%). Urinary symptoms and pruritus vulva improved by 80% and 50% respectively. 84% patients had good tolerance and only 2% patients had bad tolerance. 19% patients had Persistent vaginal discharge(PVD) which were due to infectious(42.1%) and non-infectious(57.9%) etiology. Out of these 31.5% had candida albicans, 10.5% had bacterial vaginosis, 15.7% had cervical erosion, 5.2% had cervical polyp and in 37.1% cases no etiology was found.
Conclusion: Combination kits are effective, well tolerable and given in single dose orally in reducing vaginal discharge, pruritus vulva and even urinary symptoms. Persistent vaginal discharge is due to candida and bacterial vaginosis (infectious) and cervical erosion, polyps and unknown cause(non-infectious).

Background: Systemic inflammatory activity has turned out to play a key pathogenic role in vascular atherosclerosis, insulin resistance, and type 2 diabetes mellitus. Inflammatory biomarkers may therefore be a valuable tool for risk evaluation. Among them, the best evidence to date supports the use of high-sensitivity C-reactive protein (hs-CRP) to monitor insulin resistance and cardiovascular risk in diabetic and nondiabetic individuals.
Aims and Objectives: To assess the relation of symptomatic peripheral arterial disease and high sensitivity c-reactive protein in known type 2 diabetes patients and to study the passive smoking as an additional risk factor for peripheral vasculopathy and elevated high sensitivity c-reactive protein.
Materials and Methods: A cross sectional, case-control study conducted on patients with (100 cases) or without (100 controls) type 2 diabetes. The data regarding detailed history, physical examination, Brachial and ankle systolic blood pressures and Routine investigations were recorded, tabulated and statistically analyzed using appropriate statistical tools.
Result: The prevalence of low ABI was significantly higher in diabetics (16%) in comparison with non-diabetic controls (4%) (p<0.05). PAD was more common among women (11.2%) compared to men (6.8%). The mean hsCRP for the study group was 6.51 ± 1.02 significantly higher than the control group 1.74 ± 0.78 (p<0.05).
Conclusions: Changes in CRP levels provide cardiovascular risk prediction, and may be useful to refine cardiovascular risk stratification in high-risk patients with type 2 diabetes mellitus.

Background: -Aging is a biological process often accompanied by debility, disease and death. In India, anyone who is above 60 years is considered as geriatric patients whereas in western world attainment of age above 65 years is considered as aged people. Elderly patients are frail with reduced physiological capacity and often suffer from multiple co-morbidities constituting this group the most vulnerable and high-risk groups in terms of health and their health seeking behaviour. Even acute illness in elderly manifests in a non-specific way.  
Aims and objective: - The objective of study aims to find out morbidity pattern among elderly population aged 60 years and above.
Methods and material: - A cross-sectional observational study was conducted on 200 elderly patients admitted in general medicine department or attending general medicine OPD. The study duration was of one year. Patients above 60 years of age were selected as per inclusion and exclusion criteria and were subjected for detailed history, clinical examination and investigations.  
Result - We included 200 cases for this study. Age ranges from 60 to 91 with male to female ratio 1.56. Maximum cases were in the age group of 70-79 followed by 60-69, 80-89 and >90. Most common symptom was weakness (48.5%) followed by dyspnoea (36.5%), body ache/joint pain (27.5%), fever
(24%), loss of appetite (20%) etc. Most common diagnosis was hypertension (50.5%) followed by diabetes mellitus (38.5%), electrolyte imbalance (27%), anaemia (25.5%), COPD (23%), renal failure (15.5%), CAD (13%), LRTI (12%), osteoarthritis (11.5%),BPH (10%), CHF (8.5%), etc. Maximum patients were having 3 morbidity (30.5%) followed by 2(26%), 4 or more than 4(24%) and 1(19.5%). 
Conclusion: - Geriatric population is rapidly increasing with multmorbidity in majority. Non-communicable disease is highly prevalent but communicable disease remains an important cause of admission.  

Newborns have unique anatomy and physiology, the presentation of which is relatively an unexplored territory to Orthopaedic surgeons and hence is a matter of concern. Due to limited literature and records available about the same, it raises a platform for further research and study.
This study aims to estimate the magnitude of musculoskeletal deformity among the newborns by evaluating the hospital incidence of musculoskeletal birth deformity and enumerate different musculoskeletal deformities and report it as proportion.
This is a prospective observatory study done in a tertiary care hospital of south India for a period of two years. All the live births born, routinely screened by the department of Paediatrics were referred to the Department of Orthopaedics in case of underlying musculoskeletal deformity. Whereas all the dead births born (inclusive of intra-uterine demises, still-births, and abortions) with any involvement of the musculoskeletal system in the antenatal ultra-sonographic foetal scan were notified to the Department of Orthopaedics. A thorough physical examination was conducted on all the referrals. Data was recorded, compiled, tabulated and analysed.
A total of 5837 new births were screened for musculoskeletal birth deformity which were inclusive of 5668 live births born and 169 dead births born. Overall hospital incidence of musculoskeletal birth deformity in our study was 9.25 per 1000 births (54 cases) and 5.46 per live births (31 cases). Club foot was the most common defect overall (17 cases/ 31.5%) and among the live births whereas spina bifida was the second (16 cases/ 29.6%) and most common among dead births.
The magnitude of musculoskeletal birth deformity is not as low as to be ignored by Orthopaedics surgeons. Few more studies will help in increasing the awareness of common deformity among the doctors thereby reducing the morbidities of musculoskeletal birth deformity by early diagnosis and apt treatment.

Background: Few of the studies advocate that cigarette smoking is highly associated with the development of hearing loss both Conductive and Sensorineural type. However, comprehensive audiological evaluation on smokers has been scarce. Thus there is an extremely important need to assess the hearing status in smokers and to view pathophysiology of auditory system in greater detail.
Objectives: To study the incidence of hearing loss in rural population by pure tone audiometry and to study the effect of smoking on hearing loss.
Methodology:, This is Cross sectional study 500 people fulfilling Inclusion/Exclusion criteria who gave their consent  were included in the study. The population included in the study was from the rural area of various age groups in Hoskote and were screened for hearing loss. Their detailed history was taken and those having ENT disease, head injury, history of ototoxic medication intake, history of noise exposure were excluded from the study. The technique of pure tone audiometry is the based on ASHA method. All the individuals were subjected to DPOAE screening.
Conclusion: In our study, mild sensorineural hearing loss was more significant in smokers. Cigarette smoking is clearly evident to effect on cochlear which was measured through a decreased response in distortion product otoacoustic emissions ( DPOAE).

Background: Tuberculosis (TB) is an air borne communicable disease caused by bacteria named Mycobacterium tuberculosis that is spread through the air from person to person. The TB bacteria are expelled in the air when a person with TB disease coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. If TB bacteria become active in the body and multiply, the person will progress from latent to active TB disease. Infection is most likely to occur when an individual is exposed to someone with TB disease on a day-to-day basis, such as by living or working in close quarters with someone who has the active disease.
Methodology: The descriptive longitudinal study was conducted among 600 HCWs at Jawahar lal Nehru medical college and Hospital, Bhagalpur. (oct 2018 to feb -2020). The data was collected by administering TB screening questionnaire (Annexure 2). Separate written informed consent was obtained for performing the tuberculin skin test (TST). Following this each study participant was administered the TST. Each subject was reviewed between 48 hours to 72 hours of the TST to read the reaction. All the subjects who gave negative TST reaction were followed up after one year.  
Conclusion: Prevalence of latent TB infection was 20.1% and it was significantly associated with age, place of residence, education, work commute time and mode of  transport. Incidence of latent TB infection was 19.4% and it was significantly associated with gender, place of residence education, work commute time and marital status. Study subjects working in laundry department, especially those who came in contact with patients while collecting linens, housekeeping workers and pharmacy workers who dispense drugs at the counter were at higher risk of developing TB infection.

Background: India is a land of diverse cultures and traditions. Infant feeding and rearing practices vary across communities, depending on social customs, traditional beliefs, literacy and socio-economic status of the family. These practices at times are not of any benefit to the newborn and can be harmful. Despite its rapid economic growth, India’s poor ranking in terms of infant mortality can be correlated to these factors influencing child feeding and rearing practices.
Methods: The study was conducted in three urban health training centers (UHTCs) which were selected by simple random sampling out of eight in Bhagalpur city. All the multiparous women who were in postnatal period were included in the study till sample size was reached. Data was collected after informed consent using pre-tested semi-structured questionnaire and analyzed in SPSS.
Results: Out of 200 mothers, 69% of the mothers had initiated breastfeeding within standard norms and 28.5% had given pre-lacteal feeds to their babies which was significantly associated with religion and type of family of the mothers. Majority of the mothers (95.5%) had given colostrum and its association with type of family was significant. Majority of them (80.1%) had breastfed their baby on demand.
Conclusion: In spite of educational messages by health professionals, certain feeding practices are found unsatisfactory and certain harmful rearing practices are still prevalent in the community. This necessitates additional focus by the policy makers towards maternal and child health to ensure the needs to be fulfilled and to impose certain regulations against prevalent harmful practices in the community.

Background: Foreign bodies in aero-digestive tract are paediatric emergencies contributing to high morbidity and mortality requiring early prompt diagnosis and treatment. Most commonly seen in children. They comprise one of the preventable causes of accidental death in children. Methods: The analysis is based on prospective study undertaken on 94 patients who came with history or features suggestive of foreign body ingestion or inhalation to Causality , Paediatric OPD and ENT OPD of Darbhanga medical college and Hospital, Laheriasarai. Study duration of  two years. A detailed history, clinical examination, investigations like blood examination and radiology findings were recorded in a printed preformed questionnaire. Bronchoscopy / Endoscopy findings and outcome were also recorded for each patient.
Conclusion: Foreign bodies in the aero digestive tract are life threatening paediatric emergencies. Measure should be taken to prevent these accidents by, instructing parents to abstain from feeding dry fruits, nuts, and seeds to their children. Parents and care givers should be trained to treat choking episodes in children. Early diagnosis and treatment helps to reduce complications and mortality.

Background: The extensor compartment of the arm is occupied by triceps muscle, through which runs the radial nerve and profunda brachii artery. Triceps arises by three heads namely long head, lateral head and medial head. Triceps is innervated by radial nerve (C6, C7 and C8) with separate branches for each head. Triceps muscle and its main motor nerve namely the radial nerve have multiple connection modalities. Each of the motor branches to triceps might be used as a donor for nerve transplantation.
Methods: The present study was performed on 52 upper limbs of 26 formalin embalmed cadavers from department of anatomy, Nalanda medical college and Hospital, Patna. And helps of other medical college, Patna.  Study duration of two years. The   nerve supply to each head of triceps was traced and carefully followed to the source of each nerve branch and noted. Results: Present study of innervation of three heads of triceps brachii showed that motor branch of long head of triceps brachii was supplied by radial nerve in 82.6%, axillary nerve in 13.4% and by posterior cord in 04% of the limbs dissected. The lateral head of triceps brachii was supplied by radial nerve in spiral groove in all the cases. The medial head of triceps brachii was supplied by radial nerve in spiral groove in all cases and additionally even by ulnar collateral branch of radial nerve in 92.6% of the cases.
Conclusion: Gross anatomical knowledge of innervations pattern of triceps brachii and variations of its motor supply are important to medical personnel especially to orthopaedic surgeons, radiologists, neurophysicians and physiotherapists for surgical treatment of traumatic nerve injuries, nerve grafting, neurophysiologic evaluation to diagnose peripheral neuropathy. 

Background: Allergic conjunctivitis and dry eye disease are major ocular surface disorders affecting millions of people interfering with their quality of life. These diseases can occur simultaneously or independently of each other. The symptoms are non-specific of any type of ocular disease.
Methods: This Study was carried out in SKMCH, Muzaffarpur. Study duration of Fifteen  months. on the subjects who attended the outpatient department of Ophthalmology. This was an observational study of 100 cases of allergic conjunctival disease after informed consent which satisfied the inclusion and exclusion criteria. Based on novel scoring system (NSS), the severity of allergic conjunctival disease was graded as mild, moderate and severe.
Conclusion: We conclude that for the effective management of allergic conjunctivitis, we should always consider treatment of dry eye as well.

Background: Common gait patterns in cerebral palsy are equinus, scissoring, jumping, stiff knee, and crouch. Crouch gait is a very resistant condition, it increases the energy costs of walking and can lead to further joint pain and degeneration if not managed. Hamstrings muscle-tendon lengthening is a standard surgical procedure for the correction of crouch or knee flexion deformity.
Aim of the Study: To compare the efficacy of rehabilitative surgery with conservative management (Medication, exercise, orthosis, gait training)
Materials and Methods: 15 patients in each group are taken. 30 limbs of 15 patients were operated. All patients (study or control) were accessed for any decrease in popliteal angle and improvement of balance at 6 weeks, 6 months, and 1 year on the four-point ordinal scale after surgery and conservative management.
Result: In all surgical patient improvement in popliteal angle was noted but only 25% of patients in the control group achieved improvement by one scale (poor to fair) at 1-year follow-up. 60% of patients showed improvement in balance whereas 33.3% of control group patients improved from poor to fair and after 1-year follow-up.
Conclusion: Fractional hamstring lengthening is a relatively easily done surgical procedure that results in improvement of popliteal angle as well as balance as compared to the routine conservative management.

Introduction: Health professionals deal with human life and have to perform many functions at a single point of time like taking care of the patients, teaching medical students and have various administrative responsibilities as well, along with the responsibilities of their own family. Lack of motivation at any level of this health profession hierarchy can affect their performance and directly or indirectly affect the patients as well. Hence, this study is planned to identify the factors that exactly motivate doctors in a Government Tertiary care hospital.
Materials and Methods: The study was carried out in a Government Tertiary care Hospital and Medical College of Chhattisgarh from Jan 2019 – March 2019 on 100 doctors who voluntarily participated in the study. A preformed and pretested proforma was used to interview the Doctors which inquired about their socio-demographic details and Work Motivation Scale by Udai Pareek (2002) was used to assess and identify intrinsic and extrinsic motivation factors of the Doctors. Data was analysed using Microsoft excel and Statistical analysis was done by percentages and T-test. Statistical significance of differences between group means was tested. The p-value Results: The mean age of doctors was 37 ± 6.01 years. Professional growth, an intrinsic factor was ranked higher (mean score 13.98) by majority of doctors. Salary and job security and benefits were the extrinsic factors that were ranked higher by majority of the doctors (mean score 17.28, 16.32 and 15.78 respectively). The mean score of Extrinsic motivating factors was significantly more than that of the Intrinsic motivating factors. (t value 21.11, p<0.001, significant).
Conclusion: The main motivating factors for the health workers in this tertiary care hospital and medical college sample were, salary, job security, benefits, professional growth and working environment.

Background: Relaparotomy (RELAP) after caesarean section is a serious complication and is associated with maternal morbidity and mortality. The data of re-laparotomy after caesarean section is limited. So in the present study, we will evaluate the risk factors and outcome of relaparotomy after cesarean section in our study population.
Objective: To identify the risk factors and complications and outcomes associated with re- laparotomy after caesarean section.
Materials and Methods: It is a retrospective study, a total of 16 relaparotomy cases were included in this study. Data such as age, parity, period of gestation, comorbidities, indication for C-section and relaparotomy, a procedure during relaparotomy and the interval between two surgeries are recorded. Using SPSS software statistical analysis is done.
Results: Incidence of re-laparotomy is found to be 0.25% and the mean age was found to be 25.5±4.2 years with 37.5% primigravidae. The Major indication for C-section and Relaparotomy was Placenta previa (37.5%) and hemoperitoneum (37.5%). The mean time interval between C-section and relaparotomy was 6.8 ± 1.2 days and the major procedure done during relaparotomy is tension suture (31.25%). The rate of recovery and maternal death was found to be 93.8% and 6.3% respectively.
Conclusion: Caesarian section will be done due to clinical complications in delivery. After C-section, women are treated conservatively, but in some cases, there is a need for relaparotomy. It will be performed when the patient’s condition is too critical. Relaparotomy is a life-saving procedure to save the life of patients. Proper care should be taken during primary and secondary surgery to prevent postoperative infection and other complications which will decrease the clinical complication and mortality rate.

Background: Ectopic pregnancy (EP) is a life threatening emergency commonly being
managed by primary care physicians where diagnosis is often being missed at the first
contact.
Objectives: To study the etiological factors, clinical presentation and maternal outcome of
cases of ectopic pregnancy.
Materials and Methods: This cross-sectional study was done among 50 confirmed cases of
ectopic pregnancy at department of obstetrics & Gynecology in Government Medical College
and Hospital, Latur, Maharashtra during October 2013 to September 2015. Data collection
was done after ethical permission from institutional ethical committee and informed consent
of clients. Inclusion criteria: All confirmed cases of ectopic pregnancy Exclusion criteria: All
cases of intrauterine pregnancies.
Results: Highest number of participants (34%) belonged to 26-30 years age group and mean
age was 27 years. Maximum participants (70%) were multipara. Present study noted 16%
misdiagnosed cases of EP. Most common site of EP was noted at ampulla (68%). Tubectomy
was the most common risk factor (28%), ‘amenorrhea (80%)’ was the most common clinical
feature. Blood transfusion required in 78% cases and post-op wound infection in 12% cases.
Conclusion: The rising number of cases of EP poses a serious concern over maternal
mortality. With advances in the field of medicine, more young women are adopting newer
fertility control methods such as newer oral contraceptives, infrastructure contraceptive
devices and various tubal surgeries to limit their families. Moreover, newer drugs for
ovulation induction and tubal reconstructive surgeries have led to delayed conception with
increased risk of EP.

As a common entity, throat pain or sore throat is related chiefly to various infective
pathologies, viral (lately COVID), bacterial or fungal. When these are treated with no relief
for the same, endoscopic procedures and imaging modalities like USG, CT Scan, MRI etc.
are ordered to detect the occult diagnosis .Our study included 51 participants, 20 females and
31 males, primarily complaining of throat pain with few other mild symptoms. Here we
discuss not so commonly thought of entities pertaining to head and neck pathologies and few
thoracoabdominal lesions detected by various imaging modes like MRI,CT and virtual
endoscopy, Endoscopy, USG and X Ray Barium studies. Anatomic variants to potentially
serious diseases were reported. A strong clinical suspicion and customized mode of imaging
assisted in arriving to a definitive diagnosis.

Introduction: Physical and mental health have a bidirectional relationship that influences
one another. Several clinical studies have shown that metabolism and emotional state may
share comparable pathways. Although metabolic syndrome and mood disorders often
manifest themselves in adulthood, the likelihood of acquiring these illnesses is influenced by
social and economic conditions in childhood, such as childhood maltreatment, neglect, and
family dysfunctions.
Aim and objectives: To examine the association between childhood adversity and
components of metabolic syndrome in patients with mood disorders and to test whether
specific types of childhood adversity and type of mood disorder interact to worsen metabolic
outcomes.

Background: Bipolar vessel sealing systems (BVSS) are accepted to be safe and efficacious
with possible advantages over conventional methods, namely fewer requirement of postoperative
analgesics, less blood loss, shorter operative time and minimum hospital stay.
Objectives: To compare the efficacy and safety between use of BiClamp (Bipolar
Coagulation Forceps) in Vaginal Hysterectomy and Conventional Vaginal Hysterectomy.
Materials and Methods: This prospective study was done among 80 cases indicating
hysterectomy for benign diseases admitted in OBGY unit were selected randomly out of
which 40 cases underwent Conventional Vaginal Hysterectomy and 40 cases underwent
BiClamp Vaginal Hysterectomy at department of obstetrics & Gynecology in Government
medical college and hospital, Latur during November 2012 to September 2014.
Results: Mean duration of hospital stay required for participants of cases and control group
was 2.6 days and 4.2 days respectively (p<0.05). Mean duration of operation of cases and
control group participants was 70.9 min and 75.5 min respectively (p<0.05). Mean blood loss
during operation noted among the cases and control group participants was 90.1 ml and 115.9
ml respectively (p<0.05). During operation, three suture material required in in 0.0%
participants of cases group and 82.5% of control group respectively (p<0.05). Post- op
complications like fever, bladder injury, bowel injury & hemorrhage noted only in
participants of control group.
Conclusion: BiClamp Vaginal Hysterectomy post-operative pain was less, intraoperative
blood loss was less, operative time was significantly shorter, duration of hospital stay was
less and BiClamp Vaginal Hysterectomy was more Cost effective than the Conventional
Vaginal Hysterectomy

Introduction: The chronic non-healing wound infections are generally identified with the presence of bacteria in the wounds. Bacterial presence in the wounds is associated with poor healing. Chronic wounds, with their polymicrobial nature, put a significant burden on health budgets worldwide.
 
Aim of the study: The present study was conducted to isolate and identify the bacterial flora along with antibiotic sensitivity profiling of the pathogenic isolates against routine antibiotics from patients with chronic non-healing wound infection sat HNB Base Hospital, Srinagar, Garhwal.
 
Materials & Methodology: A total of 102 specimens (pus, wound exudates, or tissue biopsy) from patients (including 56males and46 females) having chronic non-healing wound infections were studied. Sample collection, Isolation and biochemical identification of aerobic bacteria followed by antibiotic sensitivity profiling of the pathogenic isolates were done using standard protocols.
 
Result & Conclusion of the study: Staphylococcus aureus were the most prevalent bacteria with 24.6 % of all the isolates. Next to these were Coagulase-negative Staphylococci (CONS) with 11.7% followed by Escherichia coli (9.7%), Enterococcus (8.4%), Klebsiella (8.4%), Acinetobacter (6.5%), Micrococci (6.5%), Diphtheroids (5.8%), Citrobacter (3.9%), Pseudomonas (3.9%) (P. aeruginosa were 66.6%, and 33.3% were P. fluorescens), Neisseria (3.2%), Proteus (3.2%), Streptococci (2.6%) (All were S. pyogenes) and Enterobacter (1.2%). Antibiotic sensitivity profiles of Gram-negative bacterial isolates revealed Acinetobacter and Klebsiella being the most resistant pathogens followed by Enterobacter, Citrobacter, Pseudomonas, E. coli, and Proteus. Antibiotic sensitivity profiles of Gram-positive bacterial isolates revealed Enterococcus and CONS being the most resistant pathogens followed by Streptococci and Staphylococcus aureus.
 791

This study aims to equip health professionals with essential directions for their practice and
research in fatty liver disease. In fatty liver disease, excess fat is accumulated in the liver
cells, and it mainly has two types: Alcoholic Fatty Liver Disease (AFLD) and Non-Alcoholic
Fatty Liver Disease (NAFLD). AFLD is widely accepted to be associated with excessive
alcohol consumption. However, in NAFLD's case, although the name acknowledges that it is
not associated with excessive alcohol consumption, the exact cause of NAFLD remains
ambiguous. Furthermore, for almost four decades, without specialised treatments and
prevention strategies, NAFLD has constantly increased, affecting more than a quarter of the
world's population. Meanwhile, although the current dietary recommendations for NAFLD
patients orbit around the conventional High-Carbohydrate Low-Fat diets, mounting evidence
advocates the broader benefits of Low-Carbohydrate High-Fat (LCHF) diets in this regard.
Therefore, focusing on the databases such as PubMed, Cochrane Library, and Google
Scholar, the authors have carried out an advanced literature search reporting on the efficacy
of LCHF diets on NAFLD. After a comprehensive search—using appropriate "keywords and
Boolean operators" and "inclusion & exclusion criteria"—the authors selected a potentially
relevant set of existing peer-reviewed articles for this narrative review. After critically
investigating the LCHF-NAFLD theme, the authors found that LCHF diets may significantly
decrease liver fat and may even reverse the disease by targeting the key causes of hepatic fat
storage, i.e., high insulin levels, excessive calorie consumption (mainly from carbohydrates),
and excessive consumption of refined carbohydrates. Additionally, LCHF diets may provide
a comprehensive health benefit beyond liver health. The authors conclude that the LCHFNAFLD
theme represents a rich vein of research opportunities. The authors encourage and
call researchers, doctors, nutritionists, dieticians, and related-health professionals to engage
more with the LCHF-NAFLD theme.

Background: The ACTT-1 trial showed that the median time to recovery was 10 days in the
remdesivir group compared to 15 days in the placebo group. However, remdesivir failed to
provide a survival benefit. This study puts in an effort to find the difference in biochemical
and other parameters in patients treated with remdesivir vs. without the remdesivir in mildmoderate
covid 19 patients.
Aims and Objectives: To study the biochemical and other parameters in patients treated with
remdesivir vs. without the remdesivir in mild-moderate covid 19 patients.
Materials and Methods: This study was done in the Department of Pharmacology,
Kanachur Institute of Medical Sciences, Mangalore. This study was done from May 2020 to
June 2021. The study was done in 30 patients who were treated with remdesivir and thirty
without.
Results: There is significant difference between the remdesivir used group when compared to
the unused group.
Conclusion: It may be useful in mild to moderate cases.

Background: The effects of Vitamin D on bone metabolism and calcium homeostasis have
already been well recognized. Emerging evidence has implicated Vitamin D as a critical
regulator of immunity, playing a role in both the innate and cell-mediated immune systems.
Emerging evidence has implicated Vitamin D as a critical regulator of immunity, playing a
role in both the innate and cell-mediated immune systems. Vitamin D deficiency has been
found to be associated with several immune-mediated diseases, susceptibility to infection and
cancer. Further elucidation of the role of Vitamin D in lung development and immune system
function may hold profound implications for the prevention and treatment of asthma.
Objective: To study the Vitamin D Status of children having severe pneumonia and to know
if there is any relation between Vitamin D levels and severe pneumonia.
Methodology: The present prospective study was conducted by the department of Pediatrics
at SCBMCH & SVVPGIP, Cuttack from October 2013 to October 2015 among the children
with the age group of 1 to 5 years of age who were admitted in the department with
complains of Pneumonia. A total of 80 children who were having severe and very severe
pneumonia diagnosed based on WHO ARI (acute respiratory tract infection) criteria admitted
to the SCBMCH & SVVPGIP (General, Pay ward & PICU) in the age group of 1 to 5 years.
Results: In this study, we found that 50% of the children among cases had vitamin D levels
in the deficiency range while 41.3% and in the insufficiency group while we had 8.8% of the
children in the sufficiency group as compared to the healthy controls 20(71.4%) among 28
belongs to sufficient age group, 5(17.9%) to insufficient group and 3(10.7%) to the deficient
group. One significant finding in this study was that out of the 27 children in the sufficiency
group none of them were there in the very severe pneumonia group which suggests as the
Vitamin D levels Increases the severity of the condition decreases.
Conclusion: In this study, we found that Vitamin D levels were related to severity of the
disease as there were no children in the sufficiency group having very severe pneumonia.
Hence we can say as the levels of Vitamin D falls the severity of pneumonia Increases.

Context: Beta Thalassemia major is a genetic disease with an autosomal recessive pattern of
inheritance that occurs as a result of disorder in haemoglobin synthesis. In Beta Thalassaemia
major patients multiple blood transfusions, ineffective erythropoiesis and increased
gastrointestinal iron absorption lead to iron overload in the body. Iron overload can be
determined by Serum Ferritin measurement.
Aim and Objectives
1. To Assess the average frequency of blood transfusion in Beta Thalassemia Major patients
2. To measure Serum Ferritin level in Beta thalassemia Major patients
3. To determine the association between Serum ferritin level and age, average frequency of
blood transfusion in Beta Thalassemia Major Patients.
Methods and Material: Fifty blood samples of clinically diagnosed Beta Thalassemia major
patients were collected for estimation of Serum Ferritin levels. Serum Ferritin measurement
was performed using indirect enzyme linked immune sorbent based assay kit. Data were
analysed to determine association between Serum Ferritin and age, gender and frequency of
blood transfusion.
Statistical analysis used: Descriptive statistics, Regression, Correlation
Results: The mean Serum Ferritin level was found to be 3639.75 mg/ml. Five patients had
Serum Ferritin <1000 mg/ml, Twenty three patients had Serum Ferritin between 1000-3500
mg/ml and twenty two patients had Serum Ferritin >3500 mg/ml.
Conclusion: The study showed high levels of Serum Ferritin in Beta Thalassemia major
patients. Serum Ferritin levels should be monitored regularly to assess the status of iron
overload and to rationalize the use of chelation therapy and avoid complications related to
iron overload.

Background: Diabetes mellitus is one of the leading cause of multisystem involvement
resulting in significant comorbidities. Various cardiac disorders such as dilated
cardiomyopathy, left ventricular diastolic dysfunction and myocardial infarction have been
frequently associated with diabetes mellitus. Present study was aimed to study cardiac comorbidities
in newly diagnosed type 2 diabetes mellitus patients with help of 2D
echocardiography.
Material and Methods: A prospective observational study was conducted in patients, 18-70
years, of either gender, newly diagnosed Diabetes mellitus type 2 based on Fasting blood
sugar/ Post prandial blood sugar/HbA1c, willing to participate in the study.
Results: Out of 175 patients, 74 patients belonged to age group 51-60, which is the most
commonly affected age group. Out of 175 patients, 109 (62%) patients were male and 66
(38%) patients were females. Most of the patients had HbA1c` in the range of 7-10%, 139
patients (79%), whereas the least number of patients were in the 6.5-7% group, 5 patients
(3%) Most of the patients had normal cardiac diastolic function, whereas only 15 (8%)
patients restrictive filling (grade 3 diastolic dysfunction). Grade 2 and 3 diastolic dysfunction
was more common in a higher age range i.e. 51-60 and >60 years whereas it was absent in
less than 40 year. Diastolic dysfunction was more common in patients having proteinuria
>200 mg/dl, higher serum cholesterol levels, hba1c levels > 10% and in patents having E/e’
ratio higher than 14. 47 patients were systolic dysfunction <50% with hba1c less than 10%,
whereas only 3 patients had EF <50% with hba1c >10%.
Conclusion: Cardiac diastolic dysfunction is observed in patients of diabetes mellitus 2 more
frequently as compared to systolic dysfunction.

Background: Diarrhoeal diseases which are one of the leading reasons behind global
mortality and morbidity is more threatening for infants and young children. Childhood
diarrhoea is becoming increasingly prevalent disease in developing countries like India.
Moreover, it is a major cause of malnutrition that contributes towards third major cause of
under 5 mortalities. This has raised a serious concern in the domain of public health.
Objective: The present study attempts to identify the prevalence of acute diarrhoeal diseases
in children below 5 years of age in Indian settings.
Methods: This community-based, cross-sectional epidemiological and single-center study
conducted in the rural field practice area attached to Department of Community Medicine of
Topiwala National Medical College, Mumbai, and Maharashtra, India from March 2017 to
February 2018 was aimed to identify the prevalence of acute diarrhoeal diseases in children
below 5 years of age in Indian settings. Ethics approval was obtained from Ethics Committee
for Academic Research Projects (ECARP). Research tools included a pre-structured
questionnaire. Baseline information of study area was taken from the Primary Health Centre.
Data was entered in Microsoft Excel spreadsheet to perform analysis.
Results: In our study, a total of 370 living children aged <12–59 months were included in the
analysis. Most of the children who belonged to in Class III socioeconomic status (61.4%),
affiliated to joint family (54.6%), belonged to Hindu religion (94.6%). Only 9.2% of mothers
were illiterate whereas remaining 91.8% mothers had completed at least primary education.
The prevalence of diarrhoea in children under 5 years of age was recorded as 20.5%.
Conclusion: The present study contributed to providing the prevalence of acute diarrhoeal
diseases in children below 5 years of age in Indian settings

Background: Diarrhea is widely recognized as a major cause of childhood morbidity and
mortality in many developing countries, particularly in India. According to World Health
Organization (WHO) report, diarrheal diseases are still leading causes of mortality and
morbidity in children under five years of age.
Objective: The present study attempts to estimate the association between maternal factors
and prevalence of Acute Diarrhoeal Diseases in children below 5 years of age in Indian
settings.
Methods: This community-based, cross-sectional epidemiological and single-center study
conducted in the rural field practice area attached to Department of Community Medicine of
Topiwala National Medical College, Mumbai, Maharashtra, India from March 2017 to
February 2018 was aimed to estimate the association between maternal factors and
prevalence of Acute Diarrhoeal Diseases in children below 5 years of age in Indian settings.
Ethics approval was obtained from Ethics Committee for Academic Research Projects
(ECARP). Research tools included a pre-structured questionnaire. Baseline information of
study area was taken from the Primary Health Centre. Data was entered in Microsoft Excel
spreadsheet to perform analysis.
Results: In our study, 340 mothers who used to take bath daily of which 61(17.9%) had
diarrhoeal episodes, whereas out of 30 mothers who do not take bath daily, 15(50%) had
diarrhoeal episodes. Further, 340 mothers of children who used to wash their hands daily
before the meals of which 58(15.8%) children had diarrhoeal episodes, whereas out of 30
mothers who did not wash their hands before meals, 18(60%) children had diarrhoeal
episodes
Conclusion: The present study indicated that maternal factors bear a significant impact on
morbidity caused by diarrhea.

Background: The new covid 19 strains having two mutations is highly infectious and the
ongoing disease has posed a huge threat to global public health, causing higher rates of
morbidities and mortalities. Keeping this in mind, this study is planned to understand the
causes leading to maternal mortality due to covid 19 infection in a tertiary care hospital
Mandya Institute of Medical Sciences, Mandya district, Karnataka, India.
Methods: A retrospective study was carried out on maternal mortality during the COVID 19
pandemic in MIMS, Mandya, and Karnataka. We collected records of MMR due to covid 19
occurred from the month of June 2020 to July 2021 over a period of one year.
Results: MMR from June 2020 to July 2021 is 0.034/lakh live births, majority were of the
age group 25 to 35 yrs., majority of the death occurred after 5 days from tested positive, all
belonged to moderate or severe category of covid 19 infection. Termination of pregnancy was
done in 7 cases i/v/o worsening symptoms, 2 were antenatal deaths, 2 post abortal, 5 deaths
were in postoperative period. Most cases were managed on oxygen initially, on Noninvasive
ventilation (NIV) and later on intubated. All cases were treated with Thromboprophylaxis,
nebulization, steroids, IV antibiotics and Remdesivir was given in four cases.
Conclusion: Maternal mortality was more during second wave of pandemic. Maternal
mortality was more among moderate and severe disease and nil among mild cases.
Unpreparedness among healthcare workers in managing severe cases was among the key
determining factors. Better team approach by physicians, intensivists, Obstetricians and
infrastructure might be helpful in preventing maternal mortality. Covid vaccination among
pregnant women and providing essential drugs and anticipation of worsening symptoms and
early intervention might be beneficial in preventing future mortality.

Background: Only 26% of women are using any method of family planning in the first year
postpartum. Studies indicates that unmet need for family planning in postpartum period is as
65% (USAID ACCCESS 2009). Recent studies estimate that prevention of unplanned and
unwanted pregnancies could help avert 20 – 35% of maternal deaths and as many as 20% of
infant deaths. Use of temporary contraceptives in our country is limited to 10.2% and that of
intrauterine contraceptive device (IUCD) is only1.8%. Post-Partum IUCD (PPIUCD) was
thus introduced in the National Family Planning Programme, India in 2009-10.
Methods: This is a Retrospective study conducted in department of obstetrics and
Gynaecology, Mandya Institute of Medical Sciences, Mandya. All deliveries during time
period from April 2018 to March 2021 were included in the study. Women accepting
PPIUCD were analysed with respect to age, parity, educational status, complaints (during the
follow up visits) and timing of insertion.
Results: Out of total 31,212 deliveries between April 2018 to March 2021.19,662. delivered
vaginally, 11,550 delivered by C section. 702 (2.24%) accepted PPIUCD as a method of
contraception. Intra cesarean insertion were 567 cases, Post placental insertion were 108
cases and immediate postpartum insertion 27 cases. 54% of users were of age group 20 -
25yrs, 53.8% were Primipara. Most common complication reported was bleeding PV in about
5. 9% and 6.4% discontinued PPIUCD due to sexual interference [2.99%] as the commonest
reason.
Conclusion: Less acceptance of PPIUCD services in our hospital reminds us to optimize
PPIUCD services by counseling pregnant women right from ANC visits. Education and
counseling can plays major role in acceptance and IUCD continuation rate. Obstetricians and
nursing staff should play a major role to dispel myths and misconceptions prevalent with
IUCDs.

According to WHO, Osteoporosis is second only to cardiovascular disease as a global
healthcare problem. International Osteoporosis Foundation (IOF) estimates that the annual
direct cost of treating osteoporosis fractures of people in the workplace in the USA, Canada
and Europe alone is approximately USD48 billion. The present study comprises of clinically,
diagnostically confirmed cases of Postmenopausal Osteoporosis both Diabetics and Non-
Diabetics and attending the orthopaedic unit of KLES Dr. Prabhakar Kore Hospital and
Medical Research Centre, Belagavi. All the cases were evaluated and selected by simple
random technique after fulfilling the selection criteria. The cases of Osteoporosis reported to
the Department of Orthopaedics unit of KLES Hospital and Medical Research Center were
screened. After finding the suitability as per selection criteria they were requested to
participate in the study and briefed about the nature of the study and interventions used. The
mean serum calcium for diabetics was 8.22±1.13 mg/dL and for non-diabetics was 8.4 ± 1.27
mg/Dl. The mean serum calcium levels were lower in Diabetics but was not statistically
significant (p=0.5564 for calcium).

Traditional treatment with closed reduction and application of plaster slab or cast is
inappropriate in the case of displaced supracondylar fractures of humerus as this method may
potentially lead to malunion & subsequent elbow deformity, as it is difficult to obtain
satisfactory reduction and to maintain the reduction due to distraction forces acting at the
elbow. Our study involved 40 children who had sustained displaced supracondylar fractures
(Gartland-Type III) who were treated in the Department of Orthopaedic at a Tertiary care
trauma center, between November 2018 to May 2020. 55% of our cases were in the age group
5-10 years, 60% were male & 40% female.
80% (n=32) of the cases had history of fall on outstretched hand, followed by 3% with fall on
flexed hand which is in concordance with the most common mode of injury established by
many studies. 70% of the cases had fracture of left supracondylar humerus as compared to
30% on the right side. 30 out 40 cases had postero-medial displacement of distal fragment &
remaining 10 cases had postero-lateral displacement.

Background: Acute stroke is one of the major cause of disability and death in India. Imaging
plays an important role in identification of cause and decision making in appropriate
treatment plan. The management of stroke differs in different types of stroke. Early diagnosis
aid in the effective management and thus reducing the disability and death. Hence the study
was undertaken to study the clinical and radiological features on the stroke patient at KRIMS
Hospital. Karwar Karnataka.
Methodology: This is a retrospective hospital based study of 250 stroke patients admitted in
a tertiary care hospital, at Karwar institute of medical sciences Karwar during a period of one
year from1st January 2020 to 31st December. A sample size of 250 stroke patients records
found in the record section analysed, considering clinical presentations and radiological
features as entered in the case records.
Results: Stoke incidence increased with increasing age after 50 years. Hemiplegia was the
most common clinical feature found in 132(52.8%) patients and males were predominant
(74.8%). 207(82.8%) had ischemic stroke and 43 (17.2%) had hemorrhagic stroke. Frontal
and parietal areas of brain were affected in both types.
Conclusion: Early identification of clinical features and radiologic features play an important
role in decision making for appropriate management protocol of stroke patients.

A study was conducted to compare blood loss, need for blood transfusion and complications
in drainage and non-drainage groups in primary total hip arthroplasty. Forty patients
undergoing total hip arthroplasty were randomly allocated into twenty patients in each of
drainage and non-drainage groups. All the operations were performed by one speciality
surgical team with same pre-intra operative and post-operative protocol. Haemoglobin,
volume of blood transfusion, superficial and deep infection and Harris hip score wer
eassesed. Blood loss (mean) in the drainage and non-drainage groups were 220.1 ml and
234.7 ml respectively. Hb levels were more in the non-drainage group on 1st, 3rd and 7th day,
but on day 7, they were not statistically significant. 10% of cases in non-drainage group
developed infection in which 5% are superficial and the other 5% are deep infections, 10% of
cases developed superficial infection in the drainage group. The incidence of superficial
infection was higher in non-drainage group, however there was no significant difference in
the length of the hospital stay. 3 (15%) patients needed blood transfusion in the drainage
group and 2 (10%) patients needed blood transfusion in the non-drainage group, mean
volumes were 1.6 units in drainage group and 1.5 units in non-drainage group respectively
and it’s not statistically significant.

Introduction: Anterior knee pain is one of the common problems in post primary total knee
arthroplasty patients. There are different methods of prevention of anterior knee pain post
total knee replacement. The objective of this study is to compare the efficacy of patellar
denervation using circumferential electrocautery versus non-denervation in relieving anterior
knee pain following primary total knee arthroplasty.
Methods: Forty patients were grouped randomly in to two groups of nineteen patients (Group
A) and twenty one patients (Group B) each. Patients in group A underwent patellar
denervation with electrocautery and group B patients didn’t undergo patellar denervation.
They were followed up at 2 weeks, 1, 2 and 3 months regularly and clinical score was
determined using knee society score and anterior knee grading system by waters and Bentley.
Results: There is no statistical difference in anterior knee pain score between the two groups.
Conclusion: Patellar denervation doesn’t reduce the anterior knee pain following primary
total knee arthroplasty and anterior knee pain was thought to be multifactorial.

Tuberculosis is a contagious bacterial infection which primarily affects the lung parenchyma
but it can affect any other part of the body. Mycobacterium tuberculosis complex is mainly
responsible for majority of cases in India and worldwide, but other species are also
responsible for causing tuberculosis among which includes M. bovis, M. africanum, M.
microti, M. Canetti. We retrospectively reviewed 40 patients of histologically or
microbiologically proven diagnosis of TB spondylitis from the time period of January 2020 to
October 2021 in the Radio-Diagnosis and Imaging Department of Pacific Medical College
and Hospital, Udaipur, Rajasthan, India. Findings such as cavitation, consolidation, tree in
bud opacities, miliary nodules are suggestive of pulmonary tuberculosis. Out of 5 patients
suffering from active pulmonary tuberculosis, cavitation was seen in 20% (1 patient) on chest
skiagram whereas 40% (2 patients) showed cavitation on HRCT chest. Consolidation was
seen in 60% (3 patients) on chest skiagram whereas it was seen in 80% (4 patients) on HRCT
chest.

SICH is caused by non-traumatic bleeding and the underlying causes such as arterial (large
and small vessel disease), venous diseases, vascular malformations and hemostatic disorders
must be further evaluated. In cases of TICH further evaluation of counter coup injuries,
presence of extradural hematoma and subdural hematoma must be looked for. Hence
differentiating between the two forms of ICH is important. Source of Data -patients
presenting to VIMS Neurosurgery department with either spontaneous or traumatic ICH and
posted for keyhole craniectomy were included as a part of the study over a period of 3 years
Aug 2017 to Aug 2021. The location of ICH in spontaneous ICH was most commonly
observed in basal ganglia region .The incidence of traumatic ICH was highest in temporal
region followed by frontal region with a few in parietal and occipital region. Though the
incidence of traumatic ICH was more common in our study it had a better outcome with death
being reported in only 2 out of 25 patients as opposed to spontaneous ICH in which 5 out of
15 patients succumbed .This may be attributed to the elderly age of presentation and presence
of comorbidities in spontaneous as opposed to traumatic ICH

Aims: To study the surgical outcome in paediatric patients presenting with spinal dysraphism
in our institution.
Materials and Method: 78 paediatric cases presented between 2014 to 2019 with
myelomeningocele to the neurosurgical OPD in Vijayanagara Institute of Medical Sciences,
Ballari which caters to mainly rural and semi urban population. Initial clinical assessment,
followed by operative work up was done. MRI Brain and spine was done as a prep operative
evaluation. Post-operative outcome was noted and Post-operative regular follow up after
discharge for at least 6 months.
Results: 78 patients were operated upon at our centre. The mean age of presentation of the
cases 5 months +/- 6 days, ranging from 8days to 24months. Post-operative average hospital
stay was 14 days. The mean post-operative follow up period was 36 months. Hydrocephalus
was associated with meningomyelocele in 30 cases, but VP shunting required in same sitting
in 9 cases only. Six patients found to have CSF leak and only 1 required reexploration and
Dural repair.
Conclusion: The clinical profile of patients presenting to us mirror the General profile across
India. Surgical outcomes at our center are on par with the standard results seen across the
country. Early and prompt surgical intervention is the key in management of spinal
dysraphism. The MOMS study comparing surgical outcomes with pre natal surgery shows
equivalent outcomes with post natal surgery

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

Background &Aim: Dual Mobility Total Hip Arthroplasty (DMTHA) is a reasonable
treatment option for osteonecrosis of femoral head (ONFH), especially in active young
patients who are at an increased risk of dislocation post-surgery. Moreover, lifestyle a
religious habits of Indian patients require extreme flexion and rotation, making DMTHA a
lucrative treatment option. The aim of our study is to evaluate the short-term results of
DMTHR for ONFH in the Indian population and their ability to resume their daily activities
after the surgery.
Material and Method: The study is a retrospective analysis of 23 DMTHA in 17 patients
who underwent DMTHA for ONFH between March 2018 to March 2020 and with a
minimum follow-up of one year. Patients were evaluated clinically using Harris Hip Score
(HHS) and Patient-Reported Outcome Measures (PROMs), such as the ability to squat and sit
cross-legged. Radiological evaluation was performed to detect implant migration, loosening,
periprosthetic osteolysis, or heterotrophic ossification.
Result: In our study, the mean age of patient was 36.7±9.1 years. The mean pre-operative
HHS scores of 53.8±15.4 improved to 97.0±4.2 at one year post-surgery. 94.1% patients in
our study could squat and sit cross-legged at a mean duration of 3.2 months post-surgery.
Conclusions: The use of DMTHA in Indian patients with ONFH showed good early clinical
and functional results without major complications, and simultaneously meeting their high
functional and cultural requirements

Background: The stress response to surgery is an unconscious response to tissue injury and
refers to autonomic, hormonal and metabolic changes that follow injury or trauma. Excessive
intraoperative stress evoked by surgical nociceptive stimulation may influence patient’s
outcome, length of hospital stay and overall costs of hospital care. Traditionally, clinical signs
like somatic or autonomic responses are used to evaluate whether analgesia is adequate. It has
been proved to be unreliable demonstrating low specificity. In the present study
hemodynamic changes are correlated with changes in surgical plethysmographic index (SPI)
and entropy at the time of stress.
Methods: A prospective non-randomised observational study was conducted in the patients
posted for elective laparoscopic cholecystectomy. Hundred ASA physical status I and II
patients aged between 18 to 60 years belonging to both the gender scheduled for elective
laparoscopic cholecystectomy were enrolled in the study.
Results: According to the correlation coefficient values SPI values are correlating with
changes in heart rate, systolic blood pressure and diastolic blood pressure at the time points of
5 min after intubation, 10 mins after intubation and before inflation. Entropy values does not
correlate with SPI as entropy indicates hypnosis level where as SPI is based on sympathetic
and parasympathetic stimulation. State entropy correlates with changes in systolic and
diastolic blood pressure at the time points of before inflation, 30 min after inflation and
deflation. However state and response entropy correlates with each
Other. Response entropy correlates with changes in systolic and diastolic blood pressure at
the time points of 5 mins after intubation and before inflation.

Heart rate variability (HRV) as a measurement of autonomic function assumes great clinical
importance. It is well known that particular patterns of body fat distribution increase coronary
heart disease risk both in adults & children. While frank obesity is associated with reduced
HRV, indicative of poorer autonomic nervous system (ANS) function, the association
between body mass index (BMI) and HRV is less clear. The dynamic autonomic responses
during exercise can be measured to give actionable information for training by analysis of the
ECG to determine heart rate variability. While application of HRV has been applied to
predict sudden cardiac death and diabetic neuropathy in assessing disease progression. The
study revealed the changes in HRV in resting condition and also after a single bout of sub
maximal treadmill exercise (50% of VO2 max.) among males and females in the age group of
17-25 years at rest and the correlations between the HRV parameters at rest and after the
exercise with BMI and WHR in the subjects. An observational cross sectional study was
conducted in the Physiology Department of R.G. Kar Medical College, Kolkata, India on 60
subjects (n=60) of both sexes (30 males and 30 females) in the 17-25 years age, participated
in this study. Their WHR and BMI were measured and HRV was recorded during rest and
immediately after exercise by digital Polyrite. Result showed that the HRV of male were
more than in female in resting condition. After submaximal exercise the HRV value of males
were more than their respective resting HRV values though it was not significant and in the
females, post-exercise HRV was significantly more than their respective resting HRV. This
study shows that females have higher parasympathetic activity than males. There is an
association between WHR and BMI and HRV in healthy female persons, which shows that
there is an increase in LF/HF(low frequency & high frequency) of values among males and
females after a single bout of sub-maximal exercise though not significant in case of males
but significant in case of females.

Background: Febrile seizures defined as seizures that occurs between the age of six and sixty
months, with a temperature of 38 degree C or higher, that are not the result of central nervous
system infection or any metabolic imbalance and that occur in the absence of a history of
prior afebrile seizures. A seizure is a transient occurrence of signs and/or symptoms resulting
from abnormal excessive or synchronous neuronal activity in the brain.
Objective: to assess the role of Magnesium and Calcium among Children with Febrile
Seizures in a tertiary care hospital. Methodology: The present Case Control Study was
conducted by the Department of pediatrics at Government multispecialty hospital, Sector-16,
Chandigarh from November 2015 to October 2016. A total of 50 Children in study age group
6 months to 5 years admitted in the pediatric ward who were satisfying the inclusion criteria
were included.
Results: In the present study the mean Serum Magnesium level was found to be 2.10+0.24
mg/dl among cases and among control the level was found to be 1.95+0.16 mg/dl. The
association was found to be statistically significant between two groups on comparing Mean
Serum Magnesium. In the present study on analyzing the mean serum calcium levels it was
found that among cases group nearly 90% of them had normal levels and 10% of them had
abnormal serum calcium levels and in the control group all the subjects had normal serum
calcium levels and the association between both the groups was found to be statistically
significant.
Conclusion: This study shows that serum magnesium levels are normal in children with
febrile seizures. It indicates that serum magnesium may not have a significant role in the
pathogenesis of febrile convulsions. Our study sample was not representative of entire
population because all children were mostly from surrounding urban area.

Background: Varicella-zoster virus (VZV) is known for causing two highly infectious diseases-Varicella (chickenpox) and Herpes Zoster (shingles). The reactivation of the varicella-zoster virus causes Herpes zoster, also called as shingles. In the contrast, Herpes zoster usually arises in adults or the elderly. This virus reactivates mainly due to failure of the immune defense system to control the latent replication of the virus.
Objective: To study the epidemiological and clinical features of herpes zoster taking place in kids below 12 years of age.
Methodology: This was an observational, descriptive and cross-sectional study. A total of 50 patients with herpes zoster were selected for the study. The study was conducted from April 2018 to March 2022 in department of dermatology and venereology at Government Medical College, Bharatpur in Rajasthan. The children till 12 years of age infected with herpes zoster were included in the study.
Results: A total of 50 patients were identified with herpes zoster were enrolled for the study. There were 28 (56.1%) boys and 22 (44.0%) girls. The ages range was one month to 12 years, the smallest subject being 1 month of age. Most of the subjects i.e. 42 (84%) exhibited no evidence of immuno-suppression on prior records, examination, and clinical investigations. Four subjects were anti-HCV positive, 2 were diagnosed with pulmonary tuberculosis, one subject was on medication of systemic corticosteroids for a chronic bullous illness of babyhood, and one patient was recently spotted with leukaemia disease.
Total 21 (42%) subjects showed thoracic dermatomal involvement, 14 (28%) subjects of cervical, 8(16%) of cranial (ophthalmic), and 6(12%) subjects of lumbar dermatomal involvement were found. Only one subject (2%) was found with dissemination.

Neuronal migrational disorders (NMD) offer a wide spectrum of disorders with specific diagnosis by CT and MRI of the brain. Most NMD are easily recognized on CT scans & MRI and offer little or no difficulty in their diagnosis (5, 6).
Through this article we propose to elucidate a subtle form of NMD by Non contrast CT scans of the brain. This subtle variety of NMD almost always escapes recognition on CT / MRI, always prompting a normal report on most occasions.
It is the purpose of this article to highlight the CT scan features of these nearly normal appearing images of NMD, which we propose to label as a subtle NMD (Subtle Neuronal Migrational Disorder).
30 CT scans of children ranging from 1 to 5 years were analysed retrospectively.
All had similar CT scan findings and identical clinical presentations.

Background: In accordance of forensic dentistry, every palatal rugae has a remarkable distinct pattern in every human, it can be applied as an identification tool.
Objective: The objective of the present study was to investigate palatal rugae patterns in dentulous and edentulous patients and evaluate the reliability of these patterns in human identification. Methodology: The study group was equally divided into 30 dentulous and 30 edentulous patients, respectively. A duly filled and signed consent form was attained from each participant. Alginate impression material is used for primary impressions in a perforated tray and dental stone (Type-3 Gypsum products) was used to develop a cast. The number, length and shape were recorded after analysing the rugae patterns. Statistical calculation done by using SPSS system. Results: The mean of the total number of rugae more in dentulous (7095 ± 1.393) than edentulous (5.99 ± 1.001) participant. Dentulous subjects shows more curved rugae patterns (2.98 ± 1.321), primary rugae (6.86 ± 1.287) and forwarded rugae (3.84 ± 1.801) while more straight rugae patterns (3.15 ± 1.44) and perpendicular rugae (2.64 ± 1.425) found in edentulous subjects. Conclusion: This study concludes that there is statistically significant variation in dentulous and edentulous participant in term of shape, number, size and direction.

Background: The impaction rate is much higher for third molars as compared to other teeth. While impacted third molars may remain asymptomatic for an indefinite period, it can cause various delinquents, such as pericoronitis, swelling with pain, distal caries, bone loss, root resorption of adjacent teeth, odontogenic cysts, and tumors. That’s why the most frequent surgical procedure in dentistry is third molar tooth extraction.
Objective: The aim is to propose a new classification for impacted mandibular third molars on CBCT images which cover all aspects of the anatomical situation
Methodology: A total of 143 images of molar teeth was collected and classified according to a relationship with the IAN canal and molar tooth. For statistical calculation, SPSS software was used.
Results: Classes 0-7 were planned and in which classes 1-6 were sectioned into two subtypes (subtypes A-B). The distribution of the classes presented an occurrence of buccal or apical course of the mandibular canal tailed by lingual position and inter-radicular one. Results emphasized that a close relationship of molar roots with the lingual side of IAN was more in female versus male other than it no anatomic differences occur in terms of IAN relationships between males and females. Younger patients displayed an increased rate of direct contact with a reduced calibre of the canal and/or without corticalization. This increases the chances of IAN damage, especially in the young woman (age range 25-30 years) with a lingual course of the mandibular canal.
Conclusion: The use of this classification is appreciated to get an equal definition of the impacted tooth on CBCT images worldwide.

Background: The term oral leukoplakia is defined as white plaques of debatable risk, diagnosed when other known diseases or disorders that bring no risk for oral cancer have been omitted. It has a malignant transformation rate of around 0.13%-34% whether it is measured as a premalignant lesion.
Objective: This study aimed to evaluate the demographic occurrence and malignant transformation of oral leukoplakia in the diagnosis of OSCC in an Indian sample.
Material and method: The study included gender, age, site of the lesion, clinical presence and histopathological analysis of 156 subjects. SPSS software is used for statistical calculation. For data analysis calculation of percentages, Shapiro-Wilk test and Chi-square test is used.
Result: This study was conducted on a total of 156 patients with oral leukoplakia. In which 142 subjects were found affected with oral leukoplakia and only 14 subjects were found affected with other premalignant disorders. However, male subjects of oral leukoplakia were 59.15% and female subjects were less in number only 40.85%. A total number of 81patients were found in the age range 40-50 years. Male patients had acquired 55.56% while female patient’s attained 44.44%. The histopathological examination stated that out of 142 oral leukoplakia cases, 39.44% were existent with malignant transformation and the P-value was 0.0185, which was found to be statistically weighty.
Conclusion: Half of OSCCs are one way or another linked with or originated by oral leukoplakia. So biopsy of chronic lesions especially male patients (because of the higher risk to develop dysplastic changes) is recommended to check dysplastic alterations within the lesion and should be advised to leave the adversarial habit.

Background: Ectopic pregnancy (EP) is one of the life-intimidating emergencies in pregnancy leading to maternal morbidity and mortality. Early diagnosis of ectopic pregnancy presents a challenging problem and is considered an emergency as it shows high mortality risk and it’s early detection and management are necessary to prevent maternal mortality and morbidity.
Aim and Objectives: To evaluate the cases of ectopic pregnancy at a tertiary health care center and to determine the incidence, risk factors, clinical presentation, management, and morbidity associated with ectopic pregnancy.
Methodology: We conducted a prospective study on 37 patients with ectopic pregnancies at Shivamogga Institute of Medical Sciences a tertiary care center from August 2020 to August 2021. The primary outcome measures studied were the incidence of ectopic pregnancy, their risk factors, mortality and morbidity in those pregnant women.
Results and Discussion: The incidence of ectopic pregnancy in this study is 0.49%. The common age and parity affected were 26-30 years (59%) and para 1 (46%). The most common risk factors were previous LSCS (49%) followed by abdominal tubectomy, laparoscopic tubectomy and recanalization. The ampulla region (59.5%) was the most common site of ectopic pregnancy. Majority of cases presented with a ruptured ectopic (70.27%) and unruptured accounted for -29.72%. In our study Salpingectomy (78.37%) was the common surgical procedure performed. Around 83.77% of women received a blood transfusion. No maternal mortality occurred during this period due to ectopic pregnancy.
Conclusion: Ectopic pregnancy is a life-threatening condition occurring in women. Worldwide the incidence of ectopic pregnancy is increasing, which will increase maternal morbidity, mortality, and fertility. Early diagnosis and management will reduce the risk of maternal morbidity and mortality due to ectopic pregnancy.

Aim: To determine the effect of various topical agents in chronic plaque type psoriasis.
Materials and Methods: The study was carried out on patients having chronic plaque type psoriasis vulgaris came to Department of Skin & VD, Medini Rai Medical College, Palamu, Jharkhand, India. Total 300 patients were enrolled and were divided into three groups comprising of 100 patients in each group. Group A patients were asked to apply ammonium lactate twice a day, Group B patients were asked to apply ammonium lactate in morning and clobetasol propionate in evening, Group C patients were asked to apply topical ammonium lactate in morning and calcipotriol in evening.
Results: Physician global assessment scale shows that in Group A, 39% patients had excellent response, 15% patients had good response, and 21% patients had fair response whereas 25% patients had poor response. In group B, 35% patients had excellent response, 29% patients had good response, and 17% patients had fair response whereas 19% patients had poor response. In group C, 31% patients had excellent response, 28% patients had good response, and 22% patients had fair response whereas 19% patients had poor response.
Conclusion: Combination therapy is effective, well tolerated with minimal side effects and better compliance was seen with patients. Ammonium lactate 12% can also be considered as one of the topical option as a monotherapy and also as a maintenance therapy.

Outbreak of pandemic SARS-CoV2 in 2020 collapse the healthcare management system all around the world. People were scared, as invisible virus spreading its infection among the individual who were close contact with infected person via droplet nuclei or aerosol transmission. The only gold standard test for early detection of viral genome that time was RT-PCR tests which was due to its high sensitivity and specificity nature. During Covid period RT-PCR sensitivity was reported much less all around the world. Hence there is urgent need to find out the reason for less sensitivity or fallacy report of RT-PCR or developed alternative method for SARS-CoV-2 and its strain detection method in less time with High efficacy.

Aim: Evaluate The Intraoperative Anaesthesia Management and Postoperative Pain Scores
after Caesarean Section.
Methods: This analytical observational study conducted in the Department of
Anaesthesiology, Madha Medical College Kovur Chennai, India during Feb 2021 to Feb
2022. All patients either receiving GA or spinal anaesthesia for CS receive IV tramadol
infusion for post-operative pain control, which is started either at the request for first
analgesia in the PACU or at 60 min, whichever comes first. Patients are assessed for pain
using numerical rating scale (NRS) immediately in the PACU and at regular intervals. Any
patient having NRS >4 is given rescue analgesia.
Results: Percentage of patients having NRS >4 and who required rescue analgesia on
immediate assessment (time zero) was 15 (15%). After that, 13 patients (13%) at 30 min, 10
(10%) patients at 45 min and 5 (5%) patients at 60 min had NRS of >4 and required first
rescue analgesia. There was no statistically significant difference among patients in PACU
having NRS >4 from those having NRS <4 in terms of the type of incision, ASA grading and
duration of surgery. Patients receiving RA had a statistically significant (P-value < 0.01) low
percentage of patients with NRS >4 and need for first rescue analgesia at time zero and at 30
min when compared to the percentage of patients operated under GA. The difference became
insignificant after 30 min. Overall, 18% of patients received some sort of co-analgesia,
mainly in the form of IV paracetamol 15% and only two patients received TAP block.
Conclusion: The pain management in the PACU was adequate as all patients were given
rescue analgesia if they had NRS of >4 and no patient was shifted from PACU with NRS of
>4.

Introduction: Cataract is one of the most common and established surgical procedure in
Opththalmology in the world with the posterior capsular opacification (PCO) as a very
common complication, which may be present in long term. This study was done to find the
incidence of the posterior capsular opacification after cataract surgery and implantation of
360 square edge PMMA posterior chamber IOL among the patients attending our tertiary care
hospital.
Materials and Methods: The cataract surgery was done with a careful implantation of a
square edged single piece PMMA IOL within the capsular bag seeing that peripheral 1mm of
the anterior capsular rim covers the optic edge of the IOL. On the 1st postoperative day, the
cases were examined under slit lamp for any postoperative complications. The next visits
were conducted at day 7, 1 month, 3 months, 6months and 8 months. The best-corrected
visual acuity was tested using Snellen chart, both aided and unaided.
Results: Out of 50 patients included in the study, 21 (42%) were females and 29 (58%) were
males. The most common age group of all the patients was 61-70 years wherein 58.6% of the
males and 42.9% of the females were present. Of the total 50 eyes operated for cataract, 90%
of the patients had no posterior capsular opacification, while 4% had fibrous membrane type
of PCO and 6% had Elsching’s Pearl type of PCO.
Conclusion: The square edged PMMA IOL is quite effective in reducing the formation of
posterior capsular opacification after the cataract surgery

Introduction: Pterygium is one of the very common ophthalmic disorders with an unknown etiology and pathogenesis. Growth of pterygium into the cornea can result in visual impairment, astigmatism, loss of corneal transparency, visual axis obstruction.
Materials and methods: This cross sectional study was done on 500 patients, where demographic details was taken from all the patients including living environment, status, time outdoors, familial history, drug abuse, history of smoking, type of work and education, use of glasses. All of them underwent regular ophthalmic examinations including systemic and comprehensive examination as well as refraction.
Results: The prevalence of Pterygium was 12.6%. 35.6% of the patients were females and 64.4% were males. 51.2% belonged to the 30-39 year age group. 33.3% were farmers and 54% were manual labourers, 61.9%) of the patients had passed their high school while 28.6% were illiterate, 73% had no familial history of pterygium, 61.9% were regular smokers and 25.4% were occasional smokers. 36.5% of the patients had hypertension and 25.4% were obese.
Conclusion: Pterygium formation in our geographical area is quite high and the most common risk factor is exposure to sunlight. Male gender, hypertension and smoking also appear to be associated risk factors. Use of sunglasses may help in reduction of the prevalence of Pterygium.

Background: The broad spectrum ß-lactam antibiotics are commonly used empirically for the treatment of gram negative sepsis. But the emergence of ESBL producing organisms has posed a serious threat for their continuing use. Present study was undertaken to find out the magnitude of the problem of infections due to extended spectrum β-lactamase producing organisms.
Material and Methods: Present study was a descriptive & observational study, conducted in patients < 18 years age, all cultures showing a significant growth of ESBL producing organisms from any of the clinical specimens, as per CLSI guidelines.
Results: Infections by ESBL producing organisms were found more common in 13-18 years of age group (36.25%) & males (71.25%). K. pneumoniae has been found to be the most commonly isolated ESBL producing organism (56.25%) followed by E. coli (38.75%). ESBL producing organisms were most commonly grown in urine samples (51.25%) followed by pus culture (11.25%) and blood (10%). All were sensitive to tigecycline and colistin (100%). In the carbapenem group, sensitivity to imipenem was highest (93.75%) followed by ertapenem (66.25%), doripenem (65%) and meropenem (53.75%). Among the 45 isolates of ESBL K. pneumoniae, all were sensitive to tigecycline and colistin. Sensitivity to imipenem is 93.33% while that to meropenem, doripenem and ertapenem were 46.66%, 62.22% and 64.44% respectively. Out of the 31 isolates of ESBL producing E. coli, all were sensitive to tigecycline and colistin. Sensitivity to Imipenem was 96.77% while that to meropenem, doripenem and ertapenem were 64.71%, 70.96% and 70.96% respectively. Sensitivity to meropenem has gone down dramatically from 71.42% to 22.22%, which is significant.
Conclusion: A growing resistance in the ESBL producing organisms is noted which is very alarming. A limited number of drugs are available against these ESBL producing organisms and the drug of choice is carbapenem.

The development of breast cancer in many women appears to be related to female reproductive hormones, particularly endogenous estrogens. Early age at menarche, nulliparity or late age at first full-term pregnancy, and late age at menopause increase the risk of developing breast cancer. In postmenopausal women, obesity and postmenopausal hormone replacement therapy (HRT), both of which are positively correlated with plasma estrogen levels and plasma estradiol levels, are associated with increased breast cancer risk. Most hormonal risk factors have a relative risk (RR) of ≤2 for breast cancer development. The elective Modified Radical Mastectomy procedure was done in standard fashion. Patients in group A (Study group) received intraoperatively instillation of 0.5% bupivacaine into operative bed at the end of surgery. Patients in group B (Placebo group) received intraoperative instillation of normal saline into the operative bed at the end of surgery position. Approval from the ethical committee of the institution was obtained. All the patients were explained about the basis of the study and informed consent were obtained. Patients who received bupivacaine had longer postoperative analgesia when compared with normal saline group.

A chronic ulcer of the foot is a frequent condition, with prevalence in the population over 60 years of age. The incidence of ulcers is rising as a result of the ageing population and increased risk factors for atherosclerotic occlusion such as smoking, obesity and diabetes.
Ulcers can be defined as ‘break in the continuity of the covering epithelium either skin or mucous membrane due to molecular death’. Prospective study of 100 cases of chronic foot ulcers admitted at Tirunelveli medical college Hospital, Tirunelveli, during the period March 2011 to March 2012, with regular dressing, debridement, treating the underlying systemic disease, skin grafting and amputation were done. In a study group of 100 cases, most of the patients with leg ulcers had an underlined systemic disease such as diabetes mellitus, varicose veins, arterial occlusion secondary to atherosclerosis, leprosy and malignancy.

Introduction: Osteoarthritis of the knee is a degenerative condition with a variety of treatment options like high tibial osteotomy (HTO), arthroscopic debridement, unicompartmental knee arthroplasty and total knee arthroplasty. This study was conducted with an aim to assess the outcomes of individuals with Grade II and III medial compartment osteoarthritis treated with a proximal fibular osteotomy (PFO) to alleviate discomfort, improve medial joint space and function of the knee joint.
Methodology: From November 2019 to October 2021, 25 Patients aged 45 to 65 years with knee OA of grade II or III (Kellgren-Lawrence classification) involving the medial compartment of the knee were included and underwent proximal fibular osteotomy and were followed up. Preoperatively as well as postoperatively, the entire lower extremity radiographs were obtained to assess the alignment of the lower extremity and the ratio of the knee joint space (medial/lateral compartment), knee pain was assessed using a visual analogy scale and knee ambulation activities were assessed using the American Knee Society score.
Results: All patients experienced alleviation from medial knee discomfort postoperatively. Postoperative weight-bearing lower limb radiographs revealed an average increase in medial knee joint space. The mean preoperative AKSS improved from 43.92 to 63.88 till the last follow-up.
Conclusion: PFO is a safe, simple and effective procedure that significantly decreases knee discomfort. It also enhances the joint's radiographic appearance and functional outcome in patients with medial compartment osteoarthritis of the knee.

Background: Chronic otitis media is an important cause of morbidity affecting all ages leading to variety of complications which has major impact on the patients and more so in Covid pandemic. Study to see the change in findings of culture and sensitivity data in chronic Otitis media during Covid pandemic and hence modify the treatment plan.
Aims: To study the bacteriology associated with the chronic otitis media and study any change in findings of bacteriology of chronic otitis media during COVID pandemic.
Subjects and methods: The retrospective study was done. The culture and sensitivity data during Covid pandemic was collected from Jan 2020 to Jan 2021 from ENT centre and their analysis and interpretation done according to age, types of culture and their sensitivity.
Result: In the total 100 cases of culture and sensitivity results during pandemic, pseudomonas aeruginosa was the most common organism isolated and showed highest sensitivity towards piperacillin/tazobactam and polymyxin B. Staphylococcus aureus was second most common which showed highest sensitivity towards linezolid and teicoplanin. Both showed lowest sensitivity towards ciprofloxacin. There was no change found in the bacteriology culture during the Covid pandemic which was compared from available literature.
Conclusion: the change in the findings of culture and study of chronic otitis media based on the study done shows almost no difference with the pre-pandemic times. But high antibiotic resistance implicates the careful use of antibiotics in treatment and avoiding empirical method of treatment.

Staphylococcus aureus is significant human pathogen which cause various kinds of infection ranging from minor skin diseases to life- threating endocarditis. It has acquired resistance to previously effective antimicrobials including the methicillin. Methicillin resistant Staphylococcus aureus (MRSA) is prototype of bacteria which is resistant and associated with long hospital stay, more mortality, raised costs & trouble-some to patient when compared with methicillin -sensitive Staphylococcus aureus (MSSA). The present study was prospective study conducted for a period 1 year 8 month (from Nov 2011-June 2013) all staphylococcal isolate in Microbiology Laboratory, Shri-Aurobindo Medical-college & P.G. institute Indore India. Gram staining of each specimen (except blood) was performed & findings noted. Each specimen was cultured on Blood agar & MacConkey’s agar aerobically incubated over-night at 37 ˚C. Staphylococcal isolate were identified by phenotyping methods like Gram stain, catalase test, slide &tube coagulase test growth on manitol-salt agar, VP test Phosphates test and bacitracin susceptibility test. The antimicrobial susceptibility testing was conducted by Kirby-Bauer disc diffusion method as per guidelines of CLSI. Sensitivity, specificity & Positive predictive valve of chromogenic-agar for identification of MRSA detection was 83.7%, 80.2% and 71.9% respectively. In our study out of 100 cefoxitin resistant strain 89 were mec a positive and 11 were mec a negative

Context: To evaluate clinico-radiological outcomes in patients with lumbar degenerative disc
diseases treated with intradiscal PRP versus steroids.
Design: Prospective double blinded randomized controlled trial.
Aims: The aim of the study was to compare and assess radiological changes and clinical
outcome in patients with degenerative disc diseases when treated with intradiscal platelet rich
plasma and intradiscal steroid.
Objectives: To compare clinical outcome in PRP and steroid treated patients, to compare
radiological changes in PRP and steroid treated patients, to assess clinical outcome in PRP
and steroid treated patients at subsequent follow ups, to assess radiological changes in PRP
and steroid treated patients at subsequent follow up.
Settings and Design: Prospective double blinded randomized controlled trial.
Methods and Material: Adults (18-50 years) with chronic low back ache (> 6 months) nonradiating
who were unresponsive to conservative treatment. A total 40 patients were
randomized to receive intradiscal PRP (Group A) or steroid (Group B) after provocative
discography in the department of Orthopaedics in Maharishi Markandeshwar Medical
College and Hospital, Solan between the time period of November 2019 to September 2021
based on inclusion and exclusion criteria were enrolled for platelet rich plasma and steroid
infiltration in a randomized manner. Pain relief as assessed by change in VAS score,
functional assessment using change in Modified oswestry disability index (MODI). Pfirrman
and MSU grades as assessed by MRI.

This retrospective observational study illustrates 30 years of experience of Therapeutic Plasma Exchange in 35 cases out of 1210 kidney transplantations performed between 1990 till 2020. Total 11 patients underwent Plex before undergoing kidney transplantation whereas 24 patients underwent Plex post kidney transplantation. Pre-transplant therapeutic plasma exchange was done in 5 Human Leukocyte Antigen incompatible, 5 ABO incompatible kidney transplant prospects and 1 prospective recipient with monoclonal gammopathy of renal significance. Whereas 15 kidney transplant recipients (Kidney Transplant Recipients) with antibody mediated rejection, 6 Kidney Transplant Recipients with thrombotic microangiopathy, 1 with myeloma cast nephropathy, 1 recurrence of Focal Segmental Glomerulosclerosis post transplantation & 1 Anti-Glomerular Basement Membrane antibody positive Kidney Transplant Recipient underwent Plex. The clinical end point after Plex exchange was achieved in 23 patients, 6 patients had a partial response. There was no response after Plex done for Kidney Transplant Recipient with Anti-Glomerular Basement Membrane antibody positive transplant glomerulopathy who subsequently progressed to requiring maintenance dialysis. One patient undergoing Human Leukocyte Antigen incompatible kidney transplant developed hyper acute rejection & had to undergo graft nephrectomy and another case with myeloma light chain cast nephropathy could not be salvaged. Pre-transplant Therapeutic Plasma Exchange used for desensitization of ABO incompatible & Human Leukocyte Antigen incompatible kidney transplants has benefitted 9 out of 10 patients in our study. Patient with end stage renal disease due to monoclonal gammopathy of renal significance was ultimately able to undergo kidney transplantation due to complete response after Therapeutic Plasma Exchange. Notably, we observed partial response for stabilizing chronic Antibody Mediated Rejection and late acute Antibody Mediated Rejection. Pathogenic entities like anti-endothelial cell antibody, thrombotic microangiopathy causing graft dysfunction can be successfully managed by Therapeutic Plasma Exchange. Therapeutic Plasma Exchange for the treatment of recurrence of Focal Segmental Glomerulosclerosis (focal segmental glomerulosclerosis) after kidney transplant has shown a partial response in terms of reduction in proteinuria.

Background: Prosthetic heart valve thrombosis (PHVT) is a very rare complication after the
replacement of a damaged valve by a mechanical valve. It contributes significantly to the late
morbidity and mortality after heart valve surgery. The incidence varies across the world
depending on the type of mechanical heart valve and its position. A little study was done on
the absolute eosinophil count in prosthetic heart valve thrombosis. So in the present study, we
are evaluating the risk factors, clinical profile and levels of absolute eosinophil count in
prosthetic heart valve thrombosis cases.
Methodology: A prospective observational study was carried out at Sri Jayadeva Institute of
Cardiovascular Sciences and Research, Bengaluru from November 2015-December 2017. A
total of 73 patients with PHVT were studied during this period. Data was collected by
detailed clinical and treatment profiles and analyzed using SPSS V 23 software and results
were represented in tables, figures, percentages, and graphs under descriptive statistics.
Results:Mean age of study participants was 39.7+11.8 years. The percentage of females was
higher than males. The main predisposing factor for valve replacement was found to be
Rheumatic heart disease (94.5%) and degenerative aortic valve disease was found only in
5.5% of the cases. Mitral valve position (60.3%) was most commonly involved in PVT. After
replacement of the valve, 32.9% of patients presented the PHVT after 5 years and 9.6%
within 6 months of surgery. Out of 73 patients, 50.7% of cases presented with NYHA class II
symptoms, and 69.9% had INR in the non-therapeutic range. Atrial fibrillation was observed
in 23.3% of cases atrial tachycardia in 5.5% of cases. Recurrent PVT was observed in 20.5%
of cases. The absolute eosinophil count (AEC) was measured in our study 39.7% of cases had
elevated levels of AEC.
Conclusion: Prosthetic valve thrombosis is a major cause of morbidity and mortality in cases
with heart valve replacement. There is a strong correlation between incidence of PHVT and
elevated AEC. Eosinophilia increases the incidence of recurrent PHVT and interferes with
events of thrombolysis. Hence it is necessary to check AEC for all cases of PVT for better
assessment and management.

Vaginal bleeding in pregnancy is a common presentation in emergency obstetric care facilities. The acuity of the symptoms may vary from occasional spotting to severe hemorrhage associated with cramping and abdominal pain.100 patients with bleeding per vagina in pregnancy underwent ultrasound examination of the abdomen and pelvis conducted using curvilinear transducer of 3.5-5 MHz and transvaginal transducer of 5-9 MHz. The patients progress was followed up clinically and sonographically, when necessary. Of the 100 patients, maximum patients presenting with per vaginal bleeding were those of abortions (44%), with it being the commonest cause of bleeding in the first trimester (87.5%). The other condition encountered in the first trimester was ectopic pregnancy (12.5%), in which ultrasonography could detect the cases with an accuracy of 100%. The most common cause of bleeding in the second trimester was also abortion (44.4%) followed by placenta previa (33.3%). The type of placenta previa frequently encountered in this study was low lying placenta previa. Other causes included molar pregnancies and placental abruptions. In the third trimester, placental abruption was diagnosed in most of the cases (59.38%) with only 21.7% cases of abruption placenta cases showing favourable outcome. Ultrasonography should be the primary modality of investigation to determine the cause of bleeding in a case of antepartum hemorrhage

The most widespread internal fixation device used today is the fixed angle extramedullary device, such as a 95-degree lag screw and side plate or blade plate. This implant includes a large lag screw positioned in the center of the femoral neck and head and a side plate alongside the lateral femur. The screw-plate interface angle is changeable and depends on the anatomy of the patient and the fracture. A total of 30 patients who were admitted with intertrochanteric fractures that fitted into the inclusion criteria and managed surgically with proximal femoral nail were included in the study. In our series, Boyd and Griffin type II and type III contributed eighteen and six cases in each group, making to 60% and 20% followed by type IV contributing 6 cases making 20%. We performed closed procedure in 26 cases (87%) and open nailing in 4 cases (13%). The average duration of radiation exposure was 120 seconds, average duration of surgery was 95 minutes and average blood loss was 140 ml with 23% intraoperative complications

Background and aim: India is one of the 7 countries of the IDF (International Diabetes Federation) SEA (south-east Asia) region. 463 million people have diabetes in the world and 88 million people in the SEA Region; by 2045 this will rise to 153 million. There were over 77,005,600 cases of diabetes in India in 2020.In our study we tried to determine the risk factors for development of Glaucoma, especially in Type-2 diabetics and its magnitude.
Methods: a cross sectional study done in KIMS OPD, Bangalore between January 2018-may 2019. Diabetes was diagnosed by history and measurement of blood sugar levels. Glaucoma was diagnosed by assessing optic disc morphology, visual fields, and intraocular pressure. Systemic blood pressure was also measured for the patients. Statistical significance was indicated by P < 0.05.
Results: Study cohort included 350 patients with Type-2 Diabetes (150 males and 250 females), mean age of 52+/- 9 years. Prevalence of glaucoma was 16% (95% CI; 13.4-18.3). Out of this 16%, 50% had primary open angle glaucoma, 32% primary angle closure, 12.5% neovascular glaucoma, 5.3% other types. 77% diabetics didn’t have Diabetic retinopathy. Presence of glaucoma was significantly associated with the duration of Diabetes (chi-square=5.80 and p<0.015). Presence of Diabetic retinopathy was Not significantly associated to the presence of glaucoma (odds ratio=1.42). Even presence of systemic hypertension did not affect the magnitude of glaucoma in diabetics.
Conclusion: Screening for glaucoma while screening Diabetic cases may yield us more cases of glaucoma and the duration of diabetes is one of the most important determinants for development of glaucoma.

Low back pain is the most common problem among chronic pain disorders in middle aged population. Epidural Steroid Injection (ESI) is one of the most commonly performed non-surgical interventions 1. Objective of study is to compare the efficacy of epidural steroid injection with & without Bupivacaine for low backache patients.
Materials and Method: Two groups of 12 selected patients with chronic low backache were randomized for midline Inter laminar Epidural injection with 80 mg Methylprednisolone acetate with saline and Methylprednisolone acetate 80mg with 0.25% Bupivacaine. All patients received 3 injections at intervals of 2 weeks. They were assessed for degree and duration of analgesia (VAS) and any adverse effects.
Results: Onset of pain relief was less in adjuvant group when compared to non-adjuvant group after ESI. VAS at the end of 6 weeks in both groups was almost same in both groups. There were no significant adverse effects.
Conclusion: Epidural Steroid Injections significantly reduce radicular pain more with Bupivacaine.

Objectives: To assess the extent of disability in patients with Alcohol Dependence Syndrome who presented for inpatient de-addiction programme.
Methods: 100 consecutive consenting patients within the age of 18-65 years, admitted under inpatient de-addiction unit of a tertiary care teaching hospital are included after excluding axis-1 psychiatric disorders, major medical illness and other disabilities. AUDIT, 36 item interview version of WHODAS 2.0 are administered and statistical analysis done.
Results: The mean summary score of WHODAS obtained in the study group is 53.7 and lies around the 95th percentile. Highest disability was found in Life activities (Work activities-84.3±17.38; household activities-75.8±22.26). Disability scores were found to be higher in complicated withdrawal group in statistically significant levels. Alcoholic Liver Disease was found to have statistically significant higher disability scores in work activities domain.
Conclusion: Alcohol Dependence Syndrome has high disability comparable to other mental illnesses. Early onset dependence group, complicated withdrawal group and those with complications resulting due to alcohol use have higher disability. These findings may help in devising better treatment approaches, planning and individualizing rehabilitation and improving productivity and functioning of patients and thus ultimately reducing burden on society.

For decades, lignocaine was the local anaesthetic of choice for spinal anaesthesia in ambulatory surgeries. Its advantages are rapid onset of action and good motor block manifested as good muscle relaxation. Its use has become limited because of transient neurologic symptoms and cauda equina syndrome following intrathecal injection. After obtaining the approval of scientific, ethics committee and written informed consent, a total of 100 patients undergoing elective lower limb surgeries under spinal anaesthesia were selected. Patients were explained before operative procedure. Pre-anaesthetic check- up was carried out preoperatively with a detailed history, general physical examination and systemic examination. Airway assessment and spinal column examination was done. In the present study it was observed that there was a statistically difference in the bromage score between groups, score 2 was significantly higher in group II, score 3 was significantly higher in group I p < 0.05. In the present study it was observed that Mean time (in minutes) to pass urine was significantly lower in group I than compared to group II p <0.05.

The lipophilic portion is essential for anaesthetic activity and therapeutically useful local anaesthetics require a delicate balance between lipid solubility and water solubility. Addition of a butyl group to the Piperidine nitrogen of Mepivacaine results in bupivacaine, which is 35 times more lipid soluble and has a potency and duration of action three to four times that of Mepivacaine. Inclusion criteria were American Society of Anaesthesiologists (ASA) physical status I or II, either sex, age 18-60 years, presenting for lower limb surgeries. Exclusion criteria were patient allergic to drug, heart block/dysrhythmia. Hundred slips were made in such a manner that fifty slips had Group 1 written on it and the other fifty had Group 2. In the present study it was observed that there was no statistically significant difference in distribution of patients based on ASA grade in between the two groups p >0.05. In the present study it was observed that there was there no statistically significant difference in adverse events in between group.

Background: Non-communicable disease (NCD) is a medical condition of non-infectious and non-transmissible nature. NCDs may be chronic diseases of long duration and slow progression. This study was carried out to assess the socio-demographic profile and risk factors of non-communicable diseases using WHO stepwise approach among adults.
Methods: A cross-sectional study was carried out among 400 adults during the period from 1st September 2015 to 31st August 2016. Study tools included a WHO stepwise approach questionnaire, Sphygmomanometer, weighing scale, non-stretchable tape and stethoscope. The data was entered and tabulated in MS-Excel 2007 and statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS 22.0) and p<0.05 is considered as statistical significance.
Results: Majority belonged to 50-59 years, of which 280 (70%) were illiterates. About 319(79.8%) were married, most of them resided in nuclear families with 350 (87.5%).Many were engaged in unskilled labor mainly agricultural activities with 196(49%) and unemployment 113(28.3%). Majority was from upper lower class, followed by lower class.
Conclusion: Proportion of tobacco smoking among the study participants was 123(30.8%) in which 118(29.5%) were males and the association between smoking and gender was statistically significant. Alcohol use (59.5%) which was high among the rural population of Wardhanapet, in which males consume more amount of alcohol than females and these difference present at significant levels. Overall physical activity is high among the study participants as heavy workers were found to be (28.8%) and these differences with gender were present at significant level.

Background: The presence of meconium stained amniotic fluid (MSAF) is a serious sign of fetal compromise, which is associated with an increase in perinatal morbidity, clear amniotic fluid on the other hand is considered reassuring. A study by Mathews and Warshaw found that in 98.4% of cases with meconium stained liquor, the neonates were admitted to the neonatal intensive care units, these were delivered at 37 weeks of gestational age or later as it shows maturation of autonomic nervous system. MSAF occurs in 10% of pregnancies with most occurring at term or particularly post term. The purpose of this study was to evaluate the effect of clear liquor and meconium stained liquor on time and mode of delivery and to find out neonatal morbidity and mortality associated with meconium stained amniotic fluid.
Aim: To correlate the maternal and neonatal factors contributing to morbidly related to Meconium stained amniotic fluid.

Background: The annual incidence of intra cerebral hemorrhage (ICH) is 25 cases per 1, 00,000/year. Although ECG abnormalities are well known in ischemic stroke and subarachnoid hemorrhage these change have been rarely been investigated systematically in patients with ICH. Present study was aimed to study any association between ECG changes to the Site of Bleed (SOB) in non-traumatic spontaneous intracerebral hemorrhage (ICH). Material and Methods: Present study was a prospective, observational study, conducted in patients confirmed of ICH on CT scan. Each case was examined in detail with history, clinical features, ECG readings & CT scan findings.
Results: In present study, male to female ratio was 1.7:1. Maximum number of patients were from > 60 years age (52%). The various CT scan findings noted in the study were < 50 cc volume of hematoma (52%), presence of mass effect (40%) & presence of intra ventricular communication (38%). The most common site of bleeding was putamen (40%) followed by thalamus (30%), lobar (14%), brainstem (10%) & cerebellum (6%). The most common ECG findings in our study were Left Ventricular hypertrophy (56%) followed by prolonged QTc (54%), T wave inversion (56%), Left axis deviation (46%), Tachycardia (36%), ST-T changes (28%), Q waves (22%), Tall T wave (8%), VPC (8%) and RBBB changes (8%). In present study, there was statistically significant association was noted between LAD, IVC and LVH with ECG changes (p<0.05).
Conclusion: Significant association could not be established between specific site of bleed and ECG changes even though the proportions ECG changes to Site of bleed was significant.

Introduction: Peripheral nerve blocks are the preferred choice of anaesthesia for surgeries involving the extremities of the human body, with fewer complications. Earlier, the most common drug to be used for the brachial plexus block was bupivacaine, but of late, levobupivacaine and Ropivacaine are used as substitutes to counter the toxicity by Bupivacaine.
Materials and methods: 100 patients aged between 18-60 years with ASA I and ASA II undergoing bony surgeries were randomly divided into Group L and Group R. Group L was given 30 ml of 0.5% Levobupivacaine and Group R was given 30 ml of 0.5% Ropivacaine. Results: The onset of the sensory blockade was significantly lesser in Group L (4.51 ± 0.45 minutes) rather than Group R (5.95 ± 1.33 minutes) while there was no significant difference in the onset of the motor blockade (8.13 ± 2.46 minutes in Group L and 8.42 ± 2.51 minutes in Group R). The duration of the sensory blockage was significantly more in Group L (11.13 ± 2.11 hours) than Group R (9.04 ± 1.42 hours) while there was no difference in the duration of the motor blockade. The duration of analgesia was 11.43 ± 2.17 in Group L and 8.23 ± 1.72 hours in Group R, which was statistically significant.
Conclusion: Since the onset is shorter and duration of anesthesia and analgesic is more effective in Levobupivacaine, it can be used as a preferred drug.

Introduction: Post-operative nausea and vomiting is one of the very common complications after a surgery. Prevention of PONV in patients results in improved patient satisfaction and cost effective patient care.
Materials and methods: 50 patients were randomly divided into 2 groups, Group A were the patients who received Propofol- Fentanyl and group B, who received Sevoflurane – Fentanyl. Before surgery, the baseline conditions, such as the baseline pulse rate, blood pressure, SpO2 were taken. Injection glycopyrolate 0.2 mg/kg was given intramuscularly half hour prior to the surgery. 100% oxygenation was given to all the patients for 3 minutes. During Preinduction, all the patients were given 1-1.5 mcg/kg IV Fentanyl.
Results: In the Group A most of the patients had no nausea post-surgery, while 5 of them had mild nausea. However. Out of the patients in Group B, 32% each had mild or no symptoms, but 7 (28%) PONV Grade III, which was significantly higher. In group A, 48% of the patients who were either overweight or obese had no nausea, while 16% of them had mild nausea, 12% had Grade III PONV. Of the patients with normal BMI in Group A, only 1 (4%) had mild nausea, while all the others had no symptoms. In group B, 7 (28%) of the overweight and obese Patients had grade III nausea i.e. 1-2 Vomiting’s in 12 hours with nausea, while 2 (8%) had >3 vomiting in 12 hours with nausea. 6 (24%) each had mild nausea or no nausea.
Conclusion: Although the efficacy of both sevoflurane and Propofol is similar, Propofol is the more preferred drug due to the lesser amounts of cases of nausea and vomiting, thereby resulting in higher patient satisfaction.

Orthopaedic implant site infection is one of the major surgical site infection in orthopaedic surgery with high morbidity and mortality. Due to the use of implants, which are foreign to the body, orthopaedic trauma surgery is at the grave risk of microbial contamination. Overall 5% of the internal fixation devises get infected. The incidence of infection after internal fixation of closed fractures is generally lower (0.5-1%), where as in case of internal fixation of open fractures, the incidence is still higher and may exceed 30%. The prevalence of orthopaedic implant site infection reported in India is about 2.6%.

Iron deficiency either absolute or functional, is an independent predictor of all cause and cardiovascular mortality and a major contributor to exercise intolerance, even in absence of anemia. Correcting these comorbidities is attractive and novel therapies targets to improve outcomes. At present, IV iron is preferred route for treatment in such patients. Most studies have used IV iron sucrose (max dose of 200mg/setting) or ferric carboxymaltose (max dose of 1000mg/setting). Our study determines advantage of IV iron carboxymaltose over iron sucrose by being cost effective, requiring fewer injections, lesser duration of hospital stay with minimum adverse effect and equivocal improvement in quality of life and hematological profile in patients with heart failure with either preserved or reduced ejection fraction.

Aim: To identify the prognostic factors in open globe injuries and its presentation.
Materials and Methods: Retrospective study at Government medical College, Bharatpur,
JLN Medical College Ajmer, GMC Churu, GMC Dungarpur, Rajasthan, India in year 2021,
patients presented to casualty department of eye and undergone intervention with follow-up
of 1 to 3 months or till better recovery.
Results: Total 62 patients, 44 (71%) were males and 18 (21%) were females. Mean age was
24 years (with range: 2.5-62 years). Factors affecting final outcomes in ocular trauma are
nature and mechanism of injury, presenting conditions initial visual acuity, timing of
presentation and timing of intervention, segmental involvement as anterior or posterior
segment and zone of injury.
Conclusion: These predicting factors helps in counseling and explaining the prognosis and
also the deciding the line of treatment

Introduction: Maternal mortality and morbidity continue to be high despite the enormous
inputs and efforts imposed through National Health Programmes. Proper utilization of
maternal health care services plays an important role in reducing the maternal mortality rate.
Hence assessment of factors influencing the utilisation of these services become essential.
The objective is to estimate the proportion of women utilising the maternal health services
and to determine the factors associated with utilisation.
Methods: A cross sectional study carried out in mothers of under five children. One village
was selected by simple random technique from the 3 villages of rural field practice area of
Kakatiya Medical College (KMC), Warangal. All the eligible mothers for the study after
obtaining consent, were interviewed using pretested semi-structured questionnaire. Data
collected was compiled and exported to SPSSV20 and analysed using chi-square test.
Results: Of the 180 women, 6.7% had teenage pregnancies, 97.8% registered the
pregnancies, 97.8% had minimum 4 antenatal care (ANC) visits, 95.6% completed TT, 81.1%
consumed recommended iron folic acid (IFA) tablets, 98.9% had institutional deliveries and
47.8% had postnatal care (PNC) with minimum of six visits. Full ANC showed statistically
significant association with education and socio-economic status.
Conclusion: Though the utilisation has improved, there is still a lag in the IFA intake and
post-natal care received by mothers. This can be improved by giving separate incentive to
health care workers for post-natal visits.

COVID-19’ can affect different body systems. At present, osteo necrosis of femoral head as a sequalae of ’COVID-19’ is rarely documented. By large-scale use of life-saving corticosteroids in COVID-19 cases, we anticipate that there will be a resurgence of AVN cases. We report a series of two cases in which patients developed AVN of the femoral head after being treated for COVID-19 infection. The mean dose of corticosteroid used in these cases was 600 mg (400–1250mg), which is less than the mean cumulative dose of around 2000 mg steroid, documented in the literature as causative for AVN. Patients were symptomatic and developed early AVN of bilateral hip at a mean of 42 days after COVID-19 diagnosis as compared with the literature which shows that it generally takes 6 months to 1 year to develop AVN post steroid exposure. Both the patient had significant dysfunction of coagulation with altered parameters. Thorough ophthalmic examination was done to both. literature has showed micro thrombi in eye, heart, liver, kidney, etc. Is corticosteroid being just a confounding factor??

Introduction: While there are considerable enthusiasm and anticipation for the COVID-19
vaccine, little is known about vaccine hesitancy specifically for COVID-19 in the general
population. Identifying specific populations, their characteristics with regards to vaccine
knowledge, awareness & acceptance will help as key components of a successful vaccination
strategy. Hence the present study was carried out to assess the knowledge, awareness &
acceptance of COVID-19 vaccination among general population of urban Raigarh,
Chhattisgarh.
Methods: A community-based cross-sectional study was conducted among 400 participants
of urban Raigarh regarding knowledge, awareness & acceptance of COVID-19 vaccine from
April-June 2021. The methodology comprises of primary data collection through survey in a
pre-designed pre-tested proforma by face to face interview.
Results: Total 400 participants among general population who had an average age of 34.3
years ±11.8 years with slight male preponderance (53.2%). Nearly half (58.2%) of
participants were from the slum, (45.2%) came under middle socio-economic class and (49%)
were self-employed. Majority (77.25%) knew about COVID-19 vaccination programme,
while (46.75%) knew about common side effects of vaccine. More than half (54.25%) were
aware that it boost up immunity against COVID-19 infection and (77.5%) were having good
knowledge regarding COVID-19 vaccination, and (36.5%) were afraid of taking COVID-19
vaccine, while (39%) were concerned about its side effects.
Conclusion: The study identified that majority of responders were aware regarding COVID-
19 vaccine, still many have doubts & concerns about its potential efficacy and safety thereby
providing an important outlook for feasible interventional awareness programs to enhance
vaccination rates. The study also identified that the concerns regarding the vaccine adverse
effects acted as the leading barrier for vaccine acceptance.

Background: Teeth and their measurements give the impression to be the most reliable method since teeth prove the most durable and resilient part of the skeleton. Especially Canines are the most durable teeth in the oral cavity due to the labio-lingual thickness of the crown and the root anchorage in the alveolar process of the jaws.
Objective: Establish the sexual dimorphism of permanent maxillary canine teeth in Rajasthan population by Orthopantomographic study
Methodology: 300 patients of 150 male and 150 females was included in the study. Use Measurement like mesiodistal width and intercanine distance in maxillary jaws were established based on radiographic examination with the help of digital Orthopantomograph.
Results: Canine mesiodistal width was higher in male (left: 7.80 ± 0.04 and right: 7.80 ± 0.04) then female (left: 7.54 ± 0.15 and right: 7.53 ± 0.12) p-value = <0.001. Maxillary intercanine distance was 36.45 ± 0.81 for male & 34.76 ± 1.55 for female. On the other hand, maxillary right and left canine index was higher in female than male P-value <0.001.
Conclusion: Maxillary intercanine distance shows maximum sexual dimorphism among all measurements and canine index shows negative sexual dimorphism.

Objectives: In addition to the physical morbidity and mortality, COVID-19 Pandemic has created a mental burden on the population as a whole. In our present web based cross sectional study we tried to assess the prevalence of the sleep pattern and different psychological problem in young University students.
Material and Methods: Using a web based study we collected data from 100 University students who volunteered to participate. We analyzed the demographic data, generalized anxiety disorder (GAD), depressive symptoms and sleep quality.
Results: The overall prevalence of GAD, depressive symptoms and sleep quality of the students were 100%, 79% and 79% respectively. Bivariate regression analysis showed female students to be more likely to have mild anxiety and moderately severe depression whereas younger age students were more likely to have mild anxiety. There was a reduction in physical activity in 58% of students.
Conclusion: In our study, we found the recent COVID-19 outbreak as a major psychological burden for the student population irrespective of gender and age. Formulation of a prior guideline, targeted at such group of population during a pandemic is necessary to avoid the development of such psychological problems as well as their fatal consequences.

Background: Many newer tests are now available to diagnose iron deficiency in CKD but these tests are not widely used in India as these tests are expensive and patients cannot afford these tests. Hence the traditional tests serum ferritin and transferrin saturation are needed to be studied more thoroughly to infuse IV iron to patients with iron deficiency anemia in CKD as many cannot afford ESAs and blood. Ferritin is an important indicator of iron overload as well as an acute phase reactant which increases in inflammatory conditions. Serum ferritin getting raised both in iron deficiency anemia and inflammatory states complicates our diagnosis. In this scenario TSAT plays important role in ruling out iron overload and inflammation is ruled out by inflammatory markers.
Objective: To study the effect of IV iron in patients with serum ferritin >1000ng/ml and TSAT <20%.
Methodology: This study was conducted at Department of Medicine, M.L.B. Medical College; Jhansi from March 2020 to November 2021, after seeking clearance from ethical committee and obtaining written informed consent from patient.
Result: It was seen than 18 patients showed improvement and had increase in Hb by 1g/dl. 1 patient had a reaction and transfusion was stopped immediately and 1 patient was lost to follow up.
Conclusion: Against the popular belief that infusion of iron in patients with raised serum ferritin should not be given, this study showed that after ruling out other causes of raised serum ferritin and iron overload by calculating TSAT, IV iron can be given to patients with raised serum ferritin as it shows improvement in anemia.

Introduction: Low back pain is one of the leading causes of physical disability in both old and younger age group. It has enormous effects on socioeconomic status and health of people. Inter vertebral disc degeneration is an active process which involve changes in cellular microenvironment and tissue that eventually leads to structural breakdown and impairment of inter vertebral disc function. These changes cause back pain. Epidural steroid injection is a well-established modality in providing pain relief and is widely practiced. PRP (Platelet rich plasma) is a new upcoming modality with promising regenerative effects. In recent literature its use in treatment of back pain is being encouragingly promoted and is under evaluation.

When it comes to wound care, dressing changes are a vital part of the process. Compliance with aseptic procedures and methods is critical to reducing the risk of infection in the healthcare setting. The ability to master the talents may be achieved via practise. Virtual reality is presented in this research as a means of increasing practise opportunities. In order to better understand the process of changing a basic wound dressing, an immersive virtual environment has been created. A preliminary user research on usability with an experienced nurse and an undergraduate nursing student yielded positive results. The simulation will undergo a thorough examination in order to enhance it even more.

Eurydice, an automated music accompaniment system, and vertical line notation are used in this research to provide music entertainment in a nursing home. Alzheimer's disease and other forms of dementia may be prevented or treated by regular music listening. Music progression on Eurydice may be achieved using two different tapping methods. A beginner piano student of ours has been asked to play from a VLN sheet music. We've put our system to the test over the last 10 months

It's difficult to identify falls in senior care facilities. Because the resident, who may be suffering from mental illness, is not instrumented by vision-based fall detection systems, it is a major advantage. Fall detection technology are being used in nursing homes as part of this research. A Convolutional Neural Network (CNN) trained to optimise a sensitivity-based metric is the basis of the suggested solution, which is based on Deep Learning techniques. It discusses the medical criteria and how they affect the CNN tuning in this study. The findings demonstrate the relevance of the timing component of a fall. Consequently, the medical team's aims are best served by a specific measure tailored to this use case and an implementation of a decision-making process.

Background: The shoulder arthroscopy is the gold standard of reference in most of the shoulder pathologies including Rotator cuff tears. However, it is an invasive surgical procedure with associated risks of surgery and anaesthesia. The objective of the present study is to find out how accurately the rotator cuff pathologies can be diagnosed by these imaging tests.
Aims and Objectives: To compare the Ultrasonography, MRI findings with the Arthroscopic findings of Rotator cuff pathology of the shoulder.
Materials and Methods: All patients in whom the history and clinical examination is suggestive of Rotator cuff pathology were included in the study. Patients were evaluated using high resolution Ultrasound (HRUS) Philips HD-11, Germany and 1.5-Tesla MRI [1.5 Tesla, GE, Excite HD and USA]. Ultrasonographic and MRI examination is performed by a single radiologist experienced in musculoskeletal ultrasonography and MR Imaging. A Real time high resolution USG imaging and MRI of the shoulder was performed in a standardized fashion and subsequently with therapeutic or diagnostic arthroscopy on the symptomatic shoulder. Results were analyzed.
Results: Considering arthroscopy as the final gold standard of investigation, out of the 24 patients studied, five (20.8%) had rotator cuff tendinosis/tendinopathy, four (16.6%) had PT RCT, twelve (50%) had FT RCT while the remaining three (12.6%) had normal rotator cuff. The average delay between the MRI examination and arthroscopic surgery was 6 days (range 0-27 days) but in one case, it was as long as 117 days. A total of five (20.8%) patients were in the age group < 40 years while another five (20.8%) were between 40-50 years age group. A majority of eleven (45.8%) patients were between 50-60 years old while three (12.6%) were above 60 years.
Conclusion: It should be noted that following USG of the shoulder performed by a dedicated radiologist, MRI offers little additional value, with regard to the detection of rotator cuff tears.

Background: Hypomagnesaemia and hypermagnesuria was reported to be associated with diabetes complications. Thus, magnesium has drawn considerable attention for its potential role in improving insulin sensitivity and preventing DM. Zinc, another important trace element, acting as a cofactor for several biochemical processes has a major role in health status. There is substantiating evidence indicating the importance of zinc in DM. Impaired zinc metabolism, decreased plasma zinc and hyperzincuria has been reported as a consequential effect of glucose absorption. But limited studies have been conducted in this part of the world. This study puts in an effort to find the answers.
Aims and Objectives: To study the association of serum magnesium and zinc levels in diabetics.
Materials and Methods: This study was done in the Department of General Medicine, SSPM’S Medical College and Lifetime Hospital, Padve.
This study was done from Jan 2019 to Dec 2020.
Ninety and an equal age and sex matched control were used for the study.
Results: There is a strong association between the serum magnesium and zinc levels in diabetics when compared to normal individuals.
Conclusion: More number of studies have to come up in different geographical locations so as to be helpful to the practicing physicians.

Background: Common causes of vocal could paralysis are neoplasms (bronchial, esophageal, thyroid), trauma, idiopathic, neurological, inflammatory & miscellaneous. With limited resource at our disposal, present study was aimed to find out etiopathology & classification of vocal cord palsy at our tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted in confirmed cases of vocal cord paralysis.
Results: This study was done on 44 patients of vocal cord paralysis. Majority were from 41-50 years age group (29.55%) followed by 51-60 years age group (20.45%). Sex incidence in this series revealed 27 male cases and 17 female cases. In present study common causes of vocal cord paralysis were Neoplastic growth (32%) followed by surgical trauma (30%), Blunt Trauma over front of neck (4%), pulmonary tuberculosis (11%), Idiopathic (16%), Cardiac hypertrophy (4%), cranial polyneuritis (4%) & Corrosive ingestion (4%). Left cord palsy, right cord paresis and bilateral paresis was noted in 55%, 27% & 18% cases respectively. 8 patients in this study were suffering from bilateral vocal cord paralysis and rest of the patients (36) had unilateral paralysis. So total number of paralyzed cords was 52. Out of these, 47 vocal cords were paralyzed completely and incomplete paralysis was seen in case of 5 cords. n most of the cases (27) it was in paramedian in position. Paralyzed cord was in midline in 12 cases, cadaveric in 8 cases. Incomplete palsy with restricted mobility was seen in 5 cases.
Conclusion: Neoplastic growth, trauma (surgical and non-surgical) & pulmonary TB were most common causes for vocal cord paralysis. Vocal cord paralysis was common in male patients, on left side & unilateral involvement.

Background: Interstitial lung diseases are heterogeneous group of disorders of the lower respiratory tract that are characterized by both acute and chronic inflammation and a generally irreversible and relentless process of fibrosis in the interstitium and the alveolar walls. High-resolution computed tomography of the chest has become an invaluable tool in the diagnostic process of interstitial lung diseases. Present study was aimed to study characteristics of interstitial lung disease using HRCT in clinically suspected cases.
Material and Methods: Present study was single-center, cohort descriptive and observational study conducted in patients of any age, gender, with clinically suspected interstitial lung disease referred for HRCT.
Results: Majority of patients were found in the age group of 60-69 years (45%), were male (65%) & had history of smoking (42.5%). Major chief complaints were cough (55%), breathlessness (25%), dry cough (15%) and cough with fever (5%). Out of total of 40 patients, 22(55%) patients showed HRCT pattern reflecting Usual Interstitial Pneumonia (UIP) and Idiopathic Pulmonary Fibrosis (IPF), 10(25%) patients showed Nonspecific Interstitial Pneumonia (NSIP), 5(12.5%) patients had Hypersensitivity Pneumonitis (HSP) as well as 2(5%) patients had cryptogenic organizing pneumonia (COP) while only 1 patient (2.5%) showed changes of respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Maximum no of patients had bronchiectasis (57.50%), reticulation (42.50%), honeycombing (35.00%), ground glass opacities (32.50%) & consolidation (5.00%). Out of total of 40 patients, only 2 (9.09%) patient shows regression in UIP in follow-up scan, while others show progression 20(90.91%). 3 each shows progression in HSP (60%) and NSIP (30%), however in COP(100%) all patients show regression.
Conclusion: Based on the HRCT features a histospecific diagnosis can be reached in most cases of Idiopathic Interstitial Pneumonias obviating the need for biopsy.

The medial collateral ligament also called as the deltoid ligament is a strong, triangular band, attached to the apex and to the anterior and posterior borders of the medial malleolus. Of its superficial fibres, the anterior also called the tibionavicular, passes forward to the navicular tuberosity, behind they blend with the medial margin of the plantar calcaneonavicular ligament. Intermediate also called the tibiocalcaneal fibres descend almost vertically to the entire length of the sustentaculum tali. Posterior fibres also called the posterior tibiotalar, passes posterolaterally to the medial side of the talus and its medial tubercle. The deep fibres (anterior tibiotalar) pass from the tip of the medial malleolus to the non-articular part of the medial talar surface.
Aims and Objectives: To study the morphometry of Deltoid Ligament.
Materials and Methods: Ten ankle joints were dissected and the measurements were taken.
Results: There is no statistical variation when compared in the sides and sexes.
Conclusion: Further large scale study is needed

Background: Though the earlier studies reported that there will be loss of magnesium and calcium ions in the patients with acute gastro enteritis, the exact measure was not provided.
Objective: The present study was undertaken to measure the levels of the calcium and magnesium in the patients of acute gastroenteritis. This information helps to plan adequate treatment in these patients.
Materials and methods: A total of 50 patients with acute gastroenteritis aged more than 18 years including both male and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study
Results; Out of fifty participants, 20 participants were males and 30 participants were females. The range for calcium was found from 6.7 to 10.7 mmol/l. Majority of the patients have the calcium levels in the range of 7.7-8.7 mmol/l. The range for magnesium is 0.1-3.1 mg/dl. Majority of the patients have level of magnesium in the range of 2.1-3.1 mg/dl.
Conclusion: Significant decline in the serum calcium and magnesium levels was observed in the patients with gastro enteritis. The study results support the results of earlier studies. The study recommends the need of future studies with involving multiple centers and multiple samples to plan adequate treatment strategies for management of diarrhea cases and to prevent death of these patients.

Background: Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease mediated by T cells directed to the hair follicle. Despite numerous studies related to individual disease associations in AA, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. Hence there is need for better understanding of the disease. This study is intended to determine the prevalence, clinical and histopathological study of the disease.
Objectives
1. To study the hospital based prevalence of Alopecia areata.
2. To study the clinical and histopathological features of Alopecia areata.
3. To study the associated cutaneous and systemic disorders.
Methods: A total of 100 clinically diagnosed cases of Alopecia Areata who were consenting for both clinical evaluation and investigations were taken after a thorough informed consent. A detailed history was taken with emphasis on age, sex, socioeconomic status, history of Atopy and other autoimmune disorders, family history of AA, mode of onset, recurrence and complete examination of skin lesions, nails and mucous membranes was done to note morphology, distribution, extent, site, number, size etc and investigations such as VDRL, complete hemogram, FBS, PPBS, urine routine and thyroid profile, biopsy were done.

Background and Objectives: There is a rapid increase in the incidence of HIV/AIDS among children. Proportionally, there is a rise in mucocutaneous involvement in this population. Mucocutaneous manifestations can pose diagnostic and therapeutic challenges. This study was done to note the different mucocutaneous lesions present among pediatric HIV population attending NMCH&RC, Raichur and their relation to CD4 counts.
Methodology: 214 consecutive HIV-positive children attending the OPD, at a tertiary hospital and research centre, between January 2015 to June 2016 were screened for presence of any mucocutaneous lesions and 100 children were included in the study. CD4 count was done in all of them along with other relevant investigations.
Results: Among 100 patients there were 118 mucocutaneous manifestations noted with overlap in a few. Prevalence of mucocutaneous manifestation was 47%. M:F ratio was 2:1. Majority of patients belonged to 5-14 year age group. Among mucocutaneous manifestations, pruritic papular eruption was commonest followed by viral and bacterial infections. The majority of patients had CD4 count <25%.
Conclusion: Mucocutaneous manifestations in pediatric HIV population are common and have varied presentations. Mucocutaneous manifestations were common at lower CD4 levels. Mucocutaneous manifestations can be taken as marker for disease progression.

Background: Rickettsial infections are the most covert re-emerging infections in present
times. They are incapacitating and notoriously difficult to diagnose, Weil-Felix (WF) test is
classic serological test which is widely available but not widely acceptable because of its low
sensitivity and specificity. Present study was aimed to study of usefulness of Weil-Felix test
as a simple diagnostic tool for diagnosis of rickettsial fever.
Material and Methods: Present study was single-center, prospective, observational study,
conducted in children < 18 years age, hospitalized with fever and presence of one or more of
the following clinical features: Rash, edema, eschar, hepatosplenomegaly, lymphadenopathy
OR had history of contact with pets or live stocks and history of tick-bite.
Results: In the present study maximum number of cases were from school going age group
(53.5%), male (67.4%), from Rural Areas (88.4%) & Tick bite could be demonstrated in
44.2% cases. Based on clinical features Lymphadenopathy was seen mainly 86.00%,
followed by maculopapular rash (76.7%), rash appearing 48-96 hrs. after fever (72.10%),
conjunctival congestion (55.80%), hepatomegaly (48.80%), rash on palms & soles, pedal
edema (34.9%) & purpura (14%). Out of 43 suspected cases, Weil-Felix test was positive in
31 cases (72.1%) and Negative in 12 cases (27.90%).
Conclusion: Rickettsial disease must be strongly suspected with a triad of fever, rash and
lymphadenopathy or having history of tick exposure/ bite and when the cause of fever cannot
be established. Weil Felix test can be carried out for early detection of suspicious casein
resource limited set up.

Aim: To estimate dimensions of thyroid gland and look for frequent anatomic variations of it.
Methods: 60 specimens (52 male, 8 female) of thyroid gland were studied in the Department of Anatomy. Position of the lobe & isthmus of thyroid gland was noted in relation to the thyroid cartilage and trachea. Length, transverse diameter, and anteroposterior diameter of lobes & isthmus as well as thyroid gland weight was measured. The thyroid gland was looked for any anatomical variations.
Results: The mean value of right lobe length was (4.69cm vs 4.6cm) and left lobe was (4.48cm vs 4.11cm). The transverse diameter of right lobe was found to be (1.94cm vs 1.93cm) whereas for the left lobe it was noted as (2.07 vs 1.71cm). The anteroposterior diameter of right lobe was (1.10cm vs 0.87cm) and left lobe was (1.03cm vs 0.96cm). The mean length of isthmus was (1.31cm vs 1.24cm) and width was found to be (1.71cm vs 1.68cm). Thyroid gland weight was measured as 14.9 g &12.48 g in males & females respectively. Pyramidal lobe and levator glandulae thyroideae were observed in 27(45%) and 12(20%) thyroid specimens respectively. Isthmus was absent in one case.
Conclusion: A sound knowledge of normal anatomy and awareness of variant forms of thyroid gland enable the surgeons to achieve the goal of safer thyroid operations.

Background: The assessment of procalcitonin not only provides valuable information about the diagnosis but is also useful in the selection of the corresponding antibiotics for the management of sepsis. The studies related to this procalcitonin role are comparatively sparse.
Objective: The present study was undertaken to observe the role of procalcitonin in the management of severe surgical patients with sepsis.
Materials and methods: A total of 50 patients diagnosed with sepsis and aged more than 18 years including both males and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study.
Results: Results were presented in Tables no 1 and 2. Table no 1 presents the gender distribution of the participants. The majority of the participants were males with 56% and females were 44%. Table no 2 presents the levels of procalcitonin levels in the participants. The majority of the participants have excessive levels of procalcitonin levels. That is procalcitonin was more than 10ng/ml in 40 patients which means nearly 80 percent of the patients have excessive levels of procalcitonin. This will testify to the importance of procalcitonin in the diagnosis of sepsis.
Conclusion: Significantly higher levels of procalcitonin levels were observed in the patients with sepsis. The study results testify to the diagnostic value of the procalcitonin. The study recommends further detailed studies in this area to support the procalcitonin in the diagnosis of sepsis.

Aim: to evaluate the results of fracture lower end of femur, treated by close/open reduction and
internal fixation using locking compression plate.
Materials and Methods: In this study 31 patients with closed fracture lower end of femur (32
distal femur fractures) were studied. All the cases were treated at Akash medical
college(devanahalli), between 20017 -2021 at our institution and followed for a minimum of 6
months. The method used for fracture fixation was closed or open reduction and internal
fixation with locking compression plate.

Background: Dengue infections vary in severity, ranging from influenza like self-limiting illness to life threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Present study was aimed to study dengue fever in 1-12 years age group at a tertiary hospital.

The study was conducted with male and female subjects, 32 in each study group. The WHR (Waist Hip Ratio) and QTc (Correction of QT interval) were measured and the correlation was obtained by statistical analysis. The WHR and QTc are both negatively correlated in both male and female subjects. But, this finding is statistically insignificant. On the other hand the mean QTc in male subjects is more than that in female subjects. This finding is statistically significant. The study might have yielded a better result if the sample size was more

Introduction: Lymphadenopathy is a common clinical problem, usually benign, but malignancy may be associated. To confirm the diagnosis often required a biopsy of lymph nodes. Methods: All patients with cervical lymphadenopathy, more than 4 weeks and size more than 1cm were included in the study and a biopsy were done and sent for histopathological study. Results: Out of total 220 patients, 54.5% (n=120) were males & 45.5% (n=100) were females. The mean age was 38.9±1.02 years & the maximum number of patients were adults (50%). The most common cause of cervical lymphadenopathy was reactive hyperplasia (51.8%) followed by granulomatous infection (17.3%). however, in older adults, carcinoma was also a common cause of cervical lymphadenopathy (40%). Conclusion: The most common histopathological diagnosis of cervical lymph node biopsies in central India were reactive disease and granulomatous infections.

Objective: To evaluate AMH as a predictive marker of ovarian response in assisted reproductive technology outcome. Methods: 70 women (age 25-40 years) selected for in vitro fertilization treatment were included in this study. Analysis of day-2 serum samples was done for the AMH, FSH, Inhibin B, and LH by ELISA kit methods. USG was done for the antral follicle count (AFC) and oocytes’ retrieval. Results: The mean AMH levels of all treated patients were 2.260 ± 0.417. ROC for AMH indicating poor ovarian response with sensitivity of 72% and specificity of 70%. A statistically significant positive correlation was observed between the number of oocytes retrieved and the AMH (r = 0.620, p = 0.0001) (Fig. 2). Significant correlation was also seen between the number of oocytes retrieved and AFC (r = 0.400, p = 0.0001). Conclusion: Our data demonstrated that AMH is an adequate predictor of both high and poor ovarian response but it does not associate with pregnancy outcomes.

Aim: to evaluate Letrozole as suitable ovulating induction agent in patients with PCOS induced infertility. Material & Method: The main source of data for this study are the women with primary and secondary infertility with anovulation attending the Department of Obstetrics & Gynecology, RVM Institute of Medical Sciences and Research Centre, Siddipet, Telangana, India. This is a prospective study with a total of 200 women satisfied the inclusion and exclusion criteria of the study. The present study consists of cases of infertility due to anovulation which were thoroughly evaluated before the diagnosis of anovulation was confirmed. Results: In this study mean age of the patients were 28.0 years and mean age of husbands were 32.4 year. 105 patients underwent diagnostic hysterolaparoscopy with chromopertubation + ovarian drilling. Conclusion: Letrozole can be considered as suitable ovulating induction agent in patients with PCOS induced infertility. It is a better drug in terms of mono follicular ovulation and better endometrial thickness than other ovulation induction agents. It has high ovulation rate with significant conception rate, with only drawbacks being miscarriages.

This competitive healthcare market has made labour planning and allocation vital to the success of today''''''''s hospitals. Nurses'''''''' real usage is plagued by inefficiencies and cost overruns because even sophisticated automated planning systems for nursing labour cannot account for the dynamic needs of patient care during and between shifts. Typical labour measures increase the situation, as we''''''''ve discovered. Iterating through many objects with practitioners in situ, we adopt an extended action design science research (eADR) strategy. When it comes to filling important nursing and support tasks in real time, we find that understanding the behaviours of complex adaptive systems is vital. We utilise this information to identify management procedures that clash and obstruct the efficient operation of feedback loops for system balance. For real-time nurse labour planning and allocation, we used an electronic ADR strategy that included co-design, co-evaluation, and co-implementation of new structures, roles, and responsibilities. Patient outcomes may be greatly improved by using this novel artefact, which takes use of the dynamic actions of the actors.

Aim: To determine the importance of HbA1C levels and normotension in predicting the development of diabetic retinopathy and the relationship between them.
Method: Prospective clinical study comprising of a group of 125 diabetics above 40 years visiting for routine eye checkup and clinically diagnosed diabetic retinopathy including both out-patient and in-patients at Department of Ophthalmology, KIMS, Bangalore. Men and women >40years with type 2 diabetes mellitus with HbA1C levels <7.5% and non-hypertensives (<140mmHg systolic and <90mmHg diastolic pressure) were included. Patient’s HbA1C levels and blood pressure were measured. The diabetic retinopathy status was classified according to the ETDRS system. Statistical analysis was done.
Results: At 3rd month follow up, the mean HbA1C levels was 7.25±0.22.At the end of 12th month, the mean HbA1C was 7.42±0.11At baseline, in group A 8.8% showed mild NPDR and 1.6% moderate NPDR. At the end of the study it was 8.8% mild NPDR, 1.6% moderate NPDR. No further progression was seen in a year span. All values showed statistical significance and absence of hypertension also goes in favour of mild diabetic retinopathy changes.
Conclusion: HbA1C levels and systemic hypertension are the two major modifiable risk factors in the development and progression of diabetic retinopathy

Background: Hypertension “A Silent killer” is a non-communicable chronic disease exhibiting a rising prevalence in today’s globalized world. In long run it causes end organ damage like cardiovascular diseases, chronic kidney diseases, neuro-cognitive damage. Autonomic imbalance with added unhealthy lifestyle & professional stress hastens the pathophysiological process of the disease.
Aim of the study: Assessment of cognition & sensory motor response using audiovisual reaction time analyzer in young adults with & without parental history of hypertension. Methodology: A total of 120 young adult participants were included in this cross sectional study after obtaining institutional ethical committee clearance & defining inclusion and exclusion criteria. Sixty young adults with parental history of hypertension were screened & 60 students with no parental history of hypertension were recruited using simple random sampling for control group.
Result: The study showed both ART & VRT were prolonged in study group & the delay in ART was statistically significant (p<0.05).
Conclusion: Cognition and sensory motor tasks are affected by sympathetic reactivity indicating genetic influence. Early screening of altered neurological functions helps to take steps to prevent further consequences.

Several theories have been proposed, the most consistent being that it acts in a similar fashion to NSAIDs by the inhibition of the cyclo-oxygenase pathways. However, paracetamol lacks both the peripheral anti-inflammatory and anti-platelet response seen with NSAIDs28. More recently, it has been suggested that paracetamol may also be linked with both direct and indirect stimulation of the cannabinoid, nitric oxide synthase, and serotonergic pathways. Patients satisfying the inclusion criteria were selected during the study period from the operation register on a daily basis. After obtaining a written informed consent, sixty patients were recruited for this study. They were allocated into two groups of 30 each. 10 patients in group D and 08 patients in group P complained of nausea, none of the patients in either group had vomiting, bradycardia, and hypotension

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

In laparoscopic surgeries, marked hemodynamic changes occur due to the effect of absorption, positioning of the patient, anesthetic agents and pneumoperitoneum. When the intra-abdominal pressure is < 10mmHg, hemodynamic alteration is not significant. Significant alteration in hemodynamics occurs, when the intra-abdominal pressure is > 10 mmHg after insufflation. When the intra-abdominal pressure is >10mmhg, it will cause inferior vena cava compression and pooling of blood in the lower extremities, which decreases the venous return to the heart thereby reducing the cardiac output. On receiving patient in operating room, the patient monitoring included electrocardiogram (ECG), noninvasive blood pressure (NIBP), heart rate (HR), oxygen saturation (SPO2). The baseline HR, NIBP, SpO2 scores were recorded. The hemodynamic parameters taken into consideration were the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure. Mean values of these parameters were analyzed from the baseline, every minute for the first 10 min thereafter for every 5 min till the end of surgery. The heart rate was significantly lower in dexmedetomidine group during the initial 10 min during infusion, lowest mean of 79.53±13.08, none of the patients from either group had bradycardia requiring atropine. Mean value of HR was higher in paracetamol group compared to dexmedetomidine group till 1 h postoperatively. Using preanesthetic dexmedetomidine 1μg/kg infusion followed by 0.5 μg/kg/h showed there was no difference in MAP between the groups, but heart rate of dexmedetomidine group was lower compared to the control group.

Background: The COVID-19 pandemic is a global health threat and is by far the largest outbreak of atypical pneumonia, since the SARS outbreak in 2003. A range of psychiatric morbidities such as persistent depression, anxiety, panic attacks, delirium and suicidality were observed in the post infectious state across the world. Hence, the aim of the study was to understand the psychological status of the patients affected by COVID during their post-COVID follow-up period and to examine the socio-demographic and clinical factors associated with high psychological morbidity.
Materials and Methods: A cross sectional study conducted in the post-COVID follow up clinic, at a tertiary care hospital between the months of July 2021-November 2021, using a semi structured proforma and rating scales such as Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS) and Insomnia Severity Index (ISI) for depression, anxiety and insomnia, respectively.
Results: The study results indicate that the prevalence of depression and anxiety among post-COVID-19 patients was 21.9% and 11.9%, respectively. Insomnia was observed among 21.7% among various socio- demographic and clinical variables examined, it was observed that female gender, patients with ongoing stressors and patients with post-COVID-19 persistent physical symptoms were found to be associated with greater depression and anxiety among the study population.
Conclusion: Persistent physical symptoms and ongoing life stressors are found to be associated with depression and anxiety among post-COVID-19 patients. Hence, periodic screening for individuals with persisting physical symptoms and care for the vulnerable population such as those with ongoing stressors will provide a significant advantage in the follow up of the mental health of the patients affected with COVID-19.

Background: Anatomy forms the core of the Medical Subjects. It is said that Anatomy forms the heart of every subject in Medical Education. It’s mandatory for the first year MBBS to study Human Anatomy. Anatomy of the eye is also dealt as a part of curriculum. Students who take fifty percent are eligible to pass on to second year where they are taught other three para-medical sciences subject and if they clear this they will land in phase-III when the Ophthalmology will be taught to them. But how much Anatomy of the eye do they actually remember is the question that we face. So this study puts in a sincere effort to find the answers and also discusses of possibilities of measures that can be taken to ensure good education.
Aims and Objectives: To study and understand the orientation of students towards anatomy of eye in 3rd year MBBS.
Materials and Methods: This study was done in the students who entered third MBBS. One hundred twenty students participated in the study. They were divided into two groups and the study was conducted.
Results: Anatomy knowledge of eye was not retained which reflected very poorly in the pre-test scores and it was found that teaching Ophthalmology was much better after the reinforcement class of Anatomy which reflected in the second scores.
Conclusion: Anatomy and other pre and para medical subjects have to be taught in tandem with clinical subjects or at least a revision is needed for effective understanding of the clinical subjects.

Background: There are various studies that suggest that short term and early prone positioning can increase PaO2/FiO2 in moderate to severe acute respiratory distress syndrome (ARDS). The aim of our study was to observe the effect of prone position on oxygenation status in spontaneously breathing non intubated covid19 patients on either non rebreathing mask (NRBM) or on noninvasive ventilation (NIV).
Aims: To observe the effect of prone position along with oxygen therapy (NIV or NRBM) on oxygenation in spontaneously breathing none intubated covid19 patient.
Material and Methods: This prospective observational study was performed in a covid19 intensive care unit (ICU) at tertiary care hospital for the period of two months. Non-intubated confirmed RTPCR (Reverse transcription polymerase chain reaction) positive covid19 patients were included and observed who were placed in prone position with NIV BIPAP (Bi level positive airway pressure) or with NRBM by ICU consultant. Primary outcome was oxygenation status from Pao2/fio2 ratio from arterial blood gas analysis. Secondary outcome was hemodynamic parameter and any adverse effect occurred during prone positioning. Collected data were analyzed using SPSS software and P value of Pao2/Fio2 ratio of before and after prone position, less than 0.05 considered significant.
Results: We observed among our study participants significant improvement of PaO2/FiO2 ratio in both group of patients.
Conclusions: Early use of prone position improved oxygenation in majority of our patients in short periods of time in both NIV and NRBM group of patients.

Background: CSOM and associated hearing loss is significant in our society and an effort directed towards the assistance of those who are afflicted is indeed worthwhile. The problem of ossicular reconstructions for CSOM in difficult chronic ears however continues to represent a major rehabilitation challenge. Various materials have been used in reconstruction of middle ear including synthetic, bony and cartilaginous materials.
Methods: The present study was prospective observational study of 50 cases who underwent ossiculoplasty for middle ear surgery over the period of 2 and half years. CSOM patients with hearing loss >40 dB were included and patients with sensorineural hearing loss were excluded out from the study. Otoscopic examination, tuning fork tests, and examination under microscope were done in all the patients.
Results: A total number of 50 patients were included in the study. Graft was taken up in 90% cases and rejected in 5% subjects after 3 months postoperatively. The average pre-operative air-bone gap was 45±3.60 dB while the average post-operative air-bone gap was 25.66±9.25 dB. The average hearing gain was 19.34 dB which was statistically significant (p=0.000).
Conclusions: This study concluded that ossiculoplasty with an autologous incus graft is safe surgical approach with good results for reconstructing the ossicular chain due to lower extrusion rate with good post-operative hearing gain.

Background: The mortality rate covid-19 is still not understood completely but was reported around five percent worldwide. This study puts in an effort to find one such difference if any between the survivors when compared to the non-survivors. This study makes an effort to find the acute inflammatory proteins in the survivors in comparison with the non-survivors.
Aims and Objectives: To study the acute inflammatory proteins levels and their significance in Covid-19.
Materials and Methods: This is a retrospective study done in the Department of Medicine, Dr. Chandramma Dayanand Sagar Institute of Medical Education and Research, Bangalore.
Results: There is a significant difference in the levels of acute inflammatory protein levels in survivors when compared to that of non-survivors.
Conclusion: This study successfully portrays the importance of acute inflammatory protein levels in understanding the progression of the disease.

Introduction: Dengue is an arboviral infection transmitted through the bite of Aedes mosquitoes having four distinct serotypes DENV 1-4. Secondary infections often lead to increased disease severity. The study was carried out with an aim to analyze dominant serotype in circulation and to find an association between serotype and hematological parameters.
Material & Methods: A total of 163 Dengue Positive samples were subjected to serotype-specific Real-time Polymerase chain reaction to identify the serotype. Hematological parameters viz; WBC counts, Hematocrit value, platelets, lymphocyte % were also studied concurrently for these patients.
Results: The mean age of the participants was 27.2 years with male preponderance.NS1 antigen positive (74.8%), IgM (38%) and both NS1 & IgM positives (12.8%) were detected. The predominant serotype identified was DENV-2(48.4%), DENV-4(43.5%), and DENV-3 (7.9%). Statistically significant difference in platelet counts was observed in DENV-2 & DENV-4.White blood cell counts showed statistically significant differences within DENV-2 and DENV-3 serotypes.
Conclusion: Cocirculation of multiple serotypes of DENV was observed in our study. The application of molecular testing will increase DENV diagnostics, especially in secondary infections which carry more chances of adverse outcomes. We recommend the inclusion of serotype testing in the Dengue diagnostic algorithm to be able to reduce morbidity and mortality.

Background: It was well reported that gabapentin has a role in the management of neuropathic pain. However, substantial evidence for the same was sparse.
Objective: The present study was undertaken to evaluate the effectiveness of gabapentin in the management of postoperative pain after total hip arthroplasty.
Materials and methods: A total of 50 patients diagnosed with sepsis and aged more than 18 years including both males and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study.
Results: The majority of the participants were males with 60 % and females were 40%. The majority of patients were having pain scores of 7-9 before the intervention in the control group. The majority of the patients are in pain scores of 7-9 after ibuprofen in the control group. Table no 5 presents the distribution of the intervention group participants according to the pain scores after intervention. The majority of the patients were in pain scores of 1-3 after the administration of gabapentin.
Conclusion: The study results confirm that gabapentin has a significant effect on the management of pain after the surgery of the knee and hip. The study recommends further detailed study in this area to recommend gabapentin in the management of pain.

Background: The present study aimed to investigate the clinical significance of urinary Kim-1 level in type II diabetic patients with and without nephropathy and to evaluate its relation to various clinical and laboratory parameters as an early predictor of diabetic nephropathy.
Methodology: The prospective study was conducted at Department of Medicine at Dr M.D.M. Hospital, Jodhpur. Attached to Dr. S.N. Medical College to study the detection of Kidney injury molecule-1 (Kim-1): An early biomarker for nephropathy in type II diabetic patients attending the Medicine Outdoor and Indoor at M.D.M. Hospital, Jodhpur. It includes 75 patients whose serum creatinine level was less than 1.5mg/dL. Diabetes was defined as fasting plasma glucose ≥126 mg/dL according to WHO criteria.
Results: Kim-1 is found raised in 68% patients and with normal albuminuria and microalbuminuria also significantly correlated with other variables i.e. fasting blood sugar, HbA1c p value is less than 0.001 for all these variables. So kim-1 can be used to diagnosis early nephropathy as a sensitive, rapid, noninvasive test in diabetes. With these we conclude KIM-1 is a good for early detection of Diabetic nephropathy and it is nicely correlating with urinary microalbumin level which is gold standard for detection of early nephropathy.

Objective: To find out the sensitivity of Indian diabetes risk score as a screening test tool of diabetes mellitus among adult population by comparing the result of IDRS with ADA diabetes diagnostic criteria (fasting blood glucose/postprandial blood glucose).As adult population is at risk for developing diabetes mellitus. Early diagnosis and treatment may reduce the morbidity and mortality.
Methodology: The study was conducted on 600 patients of Dr. Sampurnanand Medical College and Associated Hospital, Jodhpur included all individuals > 20 years of age, a verbal consent taken from all individuals entering in to the study. IDRS will be applied to all individuals, then all subjects will tested for fasting (8 hours fasting) blood glucose level and, or 2 hours postprandial blood glucose level population attending the outdoor clinics, indoor wards and general population (attendants, accompanying peoples) using venous blood sample in fluoride vial.
Conclusion: In our study it can be concluded that IDRS can be applied as a screening test in our country regardless of the demographic variation in the prevalence of diabetes. Thus IDRS is a simple, reliable and easy to use tool for mass screening of the high risk individual of Diabetes mellitus.

Background: Opioids and local anaesthetics act synergistically and it’s a popular technique to combine bupivacaine and fentanyl in spinal anaesthesia for caesarean delivery. The aim of the study was to find out optimal dose combination of bupivacaine and fentanyl for spinal anaesthesia for better quality of perioperative analgesia and reduction of feto-maternal adverse outcome during caesarean section.
Methods: Three hundred and four parturients scheduled for caesarean delivery were randomly allocated to four groups of 76 each. Data of 298 parturients (Gp I=73, Gp II=75, Gp III=75 and GP IV=75) was included in the primary outcome analysis. The control group received 12 mg of 0.5% hyperbaric bupivacaine for spinal anaesthesia. Fentanyl 15, 20 or 25 μg was added to each study group who received 9 mg of 0.5% hyperbaric bupivacaine in spinal anaesthesia. Onset and duration of spinal anaesthesia, hemodynamic parameters, intraoperative nausea & vomiting (IONV), failed block, APGAR score and other side effects were noted.
Results: The duration of effective and complete analgesia was significantly longer in all fentanyl groups. However, increasing the dose of fentanyl from 15 to 25 μg had little effect on further prolongation of analgesia. Duration of motor blockade was significantly prolonged in control group. The incidence of hypotension and IONV episodes were significantly low in the study groups.
Conclusion: Bupivacaine and fentanyl have super additive effect in spinal block. However, strict drug dose calculation is required in spinal anaesthesia to minimize adverse outcomes during caesarean delivery. Spinal anaesthesia with fentanyl 15 μg and 0.5% hyperbaric bupivacaine, 9 mg provides optimal surgical conditions for caesarean delivery with negligible side effects as compared to other dose combinations.

Background: Wound debridement is very crucial step for wound healing and prevention of infections complications. Traditionally, several types of wound debridement techniques have been used in clinical practice such as autolytic, enzymatic, biodebridement, mechanical, conservative sharp and surgical.
Aim & objective: Compared the surgical debridement and autolytic debridement methods for wound.
Results: This study involves selecting fifty patients suffering from acute or chronic wounds, randomly distributing them to the following groups irrespective of age, sex and etiology of wounds and then treating them with different methods of debridement as denoted by the group’s name Group I Surgical debridement group, Group II Autolytic debridement group. Male patients were predominant than female, mainly 41-60 years age groups. Discomfort reduction more in surgical group whereas pain and discharge reduction more in autolytic group.
Discussion: The choice of the debridement technique depends on type of ulcer/wound patient’s age, economic status, state of wound edges and skin, exudate and resources of the caregiver. Surgical debridement is low cost, highly sensitive and rapid acting but it can cause pain and invasive. Autolytic debridement is a painless, less invasive, less chance of infection and safe technique, but with slow action, so with high costs, because dressing are usually changed once a day.
Conclusion: Surgical debridement is the fastest way to remove the source of infection, promotes healing and helps accurate assessment of wound. Pain and discomfort are less in autolytic debridement.

Background:
Introduction: This study is about explaining how elderly people with chronic disease experience their lives, their emotional reactions, their social & physical functions and their adaptation to life.
Methodology: A cross sectional analytical study was conducted in wards and OPD of medicine department of associated hospitals of S.N. Medical College, Jodhpur, and Rajasthan. This study included a total of 200 elderly patients. Out of which 100 elderly patients were having chronic diseases and rest of 100 were not having chronic diseases (which had been used as control). Data were collected by means of questionnaire & clinical examination.
Results: Male elderly had better mean QOL score than Female elderly. Patients who were widowed had poorer mean QOL score (434±137.6) than in patients who were living with spouse (454.7±171.11). Patients living alone had mean QOL score (452.3±71.6) and patients living with family had score (448.09±164.7) that was slightly better. Patients living in rural area had better mean QOL score (477.1±157.4) than patients living in urban area (435.9±164.1). In study group mean quality of life (QOL) score was decreasing with increasing age up to 79 year but after age 80 year and above mean quality of life score was better. There was negative relationship between presence of chronic disease and QOL in elderly. All the chronic diseases were decreasing QOL score in elderly.
Conclusion: Geriatric patients require different approach for the treatment of chronic disease because in this population there are several factors which influence the overall management of chronic disease. So all the clinician need to consider the overall quality of life as the very important parameter to look for, in the best management of chronic disease in elderly.

Objectives: To assess results of proximal femoral nail in the treatment of peri-trochanteric fracture of femur.
Methods: This study included 90 patients of proximal femur fracture admitted in our institute. The patients were informed about the study in all respects and informed consent was obtained from each patient.
Results: Results were evaluated using the Harris Hip Score. We had 45(50%) excellent, 31(34.44%) good, 12(17.8%) fair and 2(2.22%) poor results.
Conclusion: The Proximal Femoral Nail Can Be Considered The Most Rational Method of Treating Intertrochanteric and Sub-trochanteric Fractures, Especially the Unstable and Reverse Oblique Type. Also the learning curve is relatively less and hence can be performed well by most of the surgeons. Thus we can conclude that the Proximal Femoral Nail is after proper training and technique, a safe and easy implant option for treatment of complex peri-trochanteric fractures.

Objectives: To evaluate the results of micro-endoscopic discectomy and open discectomy in lumbar disc prolapse.
Methods: This study is a prospectively conducted study of 30 patients operated by a single surgeon with both modalities. The first modality is endoscopic discectomy using METRx system (Medtronic, Sofamor-Danek, Memphis, TN) using 22mm port and the second is open method of discectomy for lumbar disc herniation.
Results: The results were evaluated using ODI (Oswestry Disability Index) and VAS (visual analogue scale 0-10) for back pain and leg pain. Patients were followed up at an interval of 1 week, 2 week, 1 month, 6 months and 12 months post-operatively.
Conclusion: By limiting the tissue manipulation via small incisions and minimal muscle dissection, MED has reported to have better perioperative outcomes, including shorter hospital stay, less blood loss, less pain medicine requirement, decreased surgical site infection rate, quicker return to activities and Early discharge rate than open method. Although MED have some advantages over the open techniques in the perioperative factors, both the techniques are effective and provide similar pain relief and functional outcomes at the end of 2 years.

Background: Paranasal sinuses fill in as a host to a wide range of illnesses and conditions from provocative to neoplasms, both benign and malignant. The use of СT with рrорer knоwledge аnd соgnizаnсe оf sinus аnаtоmy аnd rаdiоlоgiсаl lаndmаrks, аlоng with сliniсаl cоrrelаtiоn аids in diаgnоsing раrаnаsаl sinus раthоlоgies ассurаtely.
Aim and Objectives:
1) Evаluаtiоn оf раrаnаsаl sinus раthоlоgies аnd their аnаtоmiсаl extensiоn аnd bоny invоlvement using multideteсtоr соmрuted tоmоgrарhy.
2) Соrrelаtiоn оf the findings оf multideteсtоr соmрuted tоmоgrарhy with сliniсаl diаgnоsis.
Material and Methods: The hоsрitаl bаsed рrоsрeсtive оbservаtiоnаl study was conducted in the Department of Radiodiagnosis & Imaging, Muzaffarnagar Medical College, U.P, for eighteen months with twelve months for data collection and 6 months for data analysis. Total 40 patients of varied age groups presenting with symptoms and signs of paranasal sinus diseases underwent CT using Siemens Sоmаtоm Sсорe 16 sliсe СT mасhine as per standard protocol. Images were acquired in the axial and coronal plane with reformation in sagittal plane.
Results: Maximum numbers of patients were in age group of 21 to 30 (35%) with male to female ratio of 1.2:1. Most соmmоn sinus invоlved wаs right mаxillаry sinus (70%). Most common chief complaint was nasal obstruction (97.5%) and nasal discharge (90%) with maximum number cases of sinusitis (22%).
Conclusion: To conclude, Multidetector Computed Tomography of the paranasal sinuses has improved the visualization of paranasal sinus anatomy along with its variants and has allowed efficient diagnosis of paranasal sinus lesions. Precise description of the disease and related microanatomy detected by CT scan provides a reliable pre-operative road map.

Introduction: Calcaneal fractures are comparatively rare injuries, which occur in 2% of all fractures According to the recent literature, 60% to 75% of these fractures are considered to be displaced and intraarticular, which evidences the difficulty of the treatment. This type of injury is more common in men compared to women because it commonly occurs as occupation associated.
Methodology: In this study of prospective design 40 patients with calcaneum fracture treated by ORIF with plates between JAN 2019 to DEC 2021 were reviewed at a tertiary centre. The
patients were called for a final follow up evaluation and the latest functional outcome assessed as for the AOFAS score and results were analysed.
Results: Young patients showed significantly better outcome with ORIF with plating. The timing of the surgery is the most important detriment for the outcome. The final functional outcome assessed with AOFAs score is encouraging with 77.1%.
Conclusion: Operatively treated calcaneum fractures with ORIF with plates gives a good functional outcome when surgical principle are strictly adhered to, proper patient selection, appropriate timing for surgery, strict asepsis, proper approach for rising full thickness flaps, accurate anatomic reduction and proper post-operative protocol with follow up which minimizes complications.

Introduction: Fracture patella is seen in all age groups but less common below 20 years of age. The most common cause of patellar fractures is road traffic accident, direct trauma or forcible pull of quadriceps. Fracture of patella accounts approximately 1% of all skeletal injuries.
Materials and Methodology: The study was a randomized, comparative study conducted from July 1st 2014 to December 31st 2015, at Tertiary center on 50 consenting patients who came to the department of orthopedics and on evaluation was diagnosed to have patellar fractures following which they were randomized to one of the following treatment modality
Conclusion: We concluded that tension band wiring was better as it yielded steady and consistent results

Background: Extra-articular distal shaft humerus fractures at the junction of cylindrical and triangular portion are seen as torsion wedge fractures. Historically most shaft fractures were treated conservatively. Today’s trend is towards surgical management due to high patient demand and availability of anatomical plates. This study aims to evaluate the functional results of plating in extra-articular distal humerus fractures with duration of clinical and radiological union.
Methods: A prospective study of 20 patients with torsion wedge fractures of AO Type 12-B1 was done over a period of 3 years. Demographic data was collected and all patients underwent fixation with posterior triceps splitting approach using an extra-articular distal humerus plate (EADHP) and inter-fragmentary screws. Results were evaluated by clinical and radiographic parameters. Functional results were monitored by modified Quick DASH score.
Results: There were 12 males and 8 females with a mean age of 34.45 years. Mean time to clinical and radiographic union was 10.5 weeks and 33.9 weeks respectively. The mean modified Quick DASH score at clinical and radiographic union was 24.8% and 13.76% respectively. Two patients developed radial nerve neuropraxia recovering spontaneously. One patient having inadequate reduction went on to unite both clinically and radiographically with good functional out come without any secondary intervention.
Conclusion: AO Type 12-B1 humerus fractures treated surgically with anatomical locking plates and inter-fragmentary screws give excellent anatomical and functional results. Though time to radiographic union is prolonged, no secondary intervention in the form of bone grafting or other modalities was required in any patient.

Introduction: Ascites is the accumulation of protein-containing (ascitic) fluid within the abdomen. Many disorders can cause ascites, but the most common is elevated blood pressure in the portal veins which is usually due to cirrhosis. If large amounts of fluid gets accumulated, the abdomen becomes distended, which may result in loss of appetite and shortness of breath. Analysis of the fluid can help in determining the cause.
Aim: To find the Differential diagnosis of ascites based on ascitic fluid analysis.
Material and Method: A total of 100 patients were studied, their ascitic fluid were analysed. Parameters used are Serum Ascitic Fluid Albumin Gradient (SAAG) and Ascitic Fluid Total Protein (AFTP).
Results: The most common differential diagnosis is Liver Cirrhosis in males and Congestive cardiac failure in Females.
Conclusion: SAAG has high positive predictive value while AFTP has high negative predictive value.

Background: Abnormal Uterine bleeding (AUB) is a cause of significant healthcare burden for the women, common methods for endometrial assessment are USG, hysteroscopy, D&C, however multiple newer outpatient method are becoming popular due to their ease of application and cost effectiveness. Present study was aimed to compare the diagnostic accuracy and histopathological success of Pipelle verses conventional curettage in diagnosing endometrial pathology in AUB cases.
Material and Methods: Present study was single-center, Prospective and comparative single blind study, conducted women aged 25 years, with complaints of abnormal uterine bleeding with or without infertility. Initially, endometrial sample was collected by pipelle sampler in the outpatient department followed by endometrial biopsy by curettage under general anesthesia.
Results: Out of 106 patient’s majority were from 40-60 years age group, had 2 or more parity. Majority had abnormal uterine bleeding alone (77.36%), infertility alone (10.37%) & infertility with abnormal uterine bleeding (12.26%). Common USG findings were endometrial polyp (19.81%), fibroid uterus (10.38%), adenomyosis (3.77%), cystic endometrium (3.77%) and Thickened Endometrium (1.89%). In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%. In the premenopausal women the sensitivity, specificity, NPV & PPV are all 100% for Pipelle sample as compared to curettage. In the postmenopausal women, specificity & PPV was 100%, however sensitivity was 66% and NPV was 95.2%.
Conclusion: In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%.

Introduction: One of the primary aims of anesthesia is to relieve the patient's pain and
agony, thereby the surgical procedures can be conducted without any discomfort. Relief of
intraoperative and postoperative pain has gained importance in recent years, considering the
central, peripheral and immunological stress response to tissue injury. Any expertise acquired
in this field should be extended into the postoperative period, which is the period of severe,
intolerable pain requiring attention. So there is need of extended analgesia without any side
effects in the process of achieving this goal. “Regional anaesthesia” is the term first used by
Harvey Cushing in 1901 to describe pain relief by nerve block 1. Regional nerve blocks are
based on the concept that pain stimulus conveyed by nerve fibers, which are amenable to
interruption anywhere along their pathway 2. Brachial plexus block is a valuable and safe
alternative to general anesthesia in upper limb surgeries. Interrupting the acute pain which
can help in limiting the development of chronic pain syndromes 3, 4. The effects of opioids on
regional blockade is controversial. So the present study is being undertaken to evaluate
Fentanyl as an adjuvant to Ropivacaine in supraclavicular brachial plexus block.
Methodology: Hospital based Prospective randomized single blinded study. Conducted on
eighty patients of ASA I and II posted for upper limb surgeries under supraclavicular block.
Patients were divided randomly by means of random number table generated by computer
into two groups as A and B. Each group consisting of 40 patients. Prior to the study
Institutional Ethical committee approval and consent from the patients were taken. The study
was conducted in the Department of Anesthesiology, at Katuri medical college &Hospital,
Guntur from January 2016 to October 2017.

Osteosynthesis with open reduction technique in comminuted fracture has several disadvantages like increase rate of non-union, non-healing of soft tissue, infection and failure of implant. These problems can be managed by percutaneous minimally invasive plating technique which preserve the vascularity and soft tissue anatomy of fracture fragments.
A total of 40 patients were involved in this study. Distal tibia with or without fibula fracture (12), Diaphyseal tibia (10), Proximal tibia (8), Supra condylar Femur (6) and Subtrochanteric Femur (4) were operated by using the principles of indirect reduction and biological fixation with plates under C-arm guidance. Weight bearing was allowed according to the clinical and radiological union at follow up.
Most patients regained excellent range of motion of adjoining joints. Mean time of radiological union was 20.12 weeks. Two patients had soft tissue infections which healed with wound care and dressing. One patient had non-union which was managed by bone grafting. In this study excellent result was seen in eighteen cases, good in five and fair in other patients.
This study indicates that minimally invasive percutaneous plating is an effective method for treatment of comminuted diaphyseal fracture of long bones. These complex fractures goes onto complete recovery and normal limb function at an early stage with fewer complication

Fetal growth restriction (FGR) is a pathological condition in which a fetus has not achieved his genetic growth potential, regardless of fetal size (1) Worldwide FGR is observed in about 24% of newborns; approximately 30million infants suffer from FGR every year. The burden of FGR is concentrated mainly in Asia which accounts for nearly 75% of all affected infants. National neonatal perinatal database of India reported the incidence of FGR to be 9.65% among hospital born live birth infants. Study was conducted for all cases with clinical/ Sonological term FGR admitted under department of OBG. A detailed history as per questioner will be taken with general physical examination and investigations will be done as per requirement. The accumulated data was evaluated and statistically analyzed. In the present study 70 patients with term gestation with FGR were recruited. Maternal (74.28%) was the commonest cause followed by Idiopathic (11.43) and Placental (10%) and Fetal (4.29%) causes. Among Maternal causes Pre Eclampsia was found to be in 50% cases. Most of the patients (50.7%) required caesarean section. A total of 9 (12.86%) neonate had birth weight of <1.5 kg, 48.6% had Birth weight between 1.6 to 1.9kg, 38.5% had birth weight between 2-2.4kg and 95.8% had asymmetrical FGR, 4.2% were symmetrical. 26 (40%) neonates had morbidity with 17(24.3%) neonatal mortality with Respiratory distress syndrome (41.18%) being most common cause. No Maternal Mortality.

The risk of morbidity and mortality depends on basic pathology which mainly caused the growth problem, severity of growth restriction, gestational age of mother -how much earlier it is, and the baby's gestational age at birth. The 10th percentile is commonly used to define "small for gestational age" at all stages of pregnancy. The risk of neonatal mortality at the 10th percentile has a bimodal distribution with higher mortality at 26 and 34 weeks ' of gestation. A detailed history as per questioner was taken with general physical examination and investigations were done as per requirement. The accumulated data was evaluated and statistically analyzed. The pregnancy outcome of 70 cases was studied, which showed that 40(61.43%) cases went into spontaneous labor, labor was induced in19 (28.57%) cases and 11(1.%) cases were taken for elective caesarean section for various indications. The fetal outcome of the study showed that out of 70 cases recruited in the study, 65 (92.86%) were live births, 3(4.28%) were still birth and 2(2.86%) cases had intra uterine fetal demise.

Caesarean sections are routinely done under spinal anaesthesia using 0.5% hyperbaric bupivacaine that has a long duration of action. As most of the caesarean sections are of short duration, we decided to compare 1% 2-chloroprocaine with routinely used bupivacaine as chloroprocaine has rapid onset of action, producing an excellent sensory and motor blockade. After ethical committee clearance and informed written consent, 70 uncomplicated singleton parturients of ASA I and II posted for elective caesarean section were randomised into chloroprocaine (CP) and bupivacaine (B) group of 35 each.
Onset of sensory block in group CP was 1.71±0.62min and in group B was 2.31±0.63min. Onset of motor block in group CP was 2.54±0.88min and in group B was 2.66±0.76min. Mean time for maximum sensory block in group CP was 12.77±3.52min and in group B was 22.34±6.46min and time for maximum motor block in group CP was 9.14±2.23min and in group B was 10.86±2.18min. Two segment regression time in group CP was 39.34±4.46min and in group B was 63.14±4.7min. Mean duration of sensory block in group CP was 2.08±0.25hr and in group B was 3.60±0.27hr and duration of motor block in group CP was 1.07±0.14hr and in group B was 3.42±0.41hr. VAS scores in first 6hrs were lesser in group CP than group B. Onset, maximum time, duration of sensory and motor block were lower in group CP than group B. hemodynamic parameters were comparable between the groups with no side effects.

Supraglottic Airway devices (SAD) have now become a fundamental tool for ventilation, oxygenation and delivery of anaesthetic gases in modern anaesthesiology. The advent of newer generation of SADs has resulted in their extended use. Baska mask and I Gel being newer generation SADs are vastly being used due to their specific designs for ease of securing the airway, better ventilation and higher patient safety. After institutional ethical committee clearance, a prospective randomized comparative study was conducted. 60 patients of age group 18-60 years of ASA grade I and II undergoing elective surgeries under GA were included. Patients were randomized into 2 groups, Group B (Baska mask group) and Group I (I Gel group) with 30 patients in each group. The ease of insertion (p value 0.035), insertion attempts (p value 0.04) and the time taken for insertion (p value <0.001) were significantly better with I Gel compared to Baska mask. Both the groups were comparable in terms of postoperative pharyngolaryngeal morbidities.

Background: The frequency and timing of priapism in acute spinal cord injury (SCI) and the level, or levels, most likely to be associated with priapism are debated.
A spinal cord injury (SCI) is defined as damage to the spinal cord caused by an insult resulting in the transient or permanent loss of usual spinal motor, sensory, and autonomic function.
Methods: This is prospective observational study done in PES Institute of Medical Sciences, Kuppam, from February 2019 to February 2020. A total of 15 cases were studied. The patients selected for study are those who presented with history of cervical /thoracic spine injury with complete neurological deficits, following trauma. Based on detailed history and thorough clinical examination diagnosis of priapism in spinal cord injury was made. Investigations done: Complete Blood counts, Blood grouping, Coagulation profile Peripheral Smear, Renal function tests, Serology, Corporeal Blood gas analysis, CT Cervical/thoracic spine, MRI cervical spine with whole spine screening.
Results: A total of 15 patients who presented with spinal column injuries with neurological deficits Quadriplegia or paraplegia, following trauma were included in the present study. Eleven of the 15 patients had priapism. Four out of the 15 patients presented with quadriplegia but without priapism. Among the 11 patients, 4 patients presented with Paraplegia with priapism secondary to complete cord transection of the lower cervical/high thoracic cord. Seven patients presented with quadriplegia and priapism secondary to complete cord transection of the cervical cord. All 15 patients underwent spine stabilization surgery along with surgical decompression of the spinal canal and conservative management for priapism. In 6 patients, the priapism subsided spontaneously within 12hours, in two pts it subsided within 24hrs for in two pts it lasted for 36 hours while in one patient it lasted for 4 days post spinal canal decompression.

Introduction: Umbilical hernias in adults are commonly acquired hernias. These are more common in women, and in conditions like pregnancy, ascites, obesity etc. More than 1 million hernia surgeries are done annually in India. Suture repair techniques have dominated ventral and incisional hernia repair over a century. The most popular of these techniques was the Mayo duplication. In larger hernias, suture repair requires the application of tension to the fascia in order to close the orifice.
Objectives of the study: To evaluate the outcome of onlay and pre-peritoneal open mesh repair in umbilical hernias in adults regarding operative time, ease of procedure, hospital stay, complications and recurrence if any.

Purpose: To identify the presence of occult (DVT) in post op patients on DVT prophylaxis and to avoid unnecessary screening, we reviewed our experience with routine duplex screening for DVT in high risk post-operative patients on DVT prophylaxis.
Methods: Over a 2 year period, all patients who were admitted with an anticipated length of stay greater than 36 hours were studied to determine the prevalence of risk factors for asymptomatic proximal DVT. Risk factors, demographics, and operative data were collected and analyzed with multilinear regression, t tests and χ2 analysis.
Results: There was a 7.3% prevalence of major DVT in the 100 patients studied. APACHE II scores (14.5 ± 6.24 vs 10.3 ± 3.15; p < 0.0001) and emergent procedures (45.5% vs 23.2%; p > 0.0344) were associated with DVT by multifactorial analysis. Age was significant by univariate analysis. An algorithm based on the presence of any one of the three risk factors identified (APACHE II score 12 or more; emergent procedures; or age 60 or greater) could be used to limit screening by 30% while achieving a 95.5% sensitivity for identification of proximal DVT.
Conclusion: Absence of all three risk factors indicates a very low risk for DVT (3%). Screening of post op patients is indicated because of a high prevalence of asymptomatic disease. Patients who have proximal DVT require active therapy and not prophylaxis. Costs and resources may be contained by using the above risk factors as a filter for duplex screening.

Introduction: HRСT Temporal bone in unsafe CSOM саn рrоvide exсellent detаils оf temроrаl bоne аnаtоmy, its соngenitаl vаriаtiоns, lосаtiоn аnd extent оf diseаse, аsymрtоmаtiс соmрliсаtiоns аnd degree оf bоne destruсtiоn. It соnfirms оtоsсорiс findings tо greаter extent, сleаr mаny сliniсаl dоubts аnd helрs in determining surgiсаl effiсасy when surgery will be neсessаry аnd аlsо fоr рlаnning the аррrоасh fоr surgery.
Aim: To assess the usefulness of HRCT imaging of temporal bone in cases of unsafe chronic suppurative otitis media and to describe the status of the disease in unsafe chronic suppurative otitis media.
Material and Methods: Total 40 patients with clinical diagnosis of unsafe CSOM were included in the study and underwent HRCT using Siemens Sоmаtоm Sсорe 16 sliсe СT mасhine as per standard protocol. Each HRCT was analysed for presence of soft tissue density in middle ear and mastoid cavity and status of ossicles, mastoid cavity, scutum, lateral semicircular canal, cochlea, facial nerve canal, external auditory canal, tegmen tymphani and sinus plate.
Results: Maximum numbers of patients were in age group of 21 to 30 (35%) with male to female ratio of 2.6:1. Most common chief complaint was otorrhoea (90%) and hearing loss (45%). Mоst соmmоn ossicle eroded wаs incus (65%) and scutum erosion noted in 55% cases.
Conclusion: HRСT is useful fоr diаgnоsis, surgiсаl рlаnning аnd mаnаgement оf temроrаl bоne раthоlоgies. Рreорerаtive СT sсаn is benefiсiаl аnd соntributоry in relаtiоn tо diаgnоsis аnd deсisiоn-mаking in indiсаting орerаtiоn tо раtients with СSОM аnd imрrоves the suссess rаte оf сhоlesteаtоmа surgeries. It serves аs rоаd mар tо аssist the surgeоn during surgery.

Background: A palpable neck mass is a commonly encountered clinical problem. They vary in etiology, pathology, and prognosis due to the complicated anatomy and physiology. This study was done to detect the effectiveness of high-resolution ultrasonography and computed tomography imaging in detecting neck masses.
Aim and Objectives:
1. To assess the utility of High-Resolution Ultrasonography and Computed Tomography imaging in the evaluation of neck masses.
2. To study mass lesions under the following headings- Location, Size and extent of the mass, relation to surrounding structures, internal mass characteristics that are benign or malignant.
Material and methods: The hospital-based prospective observational study was conducted in the Department of Radio diagnosis & Imaging, Muzaffarnagar Medical College, U.P. for eighteen months, with twelve months for data collection and six months for data analysis. A total of 40 patients of varied age groups presenting with a clinically palpable neck mass who underwent both USG and CT were studied.
Results: The maximum number of patients was 41-50 years old (28%), followed by 21-30 years (12.5%). Of the total cases (40), non-nodal masses were 22 (55%), and nodal masses were 18 (45%). The most common pathology in the present study was lymph nodal mass of aerodigestive malignancies, noted in 13 cases (32.5%), and followed by thyroid mass, noted in 12 cases (30%).
Conclusion: High-resolution sonography is valuable modality for the diagnostic evaluation of neck masses in every age group. It is a simple, non-invasive, and inexpensive diagnostic tool. It provides accurate and reproducible results. It can be used as a first-line modality for evaluating cervical soft tissue masses in many clinical conditions, especially in young and pediatric populations. CT ensures accurate anatomical localization and lesion characterization in benign lesions. It is helpful in staging malignant tumours and provides essential information about the tumour extent that directly affects the surgical approach necessary for curative resection.

Background: Herpes zoster (HZ) is classically unilateral in its presentation appearing along the distribution of the cranial or spinal sensory nerves, with an occasional spill into the neighbouring dermatomes. An observation that many patients of facial herpes zoster have predominantly left sided involvement led us to validate further if any significant association of herpes zoster really occurs with cerebral dominance and handedness of the individuals.
Aims & Objectives: To see any correlation between handedness of individual and laterality of facial herpes zoster and to compare it with extra-facial herpes zoster.
Material & Methods: All the patients with clinically diagnosed herpes zoster presenting to the dermatology outdoor or admitted in indoor of a tertiary care centre were included in this study during a period of year from January 2017 to December 2018. Clearance from institutional ethical committee was taken.
Results: Out of a total of 191 patients, males 105 (55%) outnumbered females 86 (45%) with a male: female ratio of 1.22. Maximum number of patients were between 20 and 40 years (67;35.08%). The right‑handed individuals accounted for 89.53% of the total cases. A higher number of right‑handed patients manifested HZ on the left side (55.56%). Of the left‑handed, 50% manifested HZ on the right side. Statistical analysis with Fisher’s test revealed a two‑tailed P = 0.637 showing a statistically insignificant involvement of the contralateral side in HZ compared to hand dominance. These values for facial and extra-facial HZ were 0.9 & 0.09 respectively. This is in contrast to older studies which found significant correlation between hand dominance and contralateral side of involvement in herpes zoster.
Conclusion: Cerebral dominance plays an important role in neuro-immunomodulation, as reflected in previous studies, but our study did not find any significant association between hand dominance and contralateral eruption of HZ.

Introduction: Obesity is associated with adverse and deranged cardiovascular events which could be due to the altered Sympathetic and parasympathetic balance seen in these individuals. In recent times Obesity is recognized and considered as a Major, worldwide, health issue.
Material and Method: The Present study was conducted in the Department of Physiology, Index Medical College, Indore (MP).50 Obese (25 male and 25 female) and 50 non obese (25 male and 25 female) young adults were included. A parasympathetic test was performed on both the groups. All data are expressed as mean± standard deviation. Comparison between groups of obese male, non-obese male, obese female and non-obese female was performed using student’s t-test (t-test for two independent samples / Two-tailed test). Differences was considered significant at p<0.05.
Result: It was observed that obese young adults had reduced parasympathetic activity.
Conclusion: This altered balance of Autonomic Nervous system increases the risk of cardiovascular disorders.

Introduction: General anesthesia, for a surgical procedure is normally done with the help of endotracheal intubation. The non-depolarizing muscle relaxant, or the non depolarising muscular blocking (NMBA) agents are known to inhibit the action of acetylcholine, while differing in the onset and the duration of action, potency, metabolic route and side effects. The main aim of this study was to compare the neuromuscular blockade of atracurium and Cisatracurium and the recovery characteristics.

Introduction: Spinal anesthesia is most commonly used for lower abdominal surgeries due to its low cost and ease of administration as well as rapid onset of anaesthesia. Adjuvants like Fentanyl and dexmedetomidine are used to accelerate and prolong the anaesthetic effect depending on the purpose. This study was done to compare the effects of intrathecal hyperbaric bupivacaine with fentanyl and bupivacaine with dexmedetomidine for lower abdominal surgeries.

Background: The mediastinum is an extremely complex and interesting area of the body. The multitude of diseases affecting the mediastinum very considerably, ranging from tumor, cysts, vascular anomalies, lymph node masses, mediastinitis, mediastinal fibrosis, to pneumomediastinum. Present study was aimed to study role of CT scan in characterization of mediastinal lesions and its correlation with histopathology report.

Background: The sрeсtrum оf sсrоtаl раthоlоgies vаries with аge (e.g. соngenitаl аnоmаlies and trаumа being frequent in сhildhооd, trаumа and infertility in аdulthооd аnd neорlаsm in elderly). This study wаs аn аttemрt tо knоw the distributiоn оf the sсrоtаl раthоlоgies аmоng the subjeсts аnd tо understаnd the sоnоgrарhiс сhаrасteristiсs оf the sрeсtrum оf sсrоtаl раthоlоgies using High-Frequenсy Ultrasonography (USG) аnd Соlоr Dоррler.
Aim and Objectives
1) Determining the sonographic features of scrotal lesions on Real Time Gray Scale Sonography.
2) Evaluating these scrotal lesions on Color Doppler Flow Imaging.
3) Classification of the scrotal lesions into testicular or extra-testicular.
4) Cor-relation of these sonographic findings with Ultrasound Guided FNAC/Biopsy wherever indicated.
Material and Methods: The hоsрitаl bаsed рrоsрeсtive оbservаtiоnаl study was conducted in the Department of Radiodiagnosis & Imaging, Muzaffarnagar Medical College, Uttar.Pradesh (U.P.), for eighteen months with twelve months for data collection and 6 months for data analysis. Gray Scale Ultrasonography with Color Doppler and Power Doppler of inguino-scrotal region using USG machine ALPINION ECUBE8 with 7-12 Hz linear probe was performed in 50 cases referred from Dept. of Surgery, Paediatrics and Casualty who presented with complaints of pain or heaviness in scrotum or tender, swollen or hardened testicle, heavy or dragging sensation in groin or empty scrotal sac.

Purpose: Corneal ulcer is one of the important ophthalmic condition causing significant morbidity especially in the developing countries. Bacteria and fungi are frequently responsible for suppurative corneal ulcers especially in the developing countries. The present study aimed to know the safety and efficacy of topical and intrastromal injection of Amphotericin B in the management of non-responding fungal corneal ulcer patients.
Methodology: It was a hospital based prospective, non-randomized, analytical study. Thirty patients of non-responding fungal corneal ulcer of any age group, of either sex were studied. Cases were studied in terms of clinical examinations, relevant investigations, appropriate treatment and documentation.

Background: The incidence of congenital heart defect is 8-10/1000 live-births according to various reports from the different parts of the world.3 this incidence has remained constant worldwide.4 It is responsible for significant morbidity and mortality in infants worldwide. These account for about 30% of the total congenital abnormalities. Neonates with CHD presents with low oxygen saturation which can be screened with the help of pulse oximetry. Pulse oximetry is an easy and non-invasive method for measuring arterial oxygen saturation in newborns with a high level of accuracy.
Objective: To asses the role of Pulse Oximetry as a Screening Tool for Detecting Congenital Heart Disease.
Materials and Methods: The present prospective observational study was conducted by the Department of Paediatrics (Post Natal Ward) at Government Multi-specialty Hospital, Sector-16 and Chandigarh from December 2015 to June 2016.
Results: Among the study out of 528 study subjects nearly 5 (0.9%) of them were found to be positive and 523(99.1%) of them were found to be negative. The mean value of spo2 in positive screened cases of the upper limb was noted to be 91.20 which ranged from 89-94. In the lower limb, the mean value was found to be 90.20, which ranged from 84-94. The mean value of hand-foot difference was 3.00. The mean SpO2 Saturation in the upper and lower Limb between screen positive and Screen Negative was found to be statistically Significant with P Value of less than <0.0001.
Conclusion: Early diagnosis of CHD is crucial to reduce the significant morbidity and mortality of CHD as the first manifestation of CHD may be associated with circulatory collapse or death. Pulse oximetry can detect mild hypoxemia which is characteristic of CHD. Therefore, pulse oximetry screening should be implemented in routine post natal examination of neonates.

Background: It has been reported in many studies that nail growth is affected in Diabetes. A recent study was done in India which has postulated that the nail growth in Diabetes was more when compared to the normal subjects. This study puts in an effort to find the answers.
Aims and Objectives: To determine the nail growth rate in diabetics.
Materials and Methods: This study was started in Feb 2019 to Jan 2022 Mata Guruji Memorial Medical College and Hospital, Kishanganj, Bihar and Hind Institute of Medical Sciences, Mau, Ataria, Sitapur. Chitrapati Shahu Ji Maharaj University, Kanpur.
Total of 211 patients were studied and have been reported.
This study is a cross sectional study.
Two hundred eleven patients were studied. Out of this 100 were from Mata Guruji Memorial Medical College and Hospital, Kishanganj, Bihar and the rest of them were from Hind Institute of Medical Sciences, Mau, Ataria, Sitapur. Chitrapati Shahu Ji Maharaj University, Kanpur.
Results: The rates of the nail growth were found to be less when compared with normal rates of growth that has been given in the textbooks.
Conclusion: This can be considered as a useful tool in the hands of paramedical workers especially in the underprivileged areas.

Background: Accurate estimation of fetal weight is vital in the management of labor. Categorization of fetus into small or large for gestational age can lead to timed obstetric intervention. There are 2 common methods of estimation of fetal weight (EFW) sonographic evaluation and clinical method. In developing countries, ultrasonography most of the time unavailable or may not be affordable by patients. The accuracy of fetal weight estimation using symphysio-fundal height multiplied abdominal circumference at the umbilical level was moderate in all different BMI groups. The prediction was the highest in normal pre-pregnancy BMI.
Materials and Methods: This study was conducted at department of OBGYN, Teaching Hospital, Kodagu Institute of Medical Sciences, Madikeri, for the period from May-2019 to October-2019. Institutional Ethical committee has approved the study.
Objectives: To estimate the fetal weight in antenatal period by symphysio-fundal height and abdominal girth measurement and to compare with the actual birth weight of the baby after birth. The inclusion criteria were pregnant women of any parity of ≥34 weeks with singleton, cephalic presentation either not in labour or in early labour with intact membranes. The exclusion criteria were Pregnant women having obesity, multiple gestation, malpresentation, oligohydromnios & polyhydromnios, intrauterine fetal demise and diagnosed cases of uterine fibroids and abdominal masses are excluded from the study. Hospital based convenient sampling method is followed.
Results: Statistical tests (Correlation) were done between estimated fetal weight (EFW) and actual birth weight (BW). It was found that there was a positive correlation present between estimated fetal weight (EFW) and actual birth weight (BW) with a Pearson coefficient of 0.205 and with the p-value of 0.041 which is significant.

Background: Abnormal Uterine Bleeding (AUB) is defined as any bleeding that does not correspond with the frequency, duration or amount of blood flow of a normal menstrual cycle. Endometrial biopsy is important in perimenopausal age group women (40-55 years) to rule out endometrial pathology and malignancy. This study was done to assess Clinicopathological aspects and different histopathological patterns related to Abnormal Uterine Bleeding as no studies have been done in this region of Karnataka, India.
Methods: This is a cross sectional study done from 2019 to 2020. All female patients in the perimenopausal age group presenting with symptoms of AUB were included. Patients less than 40 years of age and endometrial tissues inadequate for opinion on microscopy were excluded. Relevant history and clinical data regarding pattern and duration of abnormal uterine bleeding was retrieved. Endometrial biopsy tissues was processed and stained by H&E. The diagnosis was done and results analysed.
Results: Present study included 94 biopsies of which 6 biopsies were inadequate for opinion. The most common age group presenting with AUB was 40-45 years (53.40%). The most common symptom was menorrhagia. The commonest histopathological pattern among all the perimenopausal age was disordered proliferative endometrium followed by simple hyperplasia without atypia. Other patterns were proliferative endometrium, secretory endometrium, simple hyperplasia, carcinomas etc. The commonest etiology of AUB was Dysfunctional Uterine Bleeding (46.59%) followed by Endometrial hyperplasias. (23.86%)
Conclusions: Correlation with clinical history, radiological investigations along with endometrial biopsy establishes etiology and diagnosis for patients with AUB.

Background: Menstruation is a normal physiological process and determines reproductive health. Poor menstrual hygiene can lead to various urinary tract, vaginal infections, skin infections or even pelvic inflammatory disease.
Aims: To assess the knowledge of menstrual hygiene among women of reproductive age group i.e.; 15-49 years attending the OPD of a tertiary care hospital and to assess their attitude and practices regarding the same.
Methods: A cross sectional observation study where an interview was conducted among 100 women of reproductive age group (15-49 years) attending the OPD clinic of our hospital over a period of 6 months and data was analysed according to that.
Results: Mean age of the participants was 32.43 ± 7.74 years. Out of 100 participants, 68% had good overall knowledge regarding menstruation.62% were using commercially available disposable sanitary napkins, 28% were using washable cloth and 10% were using homemade reusable cloth napkins. 70% of the participants were practicing good menstrual hygiene practices. 45% of the participants had local complaints suggestive of reproductive/urinary tract infection associated during menstruation out of whom 35% were not following satisfactory menstrual hygiene practices.
Conclusion: Menstrual hygiene is an important aspect of reproductive women's health. Unsatisfactory menstrual hygiene management acts as a risk factor for reproductive tract infections. This calls for spreading awareness to bring about a change in attitude and practices regarding the same.

Introduction:
Pain is defined as “As unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Pain is an inevitable consequence of surgery. Surgical intervention done to reduce human suffering is associated with pain and distress to patients. Severe pain  causes increased stress response to surgery, seen as a cascade of endocrine, metabolic and inflammatory events that may contribute to organ dysfunction, morbidity, increased hospital stay and mortality.
Material and Methods: 
The present study from  May 2020  to March 2022 was conducted on 60 cases prospectively in patients admitted to the, Department of anaesthesia ,Dr. N.D. Desai FMSR, Dharmasinh Desai University, College Road, Nadiad, Gujrat, undergoing elective upper limb surgery. The inclusion and exclusion criteria, 60 ASA physical status I or II patients of either sex, aged 18-60 yrs  were randomly allocated in to 3 groups of 20 each.
Group I: Patients receiving 0.5% Ropivacaine (30ml) + Dexmedetomidine 50mcg (diluted to 2 ml).
Group II: Patients receiving 0.5% Ropivacaine (30ml) + Dexamethasone 8mg (2ml).
Group III: Patients receiving 0.5% Ropivacaine (30ml) + saline (2ml).
Under strict aseptic precautions, patients were given Ultrasound guided Supraclavicular brachial plexus block with any one of the study drugs .
Results: 
Demographic data(age ,sex distribution ,weight) and surgical characteristics (duration of surgery and type of surgery) were similar in all the 3 groups.
ONSET OF SENSORY AND MOTOR BLOCKADE : The mean time for onset of sensory block in group I was 7.45±1.10 min and in group II was 10.15 ± 1.14 min and group III was 12.45±2.76 . The mean time for onset of motor block  in  group I was 10.60 ± 1.05 min and in  group II was 14.95 ± 0.83 min and and  group III was 16.05 ± 1.96. 
The onset of sensory and motor  block was significantly early in Dexmedetomidine group (group I) i.e, 7.45±1.10 min followed by dexamethasone group (group II) as compared   to plain Ropivacaine group (group III).
DURATION OF SENSORY AND MOTOR BLOCKADE: The total duration of sensory block  in  group I was 768±25.52  min and in group II was 909±22.10 min and in group III was 450±27.74 min.   The  duration of motor block in group I is 717.50±22.09  min and in group II was 878±19.47 min and in group III was 420±23.17 min. 
There is significant difference in the total duration of sensory and  motor block between the three groups. (P <0.001).The duration sensory and motor blockade is longest in Dexamethasone group followed by Dexmedetomidine group as compared to the control group Ropivacaine alone.
Conclusion: 
We conclude that although both Dexmedetomidine and Dexamethasone are better adjuvants to Ropivacaine as compared to Ropivacaine alone  in Supraclavicular Brachial block , Dexamethasone is a better choice in terms of  prolonging the  duration of sensory and motor blockade and duration of analgesia,  followed by Dexmedetomidine than Ropivacaine alone.

Background &Method: The aim of this study is to study the Effect of Core Stabilization
exercises in Physiotherapist with work related Musculoskeletal disorders involving Lower
back. Out of 54 subject, 50 volunteered for participation in the study. Of them, 4 were
screened out on the basis of exclusion criteria. Remaining subjects (50 in number) were
divided into control group (group A) and experimental group (group B). group A had 25
subjects and group B had 25 subjects.

Background: Varicose veins of the lower limbs are the most common vascular disorder affecting human beings. Although venous ulceration is a benign condition, there is considerable morbidity due to recurrent cellulitis, phlebitis and stiffness of joints. Present study was aimed to study venous ulcers occurring in patients with varicose veins & response to various modalities of treatment at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, observational study, conducted in patients with venous ulceration in the leg due to varicose veins, willing to participate & follow up.
Results: In present study 32 patients were included. All patients were male. age ranged between 28 to 70 yrs. Majority of were from 40-49 years age group (31.25%) & duration of illness was 1-5 years (53.13%). Apart from ulcer & varicose veins (100.00%), common complaints were itching (31.25%), pain (28.13%) & pedal oedema (9.38%). Four patients (12.50%) had bilateral disease Fascial defects due to perforator incompetence was clinically well palpable in all patients with below knee perforators. Perthes’ test was negative in all patients and doppler (Duplex) assessment showed patent deep veins in all patients. All 32 patients (36 limbs) underwent Trendelenburg operation. Treatment modalities were Trendelenburg operation with stripping with stab avulsion (52.78%), Trendelenburg operation with stripping with subfascial ligation (36.11%), short saphenous vein ligation and stripping (5.56%) & excision of fibrous tissue and split skin grafting (5.56%).Post-operative complications in present Wound infection of the transverse groin incision was present in 2 patients.
Conclusion: In cases of venous ulcers occurring in patients with varicose veins, meticulous clinical assessment leads to successful treatment. Conservative treatment of venous ulceration should be tried before embarking on surgery which is the definitive treatment.

Background: Varicose veins of the lower limbs are the most common vascular disorder affecting human beings. Although venous ulceration is a benign condition, there is considerable morbidity due to recurrent cellulitis, phlebitis and stiffness of joints. Present study was aimed to study venous ulcers occurring in patients with varicose veins & response to various modalities of treatment at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, observational study, conducted in patients with venous ulceration in the leg due to varicose veins, willing to participate & follow up.
Results: In present study 32 patients were included. All patients were male. age ranged between 28 to 70 yrs. Majority of were from 40-49 years age group (31.25%) & duration of illness was 1-5 years (53.13%). Apart from ulcer & varicose veins (100.00%), common complaints were itching (31.25%), pain (28.13%) & pedal oedema (9.38%). Four patients (12.50%) had bilateral disease Fascial defects due to perforator incompetence was clinically well palpable in all patients with below knee perforators. Perthes’ test was negative in all patients and doppler (Duplex) assessment showed patent deep veins in all patients. All 32 patients (36 limbs) underwent Trendelenburg operation. Treatment modalities were Trendelenburg operation with stripping with stab avulsion (52.78%), Trendelenburg operation with stripping with subfascial ligation (36.11%), short saphenous vein ligation and stripping (5.56%) & excision of fibrous tissue and split skin grafting (5.56%).Post-operative complications in present Wound infection of the transverse groin incision was present in 2 patients.
Conclusion: In cases of venous ulcers occurring in patients with varicose veins, meticulous clinical assessment leads to successful treatment. Conservative treatment of venous ulceration should be tried before embarking on surgery which is the definitive treatment.

Background: Varicose veins affect 20–30% of adults. If symptoms persist, the main treatment options are sclerotherapy, surgery (usually stripping and ligation of the long or short saphenous veins and phlebectomies), and ablation (by laser or radiofrequency ablation). Present study was aimed to compare the efficacy of treatment of varicose veins with Saphenofemoral ligation and Foam sclerotherapy compared to Saphenofemoral ligation and stripping.
Material and Methods: Present study was single-center, prospective, comparative, study, conducted in patients of either gender with varicose veins of the lower limbs, including those with venous ulcers. Patients were randomly allocated to group 1(SF ligation with foam sclerotherapy) &group 2 (SF ligation and stripping).
Results: The demographic data of the patients included in this study showed no significant difference between both groups in terms of age and sex. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group: 40 vs. 55 min. The rate of longer-term (>30 days) ulcer healing rate in the case series ranged from 75 to 85%. 6 (85.7%) of 7 ulcers healed in the foam sclerotherapy group compared with 6 (75%) of 8 in the SF ligation and stripping group. At 3 months, median CEAP class dropped from four preoperatively to one following treatment in both groups. 1 patient out of 25 treated by foam sclerotherapy reported venous recanalization at one year after treatment. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (4 days) compared to the surgical group (9 days). Rates of thrombophlebitis was 16%.skin staining/pigmentation at 8%, and pain at the site of injection ranged was 28%.
Conclusion: Treatment of varicose veins with Foam sclerotherapy instead of stripping and avulsions reduces the operative and post operative recovery time.

Background: Preoperative counseling is one for pregnant women help to improve the surgical outcome and also reduce the number of analgesics used. Though it is known that preoperative counseling is effective, there are limited studies to testify to its importance.
Objective: The present study was undertaken to observe the preoperative knowledge about spinal anesthesia on anxiety and pain in patients undergoing cesarean section.
Materials and methods: A total of 60 patients who were elected under CS anesthesia were part of the study after obtaining informed consent. After recording the baseline pain scores, depression, anxiety and stress scores, the participants were randomly grouped into control and intervention groups with 30 participants in each group. Preoperative counseling was offered to the participants of the intervention group. No counseling was offered to the participants of the control group. Post-surgical pain and depression, anxiety and stress scores were recorded in both groups. A visual analog scale was used to record the pain scores. Depression, anxiety and stress scores were recorded using DASS 42.
Results: There was no significant difference in the scores of depressions, anxiety and stress among the control and intervention group participants before the counseling. There was a significant decrease in the depression, anxiety and stress scores in the intervention group participants. Further, a significant decrease was observed in the pain scores also in the participants of the intervention group.
Conclusion: There was a significant decrease in the pain scores, depression, anxiety and stress scores after the surgery in the intervention group participants who underwent the preoperative counseling. The study recommends further detailed study in this area to recommend the implementation of preoperative counseling for the women undergoing cesarean section.

Background: Neonates pose a challenge in Neonatal intensive care unit (NICU) for central vascular access, which represents a daily practice. We have reported our experience with Central venous cut down through long saphenous vein (LSV) at sapheno-femoral junction (SF), its indications, feasibility and complications.
Objective: To assess the feasibility of insertion of central line by Sapheno-femoral (SF) cut down.
Methods: This is a retrospective study carried out in a Tertiary care hospital in a Metropolitan city of India. All the neonates who required Central venous access were included in the study.
Results: In our setting 176 neonates required LSV cut down for vascular access over a period of 3 years (2019-2022). The mean weight of the neonates was 1980 grams (range 680-4.1kg). The mean day at which the catheter was inserted was 7.1 days. Out of 176 neonates 8 neonates required vascular access for surgical condition and remaining 168 for medical condition. In 10 neonates the central line was inserted in operation theatre under general anesthesia. In the remaining 166 neonates the catheter was inserted in NICU under local anaesthesia. The mean time required for insertion of catheter was 14.2 minutes. The most common indications for Central line insertion included Sepsis, Respiratory distress syndrome, prematurity. The complications of CVL in our setting were central line induced sepsis followed by limb oedema.
Conclusion: Open surgical cut down of long Saphenous vein is feasible and a safe procedure, It can be performed as a bedside procedure without the need for General anaesthesia.

In Premenopausal women the levels of reproductive hormones are variable and the effects of hormonal withdrawal are present and they may have menstrual cycles which may be regular or irregular. Perimenopause or menstrual transition is the period preceding the menopause characterized by irregular menses and missed cycles which is associated with increase in follicle stimulating hormone levels (> 20 IU/mL). The clinical data pertaining to all patients were recorded as per proforma. A detailed history was taken pertaining to last menstrual period, year of menopause, history of diabetes mellitus, hypertension, cardiac events, and drug intake. The study showed the positive correlation of plasma homocysteine with TC, LDL, VLDL, TG in postmenopausal and premenopausal women and negative correlation of plasma homocysteine with HDL.

Background: COVID Vaccination has given a ray of hope in fighting against coronavirus disease 2019 (COVID-19).Since the experiences are relatively new to all, it is important to monitor safety of vaccines in a real-world setting. With this background, this study was conducted.
Objective: To assess the pattern of AEFI among undergraduate students.
Methods: This cross-sectional study was conducted in a Hospital setting with 200 vaccinated medical students being enrolled in the study and Data were analysed using SPSS version 20.00.
Results: Total of 200 medical students, 142(71%) and 74(37%) of study subjects had one or more AEFI following COVID-19 vaccination following 1st and 2nd dose respectively. All the AEFI’s (100%) were only minor reactions.
Conclusion: The study reflected that COVID-19 vaccination caused only mild and non-serious AEFI in most of the vaccine recipients. Hence the vaccine given can be considered safe. 

Introduction: COVID-19 Pandemic was supposedly one of the deadliest events in the 21st century which has caused immense strain on the healthcare and human resource. Globally this has caused 450 million of infective cases and over 6 million deaths till now. Studies have shown that ABO polymorphism plays a vital role in occurrence of various communicable and non-communicable diseases. ABO polymorphism was also considered to play a significant role in susceptibility and progression of SARS-CoV-2 infection by various studies. Though the results are not equivocal, globally researchers are interested in identifying the trend of infection and severity of illness among particular blood groups which could be helpful in framing certain prognostic markers for the COVID 19 disease and also can aid the researchers in inventing the vaccines and the novel therapies in curing the COVID 19 disease. This can also lay the foundation for some genomic studies which can link certain blood groups with certain novel diseases in the era of biological warfare.

Introduction: Neutralization of a key Wnt inhibitor elevated in the circulation in CKD, Dkk1, and inhibited CKD induced vascular dedifferentiation, vascular calcification, and renal osteodystrophy. This effect was surprising since Wnt signalling in the vascular smooth muscle is implicated in stimulating osteoblastic transition and vascular calcification. However, recent studies demonstrate that Dkk1 mediated inhibition of aortic Wnt7b stimulates smad mediated aortic endothelial-mesenchymal transition (EndMT) and vascular calcificatio. EndMT is a developmental physiologic process involved in the development of the cardiac valves, the cardiac septum and the aortic root, and it may or may not contribute to cardiac fibrosis in various adult disease states.
Methodology: This is an observational study with no interventions carried out on any subject. Furthermore, all the CKD individuals were divided in to two groups based on the dialysis. Finally, the statistical analyses were performed between the predialysis, dialysis and control population to find the possible or potential diagnostic marker for CKD-MBD. Results: A total 68 individuals were genotyped for this study which includes 19 control subjects, 25 Non Dialysis patients and 24 Dialysis patients. The distribution of OPG gene polymorphisms among the control, Non dialysis and dialysis group were documented. Of the 19 studied control subjects 17 (85%) TT, 2 (10% TC) and 1 (5%) TC genotypes were observed.
Conclusion: Among the 25 non dialysis patients the observed genotypes are 15 (60%) TT, 6 (24%) and 4 (16%)TC. The Dialysis group 11 TT (45.8%), 8 TC (33.3%) and 5 TC (20.8%) genotypes were observed.

Introduction: CKD-MBD is thus thought to be a major contributor to the high mortality among patients with CKD. The negative regulation of osteoclastic bone resorption exerted by OPG could increase BMD and bone volume by decreasing the active osteoclasts as demonstrated by in vitro studies
Methodology: This is an observational study with no interventions carried out on any subject. Furthermore, all the CKD individuals were made two groups based on the dialysis. Finally, the analyses was done between the predialysis, dialysis and control population to find the possible or potential diagnostic marker for CKD-MBD.
Results: Distribution of rs3102735genotypes between the non-dialysis and dialysis groups were not found significant differences for allelic (OR: 1.54, 95% CI (0.65-3.60)), genetic TT vs TC (OR: 1. 81, 95% CI (0.48-6.76) p=0.37) TT vs CC (OR: 1. 70, 95% CI (0.36-7.85) p=0.49) and dominant (OR: 1.77, 95% CI (0.57-5.50) p=0.32) models. Similarly, we have not found significant difference for rs3102735 in recessive model (OR: 0.72, 95% CI (0.16-3.09) p=0.662).
Conclusion: The serum OPG may be a useful biomarker for early diagnosis of CKD-MBD.