European Journal of Molecular & Clinical Medicine

Background: This prospective consecutive case series was done to evaluate indications, technical pearls and pitfalls and functional outcomes of elastic stable intramedullary nailing of displaced mid clavicular fractures and the effectiveness of the titanium elastic stable intramedullary nails in the surgical treatment of the mid clavicular fractures in adults.
Materials & Methods: A total of 30 patients (20 men, 10 female) were included in this study. Constant score and radiographs were evaluated after 1 and 6 weeks, 3 months and 6 months in 30 patients. Mean age was 28 years.
Results: Length of incision, operation time, blood loss and duration of hospital stay were significantly less. The average follow-up was 12 months. Mean operation time was 58 minutes. Open reduction through an additional small incision was necessary for some fractures. Mean hospital stay was 1.2 days. The Constant score averaged 78 after 1 week, 94 after 6 weeks and 96 after 6 months. Compared to the contralateral side, average shortening of the clavicle was 1.5 mm. Conclusion: Titanium elastic nailing system provided a good restoration of the length of the clavicle allowing immediate active mobilization and early return to normal activity with excellent functional results.

Objective: There is evidence that patients with diabetes have an increased risk of asymptomatic bacteriuria and urinary tract infections (UTIs).  The aim of this study was to detect the prevalence of UTIs among diabetic patients admitted in the hospital  and  to identify the most frequent bacteria responsible for UTI:
Material and methods: The study population included 570 diabetic patients suggestive of UTI (847 women and 623 men), from Maharani Laxmi Bai medical college, Jhansi between December2018 to August 2020 . We collected patients’ personal history data and performed urine cultures.  Result: Total number of patients, 158 had urine cultures positive, meaning 10.7%. Out of the total number of 158 UTIs, 124 (78.4%) were asymptomatic bacteriuria. The most frequent bacteria involved in Urinary tract infection was Escherichia coli (68.9%). Conclusion: Infection of UTI are frequent in diabetic patients Because of the great proportion of asymptomatic forms among diabetic patients, the  culture should be performed in all hospitalized admitted patients with diabetes..

Background: Androgenetic alopecia (AGA) is the most common form of hair loss experienced in genetically predisposed individuals. The present study evaluated efficacy and safety of 5% minoxidil and 1 mg finasteride in Androgenetic Alopecia male patients.
Materials & Methods: 74 male Androgenetic Alopecia male patients were divided into 2 groups. Group I patients received minoxidil 5% topical solution 1 ml twice a day and group II received oral finasteride 1 mg tablet once a day. Standardized colour global photographs of the affected area were taken and baseline and post‑treatment photographs were compared.
Results: Age group 20-40 years had 14, 40-60 years had 25 and >60 years had 35 patients. The difference was significant (P< 0.05). The mean scalp hair count in group I before treatment was 94.2 per square centimetre and in group II was 96.4 per square centimetre. The mean scalp hair count in group I after treatment was 116.4 per square centimetre and in group II was 106.2 per square centimetre. The difference was significant (P< 0.05). Score -1 was seen in 3 in group II, 0 in 17 in group I and 10 in group II, 1 in 8 in group I and 6 in group II, 2 in 6 in group I and 8 in group II and 3 in 6 in group I and 10 in group II. The difference was significant (P< 0.05).
Conclusion: Oral 1 mg finasteride was found to be more effective than topical 5% minoxidil in management of Androgenetic Alopecia.

Background & Aims: We compared  dexmedetomidine with combination of midazolam and ketamine via nebulization for sedation in pediatric patients posted for elective surgery
Methods: Ethical clearance followed by informed consent was taken from guardians. Sixty was our sample size which was divided into two groups of 30 per group. Group A   received dexmedetomidine 2µg/kg & Group B received midazolam 0.1 mg/kg with ketamine 1 mg/kg. The primary objective was mask acceptance scale. Secondary objectives were sedation score, parental separation anxiety scale, post operative emergence agitation, recovery times and side effects. The MS EXCEL was used for data entry & outcomes averaged as Mean with standard deviation (SD) or Median with inter quartile range (IQR). Chi‑square test/ Fisher Exact test, Independent t‑test/Mann‑Whitney U test was used. P < 0.05 was regarded as remarkable.

Background: Arrhythmias and conduction disturbances those are likely to be significant problems during the early phases of AMI. The arrhythmias and conduction abnormalities discussed include sinus bradycardia, AV block, Idioventricular rhythm, VT, and VF. In general, the acute management of these rhythm disturbances is the same in the early and in the late phases of AMI
Materials & Methods: The present study was conducted in 100 patients of acute myocardial infarction to evaluate the incidence and significance of early and predischarge cardiac arrhythmias.
Results: By seventh hospital day, twenty patients had expired and the remaining eighty patients were monitored in CCU for two hours and arrhythmias were noted. Complicated ventricular premature contraction (i.e.Lown class III-V) was observed in two (25%) patient. Fifteen (18.75%) patients had Lown class 0-II VPC's. Two (2.5%) patients had supraventricular tachycardia and 6 (7.5%) patients had heart blocks.
Conclusion: Early arrhythmias (within 24 hours of AMI.) were significantly associated with in hospital mortality and complicated course, while no significant bearing on long term (6 month) cardiac event was noted.

Background: The present study was undertaken for evaluating serum vitamin D levels and its relation to diabetic peripheral neuropathy in type 2 diabetic patients.
Materials & methods: A total of 100 type 2 diabetic patients were enrolled in the present study. Complete demographic and clinical details of all the patients was obtained. Clinical examination was carried out in all the patients and data was recorded. assessment of peripheral neuropathy was done by neuropathy disability score (NDS) and nerve conduction studies. The NDS was established by bilateral examination of the pin–prick sensation, temperature sensation, vibration test, and Achilles tendon reflex. Serum levels were obtained and vitamin D levels were evaluated using auto-analyser. Correlation of vitamin D levels was done using auto-analyser. All the results were recorded and analysed using SPSS software.
Results: DPN was present in 56 percent of the patients. Mean vitamin D levels among the patients with and without DPN was 19.12 ng/ml and 32.95 ng/ml respectively. While analysing and comparing statistically, significant results were obtained.
Conclusion: Significant correlation exists between DPN and serum vitamin D levels among type 2 diabetic patients.

Background: Pediatric thyroid cancer is a rare entity that is treatable with an excellent prognosis. The present study was conducted to assess thyroid cancer in children.
Materials & Methods: 56 pediatric patients of suspected nodules of both genders were included. Serum TSH was measured in all children referred for suspected thyroid nodules. Hypothyrotropinemic patients underwent ¹²³I scintigraphy to assess for nodule autonomy. Thyroid ultrasonography was performed with a 5 to 18 MHz transducer.
Results: Out of 56 patients, boys were 30 and girls were 26. The number of nodules ≥ 1 cm per patient was 1 seen in 46, 2 in 7, 3 in 2 and 5 in 1 patient. Lobe involved were bilateral in 10, isthmus in 4, right lobe in 24 and left lobe in 20 patients. The difference was significant (P< 0.05). Cystic content was 0% (solid) in 60%, <25% in 25%, 25-50% in 10%, 50-75% in 3% and >75%          in 2%. Calcifications was present in 84% and absent in 16%. Nonspecific lymph node enlargement was present in 55% and absent in 45%. The difference was significant (P< 0.05).
Conclusion: Pediatric patients with discrete thyroid nodules ≥ 1 cm in maximum diameter have greater relative cancer risk.

Background: The present study was conducted for evaluating the role of serum magnesium levels in chronic heart failure.
Materials & methods: A total of 100 patients with chronic heart failurenormal sinus rhythm were included in the present study. Blood samples were obtained and serum magnesium levels were assessed in all the patients. On the basis of magnesium levels, all the patients were divided into two study groups; 41 patients with normal magnesium levels (>2mEq/L) and 59 patients with low magnesium levels (≤ 2 mEq/L). Profile was compared among the two study groups. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software.
Results: Significant higher proportion of subjects were diabetic among low magnesium level group. Age and diabetic status were found to be significantly correlated with low magnesium levels.  Blood pressure was significantly higher among subjects with low magnesium levels. Non-significant results were obtained while correlating serum potassium levels and Left ventricular ejection fraction with magnesium status.
Conclusion: Low serum magnesium levels were predictor of deranged cardiac and biochemical profile in chronic heart failure patients.

Aim: Airway management in patients with thyroid swelling undergoing thyroid  surgery.
Methodology: After approval from Institutional ethics committee, we conducted a prospective observational study including 60 consenting patients with thyroid swelling undergoing thyroidectomy. A standard OT protocol for routine pre anaesthetic check up was followed. The usual airway parameters such as mouth opening, MPC, slux, thyromental distance (TMD), neck movement were assessed. The euthyroid status of the patient was confirmed.
Results: In 54 (88.3%) patients propofol was used as induction agent. In 3 (5%) patients combination of dexmedetomidine & propofol was used as induction agent. In 2 (3.3%) patients sevoflurane and propofol was used as induction agent. In 1 (1.4%) patient etomidate was used as induction agent. 16 (26.7%) of patients required external laryngeal manoeuvre whereas 44 (73.3%) didn’t require external laryngeal manoeuvre. Highest percentage of patients 48.3% (29) were intubated in 15-30sec, 13 (21.6%). patients required 30-45 sec, 12 (20%) required less than 15 sec, while 6 (10%) patients required more than 45 sec. Maximum time required for intubation was 58 sec. 1 (1.7%) patient had complaint of hoarseness of voice post-operatively. 1 (1.7%) patient had tracheomalacia for which tracheostomy was done. 1 (1.7%) patient was not extubated due to prolonged surgery. no patient had post-extubation desaturation.
Conclusion: From this study we concluded that thyroid swelling accompanied with airway deformity is a risk factor for difficult intubation. A thorough preoperative history in all patients with thyroid swelling is mandatory and should include duration of thyroid swelling, pressure symptoms and radiological investigations of the neck and thorax.

 This study was directed at the Atshan stream in Al-Samawah for the duration of the October 2020 till September 2021. The station (31°18'12.2"N 45°11'01.1"E). The aquatic factors included by this study has been recorded monthly from stations which include dissolved oxygen , water heat, pH , salinity. Fishes were taken by gill nets, electro-fishing, and hand network. A whole of 1055 fish were founded which included 12 species plus 7 families. 7 species from them are  local species where as five of them are foreign species. The mainly abundant species was Oreochromis aureus (blue tilapia)  established 33.2% of all caught, the second species is C. auratus represented 27.7% of caught fish and third species is Carasobarbus luteus (Himri) instituted 15.9%. It is noticeable that alien species prevailed in the Atshan  river, they constituted 68.6% of total caught. This study considers the first fish assemblage in Atshan river.

Introduction: Acute urticaria (AU) is a common manifestation with the relatively infrequent occurrence of chronic urticaria (CU) in childhood. Pediatric urticaria has specific features and remains poorly understood. Methodology: A prospective study was conducted in 100 patients below the age of 18 years with diagnosis of urticaria from 2014 to 2016. Patients were evaluated taking a detailed history, examination, and basic laboratory investigations. Results: Out of hundred children, males were 56 and females 44. Male to female ratio was 1.2:1. Youngest was 7 months male, oldest was 17 years male child and mean age was 7.1 years. Out of 100 cases, 89% presented with acute urticaria and 11% were chronic urticaria. In acute urticaria an underlying cause was present in 59.55 % (53) whereas 40.44 % (36) were idiopathic. Infection was the most common factor (75.47%). Family history was present in five cases. 71% patients presented with first episode whereas 29% gave a history of recurrence. All children were treated with non-sedative antihistamines along with avoiding underlying triggering factors. Conclusion: Acute urticaria is a common manifestation seen in our study. Triggering factors in urticaria were dominated by infections followed idiopathic in our study. 16.85% of acute urticaria evolved into recurrent disease and progressed into chronic form due to incomplete treatment and follow-up were observed in our study.

Background: Postoperative infection following mastoid exploration under strict aseptic conditions and antibiotic coverage postoperative cases of cortical and modified radical mastoidectomy do pose challenging infections. Aim: The present study identifies the organism and antibiotics to which they are sensitive. This measure prevents postoperative permanent disease and discharge and improves the success rate of surgery without complications. Materials and Methods: A total number of 120 patients of mastoid exploration with discharge were the subjects of present study. The study was carried out from Feb 2018 to Feb 2021. Result: Males were 72 who constituted 60% and females were 48 who constituted 40%. Emergency procedures were 85 who constituted 71% and elective procedures were 35 who constituted 29%. 48% (58) were clean surgeries and 52% (62) were clean contaminated surgeries, 109 (91%) of patients showed significant growth and 11 (9%) of patients had no growth. 50% of the patients had culture positivity and duration of surgery was greater than 2 hours. Diabetes is the most common risk factor   followed by hypertension. A total of 109 samples showed growth, 114 organisms were isolated. E. coli was the organism which was predominant followed by Staphylococcus aureus. Ampicillin showed maximum resistance followed by ceftazidime. Cefipime and Piperacillin showed least resistance to E.coli. Among 38 isolates, 12 (33%) were ESBL producers. Conclusion: The present study provides information about the incidence of commonest organism E. coli in post operative mastoid exploration to enable treatment of a patient immediately to prevent complications from re- infection.

Background: Retinopathy of Prematurity (ROP), is a disease process seen in preterm low birth weight infants that affects the normal retinal vascular development. In case of a premature birth the process of normal retinal vascular development is altered and abnormal neovascularization ensues, thus making this disease one of the major emerging causes of childhood blindness accounting for  38 to 47% of childhood blindness in India. Management of Retinopathy of Prematurity differs in modalities depending on the Stage and extent of the disease. Laser Photocoagulation is the treatment of choice and the most common modality advocated for early management to provide better prognosis. Aim: This study evaluated the clinical outcome and efficacy of laser photocoagulation in the management of retinopathy of prematurity among neonates at a tertiary Care hospital in Hyderabad. Materials and Methods: This is a prospective interventional study conducted at a tertiary eye care Hospital during December 2019 to June 2021 with a sample size of 30 from the Neonates screened for ROP at Sarojini Devi Eye Hospital and Niloufer Children’s Hospital, Hyderabad.  In this small study, all the neonates with birth weight less than 1500 gms and age of gestation less than 32 weeks with the help of a Binocular Indirect Ophthalmoscope and diagnosed  with  Threshold  for  treatment  ROP  were  treated  by  Laser photocoagulation using the Laser Indirect Ophthalmoscope delivery system. Result: All neonates treated were followed up for outcome.30 neonates underwent confluent laser photocoagulation at a mean postconceptional age of 36.4 weeks (range 32-40 weeks).The mean post-laser follow-up visits were 5 (range 4-8) i.e. upto postconceptional age of 46.25 weeks (range 40-53). It was observed that Laser had a favourable outcome in 25 patients (83.3%) who showed regression of the disease. 5 patients (16.7%) showed progression even after 2 treatment sessions and they were planned for Intravitreal anti-VEGF later. Conclusion: Thus,  it  can  be  concluded that  effective  screening  strategies  especially  in  at risk babies (pre-term and/or Low birth weight) leading to early diagnosis of ROP and timely treatment help in preserving vision and preventing blindness in neonates.

Background: Abortion is a major social &health issue in India. It is estimated that nearly 15 million abortions are taking place in our country every year. About 15,000 to 20,000 women die from complications arising out of legal abortions every year. Aim: The aim of the  present  study was to compare efficacy of the vaginal misoprostol alone versus extra amniotic instillation of ethacridine lactate followed by vaginal misoprostol for second trimester(13 to 20 weeks of gestation) termination of pregnancy. Materials and Methods: This study was a prospective, randomized and comparative study which was conducted in the Department of Obstetrics and Gynaecology, for a period of 1 year. A total of 53 patients were selected and divided into 2 groups. In group 1 (28 patients) vaginal misoprostol 400 mcg was inserted followed by every 4^th hourly up to maximum five doses or untill expulsion of the fetus. 25 women were allocated to group 2,  Ethacridine lactate followed by vaginal misoprostol was administered and all of them received the intervention. Results: Mean IAI in Misoprostol Alone group was 14.93 ± 2.04 hours and in Combined group was 9.72 ± 1.10 hours .The difference was significant(P<0.001). In Misoprostol group, 85.7% had complete abortion and 14.3% underwent Suction & Evacuation i/v/o retained products of conception, in Combined group, 96% had complete abortion and 4% required Suction & Evacuation i/v/o retained products of conception. The difference was not statistically significant.(P<0.201). There were  no significant side effects seen in either group. Conclusion: Combined extra amniotic instillation of ethacridine lactate followed by vaginal misoprostol  is more effective than vaginal misoprostol alone  for second trimester termination of pregnancy, resulting  in shorter induction  to abortion intervals. Use of either  method was safe with regard to side effects observed and completion of procedure.

Background: Both the mother and the foetus experience significant physiological stress throughout pregnancy. Endocrine conditions like hypothyroidism during pregnancy can have serious consequences for both the mother and the foetus. While the negative effects of hypothyroidism on foetuses have received a lot of attention, the disorder's negative effects on mothers are extensively investigated. Aim: In this study, screening of all pregnant women at their 1st antenatal visit by estimate serum TSH and look for maternal hypothyroidism and the hypothyroid pregnant women were observed for the development of any maternal and perinatal complications. Materials and Methods: This is a prospective observational study which was conducted in Government General Hospital, Nizamabad during the period of January 2021 to June 2021. 1000 pregnant women were screened with serum TSH at their first antenatal visit. 852 cases (85%) were selected in the control group, 110 cases (11%) were selected in the neo hypothyroid group and 38 cases (4%) were selected in the known hypothyroid group. Results: Pre-eclampsia, GDM, Anaemia, IUGR, oligohydramnias, term delivery, induction of labour, caesarean section, PPH, small for gestational age, neonatal admissions among hypothyroid pregnant women was high, with statistically significant difference. Among three groups, high frequency of birth weight were between 2.6-3 kg.
Conclusion: This study concluded that early gestation thyroid screening and treatment for all pregnant women is useful in preventing or minimising the large amount of obstetrical and perinatal problems. This study's overall prevalence of hypothyroidism in pregnancy is high enough to warrant widespread monitoring.

Background:: Sonographic evaluation of the carotid arteries, both gray scale and doppler is widely used for risk assessment for cerebrovascular accidents.
Aims: Aim of this study was to evaluate stroke and transient ischaemic attack patients with carotid ultrasound for Intimal thickness, presence and characterization of plaque (type, surface and site), spectral waveform analysis with percentage of stenosis,
Materials and methods: This is a prospective studyof 50 patients of cerebrovascular insufficiency who presented to the Radiology and Imaging During the period of 20 months of study, cases of cerebrovascular insufficiency were evaluated with colour Doppler sonography and CT.
Results: In our study of 50 cases, 30 were males and 20 were females with a male: female ratio of 3:2.26 patients had hemiperisis,12 had hemiplegia ,aphasia 4 patients and TIA seen in 5 patients. .It is observed that IMT more than 0.8mm has high risk of CVA .in our study IMT more than 0.8mm was found in 35 pts(70%).out of which 20pts were in age group of 60-69(57%),10 patients in the age group of 50-59(28%),and 5 patients in age group of 40-49 (14%). Out of 100 vessels examined, significant stenosis i.e., >50% stenosis was seen in 8 (8%) vessels on colour flow imaging. Out of the 8 vessels with significant stenosis 7 showed 50-69% stenosis, 1 showed >70% stenosis . Based on the Peak systolic velocity ratio of ICA/CCA, 7 vessels showed significant stenosis i.e, ratio > 2. In 7  vessels the ratio was between 2-4, , in 1 vessels it was more than 4, Out of the 12cases with significant stenosis ( > 50%) , cases (75%)  had a cortical infarct,  two cases(16.6%)  had a subcortical infarct.
Conclusions:Doppler sonography provides a rapid, non-invasive, relatively in expensive and accurate means of diagnosing  carotid stenosis.

Background: Postoperative infection following mastoid exploration under strict aseptic conditions and antibiotic coverage postoperative cases of cortical and modified radical mastoidectomy do pose challenging infections.
 Aim: The present study identifies the organism and antibiotics to which they are sensitive. This measure prevents postoperative permanent disease and discharge and improves the success rate of surgery without complications.
Materials and Methods: A total number of 120 patients of mastoid exploration with discharge were the subjects of present study. The study was carried out from Feb 2018 to Feb 2021.
Result: Males were 72 who constituted 60% and females were 48 who constituted 40%. Emergency procedures were 85 who constituted 71% and elective procedures were 35 who constituted 29%. 48% (58) were clean surgeries and 52% (62) were clean contaminated surgeries, 109 (91%) of patients showed significant growth and 11 (9%) of patients had no growth. 50% of the patients had culture positivity and duration of surgery was greater than 2 hours. Diabetes is the most common risk factor        followed by hypertension. A total of 109 samples showed growth, 114 organisms were isolated. E. coli was the organism which was predominant followed by Staphylococcus aureus. Ampicillin showed maximum resistance followed by ceftazidime. Cefipime and Piperacillin showed least resistance to E.coli. Among 38 isolates, 12 (33%) were ESBL producers.
Conclusion: The present study provides information about the incidence of commonest organism E. coli in post operative mastoid exploration to enable treatment of a patient immediately to prevent complications from re- infection.

Aim: To assess the reliability of continuous fetal heart rate monitoring in detecting
fetal distress in pregnant women in labor.
Materials and methods: In our prospective study, term patients who were admitted in latent or active phase of labor in CKM hospital, were subjected to intra-partum fetal heart monitoring with cardio-toco-graph.
Results:  Average age group of our study population was 23 years, average gestational age- 39 weeks and average neonatal birth weight was 3.04 kgs. 6% normal, absent variability in 33%, minimal variability in 40%, moderate variability in 17%, and sinusoidal pattern was observed in 4%. All the abnormal CTGs were divided according to NICHD into 3 categories and 6% had category I CTG, 58% had category II CTG and 36% had category III abnormal CTG of 100 women. Out of 36 women categorized under NICHD III, 27(75%) had intra-op abnormalities and the association was significant, while out of 58 women with NICHD category II CTG abnormality, 17(29%) had abnormal intra-op findings and none of the women with category I abnormal CTG tracings had significant findings. 17(47%) neonates of 36 who had category III abnormal tracing intra-partum, had APGAR </= 7 which was statistically significant and 5(8%) neonates of 58 with category II tracing, had APGAR </= 7. 29 of 36(80%) neonates who had category III tracing intra-op required NICU admission which was statistically significant and 11 of 47(24%) neonates with category II required admission.
Conclusion: Electronic fetal monitoring is a useful intrapartum tool, if used judiciously and according to evidence-based guidelines and can be used to improve perinatal outcomes.

Background: Myasthenia gravis is a rare autoimmune disease caused by antibodies that probably originate from the thymus glands. In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Transsternal approach with thymectomy is the accepted standard surgical approach for many years.
Aim: To evaluate the outcomes of 60 patients who underwent thymectomy for myasthenia gravis, quantify the degree of clinical improvement after thymectomy by evaluating changes in stage and medication requirement, and identify prognostic factors that may be helpful in determining the best patient selection.
Materials and Methods: The study group consists of 60 myasthenic gravis patients who were admitted to Gandhi Hospital's Cardiothoracic Surgery Department and received a trans-sternal complete thymectomy between February 2014 and December 2022.
Results: 34 (56.7%) were males and 26 (43.3%) were females in the study. Females were aged between 9 to 60 years and mean age was 33.8 years. Before thymectomy, 21 patients were on anticholinestrase agents (Pyridostigmine). Post-operative pathologic study of thymus findings were reported as follows, hyperplasia of thymus was observed in 22 patients (36.6%), thymoma in 13 patients (21.6%), thymic carcinoma, atrophy in 5 patients (8.4%) and normal thymus in 20 patients (33.4%). 16 days was the mean hospital stay with 4 patients having prolonged hospital stay due to complications. Follow up ranged from 7 months to 10 years. Mean follow up is 2.5 years. Complete remission was observed in patients in Osserman stage I, IIA and IIB.
Conclusion: Thymectomy is recommended for patients younger than 60 years with non-thymomatous, generalized AChR antibody-associated myasthenia gravis. The early-onset, severe myasthenia gravis, female, thymic hyperplasia, benefit the most. Patients classified as Osserman Class IIA and IIB benefit most from this procedure.

Background: Osteoporosis leads to an increase in bone fragility with a decrease in bone mass. Literature data reports a decreased risk of fracture and a higher bone mineral density in subjects on beta blockers. However, few literature studies reported no effect of non-selective or selective beta blockers on fracture risk in osteoporosis subjects.
Aim: The present study aimed to assess the effect of non-selective and selective beta-blockers on fracture risk in Indian subjects with osteoporosis.
Methods: 120 subjects with osteoporosis from both genders were divided into 3 groups using cardio-selective beta-blocker (CSBB), NSBB (non-selective beta-blocker) group, and a control group. In all the subjects, bone turnover markers, BMD (bone mineral density), FR (fracture risk), and T-scores were assessed and results were formulated.
Results:  After 6 months of assessment, it was seen that mean T-scores had a significant difference between the three groups. Bone mineral density was significantly higher in NSBB (non-selective beta-blockers) receiving group compared to the control group. Fracture risk was statistically lesser in CSBB and NSBB groups. Also, in comparison to the control group, lesser bone turnover markers were seen in both NSBB and CSBB groups.
Conclusion: CSBB and NSBB can help in improving bone mineral density with decrease bone turnover markers and fracture risk in subjects with osteoporosis. NSBB has a more pronounced effect on reducing fracture risk at all three studied locations. Also, a significant reduction in bone turnover markers was seen particularly in s-CTX compared to the CSBB group.

Background: Cancer has become highly prevalent in developing countries, and Africa is not far from it. The treatment of these cancers increases the risk of infertility in women. This review aims to understand the effects of different types of cancer treatments on the fertility in women.
Method: PRISMA guidelines were followed for scrutinizing the articles. Original research articles were searched and obtained from online databases including Pub Med, Pub Med Central, Springer, Nature, Web of Sciences, Semantic Scholar, Medline, Science Direct, Directory of Open Access Journals, Google Scholar, Research Gate, EMBASE, National Center for Biotechnological Information etc. After removing irrelevant, duplicated, and less correlated articles from the total of 1671 obtained articles, 19 studies were included in the systematic analysis.
Results: Among The 19 Studies Included, 14 Were Retrospective. Based On The Systematic Analysis Performed, Overall Fertility Deficits Were Observed In Female Survivors Of Cancers. Sex, Age At Diagnosis, Pre-Diagnosis Parenthood, And Diagnostic Period All Had An Effect On Fertility After Cancer Treatment. Treatment with alkylating agents, second line therapy, and age>35 years also influence the chances of pregnancy. Pre-term delivery was also found to be linked to cancer-related therapy. The probability of having a first live birth among cancer survivors was low. The site of cancer and age at the onset of cancer were independent predictors of a reduced probability of giving birth after diagnosis. Pelvic radiation was found to be more damaging than abdominal or supradiaphragmatic radiation.
Conclusion: The present review suggests that future measures should be taken to include an assessment of women’s desire for future fertility and also provide fertility preservation options. Fertility preservation strategies for cancer-affected women in their reproductive years. Long-term fertility data on cancer survivors in South Africa are needed. Counseling tools and guidelines for referral to onco-fertility specialists should be developed for newly diagnosed young patients.

Aim: To evaluate the antibiotic knowledge, practise, and attitudes among Indian dentistry practitioners.
Material and methods: Dental professionals were the subjects of a descriptive cross-sectional research. The dentists were included in the sample because it was convenient for them to do so. Google forms were used to distribute the surveys to the participants, while those who couldn't be reached online were given paper copies of the survey. All forms were included in the research exclusively from dental professionals in India who gave their informed permission. Participants were guaranteed complete anonymity and data confidentiality.
Results:  A total of 100 dental practitioners participated in the research and completed the questionnaire, including 74 (74%) females and 26 (26%) men. Their average age was 27.58±3.69 years. More over half of the 52 participants (52%) said antibiotics helped them recover from colds and coughs. About 55 (55%) of participants believed that newer and more expensive antibiotics had no influence on effectiveness. Antibiotic resistance was known to around 91 percent of the population. Approximately 72 (72%) of participants disagreed that antibiotics were a safe treatment, while 75 (75%) disagreed that antibiotics were the first drug of choice in cough and sore throat. Antibiotic resistance was identified as an issue in India by the vast majority of participants (86%). Approximately 68 (68%) were opposed to maintaining antibiotic stockpiles at home. 55 (55%) of the 100 dentists polled prescribed antibiotics based on symptoms. Most dental practitioners administered antibiotics for intra and extraoral sinus drainage, severe facial edoema, dental trauma, pericoronitis, open extraction, and periapical abscess. Amoxicillin was the most popular medicine (69%) followed by Amoxicillin-clavulanic acid (25%) Almost every dentist has likely replied favourably to the request for a medical history.
Conclusion: Although dentists in the current research were found to have understanding of antibiotic prescription, it was found that there is an undeniable gap in training and perspective of dentists with respect to antibiotic recommendations. Therefore, dentists will need to improve their use of antibiotics by updating their procedures over time.

Background: Surgical removal of the third molar is one of the most common surgical procedures performed as a day case or as an inpatient. The present study was conducted to assess frequency estimate and assessment of risk factors in third molar removal.
Materials & Methods: 78 patients undergoing third molar extraction of both genders were recruited. Level of impaction (soft tissue, partial bony, or total bony), angulation, and the presence or absence of an inflammatory condition associated with the impaction, type of anesthesia (local anesthesia alone or local anesthesia and sedation), type of flap (envelop or triangular), bone removal and postoperative complications were recorded.
Results: Out of 78 patients, males were 42 and females were 36. Alveolar osteitis was present in 5, trismus in 8, infection in 4 and paresthesia LN in 7 cases. The difference was significant (P< 0.05). Maximum cases of alveolar osteitis had mesio- angular impaction (2), anesthesia used was LA+ sedation (3), triangular flap (4) and partial bony (3) level of impaction. Maximum cases of trismus had mesio- angular impaction (4), anesthesia used was LA+ sedation (5), triangular flap (5) and partial bony (5) level of impaction. Maximum cases of infection had mesio- angular impaction (4), anesthesia used was LA+ sedation (5), triangular flap (5) and partial bony (5) level of impaction. Maximum cases of paresthesia LN had mesio- angular impaction (4), anesthesia used was LA+ sedation (5), triangular flap (4) and partial bony (4) level of impaction.
Conclusion: Common complication found were alveolar osteitis, trismus, infection and paresthesia LN. Most commonly mesio- angular impaction, LA+sedation, triangular flap and partial bony level of impaction was the leading cause.

Background: Assessment of association between Dietary Habits and Asthma Severity in Children.
Materials & methods: A total of 100 children with persistent asthma and 100 children with intermittent asthma were enrolled. Complete demographic details of all the subjects were obtained. A questionnaire was framed and dietary habits of all the subjects was recorded separately. The questionnaire was filled under the direct supervision of their parents/guardians. All the results were recorded and analysed using SPSS software.
Results: 62 percent of the subjects of persistent asthma group and 60 percent of the subjects of the intermittent asthma group were boys. Positive family history of asthma was seen in 65 percent of the subjects of the persistent asthma group and 69 percent of the intermittent asthma group. While comparing the association between Dietary Habits and Asthma Severity in Children, non-significant results were obtained.
Conclusion: While evaluating the association between the dietary habits and severity of asthma, it can be concluded that dietary habits does not affect the severity of asthma among children.

Background: Urinary stone disease (USD) is an increasing clinical problem in both children and adults. The present study was conducted to assess bacteriological profile of bladder stones.
Materials & Methods: 80 patients of urinary stones of both genders were included. Midstream urine specimen was collected from each patient before surgical stone removal and cultured using calibrated (4mm dia.) loop providing fixed quantity on CLED agar, MacConkey agar (MA) and Blood agar plate (BA) (HiMedia Laboratories) for isolation of bacterial pathogens. Cultures were incubated at 37oC for 24 hours. Urinary pH was noted using pH test strip and color change was documented comparing with the provided color chart.
Results: Out of 80 patients, males were 46 and females were 34.UTI was seen in 56 and stone core culture infection in 24. Urine pH was acidic in 52 and alkaline in 28. The difference was significant (P< 0.05). Bacteriological profile in UTI and stone core culture was staphylococcus aureus          in 24 and 12, E. coli in 16 and 6, Klebsiella aerogenes in 4 and 3, Pseudomonas aeruginosa in 6, mixed organisms in 4 and 3 and proteus mirabilis in 2 respectively. The difference was significant (P< 0.05).
Conclusion: The most common type of organism associated was E. coli. This study highlights the importance of microbiological analysis of stones for complete sterilization of urinary system and prevention of recurrence.

Introduction: Nonalcoholic fatty liver disease (NAFLD) prevalence is high, especially in patients with obesity and type 2 diabetes, and is expected to rise steeply in the coming decades. Objective:  We estimated NAFLD prevalence in patients with type 2 diabetes and explored associated characteristics and outcomes.
 
Material and Method: This is a prospective and cross-sectional study was conducted in the Department of Medicine at Tertiary care Teaching Hospital over a period of 6 months. The study population comprised of male and female patients who were diagnosed as having type 2 diabetes mellitus based on their fasting and random blood sugar levels. Frequency and percentages were calculated for categorical variables like sex and non-alcoholic fatty liver diagnosed on abdominal ultrasound. Non-alcoholic fatty liver was stratified among the age, sex and duration of type-2 diabetes mellitus to see the effect modifiers.
 
Results: Out of 320 participants, 200 patients (62.5%) had NAFLD on ultrasound. A total of 320 participants were enrolled for the study, of whom there were 140 (43.75%) males and 180 (56.25%) females. The mean age and mean duration of T2DM are presented. Overall, NAFLD was present in 200 (62.5%) study participants. Moreover, patients having NAFLD were compared with patients having no ultrasonographic evidence of NAFLD. There was no statistically significant difference between the two groups regarding mean age and gender distribution. Though, there was a statistically significant difference amongst the two groups in terms of HbA1c, triglycerides, total cholesterol, LDL and HDL cholesterol and serum uric acid.
 
Conclusion: This study reported an increased frequency of NAFLD in our diabetic population and evaluated in depth the risk factors associated with NAFLD, underpinning the significance of carrying further large-scale studies to assess the effects of lifestyle modification in the form of physical activity and dietary modifications on the status of NAFLD and glycemic control. Taking in to account the results of this study, patients and their treating physicians should emphasize on the modification of the associated factors and it is also advisable to screen diabetic patients for this condition in routine clinical practice. Early detection and timely management will help promote healthy lifestyle and prevent long term complications of the condition

Background: Healthcare-associated infections (HCAIs) are one of the worst events that can occur to a hospital admitted patient. HCAIs can cause increase in economic burden to patient and patient load to hospital. Objectives: The objective of this study was to generate HCAI rate based on laboratory data and to identify the common pathogens associated with nosocomial infections prevalent in various Intensive Care Units (ICUs) and surgical wards.
Method: This is a laboratory-based targeted surveillance conducted from 1^st June 2019 to 30^th September 2019. The study included all the patients admitted in the ICUs, surgical wards and burn ward within the study period and had positive culture result of their clinical specimen. Results: The incidence of nosocomial infection in ICUs and wards was 21.49%. It was observed that people are more prone to acquiring infection if the duration of stay in ICU is ≥ 7 days. Most common isolated organism was K. pneumoniae followed by P. aeruginosa, A. baumannii and E. coli making more than 70% isolates. Conclusions: The mean HAI rate was 21.49%, implicates massive failure in preventing these infections by the health care workers. All parties involved must make a conscious effort to implement hospital Infection Prevention & control practices. Use of devices such as urinary catheter and peripheral/central iv lines should be minimized and used judiciously.  Duration of device days should be reduced as much as possible.

Background:
Aims: The aim of my study is to evaluate the maternal and perinatal outcomes in pregnant women with Sickle cell anemia and Thalassemia.
Material and methods: The present study was undertaken in Mamata General Hospital with an aim to know the occurrence of sickle cell anemia and thalassemia in antenatal women and to evaluate the maternal and perinatal outcome.
Results: Out of the 30 women considered for the study, 20 had sickle cell disease and 10 had thalassemia. Most common age group was between 21-25years of age in both groups of women with 85% and 50% in each respectively. Mean age is 23±2years. Contracted pelvis was the indication in 17% in SCD. However abnormal color doppler study was the indication in 8% of SCD women and 17% in women with thalassemia. Maternal request and abruption were the indications in 8% each in SCD group. The need for transfusion was seen in about 45% of the SCD women and in 30% of the women with thalassemia. The incidence of Low birth weight of <2.5kg was among the most probable cause for neonatal morbidity in 40% of the neonates born under in each group with SCD and thalassemia.  There was 5% intrauterine fetal death and another 5% of the women had intrauterine growth retarded babies.  In thalassemia the most common fetal complications were neonatal jaundice in 30%, low birth weight in 20% and respiratory distress in 20% respectively.  The perinatal outcome in the 20 neonates born to women with SCD, 80% neonates were alive, intrauterine death was seen in 5% and neonatal deaths were 15%. Whereas in 10 neonates born to thalassemia women 70% of the neonates were alive and 30% neonatal deaths were recorded. Among the study group, the most preferred mode of family planning for the women with SCD in the present study was permanent sterilization in 50%. Next most preferred modality was injectable (DMPA) in 45%, and remaining 5% opted for barrier method of contraception.
Conclusion:   The obstetric outcome in women with Sickle-cell disease showed significant maternal morbidity. However though low in prevalence, the obstetric outcome in the group of women with thalassemia had low incidence of complications when compared to pregnancies with SCD. However both the groups were prone to neonatal morbidity and mortality.

Patients are more likely to take their medication when it is combined into a fixed dose combination (FDC). However, the irrational use of FDCs poses serious risks to public health. Knowledge of how to prescribe FDCs is crucial, as residents play a pivotal role in patient management at tertiary care facilities. From February 2016 to July 2016, a cross-sectional observational study was carried out at tertiary care centre in Central India. Hypertensive patients taking anti-hypertensive fixed-dose combinations (FDCs) were recruited for the study; 92 prescriptions met the inclusion and exclusion criteria and were included in the trial. Nonetheless, 53 percent of the medical professionals lacked understanding about the efficacy of specific FDCs. Textbooks and scholarly periodicals were the usual go-tos for research. Seventy-three percent of locals surveyed thought FDCs should be legally sold. According to the doctors' estimates, antimicrobial FDCs, specifically amoxicillin + clavulanic acid, account for the vast majority of prescriptions. Using a piloted questionnaire, researchers in Jammu conducted a cross-sectional study at a university-affiliated medical centre (Jammu and Kashmir). In order to gauge respondents' FDC-related KAP, a questionnaire was developed. Researchers included physicians from the Departments of Medicine, Obstetrics and Gynecology, Surgery, Pediatrics, Skin, and Psychiatry who were employed at the hospital during the study period and who provided written informed permission. Appropriate statistical tests were used to assess the data.

Background - To reduce the magnitude of antimicrobial resistance, future prescribers' knowledge of antibiotic use and prescription must be strengthened. Prior to that, conclusive evidence about that group's knowledge, attitude, and practises is required.
Aim: To assess the knowledge, attitudes, and the practices of medical students in India with respect to antibiotic resistance and usage.
Materials and Methods- A semi-structured questionnaire with a five-point Likert scale was distributed to medical students. The study also used a respondent-driven sampling technique.
Statistical Analysis Used: Descriptive statistics, parametric (Chi-square), and nonparametric (Kruskal--Wallis and Mann--Whitney U) tests.
Results: A total of 474 responses were received from medical students. The mean score of knowledge was 4.36 ± 0.39. As compared to first year students, knowledge was significantly higher among students of all the years. As much as 83.3% students have consumed antibiotics in previous year of the survey. Around 45% of medical students accepted that they buy antibiotics without a medical prescription.
Conclusion: Medical students' knowledge level was quite satisfactory. There is a significant need for improvement in terms of attitude and practises.

Background Physicians, pharmacists, and nurses have a big duty to report a negative drug reaction because they are key healthcare providers (ADR). As a result, the goal of the study was to assess the MBBS interns' knowledge, attitude, and practises (KAP) regarding pharmacovigilance and adverse drug reactions (ADRs).
Aim: To assess the knowledge, attitudes, and the practices of MBBS interns with respect to pharmacovigilance and adverse drug reactions (ADRs).
Materials and Methods- A cross-sectional survey of MBBS interns at a tertiary care hospital in central India was conducted A semi-structured questionnaire was used.
Results: A total of 202  responses were received from MBBS Interns. With the help of a Microsoft Excel spreadsheet, the completed KAP questionnaires were analysed question by question and their percentage value was determined. Average students agreed that reporting ADRs is required, important, and improves patient safety, with an average of 34.83% correct and 64.08% incorrect knowledge about ADRs and pharmacovigilance. Only 7.92% of MBBS interns at the institute reported an adverse drug reaction.
Conclusion: Most MBBS interns agreed that ADR monitoring and reporting are very important, but few had ever reported ADRs due to a lack of pharmacovigilance and ADR sensitization and knowledge.

Background: Hysterectomyare mostlycommon performed in the gynecological procedure for clinical problem in its treatments includes fibroids, prolapse, adenomyosis, endometriosos. Hysterectomy is performed worldwide in women at 30- 55 years of age. Aim and objectives to indicate the diagnosis to performed hysterectomy in patients and complications associated undergoing hysterectomy.
Methods: Total 255 patients undergone hysterectomy in the hospital was studied and analysed it clinical indications of surgery and complication of it, surgical specimens were sent for histopathology and report.
Results: The study shows thathysterectomy was performed in the major diagnosis of uterine prolapse (33.50%), leiomyoma (45.50%), adenomyosis (12.50%) while the report specimens also showed it. The diagnosis before the hysterectomy was confirmed by histopathology. There was no major complications were observed in the patients undergoing hysterectomy as this procedure is widely used for gynecological problems.
Conclusions: The study shows the data of patients’ trends of the hysterectomy and diagnosis that leads to perform hysterectomy was analyzed by histopathological finding in the patients. Complications were negligible in the hysterectomy and safe procedure

INTRODUCTION: Heart failure is a complex clinical syndrome resulting from structural and functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue and signs of HF, namely edema and rales^.[1] According to the World Health Organization (WHO), anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men.^[2] Anemia in HF decreases the oxygen delivery to the tissues leading to dyspnea and fatigue which worsens the quality of lives of the patients. The guidelines of the American College of Cardiology Foundation/American Heart Association and the European Society of Cardiology both recognize anemia as an important comorbidity in patients with HF. ^[3,4] Management recommendations focus on determining the underlying etiology and subsequent treatment, although, often no specific cause is found. In this study, we evaluated the patients of heart failure for anemia.
AIMS AND OBJECTIVES: To study anemia in hospitalized patients of heart failure with reduced ejection fraction.
METHOD AND MATERIAL: This is a hospital based cross sectional study of 140 patients of heart failure with reduced ejection fraction admitted in the Department of General Medicine, NHL Medical college, Ahmedabad, Gujarat. The material for this study was formed by adult patients admitted in the hospital between October 2019 to 2021 fulfilling the inclusion and the exclusion criteria.
RESULT: Out of 140 patients admitted heart with reduced ejection fraction, 58 (41.3%) had anemia with 59% being male. The mean age of patients in the anemic group was 58.5±9.95 years and iron deficiency anemia (53.44%) was the most common cause of anemia in patients of HFrEF with mean Hb being 8.42±1.62 g/dl. We found an inverse relationship between NYHA class grading and mean Hb but no correlation between EF severity and mean Hb.
CONCLUSION: Anemia is a common comorbid condition in patients with HFrEF and has been associated with poor clinical outcome. In this study, nutritional anemia is the most common cause, hence by providing adequate nutrition and awareness we can reduce the burden and can attenuate worse outcomes in patients of heart failure.

Background: Alcohol consumption produces a wide spectrum of hepatic diseases, including fatty liver, alcoholic hepatitis, and chronic hepatitis with liver fibrosis or cirrhosis. Neutrophil lymphocyte ratio (NLR) is an easily measurable laboratory marker that is used to evaluate systemic inflammation and is used as a marker to assess the severity of the disease.
Methods: The study involved subjects aged > 40 years of age who were admitted to a tertiary care center. This study was conducted on 100 patients who were consuming alcohol and were divided into two groups based on the duration and amount of alcohol consumed.
Results: The mean age was 50 ± 9.54 years. Raised NLR was seen in patients who consumed heavy amounts of alcohol and in patients who had consumed alcohol for a longer period of time, irrespective of their complications. A significantly raised NLR is seen in patients consuming moderate and heavy amounts of alcohol and in patients consuming alcohol for a longer period with complications.
Conclusion: NLR can be used as a useful marker of disease progression that correlates well with complications like hepatic encephalopathy (HE), ascites, and gastrointestinal bleeding (GI bleed).

Anaesthesiology is still a young yet growing specialty, especially regarding its long-term effects on the pediatric population and their developing brain. The delayed effects are still under study because potential interventions cannot be studied directly on humans especially on the pediatric population. Anesthesia in newborn infants is sometimes necessary as newborn infants may require surgeries that can not be postponed. Although the development of the brain begins during the last semester of intrauterine life, the brain is not fully developed at birth and continues to grow up to the age of 2 years. It has been studied and widely accepted that the commonly used general anesthetics potentiate inhibitory transmission through gamma-amino-butyric-acid type A (GABA_A) receptors and the excitatory transmission is reduced through N-methyl-D-aspartic acid (NMDA) glutamate receptors causing widespread apoptotic neurodegeneration.¹The adverse effect of halothane on the developing brain was reported some two decades ago when it was studied and accepted that long-term exposure to an inhalational agent like halothane, beginning in utero and continuing for several days in the postnatal period, caused impairment of synaptogenesis, reduction in dendritic branching, suppressed axonal growth and reduced myelinated nerves in rodents.² Studies in some young animals and human primates have shown that several drugs used for general anesthesia, at therapeutic concentrations used for anesthesia, killed cells, and produce neurodegeneration much before anesthesia when the brain is undergoing developmental changes.¹ Studies done on the adults have shown that GABA_A receptor activation leads to an influx of chloride ions (Cl^–) into the cell, this results in hyperpolarization and can lead to neuroprotection in many models during the period of hypoxia, ischemia, and other forms of cerebral insults. However, during the early stage of life when the brain is still developing, especially during synaptogenesis, the intracellular concentration of Cl^– is high; activation of GABA_A receptor may result in Cl^– efflux, and depolarization of neurons.²
As per the above studies, there are chances that general anesthesia including halothane can affect the developing brain of young children. In this retrospective observational study, we intended to study the effect of general anesthesia using halothane predominantly on the developing brain of young children undergoing surgery for cleft lip, cleft palate, or both.

Background: The immune system defends the host against many harmful microorganisms. The immune system has developed to contain various specialized cell types, signaling molecules, and functional responses to deal with this wide range of threats. In Covid-19 infections immune system is the key component for prevention of the disease. Hospital admission and duration of stay due to covid 19 infection have a considerable physical, financial, and psychological burden for the individual, family, and country. Diet has been shown to have a vital role in boosting one's immunity. Non vegetarian diet is traditionally considered to be immunity boosting as it is rich in protein, vitamins, and micronutrients.      
Aims and objective: To study the effect of dietary pattern on duration of hospital stay in patients with respiratory Covid illness
Material and Methods: This was a double blind retrospective cohort study comprising of 113 patients tested positive in RTPCR for SARS-CoV-2 and admitted at DCH located at super specialty hospital of Jayarogya Group of Hospitals, Gwalior, Madhya Pradesh, was studied retrospectively between July 2020 to October 2020. Patients were divided based on diet pattern into Group A (patients following a vegetarian diet; n=70) and Group B (patients following a non-vegetarian diet; n=43). The outcome was measured as the duration of hospital stay and comparison of diet type, age, and gender of patients. All these patients were discharge stable and case files of deaths were excluded. Non vegetarian diet was defined as inclusion of eggs, meet, fish in the routine diet whereas a vegetarian diet was exclusion of these items.   
Result: Out of 113 patients, most (61.94%) had a vegetarian diet, whereas 43 (38.06%) had a non-vegetarian diet. Duration of hospital stay was more in patients in Group A (10.71±5.5 days) than Group B (8.4± 4.7 days), p=0.0302. Hospital stay was longer (11.05 days) in older patients (>50 years) compared to younger patients (≤50 years) (9.2 days) (table 3).  In Group A, hospital stay was longer in those with age >50 years (11.4 days) compared to those with age ≤50 (9.2 days). On the contrary, older patients had shorter hospital lengths (9.9 days) than younger patients (10.09 days) in Group B (p value =     ).
Conclusion: A significantly shorter hospital stay was observed in patients of respiratory covid infection following a  non-vegetarian diet with Covid-19 infection.

Objectives: To study the awareness about the disease related complications in the diabetic patients who are, as yet, not suffering from any long-term complication.
Methods: A cross-sectional observational study was conducted involving 389 patients of type 2 diabetes for a period of two years, from March 2018 to March 2020 in a tertiary care centre. The patients having disease diagnosed with in last five years and not suffering from any diabetic related complication were included in the study. The questions pertaining to the knowledge about complications related to eyes, kidneys, nerves, brain and heart were asked and recorded. The data was entered in MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0.
Results: The most common complication known was retinopathy (45.48%), followed by nephropathy (38,69%), peripheral neuropathy (33.42); cardiac complications (26.13%) and stroke (37.19%). The factors associated with good knowledge and awareness were advanced age, higher socioeconomic status, male gender and presence of positive family history of diabetes.
Conclusion: There is a wide gap in the knowledge of Diabetes and its related complications among the patients which may prevent them from taking good care about their glycaemic levels. It demands a bidirectional approach by the treating doctor and the patient himself to update the knowledge about the chronic debilitating nature of the disease to better the outcomes of the patients in terms of associated morbidity and mortality.

Background – Induction of labor is defined as iatrogenic stimulation of uterine contractions to cause the delivery of fetus before the onset of spontaneous labor. Since Labour induction is among the common and widely practiced obstetric interventions aiming at achieving the vaginal delivery,it is necessaryto find out the factors responsible for cesarean delivery in induced labor at term, as risk factors in terms of sociodemographic characteristics of pregnant females.
Methods – Prospective analysis of 120 Study subjects who were having singleton live fetus in cephalic position and at gestational age equal to or more than 37 weeks were included in our study. A pre-formed written consent was also taken from study subjects.
Results – Sociodemographic factors of study subjects were the risk factors in cesarean delivery in induced labor at term, besides the obstetric risk factors. In patients undergoing labor induction, primiparity, urban residence, working women, higher socioeconomic status were found to associated with an elevated risk of cesarean delivery.

Background and objectives: People with metabolic syndrome (MetS) may benefit from regular exercise. Here, we investigated the effects of aerobic, resistance, and combined (aerobic + resistance) exercise on insulin resistance and muscle function in people with MetS.
Data searches: MEDLINE via PubMed, Cochrane-CENTR, SPORTDiscus, and EMBASE.
Study choice: The efficacy of exercise training in reducing at least one of the following outcomes was evaluated: HOMA, fasting glucose, and fasting insulin in adults with MetS. Two independent reviewers extracted data and evaluated the quality of the studies included. The results of the exercise training group and control group were compared based on random effects.
Results: Seven of the 1671 articles retrieved were included in the review. In the studies, the irisin-1 levels increased in both aerobic and resistance exercise groups, and the nesfatin-1 level increased in all groups. Compared with the control, three groups showed positive changes in anthropometric indices, lipid profile, and insulin resistance. Both aerobic interval training (AIT) and strength training (ST) reduced the total body fat, fat mass, and waist circumference of participants. AIT increased the VO_2max by 11%, and ST increased the maximum leg strength by 45%. The Ln HOMA-IR, carnosine, or musclin levels did not differ between the high-intensity interval training (HIIT) and moderate-intensity continuous training groups. HIIT + resistance training reduced the body weight, body mass index, waist circumference, and fasting glycaemia of participants. Meanwhile, HIIT + HIIT improved the triglyceride levels and mean blood pressure. Both therapies caused a non-significant decrease in the musclin levels. Exercise training also reduced insulin resistance and improved cell function.  
Our findings show that combined training exhibits greater efficacy in controlling MetS parameters than the other forms of physical activity studied. This modality can be applied widely to prevent MetS and improve MetS parameters in affected individuals.

Introduction: Skin diseases in the paediatric population is a common community health problem with impact on the parents, children and society. The paediatric dermatoses has a wide variation in clinical and morphological presentation, which could be due to environmental factors, region of study, standard of living, per-capita income, education, type of population studied, personal hygiene, season in which study conducted and nutritional status of the person.
Aims and Objectives: To study the clinical pattern of various skin disorders and their prevalence in the paediatric age group under 18 years of age.
Material and Methods:  This is a hospital based cross-sectional observational, retrospective study conducted at department of Dermatology, Venereology and Leprosy, Government general hospital Suryapet, Telangana, for a period of 3 years (2019-2021). Out of 10,044 cases, 28.31% were under 18 years age. A detailed history including the biographic data was taken. General, physical, cutaneous and systemic examination was carried out. The data was collected and analysed.
Results: Out of 10,044 patients, 2,844 subjects under the age of 18 years were recruited for the study. 67.51% were males and 32.49% were females (M:F=2.07:1). The maximum number of patients were in the age group of 12-18 years (51.09%). Clinico epidemiological analysis revealed that infections and infestations were the most common dermatoses (60.76%) followed by dermatitis and eczemas (11.6%), appendageal(8.86%), keratinization disorders(4.85%), urticaria (4.85%), pigmentary disorders(2.95%), papulosquamous disorder(2.11%) vascular malformations (1.48%) and others(2.32%).
Conclusion: Paediatric dermatoses is responsible for significant morbidity in the children and society. Infections and infestations were most common dermatoses seen in our study and that could be due to poverty, overcrowding, undernutrition, poor hygiene, low standard of living and lack of health education. Early diagnosis would possibly decrease the transmission of infection and infestation that would in turn reduce the disease burden in the society.

Background
The widespread use of medical software applications and internet for browsing health related topics have become a novel way to improve health and health care delivery system. Especially, in these days when covid 19 pandemic have struck the world so badly that people have less access to hospitals for their routine medical care, mHealth have shortened the distance between a patient and doctor. Advancements in mobile technologies and better reach of mobile networks have accelerated the usage of mobile apps and other electronic devices for planning ,programming and executing various health care services round the globe. Even in India during the covid pandemic, use of mobile apps like Arogya Setu have made a great impact in planning and provision of health care. This study aims at assessment of awareness on mHealth among undergraduate medical students in a tertiary centre at Maharashtra, India.
Methodology
A cross sectional study was conducted among undergraduate medical students of Government Medical College, Aurangabad, Maharashtra. A pretested semi structured questionnaire was used to collect data from the medical students. About 400 students studying in first year and second year were included in the study. An informed consent was attached along with the questionnaire. Collected data was entered in MS Excel and analyzed using SPSS 26 trial version. Quantitative data was expressed in terms of mean and standard deviation, categorical data was expressed as frequencies and percentages. Chi-square test was used to check the association between the parameters. Data was represented in tabular and graphical form.
Result
Among the 379 participants,226(59.63%) were males and 153(40.36 %) were females.55.4% belonged to age group above 20 years,85.22% were Hindus. 82.32% belonged to Class I socioeconomic class according to modified B G Prasad’s classification. Among the respondents,47.75% only had adequate knowledge, 54.8% had appropriate attitude and 64.3% followed appropriate practice regarding mHealth.
About 70% thought that usage of health related apps is not a wastage of time.87.07
% browse internet for health related queries and 76.78% of them spend only less than 30 minutes for that. 67.8% do not prefer to recommend health related apps to their colleagues. About 57% are expecting more health related apps in future, after solving the glitches in the currently available ones. Among the respondents, 95 (55.8%)of those belonging to age group less than 20 years have adequate knowledge regarding m-health, while only 40.6% of those belonging to age group more than 20 years had adequate knowledge in this regard (p value= 0.0015). Males had more knowledge about mHealth than females (p=0.0015).102 respondents belonging to 1^st year MBBS(54.5%) had adequate knowledge as compared to 79 belonging to 2^nd year MBBS(41.4%) (p=0.004).
Males had a better attitude regarding mHealth than females(p= 0.016).Also, respondents aged less than 20 years had better appropriate practice of mHealth than others (p=<0.00).
 
Conclusion
In this study,it has been found that more awareness must be created among health
care professionals regarding use of mHealth in healthcare delivery. Majority of the respondents agreed upon the utility of health related apps in easy access to national guidelines and lab reference, faster medical score and dose calculations and for acquiring knowledge, developing skills and for evidence based practice. Hence in this context, developing an e-platform for the same can save time ,money and manpower to a great extend.
Therefore, focus must be on creating apps which are user friendly and which provides maximum data in short span of time. Periodic quality checks on apps must be given to ensure accurate content delivery.

Background &amp; Objectives-
Glioblastoma multiforme (GBM) is the most common CNS neoplasm worldwide .The aim of this
study is to identify the demographics and response evaluation in the patients of GBM ,diagnosed
between the year 2015-2022 in a cancer institute of Punjab in North West India and determine its
significance, while comparing results with national and international standards.
Materials and Methods-
Demographic data of patients of GBM who underwent treatment at our institute between the year
2015-2022 was obtained retrospectively and comparative evaluation of MRI findings pre and post -
treatment after 6-8 weeks was done, which was followed by response evaluation with the Revised
RECIST guideline (version 1.1).
Results-
A total of 82 patients (44 males; mean age 45.61±15.96 years and 38 females; mean age
46.07±15.14 )were diagnosed with GBM over the period of 2015 to 2022 .The incidence is highest
amongst the age group 41-50 years in males (14.63%) and 31-40 years in females (17%).Out of 82
patients ,16 patients (19.51%) achieved a Complete Response (CR) ,47 patients (57.32%) achieved
a Partial Response(PR),14 patients(17.07%) had a Progressive disease(PD) and 5 patients(6.10%)
had a Stable Disease(SD). Complete Response was higher in females(13.41%) than males(6.10%).
Conclusions-
The present study on the demographic profile of GBM patients in a cancer institute of Punjab in
North West India between the year 2015-2022 produced overall incidence higher in males (54%)
and in the age group (41-50years in males) and (31-40 years in females) which is a decade earlier
than found in international studies ,while being at par with previous studies conducted in India.

Background - Dengue diagnosis is routinely carried out by detection of dengue virus (DENV) antigen NS1 or anti-DENV IgM antibodies using enzyme-linked immunosorbent assays and rapid diagnostic tests. This study was aimed at evaluation of quality of diagnostic assays currently in use in India for the identification of DENV infection.
Methodology
Study design - Retrospective Study.
Study Centre - Microbiology LaboratoryBundelkhand Medical College, Sagar, Madhya Pradesh
Study duration - June to November 2021
Methods and material- Serum samples from patients (n=1003) seeking dengue diagnosis were tested using J Mitra dengue NS1 antigen Microlisa kit andMedSourcedengue NS1rapid antigen diagnostic kits. The presence of NS1 antigen was taken as evidence for dengue-positive diagnosis.
Result – In this record review J Mitra ELISA identified 91% patients as dengue NS1 positive. J Mitra ELISA taken as reference, the Medsourcedengue NS1 test kit was found to be less sensitive (82.4%) and less specific (87.8%).
Interpretation &conclusions - These results confirmed superiority of ELISAs forNS1 antigen dengue diagnosis, and emphasized on improvement in sensitivity of RDTs.

Background - Patients with Dissociative Identity Disorder (DID) have high rates of comorbid psychiatric disorders. Although distinguishable from other psychiatric disorders, with some effort and skills, it can have an entire gamut of clinical presentations which can lead to misdiagnosis and can change the line of management. We aim to study a variety of clinical presentations about Dissociative Identity Disorder

BACKGROUND: Neonatal jaundice is observed in 60% of healthy term neonates and about 80% of preterm neonates in the first week of life. Unconjugated jaundice affects the central nervous system and results in kernicterus which causes permanent neurological sequel. So, the importance of early prediction of neonatal jaundice has become important to identify the newborns who intend to develop jaundice.
AIM:  To study the Cord Blood Bilirubin to Albumin Ratio as a surrogate marker for neonatal jaundice.
OBJECTIVE: To evaluate the predictive value of umbilical cord bilirubin to albumin ratio in identifying infants for subsequent jaundice.
METHODOLOGY:  A prospective cross-sectional study was conducted over a period of 6 months in 63 term healthy neonates. Under aseptic conditions, umbilical Cord blood was collected after delivery of the newborn and analyzed for bilirubin and albumin levels and cord blood bilirubin to albumin ratio was measured. Measurement of serum bilirubin was done on the 3rd-5th day of life.
RESULT: Out of 63 newborns 28 were males and 35 were females. 26 newborns were born by LSCS and 37 by vaginal delivery. Our study showed a 24% incidence of neonatal jaundice. 15 out of 63 term neonates have developed jaundice. The cut-off point for CBB by ROC curve analysis was 1.88mg/dl with a sensitivity of 87% and specificity of 80%. The cut-off of 0.61 was observed for CBB/CBA ratio with 93% sensitivity and 90% specificity.
CONCLUSION: Cord blood bilirubin and cord blood bilirubin to albumin ratio CBB/CBA are early predictors of neonatal jaundice but cord blood bilirubin to albumin ratio CBB/CBA ratio is a better surrogate marker to predict significant jaundice in healthy term neonates

Urinary tract infections (UTIs) are the most common bacterial infections affecting approximately 11% of adult women each year globally, with approximately 60% of women experiencing UTI during their lifetime. Extended-spectrum β-lactamases (ESBLs) are extremely broad spectrum β-lactamase enzymes, which can be produced by Gram-negative bacteria. They are mainly found in a family of Enterobacteriaceae. ESBLs are produced by the mutation of the TEM-1, TEM-2, and SHV-1 β-lactamases.

Aim: To compare the intraoperative haemodynamic parameters and cost effectiveness between sevoflurane   (inhalational)   anaesthesia   and propofol (tiva) based anaesthesia
Methods: Following informed consent, hundred ASA I and II patients aged 19-63 years of either sex having general anaesthesia were randomly split into two groups of 50. Patients with an ASA of III or higher, major cardiovascular, renal, or pulmonary disease, a history of malignant hyperthermia, any documented allergy to the study agent, H/O any mental condition, or use of sedative medicines were excluded from the study. Sevoflurane was used in Group A, while Propofol was used in Group B.
Results: The Sevoflurane group (51.02±4.52) had a quicker induction time (sec) than the Propofol group (61.29±5.51), which was statistically significant (p<0.001). The recovery profile after the agents were withdrawn at the conclusion of surgery revealed a significant difference in spontaneous eye opening (9.5±1.3 min in Sevoflurane group and 13.4±1.4 min in Propofol group), verbal communication (11.5±1.9 min in Sevoflurane group and 14.6±1.9 min in Propofol group) and mental orientation (16.1±1.6 min Sevoflurane group and 20.3±2.1min Propofol group) (p<0.001), with Sevoflurane demonstrating the superior recovery profile.
Conclusion: In terms of quicker induction and rapid recovery characteristics, we discovered that Sevoflurane outperforms Propofol. The intraoperative hemodynamics of the two groups were equivalent, with no statistically significant difference. However, Sevoflurane-based anaesthesia is still more expensive than Propofol, which if addressed would serve as a good choice of anaesthesia in impoverished nations.

Maxillofacial fractures are drawing the attention of healthcare professionals as there is an increase in incidence and related injuries. Maxillofacial injury causes the both objective and subjective changes in the face visibly. This appearance can cause mental health difficulties, with psychological disorders such as depression, and anxiety which are more prevalent.There are strong correlations with the correlations between and bad psychosocialability. This condition is often associated with morbidity and agreement thoughhumansconsider that face considersal component of one personality and the body image.^[1] Medical treatment may repair the bones that are broken. Many of the patients continue to be at a risk of re- injury or poor psychological outcomes because there is a lack of evaluation in their mental health post traumatic.

Aim: The aim of this study to determine the complications and causes of incisional hernia repair with preperitoneal meshplasty.
Material and methods: Fifty patients hospitalised with the diagnosis of incisional hernia to various surgical wards underwent open preperitoneal polypropylene mesh surgery. Six months to one year after surgery, it was reviewed for problems and recurrence, and the findings were recorded. Incisional hernia patients were included in this research if they were between the ages of 14 and 77.
Results: There were 40 female patients and 10 male patients among the 50 total. In terms of defect size, 12 patients had less than 2 cm, 34 patients had between 2.1-4 cm, 2 patients had between 4.1-6 cm, and 2 patients had between 6.1-8 cm. Infraumbilical hernia was found in 39 cases, whereas supraumbilical hernia was found in 11 patients. In terms of post-operative complications, four patients experienced seroma, two had edge necrosis, two had post-op ileus, and two had persistent discomfort. Six patients were followed for six months, twelve for nine months, and thirty-two for a year.
Conclusion: The current research found that open preperitoneal polypropylene mesh repair has much less postoperative problems compared to other mesh repair procedures, and that there was no recurrence among its individuals throughout the follow-up period.

Cardiovascular genetic diseases include syndromic and non-syndromic congenital structural heart diseases and cardiomyopathies, arrhythmic disorders, vascular disorders in connective tissue diseases, lipid disorders such as familial hypercholesterolemia, storage disorders etc. We aim to discuss spectrum of genetic diseases seen in cardiology practise while performing routine echocardiography and also try to propose and highlight a simple approach to identify such patients to prioritise for genetic testing to aid further management. Out of total 930 patients seen in the OPD (from July 2021 to July 2022), 65 patients were suspected to be affected with genetic disease. Out of these 65, only 25 underwent genetic testing (38%). Amongst these 25 patients, a genetic diagnosis was possible in 11 patients (yield -44%). Authors concluded that lack of suspicion and training, or resources cardiac genetic disorders are often diagnosed late or sometimes never diagnosed and this leads to missed opportunities to treat and prevent recurrences in the same family, either through reproductive counseling or cascade screen of at-risk relatives. As seen, any genetic disorders ranging from chromosomal to single gene defects have characteristic cardiac lesion and a cardiologist doing echocardiography can play a pivotal role in diagnosis. A multidisciplinary approach and basic sensitization of cardiologist when to suspect and refer for genetic work up/testing becomes important for clinical management of all such patients and cascade screening in at-risk relatives.

Background: Microvascular decompression is an established surgical modality for treatment of trigeminal neuralgia with variable long-term success rates depending on numerous patient and disease related factors. 
Methods: A prospective study was done including 31 patients, aged between 18 to 74 years who underwent microvascular decompression for primary trigeminal neuralgia at our institution. Barrows neurological institute pain intensity scale and facial numbness score were used to assess outcome till 1 year follow up period. 
Results: 71% patients were suffering from typical trigeminal neuralgia with involvement of both V2 and V3 divisions being the most common presentation. All patients achieved favorable outcome based on BNI pain and numbness score in the immediate post-operative period however at one year 3 patients had un-favourable pain score. Younger age, longer duration of neuralgia before surgery, involvement of all three trigeminal nerve divisions, pure venous compression and presence of focal arachnoiditis were factors associated with poor outcome. 
Conclusions: MVD is a safe and effective procedure in all age groups including elderly patients with both typical and atypical symptomatology. It is seen to be effective in relieving both arterial and mixed venous neurovascular conflict especially in patients with NVC grade III severity. However, the distribution of pain in all three divisions of trigeminal nerve, pure venous compression and presence of focal arachnoiditis seem to be associated with poorer outcome. 

Background: Apical debris extrusion may be clinically associated with pain and/or swelling in the presence of an intense inflammatory response. The present study was to evaluate apical extrusion of debris during endodontic instrumentation with continuous rotation and reciprocating motion.
Materials & Methods: 60 extracted single-rooted mandibular premolar human teeth which were divided into 4 groups of 15 teeth each. The canals were instrumented with the following instrument systems: ProTaper Next, 2Shape, Reciproc Blue and WaveOne Gold. Apically extruded debris during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was done with Eppendorf tubes.
Results: The mean debris (grams) with 2shape was 0.047, Protaper next was 0.091, Reciproc Blue was 0.054 and WaveOne gold was 0.051. The difference was significant (P<0.05). Statistically significant difference was observed between TS and PTN, PTN and RB and PTN and WOG (P < 0.05).
Conclusion: All instruments were associated with apical extrusion of debris with TS rotary file system associated minimum extrusion and PTN, resulting in maximum extrusion of debris.

Aim: The aim of the present study to evaluate the oncologic prognoses of people with nonurothelial bladder cancer.
Material and methods: This prospective observational study was carried out after being given the all-clear by the protocol review committee and the institutional ethics committee. Twenty-two adults were included in the study because they all had histologically confirmed NUBCs.
Results: Twenty-two people who had NUBCs participated in this study. Adenocarcinoma was found in 12 of them, whereas Squamous Cell Carcinoma was in 5, small cell carcinoma in 3, and inflammatory myofibroblastic cancer in 2. The patients' median age at presentation was 53.55 years, and 19 of them (86.36%) presented with hematuria as their primary complaint. Two people reported soreness in the lower urinary tract. The majority of patients were diagnosed at T3, and just one had advanced cancer.
Conclusion: Rare uveo-uveal biliary cancer (NUBC) exhibits several histological variants. We conclude that NUBC is a very aggressive disease with a poor prognosis since it is often diagnosed late in the course of the disease. The courses of therapy vary. To improve long-term survival rates, we need a concerted effort from institutions all around the world to shed light on the biology of these cancers and evaluate current treatment methods

Background: In Percutaneous Nephrolithotomy, the track may be dilated using numerous incremental flexible Amplatz type, Alken metal telescopic dilators, or balloons (PCNL) (PCNL). The balloon dilator is the most expensive method. In both cases, the gradual dilation methods take longer and are more prone to failure. The goal of this study was to evaluate the effectiveness of metal telescopic dilatation vs a single dilatation procedure in percutaneous nephrolithotomy.
Material and methods: All adult patients undergoing PCNL surgery for renal or upper ureteric stone disease were included in the analysis. One hundred patients were used in this study, and they were randomly divided into two Categories. Category 1 patients were treated with MTD, whereas Category 2 patients underwent OSD. After the nephroscope was dilated enough, its sheath was inserted. In this case, pneumatic lithotripsy was used once the stone was located. As soon as the fragments were extracted, a standard DJ stent was placed across the ureter into the bladder. The patient was turned supine and sent to the ward when they were stabilised.
Results: Hydronephrosis, symptom duration, and history of flank surgery were all similar across the two Categorys (Table 2). Category B had somewhat bigger stones than Category A (2.80±0.77 vs. 2.50±0.71), but this difference did not reach statistical significance (0.21). Laterality and dispersion of stones were uniform throughout cultures. It was shown that the lower calyx was more often chosen for puncture in both sets of subjects. Category A required significantly more time under fluoroscopy for dilatation of the tract than Category B (54.11±3.58sec vs. 37.89±2.74 sec, p=.002) Category A also had a much longer time to access than Category B (407.58±55.87 sec vs 301.71±39.71 sec, P=0.001).  Haemoglobin dropped considerably more in Category 2 at 24 hours post-op . Both Categories had similar mean hospital stays and blood transfusion rates (p=0. 41 and p=0.55). There were five patients in Category 2 with Grade 3 issues, compared to three in Category 1.
Conclusion: When it comes to dilatation of the tract during PCNL, both OSD and MTD are effective and safe options. When it comes to tract dilatation, OSD saves time and reduces radiation exposure compared to MTD. Same length of hospital stay, decrease in haemoglobin, percentage of patients without stones, and occurrence of complications were seen with both methods.

Background: The present study was undertaken for assessing the quality of life in patients with breast cancer before and after diagnosis.
Materials & methods: 200 patients were enrolled for the present study. A complete demographic and clinical detail of all the patients was obtained. At the baseline stage, interview was conducted among all the patients after obtaining their prior consent. This interview was conducted with the aim of gathering data in relation to quality of life. Afterwards, 100 patients that had confirmed histopathological diagnosis of breast cancer were separated and remaining all the patients was excluded. Follow-up of all the patients was done and re-interview of all the patients was again carried out. All the results were recorded and analysed using SPSS software.
Results: At the baseline period, initial treatment was mastectomy in 81 percent of the cases followed by conservative surgery in 9 percent of the patients. Quality of life score showed abrupt phases at different follow-up. Overall, global quality of life score showed improvement from score of 63.3 to 75.8 at 6 months follow-up followed by a significant decline to a value of 39.8.
Conclusion: Breast cancer patients should be followed up for their quality of life and provided effective therapy for their physical and psychological problems.

Aim: To evaluate Lipid profile of pregnant women during all the three trimesters of pregnancy.
Materials and Methods: This prospective observational cross sectional study was conducted in the Department of Obstetrics and Gynaecology, Rajindra Hospital, Patiala in 1000 women attending antenatal clinic and labor room. Their lipid profile was done and proportion of dyslipidemia during pregnancy was recorded. Samples from all subjects were collected under aseptic precaution; 5 ml of non-fasting venous blood was collected in plain vacutainer from antecubital vein. After the clot retracts the sample was centrifuged at 4000 rpm for 5 min the serum separated and stored at 4°C pending assay for lipid profile. Serum TGs, TC, and HDL cholesterol was analyzed by enzymatic methods with the help of Glaxo kits on ERBA Chem-5 plus semi-auto analyzer in the department of biochemistry, GMC, Rajindra hospital Patiala.
Results:  Out of 1000 patients, 5.6% patients were from <20 years age groups, 31.6% patients were from 20-25 years age groups, 35.7% patients were from 25-30 years age group, 20.9% patients were from 30-35 years age group and 6.2% patients were from >35 years age group. 20.5% patients came from rural area and 79.5% from urban area. The mean cholesterol levels in first second and third trimester were 187.86 mg/dl, 252.36 mg/dl and 294.43 mg/dl respectively showing significant rise in levels of TC with subsequent trimester. The mean TG levels in one, second and third trimester were 142.2 mg/dl, 252.33 mg/dl and 309.97 mg/dl respectively showing a significant rise in levels with subsequent trimester. The mean HDL levels in one, second and third trimester were 53.78 mg/dl, 57.12 mg/dl and 54.07 mg/dl respectively. Levels rise in 2nd trimester and there is significant fall in values between 2nd and 3rd trimester. The mean LDL levels in one, second and third trimester were 105.6 mg/dl, 144.8 mg/dl and 178.4 mg/dl respectively. Values increases with subsequent trimesters. The mean VLDL levels in one, second and third trimester were 28.4 mg/dl, 48.5 mg/dl and 57.6 mg/dl respectively showing significant rise in levels with subsequent trimester. The mean TG/HDL ratio in one, second and third trimester was 0.16 mg/dl, 0.68 mg/dl and 1.73 mg/dl respectively.
Conclusion: After three months of pregnancy, there was a substantial increase in total cholesterol, triglyceride level, HDL, LDL, VLDL and TG/HDL ratio in the serum. Values of HDL rises in 2nd trimester and there is seen a decline in 3rd trimester.

Background: This study aimed to evaluate the functional outcomes of primary flexor tendon repair in relation to the number of core sutures, the mechanism of injury and the zone of injury and post operative mobilization protocol.
Material and methods: A prospective and hospital-based study involving observation of patients from admission to final outcome after discharge was carried out at Gandhi Medical College, Bhopal. Routine information like age, sex, clinical history, mechanism of injury, detailed local examination findings of injury and other relevant data was collected. The flexor tendon involved was repaired using modified kesseler techniques and progression, range of movement and pain during movement analyzed.
Results: Strikland scoring was decreased form baseline (68.16) to 3 weeks (75.76), 6 weeks (81.08) and 3 months (86.08). Comparison of strikland scoring with different time interval was showed statistically significant results. Excellent score was found in 40% case and good score was found in 60% cases.
Conclusion: We have evaluated the functional outcome of primary flexor tendon repair in different zone of injury with injury by sharp subjects are better and superior.

Hospital Acquired infections are now frequently recognised as a threat to treatment failure in intensive care units. More than 70% of critically sick patients receive an antibiotic during their stay in the ICU, either for prophylaxis or for treatment. Injudicious use of broad-spectrum antimicrobial agents has led to the emergence of multi drug resistant organisms (MDROs), which can cause addition of more antibiotic resistance organism to Hospital Flora. Objectives: The objective of this study was to know the antimicrobial resistance pattern of the pathogens isolated from patients with HCAIs, including identification of Methicillin resistant Staphylococcus aureus (MRSA) and Extended Spectrum Beta Lactamases (ESBL). Method: This is a laboratory-based targeted surveillance conducted from 1st June 2019 to 30th September 2019. The study included all the patients admitted in the ICUs, surgical wards and burn ward within the study period and had positive culture result of their clinical specimen. Results: Most of the 3rd and 4th generation Cephalosporins were found resistant. Fluroquinolones were resistant in more than half of cases. Most of the organism were resistant to aminoglycosides too. Piperacillin-Tazobactam and Carbapenems were also found resistant in about 70 % of A. baumannii, about 80 % in Pseudomonas and about 90 % in Klebsiella. For many Klebsiella and Pseudomonas isolates, Colistin was the only available option to treat the infection. Conclusions: This study showed the alarming trends of resistance especially in gram negative bacilli isolated from clinical specimens of patients with HCAIs to the various classes of antimicrobials. 

Background:At various times during her cycle, a woman experiencing her menstrual cycle may experience a number of physical and mental symptoms that may have differing effects on her working memory. This study was carried out on forty healthy female interns to assess working memory during the premenstrual and postmenstrual phases because the medical field places a premium on high levels of cognitive ability, particularly working memory, for the purpose of making challenging and time-sensitive decisions.
Methods:The Self-Ordered Pointing test and the Brown-Peterson task were utilised in this study to perform an evaluation of participants' working memories. In order to evaluate the difference in working memory between the two stages, a paired t test was carried out.
Results:The number of errors was significantly higher (p = 0.022) in the postmenstrual period (5.31.56) compared to the results of the test during the premenstrual phase when the results of the Self-Ordered Pointing test were analysed (4.31.15). The Brown Peterson task findings showed that the individuals' total number of letters remembered was significantly less (p = 0.041) in the postmenstrual period (26.32.16) than in the premenstrual phase (27.22.44).
Conclusion:According to the findings, working memory task performance was strong throughout the premenstrual phase. Since the findings of the current study are supported by earlier research, it is believed that oestrogen secreted in connection with the menstrual phase plays a role in maintaining sharp working memory during the premenstrual phase.

Aim: Assessing the impact of hyperlipidemia on fundus alterations in hypertensive individuals and correlating the aforementioned results with elements of the lipid profile.
Methods: In the Ophthalmology Department of I Care Institute of Medical Science and Research, Haldia, 135 individuals with essential hypertension underwent a cross-sectional study. Patients with diabetes mellitus, myopia, cloudy ocular media, and other abnormalities of the posterior segment were not allowed to participate in the study.
Results: In 135 patients with essential hypertension, 65.44% of them developed retinopathy, whereas the other patients showed no symptoms of it. Patients were 60.24(±15.14) years old on average. Although there was no gender preponderance in retinopathy, this investigation demonstrated that the incidence of hypertensive retinopathy increased dramatically after the age of 60.
Conclusion: It was found that the onset of hypertensive retinopathy was substantially correlated with the duration of hypertension. It was discovered that obesity and an increase in all of the lipid profile markers (Serum TG, TC, LDL, and LDL:HDL) were substantially linked with retinopathy in hypertensive patients.

Background: Endoanal ultrasound (EAUS) and magnetic resonance imaging (MRI) of the pelvis are commonly employed for imaging of perianal fistulae, sinuses, and abscesses. The present study was conducted to assess role of transcutaneous perianal ultrasonography in assessment of perianal fistulae with MRI correlation.
Materials & Methods: 74 cases of perianal fistulae of both genders underwent perianal sonography and MRI examinations.
Results: Out of 74 patients, males were 44 and females were 30. Type was intersphincteric in 38, transsphincteric in 36 and suprasphincteric in 1. The difference was significant (P< 0.05). St. James’s classification showed grade I in 30, grade II in 16, grade III in 10, grade IV in 14 and grade V in 4 cases. The difference was significant (P< 0.05). Detection of primary fistulous and sinus tract was positive on TPUS and MRI in 74 cases, detection of secondary tracts/ramifications was positive on 8 cases on TPUS and 9 cases on MRI, detection of abscess was seen in 11 cases on TPUS and 10 cases on MRI and detection of internal opening was seen in 70 cases in TPUS and 72 cases of MRI.
Conclusion: TPUS is an effective imaging modality in the evaluation of perianal fistulae. It has high sensitivity and specificity in diagnosing and classifying perianal fistulae and abscess comparable with MRI.

This study was interventional education research aiming to assess the effectiveness of the project method of teaching when compared to traditional teaching methods in Medical Microbiology to undergraduate medical students.
MATERIALS AND METHODS:
A total of 162 students volunteered to get enrolled in this study. The students were broadly divided into Group A and Group B. Each of the groups was further divided into 20 small groups. Group A students worked on one topic and Group B students worked on another topic. Each project had 30 – 35 slides in Microsoft PowerPoint format. The topics assigned for project work were taught again by didactic lecture after the completion and submission of projects. Assessment for the topic was conducted by MCQs and feedback from students was collected regarding their experience during the project.
RESULTS:
Out of 208 students, a total of 162 (77.88%) students volunteered to get enrolled. A total of 40 projects were submitted, out of which 16 groups scored between 61 to 80 points, 19 groups scored between 41 to 60 points and 5 groups scored between 21 to 40 points. The topics for project work were taught again by didactic lecture and the average marks obtained by students who participated in the project were higher than students who did not participate in the project. The feedback displayed that 92% of students who participated in the project enjoyed being part of it and that it helped them in gaining knowledge.
 
 
DISCUSSION:
There was a significant difference in marks of students who participated in the project and also attended lectures when compared to students who did not participate in the project or class. The students who agreed that they enjoyed being part of the project did not find any difficulty in finding material on the internet and were willing to participate in similar projects in the future. To conclude, project-based teaching and learning methods will aid in increasing interest and knowledge in the subject of Microbiology in medical students.

Background: Denture stomatitis (DS) is the clinical diagnosis of the disease that occurs in adults with removable dentures. The present study was conducted to assess risk factors of denture stomatitis.
Materials & Methods: 150 cases of complete denture wearer having denture stomatitis were diagnosed of DS based on DS-modified Newton’s index (NI): 0 = no inflammation; 1 = pin-point hyperemia; 2 = diffuse erythema; and 3 = papillary hyperplasia) in the complete denture wearers. Denture hygiene and year of denture wearing was also recorded.
Results: Out of 150 patients, males were 90 and females were 60.Grading 0 was seen in 0%, 1 in 20%, 2 in 25% and 3 in 55%. The difference was significant (P< 0.05). Denture age was 1-5 years in 42%, 5-10 years in 23% and >10 years in 35%. Denture hygiene was good in 26%, satisfactory in 24% and poor in 50%. The difference was significant (P< 0.05).
Conclusion: Common risk factors for denture stomatitis were chronic denture wearing and poor oral hygiene.

Background: Pregnancy-related hypertensive disorders, a condition with numerous maternal and foetal consequences, can be avoided. By measuring serum uric acid levels, the condition can be detected early on and its progression can be stopped. In India, the prevalence of PIH varies from 5% to 15%. Fetal growth restriction, low birth weight, spontaneous or iatrogenic premature delivery, respiratory distress syndrome, and admission to neonatal intensive care are all significantly linked to preeclampsia. Preeclampsia prediction may aid in classifying women into high risk groups so that surveillance can be stepped up and preventative treatments can be started.
Aim and Objectives: The purpose of this research is to investigate the role that serum uric acid plays as a predictive factor in hypertensive disorders of pregnancy. The purpose of this study is to determine the function that serum uric acid plays in the determination of hypertensive problems in pregnancy. The purpose of this study is to evaluate the accuracy of blood uric acid as a potential predictive predictor of maternal and foetal problems related with hypertensive diseases of pregnancy.
Methods: Patients with hypertensive disorders of pregnancy who came in for antenatal checkups between 24-32 weeks and had blood pressure readings of more than or equal to 140/90 mmHg but did not have proteinuria were included in a study that was conducted in the department of obstetrics and gynaecology at the Modern government maternity hospital in Petlaburz. The inclusion and exclusion criteria were met by these patients. As part of the standard evaluation, the level of uric acid in the serum was determined for each and every hypertensive patient. Recording was done for both the maternal and perinatal outcomes.
Results: In the current study, 46 (46%) of the 100 women with HDP had elevated serum uric acid levels. Of the 64 women who had pre-eclampsia, 34 (53.1%) had high serum uric acid levels. The median serum uric acid level was 6.2mg/dl, with an SD of 1.8. Numerous maternal and postnatal problems, including eclampsia, abruption of the placenta, HELLP syndrome, and foetal growth restriction, were linked to hyperuricemia in HDP patients.
Conclusion: Patients who have been given a diagnosis of hypertensive disorders of pregnancy and who also have hyperuricemia are at an increased risk for a variety of different maternal and perinatal complications.

Background and objectives:
Complications during pregnancy are frequently associated with adverse outcomes for the mother and foetus. These complications may result from preexisting maternal conditions and prior obstetric complications. A higher risk of developing intrauterine growth restriction, Hypertensive disorder is associated with impaired trophoblastic invasion of the maternal spiral arteries. The objective of study is the to predict this complication of hypertensive disorder and IGUR in 1st and 2nd trimester pregnancy by using Doppler study on uterine and umbilical arteries.
Method:
This study on Uterine and umbilical arteries Doppler Ultrasound assessment among pregnant women in 1st and 2nd trimester to predict hypertensive and IUGR disorder, There were a total of 200 women enrolled in the study, same 1st trimester pregnant women continuation with 2nd trimester for Doppler study. Data were obtained from 200 registered patients attending prenatal OPD in hospitals between 1st and 2nd trimester.
Results:
In the present study we found that Uterine artery Doppler RI: 12%, PI: 10 %, S/D: 12 % in first trimester, and Uterine artery Doppler RI: 38%, PI: 34 %, S/D: 38 %, ED Notch: 18 % in 2nd trimester and 15 % of women had raised SBP and DBP Of the total 200 pregnant women.
Conclusion:
Uterine and umbilical artery Doppler has potential. Clinicians would have the chance to stop the condition before it shows clinical symptoms by implementing an ultrasound screening programme in high-risk pregnant mothers.

Introduction: More over 20% of the world's population is in the adolescent age range, which is defined as being between 10 and 19 years old. Around 16 million teenage girls give birth each year, or 11.0% of all births worldwide. Pregnancy among teenagers aged 10 to 19 is referred to as adolescent pregnancy. Teenage birth rates are rising, particularly in developing nations where the consequences for their health are worse. Around the world, adolescent moms were responsible for more than 11% of births. Adolescent pregnancy has been linked to medical, social, and economic issues that affect girls, their families, and nations, according to earlier research.
Aims and Objectives: To look into the impact that being pregnant as a teenager has on both the mother and the unborn child. The purpose of this study is to estimate the frequency of pregnancy among teenage girls and to evaluate its effects on those girls (15-19 years). In order to investigate the factors that lead to pregnancy among adolescents. To investigate the challenges associated with pregnancy and delivery in adolescents.
Methods: The investigation was conducted at Hyderabad's Peltaburz Modern Government Maternity Hospital. Study population: all 15-19-year-old pregnant girls. Cross-sectional prospective study 2019-2020: Studied Used 50 samples. Eligibility: During the study period, all 15-19-year-old pregnant girls were admitted, regardless of parity. Exclude non-obstetric instances. All pregnant women in the research were 20 or older. Before beginning the probe, ethics committee approval was acquired. The study's participants gave signed, informed consent. They had a general checkup, abdominal and vaginal exams. Routine and repeat ultrasonography ruled out congenital defects, placental maturity, amniotic fluid index, biophysical profile, and issues.
Results and discussion: In the study, the prevalence of adolescent pregnancy was determined to be 4.6%. 1260 of the 27376 women who gave birth during this time were in the adolescent age bracket. 50 of these teen pregnancies were examined and evaluated. Adolescent women's pregnancy and childbearing have negative health, demographic, and societal effects. Compared to pregnancy in non-adolescent women, an adolescent mother and her child are more at risk. Adolescent pregnancy is a high risk pregnancy, so organised prenatal care is crucial. In this study, 50% of the patients are from low socioeconomic position, 40% are from middle socioeconomic status, and 10% are from high socioeconomic status. 54% of the cases in this study were illiterate, 16% had only received their primary education, 20% had completed high school, and 10% had attended college.
Conclusion: Adolescent pregnancy and childbirth are associated with negative outcomes across a variety of domains, including health, demographics, and society. When compared to pregnancy in non-adolescent women, the potential dangers to an adolescent mother and her child are significantly higher. Because adolescent pregnancy is a high-risk pregnancy, it is absolutely necessary to have prenatal care that is well organised

Introduction: The term "abortion" refers to the natural or artificial termination of a pregnancy prior to foetus viability. The second trimester, which is divided again into early and late periods, lasts from 13 to 28 weeks of gestation. Because of foetal abnormalities such as chromosomal aneuploidy, structural defects, and oligohydramnios discovered by antenatal screening programmes, many second trimester abortions are medically induced (resulting in intrauterine foetal demise). The combination of antiprogestin (mifepristone) and PGE1 analogue Misoprostol seems to be the most effective medical technique for ending a pregnancy in the second trimester.
Aims and Objectives: To evaluate the safety and effectiveness of two medical procedures for an abortion in the second trimester: preinduction with mifepristone followed by a misoprostol regimen (group 1), and preinduction with a foley cather followed by a misoprostol regimen (group 2). (Group 2). In order to make a comparison between the length of time that passed between the induction and the abortion in both groups, we will compare the length of time that passed. In order to provide an accurate assessment of the disparity in abortion rates between the two populations:
Methods: This study is a prospective randomized trial involving sixty healthy women who chose to have their pregnancies terminated at a tertiary care center's Department of Obstetrics and Gynecology. The women's ultrasounds confirmed an intrauterine gestational age ranging from thirteen to twenty-six weeks of pregnancy.
Results and discussion: Group 1's average induction abortion time was 8.93 hours, whereas group 2's was 8.75. None was statistically significant. 42 women who used mifepristone and misoprostol had IAIs under 6 hours, according to Bijeta et al. The average IAI for Mifepristone + Misoprostol was 8.6 hours and 15.5 hours for Misoprostol. Hourly comparison of mifepristone-misoprostol induction abortion studies: Neha Agarwal et al. found a 6-hour IAI. Sin Eh Goh et al. found a 6.7-hour average IAI. Kulakarni Kranti's average IAI was 8.15 hours. Tang et al. found a 10.5-hour IAI. Ashok et al. found a 6.25-hour IAI. In Subha et altrial, the foley catheter termination group received misoprostol after 13.84 5.37 hours.
Conclusion: Both the mifepristone preinduction with misoprostol and the foley catheter preinduction with misoprostol procedures are risk-free and simple ways for terminating a pregnancy in the second trimester. There was no statistically significant difference between the two groups in terms of the mean induction-abortion interval, the mean doses of misoprostol required, the side-effect profile, or the rate of women who experienced a complete abortion. In the group that used mifepristone and misoprostol, the success rate was 100%, while in the group that used foley bulb induction, the success rate was 96.7%. In this particular trial, the group that received mifepristone and misoprostol had a significantly lower level of pain intensity and a shorter length of time spent in the hospital. This difference was statistically significant. Therefore, it is possible to utilise either of these approaches to stop a pregnancy in the second trimester, although this will rely on whether or not mifepristone is readily available.

Maternal weight gain determines maternal and fetal outcome. Lower weight gain is associated with low birth waight of fetus and pre term delivery while higher weight gain is associated with gastational diabetes mellitus  higher birth weight and complication related to it. Maternal weight gain  itself depends on  nutritional intake and also various medical condition like diabetes mellitus, hypertantion. The institute of medicine guideline says that required gastational weight gain depends on pre gastational BMI, and it needs to be tailored indivisualy. We have done prospective observational study at Kamla Raje hospital Gwalior from january 2019 to june 2020,  in which we studied on 500 women maternal weight gain , factors affecting it and maternal outcome. We found 41% underweight while only 4.2% women were overweight. Maximum women were from 20-29 age group(69.8%) and they commonly gain inadequate weight (71%). 53% of women were rural and 47% were urban.  65% of women who gained  inadequately weight  were rural while 60% of higher weight gained women are urban. women with adequate weight gain were associated with adequate weight gain (83%). most common maternal outcome in inadequate weight gain women was PROM(25%) while in higher weight gain women developed hypertention commonly (38%). 71% of inadequately weight gained women delivered by normal vaginal delivery and 78% of higher weight gained women needed cesarian section. We found that women with inadequate or higher waight gain as per IOM guideline associated with poor maternal outcome.   Preconceptional counciling regarding nutrition according to BMI and physical activity to be done and also gastational waight gain according indivisual  BMI should be advised. 

Inflammatory and neoplastic lesions are the most common cause of upper GIT tract lesions. Although the inflammatory conditions could be easily treated, but the malignancy are the most lethal ones. Cancers of the gastrointestinal (GI) tract account for more than one-quarter (26%) of global cancer incidence and more than one-third (35%) of all cancer-related deaths in 2018, with an estimated 4.8 million new cases and 3.4 million deaths worldwide.(1) Because of the similarity in benign causes of dysphagia and dyspepsia, as well as the insidious nature of the onset of symptoms, the majority of these neoplasms are detected at an advanced stage. (2) Globally, esophageal cancer is 7th most common cause of cancer morbidity and the sixth leading cause of death, and stomach cancer is the fifth most frequently diagnosed cancer and the fourth leading cause of death. (1,3) The use of the upper gastrointestinal flexible fibre optic endoscope in 1968 was a major breakthrough in the diagnosis of gastrointestinal tract (GIT) lesions.1.. It explores the upper gastrointestinal tract visually with a flexible fibre optic or video endoscope, allowing for easy inspection of the GIT with no gaps. Endoscopic guided biopsy is a well-established diagnostic tool and the current gold standard investigation for patients suffering from upper GIT symptoms. It may prevent neoplastic tumours from developing into invasive cancer by detecting them in their early stages.(4) Histopathological examination of endoscopic biopsies enables an exact diagnosis for further management

Aim: To compare central macular thickness (CMT) of diabetic patients with type 2 diabetes without clinical retinopathy and healthy subjects.
Material & Methods: This is a prospective study, carried out on 92 patients. The patients were divided in to two groups: study group included 50 patients and control group comprised of 42 patients.
Results: The mean HbA1c level was 8.68 ± 2.39% in the study group and 5.10 ± 0.76% in the control group. The mean level of HbA1c was statistically higher in the study group than in the control group (Table 1, P = 0.001). Fasting plasma glucose level was statistically higher in the study group than in the control group (P= 0.001).
Conclusion: Central macular thickness was not significantly thicker in patients with type 2 diabetes without clinical retinopathy than in healthy subjects

Background: Objectives: To determine the microbiological profile and antimicrobial susceptibility pattern of bacterial isolates from aural swabs in patients with CSOM. Materials and Methods: A total of 142 patients of CSOM with unilateral or bilateral ear discharge who attended the outpatient department from March 2020 to November 2020 were included. Results: Among 142 patients included in the study, most common age group was 11-20 years. CSOM was found to be more common in females (56.33%) than in males (43.66%). The most common bacterial isolate was Pseudomonas aeruginosa (45.8%) followed by Staphylococcus aureus (30.5%), Proteus mirabilis (13.8%), Acinetobacter baumannii (2.7%), Klebsiella pneumonia, Micrococcus, E. Coli, Citrobacter and Providentia species. Pseudomonas aeruginosa was found to have maximum  sensitivity to Polymyxin B (87.8%) and least sensitive to amoxicillin (15.1%). Among Staphylococcus aureus (87% MRSA and 13% MSSA) maximum isolates were sensitive to piperacillin+tazobactam (90.9%) and least sensitive to amoxicillin (13.6%).

Background: Low backache (LBA) in females is a major public health problem world-wide and treating this condition is also challenging due to its vast differential diagnosis. Pelvic inflammatory disease (PID) is the most frequently encountered condition in females for LBA and if diagnosed and treated early can lead to significant improvement in symptoms of LBA.       Aim: The present study is conducted to determine the incidence of Pelvic inflammatory disease (PID) and its associated risk factors in women with complaints of low back pain (LBP).      Material and Methods: A prospective epidemiological study was done in the department of orthopedics in GRMC Gwalior, M.P. 400 female patients attending OPD with the presenting complaint of LBP were enrolled in our study. Detailed history was taken and thorough examination was done.      Results: Out of 400 patients with LBA, PID was found in 324 (81%) patients. Maximum number (32%) of patients was from the age group of 41- 50 years. Majority of patients (60.7%) were of low socio-economic status, 51.7% females were illiterate, 69% females were overweight  31.8% of patients complained of vaginal discharge were age group of 41-50 years. 37.4% women used oral contraceptive pills and 58.1% females had an intrauterine contraceptive device inserted. Majority of the PID patients (53.4%) showed inflammatory cell on Pap smear
Conclusion: The present study suggests that PID is a major contributing factor in LBP in middle age females.

Background: Carpal tunnel syndrome (CTS) is a most common type of upper limb compression neuropathies. Carpal tunnel syndrome is common during pregnancy and the symptoms are mostly high in the third trimester. Various physiological and electro diagnostic tests are used to detect carpal tunnel syndrome in this stage. Aim: this study was aimed to find the prevalence of carpal tunnel syndrome among pregnant women.
Materials & Methods: A cross-sectional study was carried out in the department of orthopedics in Gajara Raja Medical College, Gwalior, India. Pregnant women presenting with sign and symptoms of CTS were enrolled in our study.
Results: Among 300 pregnant women, prevalence of CTS was 24 (8%). Majority of the women (66%) were found in third trimester of pregnancy. 37.4% pregnant women were 26-30 years age group, 54% was primiparous and 65.3% women were obese category. Physiologic tests (Phalen’s Test, Tinel’s sign and Carpal Compression Test) used for diagnosis of CTS.
Conclusion: Prevalence of carpal tunnel syndrome was higher among pregnant women mainly in third trimester.

BACKGROUND: Osteoarthritis (OA) is the most prevalent type of arthritis in the world. With the progressive aging of the population, it is becoming a major problem of public health. Symptomatic Knee osteoarthritis (OA) is chronic, progressive degenerative joint disease with accompanying pain, stiffness, and deformity of the knee joint. Osteoarthritis is the most frequent joint disease with a prevalence of 22% to 39% in India. OBJECTIVE: To evaluate the pain relief and  radiological improvement in medial joint space following proximal fibular osteotomy in medial compartment knee osteoarthritis. METHODS: From November 2018 to May 2020, 25 patients (four cases were bilateral so total of 29 knees) who underwent proximal fibular osteotomy for medial compartment osteoarthritis in teaching hospitals attached to Bangalore Medical College & Research Institute, were followed up. Preoperative and postoperative weightbearing and entire lower extremity X-rays were obtained to analyze the alignment of the lower extremity and ratio of the knee joint space (medial/lateral compartment). Functional assessment was done using Visual Analogue Scale (VAS) & American Knee Society Score. (KSS). RESULTS: A total of 25 patients and 29 knees were followed-up. Of these, 6 were male and 19 were female patient. The average age was 58.72 years. The average preoperative VAS score, KSS clinical & KSS functional score were 6.75 points, 40.31 points & 44.82 respectively. According to KL grading, there were 20 knees of grade 2 and 9 knees of Grade 3. The average postoperative VAS score, KSS clinical & KSS functional score were 2.34 points, 76.79 points & 76.72 points respectively. The medial joint space has improved significantly from a preoperative value of 1.22 mm to postoperatively 3.71 mm. The ratio of medial to lateral joint space improved from a preoperative value of 0.20 to 0.67. CONCLUSION: Patients who underwent Proximal Fibular Osteotomy showed statistically significant improvement in functional & radiological outcome at 6 months follow up. We conclude by stating that PFO is an attractive option for pain relief in patients with medial compartment osteoarthritis of knee. The procedure is simpler, effective, and easy to perform. It is less expensive and requires lesser rehabilitation than alternative procedures like HTO, UKA & TKA. It gives excellent pain relief postoperatively & is associated with fewer complications

Background: The excessive, regular use of topical fluorinated steroids on the face often produces an array of skin complications, including an eruption clinically indistinguishable from rosacea-‘steroid-induced rosacea like eruption ’  or iatrosacea . Although it was believed that only high potency topical steroids could produce SIRD, it is important to note that topical hydrocortisone 1% can also cause such an eruption after prolonged use. Objective: To assess the efficacy and tolerability  of low dose oral Isotretinoin for  steroid induced  rosacea- like eruption. Methodology: A retrospective registry/ photographic analysis  of 30 patients enrolled between Jan 2013 to Jan 2014 was done at  Cutis academy. Case records and photographs  of 30 patients between the age group of 15- 45 years   clinically diagnosed with steroid induced rosacea  on  low dose oral isotretinoin 20mg alternate days for 3 months were analysed. Patients were evaluated by a rosacea clinical score at weeks 0, 6,  and 12 weeks. Results: A total of  30 patients (23females and 7 males) were enrolled in this study.  The mean age of the study population was 30.1+/- 14.8 (14 to 45) years. Among the 30 patients, 2  dropped out due to side effects of  treatment such as dryness and itching. According to seven point static score, Investigator global assessment of steroid induced rosacea eruption at baseline was 5.36+/- 1.1. This score decreased to 3.2 +/-0.8 at week 6, then 0.73 +/-0.6 at week 12.The difference of IGA between week 0, week 2, and week 6 was statistically significant.(p<0-0001) . At baseline the 16 patients had ratings of ‘severe’ , 7 patients had ratings of  ‘moderate to severe’, 2 patients had rating of ‘moderate’, 3 patients had rating of ‘mild to moderate’ .Conclusion : Low dose oral isotretinoin with cessation /avoidance of topical steroid use as well as the avoidance of other agents known to aggravate rosacea is proved to be an   effective alternative mode of treatment of steroid rosacea like eruption.

Background: Olecranon fractures are one of the common fractures around the elbow, they constitute around 37% of all fractures occurring around the elbow joint. Olecranon fractures are common and account for 10% of upper extremity injuries. Simple displaced transverse fractures account for approximately 85% of all adult fractures. These fractures are traditionally managed operatively with operatively with open reduction and internal fixation using tension band wiring. Open reduction internal fixation with plate is advocated in the presence of comminution or fracture dislocation Objective: to compare the functional outcome between tension band wiring versus plating in olecranon fractures. Methods: A prospective study of 42 patients among which 21 patients were treated with tension band wiring and 21 were treated with plating was conducted in dept of orthopaedics MMCRI, Mysore from February 2021 to August 2022. Before subjecting the patients for investigations and surgical procedures consent was obtained and patients were followed up at 6 months interval and were assessed using Mayo Elbow Performance index. Results: Patients were assessed using Mayo elbow performance score .Out of total 42 patients, 21 were operated with TBW and 21 were operated with plating. Out of 21 operated with tension band wiring on follow up 10 showed excellent results 8 had good results and 3 had fair results. 21 Patients operated with plating 14 showed excellent and 3 good results and 4 showed fair results Conclusion: Best modality of the treatment for fracture depends upon the type of fracture. We could conclude that both plate and TBW is equally effective for management of olecranon fractures. However , plate has a slight advantage over TBW in terms of early mobilization and less  complications

Background: Supracondylar humerus fractures are one of the commonest fractures in the paediatric age group. Displaced fractures of these kind, that is, Gartland type III are treated by closed or open reduction and k wire fixation. Cross k wire and lateral wires are the commonest configurations used for fixation. The present study aims to evaluate the difference between the two configurations in terms of surgical technique, functional outcome and complications. Objectives: To compare the functional and radiological outcome of lateral and cross pinning of displaced supracondylar humerus fractures of children METHODOLOGY:This was a prospective comparative study of 40 paediatric patients with supracondylar fracture humerus in the department of Orthopaedics in a Tertiary care Centre after the inclusion & exclusion criteria were met. Immediately after admission , a detailed neurovascular examination was done. Anteroposterior & Lateral Radiographs of the elbow were taken & type of fracture was noted. Informed and written consent was taken from the parent/guardian. Then 20 patients were treated with Lateral K- wire technique  (Group A ) and another 20 patients with Cross K- wire (Group B) pinning technique of fixation. Results: The average follow-up period for patients in lateral K wiring technique  was 12.23 ± 1.9 months while that for patients in cross K wiring technique was 11.26 ± 2.5 months. This difference was not found to be statistically significant.  As per the Flynn criteria, 13 patients in group A had excellent results, 5 patients  had good results and 2 patient  had fair result. In group B, 12 patients had excellent results, 7 patients  had good results and 1 patients (20.0 %) had fair results. No patients in either group had a poor result. Conclusion: Both lateral and cross k wire fixation are similarly effective techniques for stabilising supracondylar humerus fractures, with comparable functional, radiological, and aesthetic results.

Introduction:Diabetes mellitus is an important global public health problem. In addition to being a chronic disease, obesity is a key risk factor for Type 2 diabetes mellitus (T2DM) that leads to disability. This study aimed at investigating the effect of Body Mass Index on serum lipid profile in type II diabetic patients.
 
Material and Methods
This is a prospective study and observational study will be done in the Department of Physiology in collaboration     with the Department of Medicine, Index Medical College, Hospital & Research Centre, Indore.Inclusion Criteria:Only Diagnosed cases of male and female Type II Diabetes Mellitus cases aged 30-60 suffering from more than 2yrs. The diagnosis of diabetes is made on the basis of (Revised American Diabetic Association criteria). Fasting glucose >126mg/dl and 2hr postprandial plasma glucose >200mg/dl.
 
Results: The mean (± SD) of various motor nerve variables like latency, amplitude and nerve conduction velocity between control and cases. When compared these variables between controls and cases was statistically highly significant (p<0.001). Comparison of various motor nerve variables like latency, amplitude and nerve conduction velocity between control and cases are graphically shown.
 
Conclusion: A significant negative correlation between BMI and HDL-C was observed, while the correlation between BMI and LDL-C was observed to be insignificant. HDL-C was found significantly higher in patients with normal BMI. These results are important to indicate that there is modest impact of BMI on lipid profile. Therefore, assessment and management for altered blood lipids should not be based on a patient’s body weight or BMI.

Background and Objective
Coronaviruses are a family of viruses that can cause respiratory illness in humans. They are called “corona” because of crown-like spikes on the surface of the virus. Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the common cold are examples of coronaviruses that cause illness in humans.
The primary mode of transmission of SARS-CoV-2 is via exposure to respiratory droplets carrying the infectious virus from close contact or droplet transmission from pre-symptomatic, asymptomatic, or symptomatic individuals harbouring the virus
This study is conducted to analyse the extent of association between COVID-19 & Diabetes Mellitus and its correlation with the inflammatory markers as it is still unclear if diabetes interferes in the prognosis of COVID-19
Material & Methods
A Cross-sectional study was conducted over a period of 6 months from April 2021–September 2021.Among 149 RT-PCR positive COVID-19 patients the random blood sugar levels, CT chest severity score & C-Reactive Protein was compared among the diabetic & non-diabetic population in ACS Medical college & hospital Chennai.
Results
The study shows that out of 149 COVID-19 positive patients, 88 (59.1%) were diabetic & 61 (40.9%) were non-diabetic. Patients with diabetes had significantly higher CT chest severity score and elevated C-reactive protein than non-diabetic patients.
Conclusion
The interaction between covid-19 & diabetes could be bi-directional, with SARS-CoV-2 potentially worsening pre-existing diabetes.

A 10 month old presented with the symptoms of  jaundice and fever since 1 week. Routine investigations reveleaed hemolytic anemia and CE-HPLC & Whole exome Sequencing  confirmed the diagnosis of compound heterozygous condition of Haemoglobin E-Beta thalassemic disease.

BACK GROUND:
Breast cancer is becoming more common in today's population. Eighty percent of lesions are harmless. No clinical examination or investigation can reliably detect BBD. When clinical examination, USG breast, and FNAC/HPR are coupled, the accuracy of diagnosis improves.
AIMS & OBJECTIVES:
The purpose of this study was to examine the roles of clinical examination, ultrasonography, and histopatholgical examination in the diagnosis of benign breast illnesses.
Materials And Methods:
Female patients with breast disorders who attended O.P.D. or were admitted to wards at Department of Surgery, Govt Medical College/GGH, Mahabubnagar and research centre between June 2019 and July 2022. A detailed history of the patient was taken in order to determine the reasonable risk factor, and complaints were recorded chronologically. A clinical examination was performed to determine the various forms of presentation. The breast USG and FNAC/HPR are then performed.
RESULT: The present study indicated that the incidence of benign lumps was higher in the age group of 11-20 years. 28 patients (90 percent) reported a lump in the breast, followed by pain and drainage from the nipple. The majority of them (60%) were 3cms. Fibroadenomas were prevalent (73.34 percent). There were 16 cases of left side lesions. The majority of the lesions were isolated in 28 patients (93.34 percent ). FNAC was performed in all patients and was diagnostic (100 percent ). The USG could clearly indicate whether the tumour was cystic or solid, however further typing of the lesion had limitations, even though fibroadenoma could be reliably diagnosed.

Background: The sacrum, an enormous triangular bone, is formed when the five sacral vertebrae fuse together. While the dorsal wall of the sacral canal is generated by the fusing of the laminae, spines, and ossified ligamentum flava, the ventral wall is created by the fusion of the sacral vertebra's body. Numerous variations can be found in the sacral canal's dorsal wall. It might be entirely open all the way down. By injecting medications into the spinal canal, caudal epidural anaesthesia provides both analgesia and anaesthesia. One of the contraindications of caudal epidural block is the full agenesis of the sacral dorsal wall.
Aim & Objective: The objectives of the present study were to document the dorsal wall agenesis of sacrum among the sacra which belong to the North Indian population and compare the findings with various races of the world.
Materials and methods: The present study has been carried out on 164 male & 112 Female (Total - 276 sacrum) undamaged dry sacrum after calculating the sacral indices and sexing of sacra.
Results: Sacrum with complete agenesis of dorsal wall are found in 3 among 276 sacrum (1.08%), in which 2 (0.72%) belongs to male & 1 (0.36%) belongs to female. So, compared to females, males are more likely to have a complete agenesis of the dorsal wall of the sacrum.
Conclusion: It's a rare variation, and therefore knowledge about it may be beneficial for anthropologists, radiologists, orthopaedicians surgeons, and neurosurgeons, as well as anaesthetics during caudal epidural anaesthesia. Understanding these variances could increase the success rate of the caudal epidural block.

Most quality control programs in blood banking are concerned exclusively with control of research center testing and staff and don't assess different region of the blood donation center or decide the capability of all work force in the presentation of administrative assignments. To accomplish the last objectives in our quality control program, during a 15-month time frame, 1,143 purposeful mistakes were placed into routine parts of all blood donation center exercises and afterward painstakingly checked and controlled. Of 498, 400, and 245 mistakes shipped off the workplace, nursing, and lab regions, separately, 12 (2.4%), 58 (14.5%), and 29 (11.8%) blunders were not recognized. Presentation of this program was likewise joined by a huge expansion in the quantity of genuine blunders that were distinguished and probably had not recently been perceived. The quantity of genuine blunders identified expanded from 4 to 43 to 73 during months 0 to 6, 7 to 12, and 13 to 15 of this review. Examination and recording of every blunder on an Error Report Form has allowed assessment of both faculty and frameworks and ensuing execution of restorative activity

Background:
SARS-CoV 2 virus infection present as varying degree of severity with many post viral complications.Although initial research was focused on the epidemiology, risk factors, clinical syndrome and treatment options; sufficient data is needed on sequelae of the patients who got discharged. The present study aimed to identify long term outcomes of COVID 19 recovered patients to safeguard their life in future.
Methods: The present longitudinal study included all 443 COVID 19 recovered patients who were admitted during the second wave at our tertiary care hospital from 1^stApril to 25^th May, 2021 and interviewed telephonically with series of questionnaire. Baseline demographic profile, comorbidities, clinical characteristics and investigatory findings were obtained from the hospital records and analysed for the long term symptoms and outcomes.
Results: Over a mean follow up period of 152 days, around 6% of the patients who recovered after acute COVID 19 infection died after the discharge. More than two third of patients were male. Diabetes and hypertension were most common comorbidities among the study population. Most common persistent symptoms was fatigue among the recovered population at follow up. Multivariate logistic regression analysis against the odds of post discharge mortality  revealed patients receiving advanced respiratory support  (AOR 5.2, 95% CI 1.8-15.1) and ICU stay during the hospitalisation (AOR 6.67, 95% CI 1.18-37.7) were predictors of post discharge mortality. 
Conclusion:  Fatigue was the most common symptoms observed after 5 months of discharge from acute COVID 19 infection. Overall post discharge mortality was 6% and admission in ICU and use of advanced respiratory support were associated mortality among recovered patients

Background and Aims: Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of pregnant women. The aim of this study is to examine severity of COVID-19 disease and maternal and foetal outcome among COVID-19 positive pregnant women undergoing caesarean section. Methods: This retrospective observational study was conducted at a tertiary teaching hospital in Karnataka between 1stApril to 31st July 2021, during which 100 COVID-19 positive pregnant women with ASA physical class II, III and IV who have undergone lower segment emergency caesarean section were selected on the basis of simple random sampling method. Results: A total of 100 women who had undergone caesarean section under spinal anaesthesia with positive SARS-CoV-2 PCR tests were assessed. Mean age was 24.45± 4.3 years, eight women were having severe covid-19 infection and overall mortality rate was 5% (5/100) in women and 1 woman had HELPP syndrome and one met with PPH (post-partum haemorrhage). Seven (7%) COVID-19 pregnant women required intensive care in the perioperative period. Eight neonates required NICU admission and had APGAR score less than 7. Fifty-five (55%) women were asymptomatic. While the rate of pneumonia in symptomatic women was 3.6% (8/45), the pneumonia incidence among all SARS-CoV-2 PCR (+) pregnant women was 8% (8/100). Conclusion: In our study, 61% of patients had pulmonary involvement and the mortality rate was 8% among mothers and 1% in neonates.

 A novel periodontal film for the treatment of periodontitis was developed by using herbal drugs Quercetin and Rutin, it is a plant flavanol from the flavonoid group of polyphenols. It is found in many fruits, vegetables, leaves, seeds and grains; capers and red onions. It has a bitter flavour and is used as an antimicrobial agent and effective against infecting microorganisms in the periodontal pocket.  Periodontal films were prepared by solvent casting technique using Eutragit and HPMC as polymers Dibutyl phthalate as plasticizers and PEG as surface active agent. The patches were cut in 1 cm ²  and placed in desiccator for further  study . In vivo animal study was performed by using Male Albino rabbit (New Zealand rabbit) 8–12 weeks. The operative area was cleaned and periodontal patch of 1cm ² was placed in the gingival sulculus of rabbit’s lower incisors. The gingival crevicular fluid of the lower incisors was then extracted using #30 standardized sterile paper point on 1, 2, 4, 7, 10, and 14hrs.  

Introduction: Osteomyelitis is a painful Inflammatory disease of bone secondary to its infection often of bacterial origin that may lead to the necrosis of bone tissue. It frequently involvesmetaphysis of long bones of knee but isolated involvement of diaphyseal region of fibula is a rare phenomenon .
Case report: 6 year female presented with swelling, pain and discharge fromleg which was diagnosed as chronic osteomyelitis of fibula andtreated thoroughly with sequesterctomy and antibiotic therapy which led to complete resolution of the symptoms on followup.
Conclusion: early diagnosis and treatment provides favourable outcome in patients.

BACKGROUND
Systemic Inflammatory Response Syndrome (SIRS) is an inflammatory condition which affects multiple systems in the body and often occurs as a response which is immunologically mediated by the protective immune system to infectious agent. Magnesium plays a vital role in sepsis and systemic inflammatory response syndrome (SIRS) The aim of this study is to estimate the serum magnesium concentrations in patients with SIRS in the medical ICU, to correlate with prognosis of SIRS patients by comparision with sequential organ failure assessment scoring and to assess the clinical outcome.
 
MATERIALS AND METHODS
This Observational analytical study was conducted in 100 patients admitted at the medical intensive care unit of Saveetha medical college and hospital, chennai who satisfy the diagnostic clinical criteria for SIRS. Detailed clinical examination was done for each patient. Serum magnesium levels were sent and the results were analysed.
 
RESULTS
In the study, 100 patients were included. The mean age of the study population was 42. 92 + 16. 69 years. 70 % of the patients in the study group were  male and 30 % were females. The mortality rate in the hypomagnesemia group was 81. 8% where as it was 14.3 % in the  normomagnesemia  group.  There was Significant mortality in the hypomagnesemia group when compared to the normomagnesemia group. The mean duration of ICU stay for patients in the hypomagnesemia group was 5. 424 days and in the  normomagnesemia group  it  was  5.286  days.  Among 66 patients with hypomagnesemia 50 patients required mechanical ventilation and it was 66 %. Among 28 patients in normomagnesemia group, 2 patients required ventilatory support.
 
CONCLUSION
Serum magnesium levels have prognostic value in  patients diagnosed as SIRS. Serum magnesium concentration shows association with increased mortality rate. There is significant greater need for mechanical ventilation and increased duration of stay under ventilator support in the patients with lower magnesium levels. There is a significant association in prognosticating the patients with SOFA scoring in hypomagnesemia and  magnesium correction may improve the outcomes in sepsis and SIRS patients.

In India, oral cancer is one of the leading cancer today. Its incidence is 12.6 per 1,00,000 population. The premalignant lesion is a disease or syndrome if left untreated have significantly increased risk to develop cancer.   Aim and Objective of the study:  The objective of this study is to evaluate clinicopathological spectrum of oral cavity lesions at our tertiary care hospital. Materials and Methods: A detailed history-taking including age, sex, complaints and duration of symptoms, site, side etc. and with thorough clinical examination relevant investigations for consistency, diagnosis, benign or malignant was done and appropriate management has been done for these patients. All relevant investigations were done. Biopsy were taken, detailed histopathological features were noted. The tissue sections were stained with H and E stain. Results: We evaluated all the subjects for oral cavity lesions with diagnostic biopsy and subjected for HPE. Among these subjects 21.9% had non-neoplastic lesion, 18.8% had benign lesion, 10.7% had pre-malignant and 48.4% had malignant lesions. The most common pre-malignant lesion was leucoplakia (64.2%), followed by oral lichen planus (16.6%), oral sub mucous fibrosis (11.9%), actinic cheilitis (7.14%) respectively and none had eryhthoplakia. Out of 48.4% malignant lesions 94.7% of the subjects had squamous cell carcinoma followed by other cancers. The most common site of oral cavity lesions was buccal mucosa (41.8%) followed by tounge (17.3%) and lower gingivobuccal region (17%). We also evaluated tobacco habits among these subjects, we found that 76.7% had only tobacco chewing habits, 3.06% had both smoking and tobacco chewing habits, 14.2% had tobacco chewing and 5.86% had no habbits. Discussion and Conclusion: In our study, we observed various premalignant oral lesions which include leukoplakia, oral submucous fibrosis, lichen planus, actinic cheilitis and erythroplakia. Oral leukoplakia was most common lesion in the present study. Buccal mucosa was the most common site. Tobacco chewing habit was common risk factor observed. Early detection of premalignant oral lesion is of utmost importance to prevent further progress to oral cancer. This study reported that the most common oral cavity lesion was malignancy with a well-differentiated squamous cell carcinoma variant. Buccal mucosa involvement was the most common in oral cavity lesions and malignant lesions.

BACKGROUND and OBJECTIVE: The incidence of multiple myeloma varies among different ethnic group and among different countries but from past few years its incidence is increasing in Asian countries. In India due to financial constraints, lack of adequate health infrastructure and lack of knowledge among people lead to delay in the treatment of Multiple Myeloma and it became a challenge to medical field in India. The objective of the study is to study the various parameters and its incidence in Multiple Myeloma patients.
METHODS: This is a cross sectional study conducted in the department of medicine and oncology of tertiary care hospital of north India. Data was taken from 2015-2022, 102 cases of multiple myeloma was diagnosed out of which 2 were excluded. The diagnosis was made based on the International Myeloma Working Group: Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorder. The demographic profile, clinical symptoms and laboratory parameters were studied.
RESULTS: Multiple Myeloma was most common in 5^th decade with male predominance and more common in urban population. Most common symptom was bone pain 63 (63%) and weight loss (9%) least common.  65% had anaemia, 18% had renal insufficiency and 34% had hypercalcemia. All of the patients had M-band in gamma globulin region with 48% had ISS stage 1. 70(70%) had lytic lesions in the skull.
INTERPRETATION AND CONCLUSION: To conclude majority of the patients of Multiple Myeloma were males and majority were farmers. Majority of patients were from urban area. Bone pain being the most common symptom followed by the fatigue. Anaemia and Hypercalcemia were less common in our study population. Most of the patients had ISS stage 1. The presentation of MM varies among patients and with adequate health infrastructure better outcome and early diagnosis of multiple myeloma will be there.

Introduction: Patient safety is the primary objective of health care. Success and failures are part of it. Adverse events can be controlled but cannot be eliminated. They should be reported, documented, and studied. Such data is important to monitor hospital performance and also they serve as a medium for training, simulation and improvement in standards of anaesthesia care.
Material and method: An observational retrospective study was conducted in a teaching tertiary level government hospital from patient records who underwent adverse events or deaths related to anaesthesia over one year from October 2016 to September 2017. Type of adverse events and their relation to ASA grading, type and speciality of operation, age, sex and comorbidities of the patient, time of critical incident when occurred with relation to anaesthesia were analysed. Mortality was included as a critical event in our study and analysed.
Results: Critical events were documented in 50 patients (0.5%), with mortality 54%, while rest recovered completely. Highest number were documented in age group 31 to 50 years (26%) and ASA III patients(50%). Critical incidences happened more with emergency surgeries (52%), in patients with single preoperative comorbidity(35) and under general anaesthesia(78%) in maintenance phase(32.8%). Highest cause of mortality was related to cardiovascular and respiratory events.
Conclusion:  Morbidity and critical events will always be part of anaesthesia practice. They might be prevented with proper vigilance. When they happen, it should be reported without fear of punitive results. They should be studied and analysed, and proper protocols and checklists should be developed according to local guidelines and medical practices. Such studies are important part of medical education process and improve patient care.

Background: Generic drugs have an important place in health care because they are less expensive and mimic the original drug in terms of the active ingredients, dose, dosage form, and bioequivalence.The present study was conducted to assess patient perception about generic vs. branded medicine.
Materials & Methods: 120 patients of both genders were provided with a questionnaire was designedwhich comprised of knowledge about difference between generic and branded medicines, attitude for buying generic medicines over branded medicines and practice of taking generic medicines.
Results: Out of 120 patients, males were 55 and females were 65.71% have heard about generic medicine, 65% knew that there is price difference between generic and branded medicine, 68% prefer buying generic medicines over branded medicines, 30% have ever asked their doctor to prescribe generic medicines, 32% have demanded chemist to give generic medicines in place of branded medicines, 64% knew there a difference in the quality of generic medicine and branded variant, 61% knew that there a difference in the price of generic and branded medicines, the type of medicines doctors prefer to prescribe was generic medicines in 26% and branded medicinesin 74%, the drug chemist prefer to sell was generic medicines in 22% and branded medicinesin 78%, generic medicines in 80% and branded medicines in 20% were prescribed in this hospital, Indian government promote generic medicines in 45% and branded medicines in 55%, 32% were aware of any government rules regarding generic or branded medicines. The difference was significant (P< 0.05).
Conclusion: Knowledge and attitude about generic medicines among participants were poor.

Background: The distal 1/3^rd femoral fractures constitute 6% of all femoral fractures. The present study was conducted to evaluate results of retrograde nailing for surgical stabilization of distal 1/3rd fracture shaft femur.
Materials & Methods: 58 patients of distal 1/3rd fractures of femu rof both gender were treated by retrograde nailing. Parameters noted were mode of injury, type of fracture, ROM, time from injury, duration of the surgery, time for fracture healing, and functional assessment by Lysholm knee scoring etc.
Results: Out of 58 patients, 32 were males and 26 were females. Mode of injury was RTA in 32, sports injury in 12, fall in 8 and others in 6 patients. Fracture type was closed in 30 and compound in 28 cases. Mean flexion at knee (degree) at 1 month was 42.6, at 3 months was 90.2, at 6 months was 112.5 and at 12 months was 121.4. The difference was significant (P< 0.05). Lysholm knee scoring was excellent in 36, good in 14 and fair in 8 patients. The difference was significant (P< 0.05).
Conclusion: Authors found that retrograde nailing for surgical stabilization of distal 1/3rd fracture shaft femur is adequate treatment options for distal femur fractures

Aim and objectives: The present study assessed the correlation between rising levels of CRP and D-dimer with morbidity and mortality in adult Covid -19 patients.
Materials and method: This retrospective observational study was conducted at Max Super speciality Hospital I.P. Extension, Delhi a tertiary care centre in North India. CRP and D-Dimer values were collected at the time of admission and within 15 days after admission. The statistical analysis was done by independent t-test.
Results: The study population consisted of 194 (64.7%) males and 106 (35.3%) females. The mean age of the study population was 56.78±15.42 (28-94) years. The mean age of the non-survivors (58.83±15.64 years) was significantly more than survivors (54.43±14.85 years). The mean CRP and D-DIMER at the time of admission and within 15 days after admission was significantly more among non-survivors compared to survivors.
Conclusion: A high CRP and elevated D-Dimer levels among COVID-19 patients predict higher odds of mortality; however, large scale and longer-term studies are needed to validate our findings. The predictive model based upon CRP and D-DIMER levels can help the clinicians to improve individual treatment, make timely clinical decisions, and make optimal use of limited clinical resources.

Background: Branching pattern of the brachial artery is important during percutaneous arterial catheterization, so as to prevent any complications arising from accidental damage to the anomalous vessel and knowledge of the variations are important for plastic surgeons.
Material and Methods: This study was conducted in the Department of Anatomy with the aim to know the variations in the anatomy of Brachial Artery and its branching patterns. This study included total n = 100 Upper limb specimens.
Results: We included n = 100 specimens in this study. Among 100 specimens, 84% showed normal branching pattern of brachial artery. Rest 16% specimens were showing variations. This study observed that 10% variation of branching pattern of brachial artery by trifurcation near its termination, 2% by Double profunda brachii artery arising from brachial artery, 2% High origin of radial artery & 2% High division of brachial artery.
Conclusion: This study concludes that exact knowledge of these arterial variations is extremely important as these are having frequent injuries and these variations are also involved in various surgeries around the shoulder, arm and fracture management of the humerus as well as multiple microvascular reconstructive surgeries and radiologic diagnostic techniques.

Background: To describe the hysteroscopy findings in a group of 504 infertile women and correlate the findings available with other diagnostic modalities mainly HSG.
Martial and Methods: After obtaining the consent, the hysteroscopic procedures were carried out in the proliferative phase of the menstrual cycle. Size and position of the uterus was confirmed by bimanual examination. Any abnormality of uterine cavity, endometrium, and uterine ostia were noted and corrective measures were taken accordingly in the same setting. Post procedure follow-up of these patients were done and pregnancy outcomes were noted.
Results: The normal hysteroscopy findings were reported in 223 women (73.84%). Remaining 79(26.16%) had abnormal findings, most commonly being endometrial polyps (32%) and intrauterine adhesions (29%) and rest were septum, T-shaped uterus, chronic tubercular endometritis, and sub mucosal fibroids.
Conclusion: We concluded that HSG can detect uterine abnormalities, but findings have to be confirmed by hysteroscopy. Hysteroscopy should be performed in all infertile women with abnormal HSG and those who fail to conceive after normal HSG findings as incidental lesions can be missed on HSG.

Background: Gastric carcinoma is the third most common cause of cancer related mortality worldwide. The present study is taken up to provide an overview of the spectrum of malignancies, age and sex incidence and risk factor such as tobacco usage, alcohol consumption, dietary intake and blood group analysis of gastric adenocarcinomas in South India.
Martial and Methods: The present study is a two year retrospective study that included all the cases received from   1^st August, 2018 to 31^st July 2020 in the department of pathology, Guntur Medical College and Government General Hospital, Guntur.
Results: A total of 49 cases were included in the study. The most common age group was sixth decade of life with male preponderance. Gastric outlet obstruction was the most common presenting symptom. Tubular type of gastric adenocarcinoma was the most common histopathological variant.
Conclusion: Regardless of growing understanding of the risk factors, phenotypic and genotypic alterations and diagnostic modalities, Gastric adenocarcinoma still linger to have poor prognosis due to limited treatment options.

Background: Diabetes mellitus is a metabolic disorder distinguished by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. Cardiovascular diseases (CVDs)-majorly coronary artery disease (CAD), heart failure (HF), and stroke are the major cause of death and disability in patients with type 2 diabetes mellitus (T2DM). The aim of the study was to asses cardiac co-morbidities in newly diagnosed type 2 diabetes mellitus with the help of echocardiography at a tertiary hospital.
Material and Methods: Present study was single-center, cross-sectional, observational study conducted in newly diagnosed patients of type 2 diabetes mellites (diagnosed in last 3 months), clinically asymptomatic, blood pressure <130/80mmHg, with normal ECG, underwent, conventional 2 D echocardiography.
Results: In present study, 60 asymptomatic type 2 diabetes mellitus patients underwent 2-D echocardiography, majority were male (73.33 %) as compared to females (26.67 %). Most common age group was 41-50 years and 51-60 years (26.66 % each), followed by 31-40 years (21.67 %). On 2-D echocardiography, diastolic dysfunction was noted in 10 patients (16.67 %). Grade I, II and III diastolic dysfunction was noted in 10 %, 5 % and 1.67 % patients respectively. Reduced early mitral inflow velocity was noted in 7 cases (11.67 %) and mitral annular early diastolic velocity was noted in 11 cases (18.33 %). As HbA1c increases, severity of left ventricular diastolic dysfunction increases, difference was statistically significant. We noted a statistically significant difference in values of age (years), BMI (kg/m2), FBS (mg/dl), PPBS (mg/dl) and HbA1c (%) between patients with LVDD and patients without LVDD. Conclusion: 2D Echo is recommended for screening for cardiovascular abnormalities in newly diagnosed type 2 diabetes melites patients to prevent further progression to symptomatic cardiovascular abnormalities. 

Background: Headache is the most ancient reported pain in humans. It has significant detrimental effect on the quality of life of the sufferers.Migraine is ranked as the eighth most burdensome disease and the seventh highest cause of disability in the world. India appears to have a very high prevalence of migraine, and of other headache disorders in line with global averages. The prevalence of common migraine among chronic headache patients attending ENT OPD in a tertiary care Centre, Kollam, Southern Kerala and to assess the trigger factors of common migraine was studied.
Material and Methods: It was a Prospective observational study conducted at Department of ENT, Government medical college, Kollam for One year. All patients with chronic headache fulfilling the inclusion and exclusion criteria, belonging to either sex between age group of 12 to 50 years coming to ENT opd were studied.The validated structured questionnaire enquired into several aspects of burden. Written informed consent from the patient was taken. Study was approved by Institutional Ethical Committee.
Results: The age-standardised 1-year prevalence of migraine was 25.2 %,  well above the global average of 14.7 %.¹The mean age of study participants was found to be 31.10±10 years. The most common position of headache was of one side of forehead seen in 50.6% patients followed by both sides forehead (10.4%). The most common type of headache in migraine was pricking in 58.5% patients followed by pulsatile type in 20.9% and Throbbing in 19.9% patients. But this was not significant (p>0.05). most of the patients had headache for 12-24 hours (87%). common causes were found to be travel (88.3%), smoking (98.3%), anger (88.9%), noise (77.5%), sleepless (65.5%), smell especially soap (75.9%), travel (88.3%) in hot climate.
Conclusion: In our study, the prevalence of migraine was high among patients which were in agreement with the findings of other studies. This may be due to their stress, duties and workload. Solutions should be considered since headaches reduce the quality of their work and have detrimental effects on their health.

Background: With the progression of the HIV epidemic there is a need to classify the papulonodular eruptions of the HIV infection based on its likely aetiology for proper management of HIV. This study was aimed to study the clinical and pathological aspects of papulonodular lesions of skin in HIV infected individuals.
Methods: The study was conducted among all Human Immunodeficiency Virus (HIV) infected patients who presented with papular and nodular skin lesions at the outpatient’s department as well as those admitted in a tertiary care government hospital. Each patient underwent a detailed history taking which included chief complaints, treatment history, and personal history. Dermatological examination included morphology of lesion, site, number, size, shape, colour, margin and surface of skin lesions. Skin biopsy was performed on all the cases and specimen sent to Department of Pathology for histopathology report to correlate the clinical and histopathological diagnoses.
Results: A total of 55 cases were studied. 48 (87.27%) cases were males and 7 (12.73%) cases were females. The age ranged from 25-48years (mean age-34.90 years) for males and 26-46 years (mean age- 36 years) in females. Of the total 55 cases, 18 (32.73%) cases had infective dermatoses and the remaining 37 (67.27%) had non-infective dermatoses. Pruritic papular eruption formed the majority of the cases 20 (54.05%), 15 of them had a low CD4 count <200/µL (Mean CD4 count was (126/µL). All patients showed good response to HAART. Eosinophilic folliculitis was found in 4 cases with 3 cases having CD4 count <200/µL (mean 72/µL).
Conclusion: Patients with infective and non-infective cutaneous manifestations are significantly immuno-suppressed than HIV-positive asymptomatic controls. The absolute CD4 count is inversely related to the number of HIV positive patients with papulonodular eruptions of skin. Hence, there is a need for histopathology examination to separate these closely related entities for precise diagnosis and proper management in HIV patients

Background: To assess efficacy of epidural bupivacaine and fentanyl for labour analgesia.
Materials and Methods: One hundred ten pregnant women primigravida and multigravida (ASA grade II) age ranged 18-30 years were recruited for this observational study. All patients were given first loading dose of 10 ml 0.25% plain bupivacaine via epidural catheter followed by continuous epidural infusion of 0.0625% bupivacaine with 2.5 mcg/ml fentanyl @ 12ml/hour. The parturients were assessed for hemodynamics, mode of delivery, VAS and APGAR (neonatal outcome).
Results: There were 42 Primigravida and 68 Multigravida. The mean visual analogue score before drug was 5.42 and after drug was 2.18. Mode of delivery was natural in 95, vacuum cup assisted in 14 and caesarean section in 1 case. Patient satisfaction score was excellent in 20 patients, good in 90 and poor in 0. The difference was significant (P< 0.05). At 1 minute, APGAR score 7 was seen in 4, score 8 in 45, score 9 in 55 and score 10 in 6 patients. At 5 minutes, score 9 was seen in 25 and score 10 in 85 patients. The difference was significant (P< 0.05).
Conclusion: Epidural labour analgesia with low dose bupivacaine (0.0625%) with fentanyl (2.5 mcg/ml), given through continuous infusion technique provides good pain relief to the parturient.

Background: The use of ultrasound for precise nerve/plexus localization has recently revolutionized the field of regional anesthesia, with ultrasound probes with appropriate frequencies being successfully tried. Present study was aimed to study ultrasound guided infraclavicular brachial plexus block by coracoid approach for orthopedic surgery below mid humerus.
Material and Methods: Present study was prospective, observational study, conducted in patients of either sex, aged between 18-60 years, belonging to American Society of Anesthesiologists Grade I/II/II, posted for operations on upper Limb below mid humerus surgeries under ultrasound guided infraclavicular brachial plexus block.
Results: Present study was conducted in department of anesthesiology in 50 patients aged between 18-60 years. There were 10 females and 40 males out of 50. Majority were from age group 31-45 years (40%). As per ASA grading, there were 39 patients of ASA I, 8 patients of ASA II and in ASA 3, there were 3 patients. The mean time taken for complete sensory block was 18 ± 0.70 minutes. The mean time taken for complete motor block was 26.1 ± 0.71 minutes. The mean Duration of sensory blockade was 8.58 ± 0.70 hours. The mean Duration of Motor blockade was 6.80 ± 0.70 hours. Rescue analgesia was required after 6,8,10 & 12 hours in 4,10, 24 & 12 patients respectively. Success rate of USG guided infraclavicular block is 100%. Among 50 patients 38 patients had excellent quality of block, good in 7 and moderate quality in 5 patients During the study of Ultrasound guided infraclavicular brachial plexus block there were 2 vessels puncture, no nerve injury, no hematoma, no hemothorax happened.

Background: Femur fracture causes moderate to severe pain which requires effective analgesia both preoperatively and postoperatively. Multimodal analgesic regimens which includes non-steroidal anti-inflammatory drugs, opioids and regional analgesic techniques have been used in femur fracture patients so far. Peripheral blocks was initially done with either paresthesia technique or nerve stimulation-based technique. Ultrasound guided needle &catheter placement is observed to be technically superior, more accurate, being placed in peripheral location probably increases the safety of USG guided compared with other techniques.
Aim & Objective:

To study USG guided femoral nerve block for positioning of femur fracture patient for subarachnoid block.
To evaluate the efficacy of ultrasonography guided femoral nerve block for pain relief in femur fracture patients.
To study VAS (visual analogue scale) before and after block.
Study of hemodynamic changes before and after block.

Methods:
Study design: Prospective Observational Study.
Study setting: Anesthesia department of tertiary care centre.
Study duration: 2 years (from…. to….).
Study population: The study population included all the cases with Surgeries involving lower limbs admitted at a tertiary care center.
Sample size: 40.
Results: Our study was done on 40 patients which included 13 females and 27 male patients. There were 9 (22.5%) patients between age of 20-40 years,13 (32.5%) patients between age
 
 
 
of 40-60 years and 18(45%) patients between 60-80 years. The youngest patient in our study was 22 years and oldest patient was 80 years. ASA distribution with 21 (52.5%) ASA 1 patients and 19 (47.5%) ASA 2 patients. there were 44% patients having intertrochanteric fracture of femur, 28% patients having femur shaft fractures and 28% patients having neck of femur fracture. VAS score 26 patients had no pain and 14 patients had mild pain. the FEMORAL block had a fall in systolic and diastolic bp up to 20 mins after the block, but there was no major hemodynamic change after the block. No patients during the study had hypotension or hypertension after the femoral block. Among the study population, 98% USG guided femoral nerve block were successful with 2% failure rate as in this study we calculated success rate from percent of successful blocks to supplemental analgesia for patient positioning.
Conclusions: USG guided femoral nerve block with 0.25% bupivacaine is a better choice for pre-operative pain relief of pain in femur fracture patients with high success rate and good post-operative analgesia with no complication

Recently dental Implant therapy has become a widely accepted treatment option for thereplacement of missing teeth.According to available literature, successful maintenance and regeneration of the keratinized gingiva and bonewhich are lost following tooth extraction at implant site is very important for long term survival of implant. In present case report, A 24-year-old Saudi femalestudent, was referred to replace her missing tooth #46. Through clinical and radiographic examination revealed inadequate keratinized gingiva and horizontalbone loss in the area of #46. After phase I therapy, soft tissue augmentation was achieved by using free gingival autograft.After three months of healing, we placed the dental implant with hard tissue augmentation by using xenograft. Six months post-operative follow-up yielded positive results with respect to esthetic and function. Prosthetic rehabilitation of the implant was done with a ceramic crown for reestablishment of masticatory function. A comprehensive treatment planning is essential for achieving positive outcomes. The presence of a bunch of soft and hard tissue improves long term survival ofimplant and makes plaque maintenance easier around it.

Aim: The purpose of the present study was to assess the comparison between midazolam-nalbuphine and midazolam-fentanyl combinations for analgesic as well as sedative effect in patients who have undergone fibre-optic intubation in awake state.
Methodology: 100 patients between the age of 20 and 60 yrs of either sex, scheduled for elective surgery were included after taking written informed consent. Premedication with Inj. Glycopyrrolate 0.2 mg i.m. 30 mins before and Inj. Midazolam 1 mg i.v. 15 mins before the procedure was given. Then patients were randomly divided into 2 groups. Group N (n=30) received inj. nalbuphine 0.2 mg/kg i.v. and group B (n=30) received inj. fentanyl 2 mcg/kg i.v., both 5 mins prior to the introduction of fiberscope. The nasotracheal fiberoptic intubation was carried out using spray as you go technique. Level of sedation, intubation score and VAS score were observed along with patient comfort score
Results: Group F patients had better sedation score (P=0.328), VAS score (P=0.184), significantly better intubation score (P=0.00), intubation time (0.00) and patient comfort score (P=0.05). Hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure) were significantly better in group F.
Conclusion: Fentanyl-midazolam combination for awake fibreoptic intubation using spray as you go technique, provided better sedation and analgesia, obtunded airway reflexes and minimized pressor response to awake fibreoptic intubation and provided better patient comfort.

Aim: The purpose of the present research was to assess the prevalence of cardiac risk factors in case of diabetic patients.
Methodology: We conducted a cross-sectional study that included 800 patients with type 2 DM. We classified the participants into three groups according to the hemoglobin A1c (HbA1c) levels. We assessed the prevalence of other cardiovascular risk factors and their association with HbA1c levels through a detailed history, full clinical examination, and laboratory tests.
Results: We found that 75% of the participants were males, 25.5% elderly, 60.25% had hypertension, 60.75% had dyslipidemia, 33.25% were overweight or obese, 19.75% had a family history of coronary artery disease (CAD), 55.75% had established CVD, 42.5% were smokers, and only 12.25% were physically inactive. We found that 84% of the participants had ≥ two cardiovascular risk factors other than DM. HbA1c level was ≥ 7% in 77% of patients. After multivariate regression analysis, we found a significant association of higher systolic blood pressure (BP), more elevated diastolic BP, higher body mass index (BMI), increased waist circumference, old age, long duration of DM, and an increase in the number of clustered CV risk factors with a higher HbA1c level. At the same time, insulin therapy was significantly associated with a lower HbA1c level.
Conclusion: All type 2 diabetic patients in Upper Egypt villages have other associated CV risk factors. The clustering of cardiovascular risk factors showed a significant association with higher HbA1c levels. These findings require the thought of associated CV risk factors in choosing medical treatments to optimize glycemic control and multifactorial intervention to improve CV risk

Background: A rise in the proportion of pregnant women who have had past caesarean deliveries is a result of rising primary caesarean section rates. Obstetricians are becoming more and more concerned with managing these high-risk situations as effectively as possible. The goal of the current study was to assess the obstetric and foetal outcomes of patients who presented at term and had a history of one prior LSCS.
Methods: The current study was conducted on 541 post-caesarean moms who had been admitted to the Department of obstetrics and gynaecology of Jagannath Gupta Institute of Medical Sciences and Hospital, Kolkata, West Bengal for two years.
Results: In these 541 patients, the average incidence of VBAC was 17.74 percent. The incidence of VBAC was 61.93 percent (96 cases) of the 155 cases chosen for TOL, while the remaining 38.07 percent (59 cases) required repeat section. The 219 individuals who had undergone a previous section for a recurring indication had an incidence of vaginal birth of 8.22 percent (18 patients) (CPD).
Conclusion: As the percentage of women who have had prior caesarean sections rises, it is crucial to provide these women with counselling when they try vaginal birth in hospitals with the necessary equipment. In order to prevent difficulties in subsequent pregnancies, it is worthwhile to limit primary caesarean sections. Recurrent caesarean sections should only be performed when absolutely necessary to prevent foetal and mother morbidity and mortality.

Aim: To assess the accuracy of placental thickness measurement as a new parameter for estimating gestational age of the fetus and also to assess the growth pattern of placenta with advancing gestational age.
Material & methods: The prospective cross-sectional study consisting of 200 normal antenatal women attending in the Department of Radiodiagnosis, National Institute of Medical Science and Research, NIMS University, Jaipur for the period of one year. Placental thickness was measured as a parameter for estimating gestational age of the fetus from 11 weeks to 40 weeks of gestation by using grey scale real time ultrasonographic examinations. The gestation age was determined by measuring the biparietal diameter, the abdominal circumference, the crown rump length, the head circumference and the femur length. Descriptive statistical analysis has been carried out in the present study. Correlation was inferred by Pearson’s Correlation coefficient. P-value < 0.001 was taken as significant.          
Results: In the present study, it is observed that mean ± SD of gestational age (weeks) by USG is 27± 6.97 with the range of 11-39 weeks. The mean ± SD of placental thickness is 27.595 ± 7.15 with the range of 11-38 mm. It was found that at 11-39 weeks of gestational age there is no statistical significance (t value = 0.33, p>0.001) between the mean difference of gestational age and placental thickness, which indicates that there was high positive correlation between gestational age and placental thickness (r = 0.94) which is significant i.e. P< 0.001. It was found that at 11-35 weeks of gestational age there is no statistical significance (t value = 0.083, p>0.001) between the mean difference of gestational age (25.65 ± 6.12) and placental thickness (25.59 ± 6.65), which indicates that there was high positive correlation between gestational age and placental thickness (r = 0.92) which is significant i.e. P< 0.001. It was found that at ≥35 weeks of gestational age there is statistical significance (t - value = 3.55, p<0.001) between the mean difference of gestational age (36.293 ± 1.188) and placental thickness (35.37 ± 1.22), which indicates that there was moderate positive correlation between gestational age and placental thickness (r = 0.53) which is not significant i.e.  P> 0.001.   
Conclusion: The relationship between the placental thickness and gestational age is linear and direct. Placental thickness (in mm) measurement can be important additional parameter for estimating gestational age along with other parameters especially from 11 to 35 weeks of gestation in the woman in whom the LMP is unreliable or is not known.

Title-" A cross-sectional observational  Study to assess the severity of coronavirus disease 2019 according to Clinical value of immune  inflammatory markers"
Background: In Wuhan, China, since December 2019, a new strain of pneumonia has appeared and spread quickly over the world. The World Health Organization determined that a separate strain of coronavirus, designated COVID-19, caused this pneumonia (WHO). This unique coronavirus was identified as acute respiratory syndrome coronavirus 2 based on phylogeny, taxonomy, and accepted practise (SARS-COV2).
Objective: a cross-sectional observational study to show the co-relation between inflammatory markers and the severity of disease
Materials and Methods: a total of 250 patients were selected who are microbiologically covid positive and ready to give consent were included in the study. There basic test will be done.
Result- There is preponderance of male gender among the patients 147 were male 103 were female. The mean age of participant is 43 ±2.825 (±6.57%)65 patient were immediately required the either oxygen or mechanical ventilation,among all this 26 patient were died. Among this entire 65 patient, 21 patients have raise CRP level,14 have raised IL -6 Level among them all 26 were have raised D-Dimer .
Conclusion- Our study showed that high level of D-Dimer, IL-6 and CRP was independent risk factors for assessing the severity of COVID-19. IL-6 played a determiningrole in the severity of SARS-COV2 and had a potential value for monitoring the process of severe cases.

In the modern era of fast living there is increased incidence of road traffic accidents. As these accidents are high velocity trauma they are frequently associated with open injury. The knee joint is vulnerable to get injured in motor vehicle collision. These open peri-articular fractures pose great economical burden on our society and mental, social and financial burden upon the patient.Although systemic antibiotics have been used for many years, newer method of local antibiotic delivery system has come up in the form of antibiotic impregnated cement beads which increases local antibiotic level, decreases systemic toxicity and possibly has greater efficacy.

Background: Shivering is a physiological response to core hypothermia to increase metabolic heat generation. Prolonged impairment of thermoregulatory autonomic function under anaesthesia, along with cool operating room temperatures and cold infusion fluids, causes shivering.
Methods: This prospective study included 90 individuals who shivered under spinal anaesthesia during abdominal or orthopaedic surgery. On shivering, patients received a 1 mL intravenous bolus dose of 50 mg tramadol, 1 mg butorphanol, or 150 mcg clonidine. All 3 groups were compared for shivering control, time to cessation, recurrence, hemodynamic changes, axillary temperatures, and side effects. Data was processed using statistical methods.
Results: Butorphanol and tramadol decrease shivering better than clonidine. Butorphanol, tramadol, and clonidine totally decreased rigours in 83%, 73%, and 53% of patients, respectively. Clonidine (3.3±0.9 minutes) took longer than butorphanol and tramadol (2.1±1.0 minutes and 1.8 ±0.5 minutes; P 0.001).
Conclusion: Butorphanol controlled shivering with fewer recurrences than tramadol, but both were better than clonidine with an early onset of action. Both opioids reduce rigours better than α-2 agonists.

This study was done to assess the morphological changes in peripheral blood smears during COVID-19 infection .We aimed to examine the characteristics of the cells detected in the peripheral blood smear and bone marrow at the time of diagnosis in COVID-19 patients. Clinical features, laboratory data, peripheral blood smear of 35patients diagnosed with COVID-19 by PCR was evaluated at diagnosis. Peripheral smear samples of the patients were compared with the age and sex-matched 35 healthy controls. The relationship between the laboratory values of all patients and the duration of hospitalization was analyzed. Peripheral smear shows neutrophilic leucocytosis, lymphopenia and thrombocytopenia while Bone marrows were normocellular to hypercellular, most showing maturing trilineage hematopoiesis with myeloid left shift. In 09 out of 35 evaluable bone marrows, hemophagocytic histiocytes were identified.

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

Background: Pilonidal sinus (PS) is a chronic inflammatory disease which is characterized by a granulomatous reaction to fragments of hair shaft penetrating epidermis from the cutaneous surface. The present study was conducted to assess etiological factors in umbilical pilonidal sinus.
Materials & Methods: 58 cases of umbilical pilonidal sinus of both genders were enrolled. Patients were put in group I and healthy subjects in group II (control group). Parameters such as body mass index, profession, skin colour, personal history of PS, family history of PS, how frequently they take a bath, and whether they wear tight clothes and use belt.
Results: Out of 58 patients, males were 38 and females were 20. The mean BMI (Kg/m2) was 24.1 and 26.4, skin colour was darkin 28 and 32, brown in 13 and 10, blond in 10 and 9 and white in 7 and 7. Frequency of taking baths was less than twice a week in 34 and 40 and more than twice a week in 24 and 18. Familial history was seen in 6 and personal history in 3 patients. Belts were used by 35 and 40 and wearing tight cloths seen in 42 and 26 in group I and II respectively. The difference was significant (P< 0.05).
Conclusion: Common etiological factors were familial history, personal history, wearing tight cloths and belts etc.

Background: The present study was conducted for assessing the pregnancy outcome among pregnant women with uterine fibroids.
Materials & methods: A total of 50 pregnant subjects were enrolled. Complete demographic and clinical details of all the subjects was obtained. Routine investigations were carried out in all the patients. Only those subjects were enrolled in the present study that had fibroids of more than 2 cm in diameter. They were followed during antenatal period clinically and scanned by ultrasonogram which was done at booking visit and during subsequent visits to assess the change in the size of the fibroid and other obstetric complications. Maternal age, parity, size of fibroid, complications during pregnancy, and mode of delivery were noted.
Results: Threatened miscarriage was seen in 24 percent of the subjects while preterm labor was seen in 20 percent of the subjects. Antepartum bleeding and abdominal pain needing admission was seen in 2 percent of the patients each. Postpartum haemorrhage was seen in 4 percent of the patients while one patient required blood transfusion. Spontaneous pregnancy was seen in 4 percent of the patients, while premature delivery was seen in 30 percent of the patients. Vaginal delivery and C section were seen in 6 percent and 94 percent of the patients. Congenital anomaly was seen in 4 percent of the patients while NICU admission was seen in 1 patient.
Conclusion: From the above results, authors concluded that pregnant subjectswith fibroids were subjected to enhanced incidence of complications throughout antepartum, intrapartum, and postpartum period.

Background: Thalassemia is haemoglobinopathy characterized by a decrease or an absence of synthesis of synthesis of normal globin chains. The disease itself has high morbidity and mortality which is augmented by the high frequency of treatment. The complexity of the problem in patients with thalassemia is related not only to biological aspects but also to psychological, social and spiritual aspects both in patients and their caregivers.
Objectives: This study was conducted to determine the Stress, Anxiety, Depression and Burden in caregivers of Beta thalassemia Major
Materials and methods: The study was conducted in OPD and day-care center for thalassemia patients of Guru Nanak Dev Hospital Amritsar. Fifty Caregivers of children with Thalassemia Major were interviewedThree proformas were used. One for general information (Socio Demographic Performa), and the others were the DASS-21 and the Zarit Burden Interview scale.
Conclusion: Patients with Beta Thalassemia Major expose to intensive and serious medical therapies and their complications lifelong. Thus, psychological status of these patients has important effects on their caregivers. It leads an increase in the frequency of depression and anxiety in both patients and their caregivers. This increase results in negative effects on physical and mental health and increases burden on their caregivers

Background: Diabetes is the commonest endocrine disease affecting mankind. The present study was conducted to assess ECG abnormalities and treadmill test findings in patients with type 2 diabetes mellitus.
Materials & Methods: 80 diabetic and 50 non-diabetic subjects of both genders were enrolled. All the subjects underwent fasting and postprandial blood sugar, glycosylated haemoglobin (HbA1c), lipid profile (fasting and post-prandial), electrocardiography (ECG), and treadmill test (TMT) monitoring.
Results: Group I had 50 males and 30 females and group II had 20 males and 30 females. Out of 80 diabetes patients, ST depression & T wave inversion was found in 24, 10 had  Left atrial enlargement(LAE), 6 had left ventricular hypertrophy(LVH), 4 had Right bundle branch block (RBBB) and 2 had left bundle branch block (LBBB). The difference was significant (P< 0.05). 52% had abnormal triglyceride (TG), 54% abnormal total cholesterol(TC), 55% abnormal high-density lipids (HDL), and 56% abnormal low-density lipids (LDL) having positive TMT test. The difference was significant (P< 0.05).
Conclusion: Patients with T2DM had a higher prevalence of ECG abnormality. T2DM patients are also found to be more TMT-positive.

Background: Diabetes is an important metabolic disorder worldwide and is characterized by a variable degree of insulin resistance, impaired insulin secretion, and increased glucose production. The present study was conducted to assess the correlation between HbA1cand microalbuminuria among diabetics.
Materials & Methods:
Results: Group I had 20 males and 20 females and group II had 18 males and 22 females. In group I and group II, mean HbA1c (%) was 7.9 and 5.2, fasting blood sugar (FBS) (mg/dL) was 174.2 and 86.2, postprandial blood sugar (PPBS) (mg/dL) was 258.6 and 124.8, blood urea (mg/dL) was 28.4 and 14.2, serum sodium (mEq/L) was 127.2 and 138.9, serum potassium (mEq/L) was 2.7 and 3.8, serum creatinine (mg/dL) was 1.5 and 0.84 and microalbuminuria (mg/L) was 43.6 and 10.6. The difference was significant (P< 0.05). There was positive correlation of microalbuminuria and duration of DM (r- 0.521, p- 0.03), microalbuminuria and FBS (r- 0.316, p-0.05), microalbuminuria and PPBS (r- 0.412, p- 0.02) and microalbuminuria and HbA1c (r- 0.833, p-0.01).
Conclusion: The prevalence of microalbuminuria in diabetic patientswas found to be high. There was a correlation between glycated hemoglobin and microalbuminuria among diabetics.

Background: Sickle cell disease (SCD) is the most prevalent monogenic inherited blood disorder worldwide, and is increasingly recognized in developing countries like India. SCD mostly occurs in rural tribal regions and low socio-economic group population
Aim: this study evaluate the prevalence of sickle cell disorder in central Indian population
Material & Methods: A cross-sectional study was carried out among 1 to 55 years age group population in a tertiary care center, Madhya Pradesh, India  Detailed information regarding the family history, socio-demographic profile was inquired. Thorough general and systemic examination was done. Haemoglobin estimation, sickling test and haemoglobin electrophoresis was performed
Results: Out of total 286 suspected patients, 277 (96.8 %) were diagnosed sickle cell disease. majority of the patients (52%) was 16-25 years age group. No significant difference between the sickling test and HPLC electrophoresis. Heterozygous state sickle cell trait (HbAS) was 206 (72%), whereas homozygous state sickle cell disease (HbSS) was 80 (28%) on Electrophoretic pattern.
Conclusion: The overall higher prevalence of sickle cell trait was found to be 96.8%.Mainly in 16-25 years age group population

Background : Hypotensive anaesthesia is extensively used during surgery, particularly maxillofacial procedures. Hypotensive anaesthesia reduces blood loss during surgery by rendering the operative field bloodless. Normal blood pressure (BP) during surgery indicates skillful anaesthesia since organ perfusion is preserved. Achieving optimal hypotension is a skill, as excess BP reduction can be dangerous due to diminished circulation to organs like the brain, heart, and kidneys.
Materials and methods: AComparative study. 52 Indian phenotype patients were randomly selected from a table and divided into two groups of 26. Group D = dexmedetomidine (1 μg /kg diluted in 10 mL 0.9% saline administered over 10 minutes before anaesthesia, followed by 0.2–0.7 μg/kg/hour). Group P = propofol (100–150 μg/kg/hour). Mean arterial pressure (MAP) and hemodynamic stability were maintained by titrating infusions.
Results: In our research, neither hypotension nor bradycardia required medication. Group D had lower heart rate and blood pressure than group P. Group D awoke faster than group P. The usual dosages of dexmedetomidine and propofol for hypotensive anaesthesia are 0.2 0.04 μg/kg/hour and 140 41 μg/kg/hour, respectively. In India, little doses may not create issues.
Conclusion: In our investigation of the Indian population, both dexmedetomidine and propofol produced the necessary hypotension in ENT surgery patients to reduce blood loss and increase operational field vision. MAP was lower in dexmedetomidine than propofol, but not significantly. Higher propofol Ramsay sedation scores suggest stronger sedation than dexmedetomidine, making it a superior candidate for hypotensive anaesthesia

Cigarette smoking has become a common tendency worldwide. In general, tobacco is consumed by approximately 1.3 billion of the world’s population. Smoking is an addiction that has been accepted by the community despite its harmful effects. In general, these have suggested that smokers have a greater risk of hearing loss than non- smokers.

Study of examination related anxiety levels in first year medical students during university examination

Background:
The present study was conducted to assess risk factors for enteric perforation in cases of typhoid fever.
Materials & Methods: 58 cases of typhoid fever of both genders were included. Group I had typhoid fever patients having enteric perforation and group II had typhoid fever patients with no enteric perforation. Symptoms, signs and laboratory findings were recorded.
Results: Out of 58 patients, males were 32 and females were 26. Symptoms were diarrhea seen in 65% and 34%, vomiting in 70% and 52%, abdominal pain in 86% and 47%, constipation in 38% and 13% in group I and group II respectively. Signs were high fever (>38.3°C) in 94% and 90%, abdominal distention in 45% and 32%, hepatosplenomegaly in 86% and 36%, abdominal rigidity in 50%, confusion in 52% and rebound tenderness in 100%. Laboratory findings were anemia        in 15% and 12%, leukopenia in 54% and 22%, gas under diaphragm was 75%, thrombocytopenia in 65% and 22% and elevated transaminase in 58% and 43% respectively. The difference was significant (P< 0.05). Risk factors for enteric perforation was male gender, age >40 years and leukopenia (P< 0.05).
Conclusion: Authors found that risk factors for enteric perforation were male gender, age >40 years and leukopenia. Typhoid fever and its complications remain an important cause of morbidity in resource-poor countries.

Background and Objectives: Endotracheal intubation is required during general anaesthesia to secure the airway. Presumed mechanisms for emergence cough include irritant or stretching sensations in the trachea brought on by the tube or its cuff. Cough during emergence results in Hypertension, tachycardia, raised Intracranial pressure and intraocular pressure, bronchospasm, wound dehiscence, and surgical bleeding. Our goal is to determine whether alkalinized lignocaine preloaded endotracheal tube cuffs are effective at reducing emergence cough following minor surgery.
Methods: After receiving approval from the institutional ethics committee, this prospective randomised controlled study was carried out on ASA grade I and II patients between the ages of 20 and 50 who were scheduled for a variety of short-duration surgeries under general anaesthesia at Mamata General Hospital for a period of one year. Total of 100 patients, are divided into two groups, Group AL, Group S (50 patients in each Group). Group AL: (study group) these patients received preloaded (alkalinised lignocaine in ET cuff 90 min before intubation) 2% alkalinised lignocaine in the ET cuff, volume decided by minimum occlusion volume technique. Group S: (control group): these patients received normal saline in ET cuff after intubation.
Results: Patients in AL Group had mild cough in 12% of the population, while Patients in S group had mild cough in 14%, moderate cough in 10% and severe cough in 4% of the group population. Emergence cough is significantly less in AL group compared to S Group (p=0.39).
Conclusion: Alkalinized lidocaine in ETTs preloaded with the same solution before surgery appears to significantly lower the incidence of emergence cough during short surgical procedures. Also reduces emergence agitation and provides hemodynamic stability during extubation by avoiding the pressor response.

Visual loss due to cataract continues to be a major public health problem worldwide. Globally, cataracts remain the leading cause of blindness in middle- and low-income countries.The most recent estimates from who reveal that 47.8% of global blindness is due to cataract which includes India, 51% of blindness is due to cataract. Cataract surgery has been viewed as one of the most cost-effective health interventions. Cataract has been documented to be the most significant cause of bilateral blindness in India. India is committed to the goal of elimination of avoidable blindness by 2020 in line with the Global vision 2020: the right to sight initiative

Introduction: The COVID-19 pandemic has been raging across the globe since early January 2020. Various geographical regions have been passing multiple swells of upsurge of cases which aren't matched temporally as well as in severity. The diapason of the complaint ranges from asymptomatic to severe life-hanging complaint. Advanced age and the presence of comorbidities similar as cardiovascular complaint, diabetes mellitus, hypertension, chronic lung complaint, chronic kidney complaint, cancer, and obesity are among the major threat factors for severe disease.
Aims and objectives: Significance of lab parameter among Corona Patients. Materials and methods: The covid- 19 opinion was verified by reverse transcription- polymerase chain reaction (RT- PCR) assay of nasopharyngeal swab sample. Hematology blood samples were used to analyze by flow cytometry. Biochemical samples were used to analyze by completely auto analyzer diagnostic outfit. Serology tests were carried out the styles based on indirect ELISA technique, immune plates are coated with a admixture of purified viral antigen and probe using the patient serum.
Results: It is found that there is statistically significant (p-value<0.05) mean difference within the lab parameters (IL-6, LDH and Ferritin) in Covid patients using the Post Hoc Analysis. It is also found that there statistically significant (p-value<0.05) mean difference between RBC, Hb level, Hematocrit, MCV, MCH, MCHC, Platelet, RDW, PCT and NL ratio while Age, WBC, MPV, M(Monocyte), E(Eosinophil), B(Basophil), D-dimer and PDW were found to be statistically insignificant (p-value>0.05) with respect to gender.
Discussion: CBC, D- dimer, IL-6, LDH and Ferritin were analysed and found associated with adverse outcomes. There is significant association of age, gender, comorbidity.
Conclusion: High NLR at admission associated with a higher mortality. Laboratory features (e.g., IL-6, LDH, Ferritin D-dimer etc.) were associated with poor outcomes

Nonspecific antidiarrheals (allopathic and ayurvedic) are routinely used in clinical practice along with routine treatment in the management of acute diarrhea.Studies comparing their efficacy are very few, although they are used extensively by clinicians. This prospective observational study was carried out at two private clinics run by pediatricians to compare the efficacy, safety, and tolerability of DIAREX, an ayurvedic formulation versus racecadotril in the treatment of acute diarrhea.
Children aged 2 years to 10 years who presented to the clinic with acute diarrhea and fulfilling selection criteria were enrolled and divided into two treatment groups viz, DIAREX and racecadotril. Data collection was done using predesigned forms and questionnaires. The groups were comparable clinically and demographically at enrolment.  
Outcome measures used were 1) Time required for improvement in stool consistency2)Frequency of stools until recovery 3) Duration of diarrhea, after initiation of treatment.
Racecadotril improved stool consistency in less time compared to DIAREX (23.07h vs 29.00h). Patients on racecadotril passed 3.85±0.11 stools before recovery, while patients on DIAREX passed 5.26± 0.27stools.Rapid improvement in stool consistency and frequency was found with racecadotril compared to DIAREX. However, there was no significant difference between racecadotril and Diarex as far as duration of diarrhea was concerned.  (39.43±1.47h Vs. 42.77±1.48h;P> 0.05).Although DIAREX was found to be clinically useful to relieve the symptoms of acute diarrhea in children, racecadotril was more effective.

Background: Regional anaesthesia for caesarean delivery is associated with a high incidence of maternal hypotension and may result in fetalacidaemia due to decreased uteroplacental blood flow. The present study was compared mephentermine and intravenous norepinephrine for maintenance of blood pressure during spinal anaesthesia for caesarean section.
Materials & Methods: 80parturients scheduled for elective caesarean section under subarachnoid blockwere divided into 2 groups of 40 each. Group I received 6 mg mephentermine for SAIH and group II received8 µg boluses of intravenous norepinephrine. Parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), Apgar score and maternal complications were recorded.
Results: Group I received 6 mg mephentermine for SAIH and group II received8 µg boluses of intravenous norepinephrine. The mean age in group I was 24.7 years and in group II was 25.2 years, height was 152.2 cm in group I and 156.8 cm in group II, weight was 62.8 kgs in group I and 63.2 kgs in group II, duration of surgery was 45.2 minutes in group I and 46.8 minutes in group II, APGAR score at 1st minute was 7.28 in group I and 7.24 in group II and at 5 minutes was 9.05 in group I and 9.04 in group II. The number of requirement of doses were 1 time seen in 15 in group I and 4 in group II, 2 times seen 14 in group I and 11 in group II, 3 times seen 8 in group I and 13 in group II, 4 times seen 3 in group I and 5 in group II, 5 times seen 0 in group I and 4 in group II, 6 times seen 0 in group I and 2 in group II. The difference was significant (P< 0.05). Side effects reported were Nausea/ vomiting seen 7 in group I and 4 in group II, headache seen 7 in group I and 5 in group II, shivering seen 4 in group I and 3 in group II and hypertension seen in 1 in group II. The difference was non- significant (P> 0.05).
Conclusion: Mephentermine was comparable with intravenous norepinephrine in maintenance of blood pressure during caesarean section.

Introduction: Spinal anaesthesia is one of the widely used anaesthetic techniques among obstetric patients due to its safety. Despite having high success, there are several instances where anaesthetists have found spinal anaesthesia difficult. Several factors influence the anaesthetic difficulty during the technique. We did this study to determine the anatomical factors influencing difficult spinal anaesthesia among women who underwent cesarean section
Methods: We included a total of 100 pregnant women who underwent spinal anaesthesia during the cesarean section. The women were enrolled consecutively during the study period using specific inclusion and exclusion criteria. Difficult spinal anaesthesia was determined based on the scores developed through various parameters. Adjusted analysis was done to determine the independent factors influencing difficult spinal anaesthesia.
Results: All women consented for the study. In multivariable logistic regression analysis, we observed that age group of >35 years, (aOR 1.3 95% CI 1.1 – 1.9), being overweight/obese (aOR 1.7 95% CI 1.2 – 2.3), with previous history of spinal anaesthesia (aOR 1.9 95% CI 1.2 – 2.3), having scoliosis (aOR 1.7 95% CI 1.1 – 2.4), lordosis (aOR 2.9 95% CI 1.7 – 5.3) and kyphosis (aOR 1.8 95% CI 1.2 – 2.7), non-palpable anatomical signs (aOR 1.7 95% CI 1.1 – 3.1) and less narrow non-palpable intervertebral space (aOR 1.9 95% CI 1.2 – 3.8) as independent risk factors for spinal anaesthesia.
Conclusion: Our study results highlight the importance of pre anaesthetic determination of anatomical indices among women who undergo C section to predict difficult spinal anaesthesia among them

Aim: The purpose of the present research was to assess the patterns of hanging cases in Gwalior district of Madhya Pradesh.
Methodology: Present prospective study of hanging cases was carried out at Mortuary of Forensic Medicine & Toxicology department, Gajra Raja Medical College, Gwalior (M.P) between Jan 2020 – Dec 2021.  A total of 4291 cases were autopsied of which 495 cases were of hanging which were included in the present research. The findings were recorded and analysis was done to find out age and sex distribution, type of hanging, level of ligature mark, type of ligature material used and reasons of suicide etc.
Results: In the present study 31 to 40 year was the most commonly involved age group followed by 21-30 years and 41-50 years in which male outnumbered the female. Complete hanging was seen in 75% deaths. Nylon rope was the most commonly used material for hanging. Evidence of salivary stains around the angle of mouth was present in 36.56% of the cases. In 78.18% of cases the ligature mark was present above the level of thyroid cartilage. The most common reason for hanging deaths was the family disputes (42.82%). The incidence of hanging was more common in Married people than unmarried people.
Conclusion: Middle age group population between 31–40 years are more susceptible victims of suicides by hanging which constitutes about 31.31% of total cases.
Suicide; Hanging; Autopsy, Demographic variables

Background: Convulsions during pregnancy is major cause of maternal and fetal morbidity and mortality. the various causes of seizures during pregnancy include anti-phospholipid syndrome, eclampsia, cerebral vein thrombosis(CVT), thrombotic thrombocytopenic purpura, cerebral infarction, drug and alcohol withdrawal, and hypoglycaemia
Objective: To record and analyze continuous and category variables of antenatal and postnatal patients presenting with seizures.
Materials and Methods: Methodology- the present study conducted in the tertiary care hospital total 270 patient presented with seizure and patient/relative were ready to give consent were included in the study. Study Design: - observational Cross-sectional study.
Result- 65% of the participant were belong to age group of 20-25 years the mean age the mean age of participant with 90 % CI was 23.4667 ±0.7 (±2.98%).64.4% cases were primigravida,and 35.6% were multigravida. morbidity seen in most of cases out of all participant 59.25% were become morbid ,40(29.6%) were remain uncomplicated and 11.11%were died. The mortality rate were observed in our study is 11.11%.Fetal outcome at time of birth the out of all delivery 222 were live birth while 48 were IUD/still birth.
Conclusion- Seizure is serious threat to the maternal and fetal/neonatal health and major contributor of maternal mortality and neonatal mortality.prompt diagnosis and treatment required for it.

Background- The Transversus Abdominis Plane (TAP) Block is a method used for regional anaesthesia. It offers analgesia during lower abdominal surgery, especially when parietal wall pain is a significant source of discomfort. Through the local anaesthetic deposition between the Transversus Abdominis muscle and internal oblique muscle, it permits sensory blockage of the lower abdominal wall's skin and muscles. In a hospital-based, prospective observational study we assessed the effectiveness of unilateral TAP Block with bupivacaine for postoperative analgesia in hernia repair.
Material & Methods - The following procedure was used on 100 patients having elective unilateral inguinal hernioplasty surgery: TAP Block with bupivacaine (n = 50 in the study group) and without TAP Block (n = 50 in the control group). At the conclusion of the spinal anesthesia-induced surgery, the study group underwent a unilateral TAP Block on the surgical side using 20 ml of 0.25% bupivacaine. In the post-anesthesia care unit, each patient was evaluated 30 minutes, 2, 4, 6, 12, 18, and 24 hours after surgery. The amount of time needed to administer the first dosage of rescue analgesia, the vas score, and the total amount of diclofenac used were evaluated in each group, and comparisons were made using a student t-test.
Result: The difference between the mean analgesia duration in the study group and control group—669.66± 346 min 220.33 ± 139.24 minutes, respectively—was shown to be statistically significant. The VAS score in the control group was consistently higher than in the study group. Diclofenac was consumed in a total dose of 95 mg in the study group and 202.5 mg in the control group, indicating a substantial decrease in diclofenac consumption in the study group.
Conclusions- When utilised in patients undergoing inguinal hernioplasty, TAP Block with 0.25% bupivacaine offered powerful and longer duration of analgesia, with little any need for diclofenac. There were no side effects linked to TAP Block or the medications being tested

Introduction: Diabetes Mellitus (DM) is a complex, chronic illness requiring continuous medical care with multi factorial risk reduction strategies beyond glycemic control. Globally, the prevalence is expected to further increase to 9.9% that reflects a population of 628.6 million people by the year 2045. To assess the prevalence of diabetes related distress (DRD) among Type 2 diabetics.
 
Material and Method: This was a prospective, observational and descriptive study conducted in the Department of Medicine at Tertiary Care Teaching Hospital over a period of 1 year among T2DM patients who were seen and followed up. Patients who were at least 18 years old, and had all recent laboratory results were included in the study. Patients with T1DM, and those who had untreated hypothyroidism, gestational diabetes, cancer, mental retardation, and psychiatric illness, were excluded from the study.
 
Results: A total of 100 subjects were screened (69 males and 31 females). Their demographic and clinical data are presented. The subjects were aged 35–85 years with a mean ± SD of 50.5 ±8.0 years. The mean age for subjects with T1DM was 51.25±9.36 years and for those with T2DM 50.41±0.642 years. Average scores for T1DM were DDS-2, 3.9 ± 1.3 and DDS-17, 3.0 ± 1.0 and for T2DM, DDS-2, 2.4 ± 1.1 and DDS-17, 1.8 ± 0.8. Scores for the different parameters of distress were graded in terms of severity. DD (score ≥2 or moderate to severe distress) was present in 70.0% for DDS-2, 49.0% for DDS-17, 56.0% for EB, 13.0% for PRD, 51.0% for RRD, and 41.0% for ID.
Conclusion: Among type 2 diabetes patients, diabetic distress is a serious problem and needs to be addressed for better glycemic outcome. Among type 2 diabetes patients, diabetic distress is a serious problem which affects their living. It is necessary as clinicians to address diabetic distress in the patients for better glycemic outcome.

INTRODUCTION: Gastric cancer is one of the prominent reasons of cancer death worldwide andin India. The majority of individuals are diagnosed at a late stage. Various chemotherapy regimens have improved overall survival slightly. The HER2 protein, which is overexpressed in many stomach tumours, is a novel therapeutic target. Trastuzumab, a monoclonal antibody that targets HER2, has been found to enhance overall survival in advanced gastric cancer.AIMS AND OBJECTIVES:(1) To examine the frequency of expression of HER2 in gastric and GEJadenocarcinoma.(2) To find its correlation with clinicopathological parameters. MATERIALS AND METHODS: The study included 80 instances of stomach adenocarcinomas (44 biopsies and 16 gastrectomies) detected in the department of Pathology at Mallareddy Medical College for Women in Hyderabad over the previous two years (November 2019 to November 2021). A study of the slides confirmed the diagnosis, and IHC with anti- HER2 antibodies was performed using the Dako Real Envision Detection system, and scoring was done using the Hoffmann et al scoring system.RESULTS: The 80 cases were mostly male (60%) and averaged 65 years old. Males (30.6%) had HER2 positive. GEJ had 45.45% HER2 positive. Intestinal type 18 (30.5%) has HER2. The diffuse type was HER2-negative. Moderately differentiated (37.5%) tumours were HER2 positive (23.0 percent ). Poorly differentiated tumours were HER2-negative..CONCLUSION: HER2 positivity was found in 26.7% of cases. A significant correlation of HER2 positivity was found with male gender, intestinal type and moderatelydifferentiated carcinomas.

Background: In the intensive care units, acute kidney injury (AKI) has been recognized as a distinct risk factor for mortality. The goal of this retrospective study was to identify the risk factors for death in AKI patients as well as the impact of AKI on in-hospital mortality in a general medical ward of a tertiary care hospital.
Methods: A detailed patient's history was obtained, and routine blood tests, such as blood urea, serum creatinine, urine routine, abdominal ultrasound, serology for leptospirosis, enteric fever, peripheral smear for the malarial parasite, and other pertinent investigations, were carried out. Once a diagnosis was made, the therapy was started with the patients' etiological factors adjusted when it was possible.
Results: Based on the etiology of AKI it was found that 56% of cases in the study has pre-renal causes out of which acute gastroenteritis was the common cause in 18% of all the cases of the study. The renal causes were found in 36% of cases and the post-renal causes of AKI were found in 8% of cases. 62% of patients underwent conservative therapy, 24% underwent hemodialysis, and 14% underwent peritoneal dialysis.
Conclusion: AKI is a common prevalent condition that makes hospitalized patients' conditions more difficult to manage. Among the risk factors, this study found diabetes mellitus as the important risk factor for AKI. The common type of AKI was due to pre-renal cause with 56% of cases followed by renal cause in 36% and post-renal was the cause in 8% of the cases. Infections were a significant factor in the development of AKI in cases of our study. High serum creatinine and decreased eGFR were the indicators of poor prognosis.

Background: Adhesive capsulitis is not completely known, and recent studies have shown that it can lead to long-term disability over the course of several years^13,17,27Long-term follow-up studies have shown that patients underestimate the amount of objective motion lost and that the duration of symptoms before medical care is sought may be correlated with recovery. Patients seeking care earlier usually recover more quickly.
Materials and Methods:
In Department Of Orthopaedics, R.G.Kar Medical College, Kolkata from november 2011 to september 2013 patients presenting to the outdoor patient department with clinical features of Adhesive Capsulitis of shoulder are evaluated with variables like  Age, Sex, Dominance of extremity, Diabetes, Duration of symptoms. A total of 44 patients satisfied the inclusion criteria. 4 patients were lost to follow up and thus 40 patients were available for follow up and evaluated.
Results: A total of 40 patients were evaluated. The MUA   group consisted of 23 patients and the ACR group consisted of 17 patients. The mean improvement in the MUA   group of patients at the final follow up of 6 months was 50.69 on the CMS score. The mean pre-operative CMS score was 22.0(+ 4.7)  and rose to  72.69 (+ 7.87) at 6 months. The mean pre-operative CMS score for ACR patients was 18.47(+4.47) and rose to 82.41 (+ 6.69) at 6 months follow up, with an improvement of 63.94 points.
Conclusion: Overall the results of ACR were encouraging over MUA across all stratifications. Abduction and internal rotation were in particular significantly better and pain reduction was earlier for ACR group of patients. This accounted for better functional scores in these patients.

Oral drug delivery system using sustained release microparticles preparation is a nice option for the methodology expansion and for up gradation purpose. In this present work microspheres containing Losartan potassium with different synthetic and natural polymers, gums like HPMC, PVP, Xanthan gum, Guar gum and Sodium alginate were prepared by Ionic Gelation Method. The influence of formulation factors (drug-polymer ratio and type of polymer) on the morphology, particle size distribution, drug loading capacity, micromeritics properties and the in-vitro release characteristics of the microspheres were investigated. Physical characterizations of Losartan potassium microspheres were also carried out using Scanning Electron Microscopy, and FTIR Spectrophotometry. Microspheres were evaluated for different parameters like bulk density, taped density, angle of repose and drug entrapment efficiency. In vitro dissolution studies were carried out in pH 7.4 Phosphate Buffer and 0.1N HCL buffer for about 12hrs and samples were examined by UV-Visible Spectroscopy. The results demonstrated that formulations (FA, FB, FC) showed Losartan potassium discharge speed in series of 91-94% when compared (FD, FE and FH) demonstrated a Losartan potassium discharge speed from 85. -94% to and those of (FG, FH and FI) which have displayed drug release rates in the range of 94.-98% up to duration of 12 hours. This denotes that if the quantity of rate retarding polymer is raised, then it leads to retard discharge of drug. The synergistic effect was observed when the HPMC was combined with Xanthan gum. Hence batch FH indicates the better results than batch FI. As formulation FH shown 97.78% cumulative drug release pattern when the HPMC is combined with the natural gums for retarding drug discharge. Formulation containing HPMC and Xanthan gum gave well >85%. FH batch gave 93.40%, other formulations gave little bit drug loading than this batch. It can be happened due to viscosity caused by used material best % recovery was obtained for batch FH-96.49%. Overall o% recovery of microsphere obtained > 83%.
 

Background: Perinatal asphyxia is a clinical or biochemical evidence of lack of oxygen or excess of carbon dioxide in the body, due to failure of efficient respiration at birth with resultant hypoxia and acidemia. It is also of medicolegal importance to know the exact cause of fetal distress whether it is antepartum or intrapartum. This study was undertaken to evaluate the use of cord blood serum erythropoietin (S. Epo) and blood gas analysis as a predictor to differentiate between antepartum and intrapartum asphyxia.
Material and Methods: A prospective cross- sectional study on 60 neonates born at term in the labor room of a tertiary hospital setting. Through clinical history and examination, cord blood serum erythropoietin and arterial blood gas analysis was performed in each case. Mild to moderate hypoxic-ischaemic encephalopathy (HIE) cases were treated with 500U/kg of recombinant human erythropoietin every alternate day for two weeks, with the first dose administered by 48 hours of life.
Results: Out of the 60 neonates, 68.3% required treatment with rHuEPO, Only those affordable of the treatment, (26.7%) were given rHuEPO. Amongst the 41 neonates with elevated S.Epo, 53.7% weighed<2.5 kg (mean weight- 2.52 kg). Low APGAR Score at 1 min (in 71.7% neonates) and 5 min (in 93.3% neonates) were strongly associated with increased levels of erythropoietin (p≤0.00). Cord blood pH showed acidosis in majority (71.7%) of the cases, while 28.3% had normal cord blood pH.
Conclusion: High levels of S.Epo is associated with antepartum asphyxia while normal S.Epo level with low pH is associated with an intrapartum cause of asphyxia

Introduction: Cerebrovascular stroke is a leading cause of morbidity and mortality in adults. Stroke is the third leading cause of death worldwide, following coronary heart disease and all types of cancer.
Objective: The study's primary goals were to investigate clinical profiles, risk factors, and the relationship between clinical profiles and neuroimaging in stroke patients. Secondary goals included determining the incidence of stroke in various socioeconomic strata, complications during hospitalisation, and the average length of hospital stay.
Methods: This prospective hospital-based study included 50 patients with a provisional clinical diagnosis of fresh stroke who underwent brain neuroimaging (CT/MRI). Patients with other than a stroke as a possible cause were excluded from the study. Imaging findings were evaluated and tabulated before being correlated with the patients' clinical findings.
Results: There were 50 stroke patients (30 males and 20 females). The study found that males (64%) had more cerebrovascular strokes than females (36%), that the most common age group was 70-80 years (38%), that the most common clinical feature was hemiplegia (70%), and that the most common risk factor was hypertension (34%), followed by diabetes mellitus (38%), and dyslipidemia (4%). The most common type of stroke (88%) was ischemic, followed by hemorrhagic (12%).The most common involved areas in ischemic stroke were parietal (28%), and frontal (28%). The thalamus (6%), basal ganglia (6%), and lentiform nucleus (4%), were the most common sites of hemorrhagic stroke. Out of 50 cases, 38 had a provisional clinical diagnosis of infarct/ischemic stroke and 12 had a hemorrhagic stroke. In 44 cases, neuroimaging revealed infarcts/ischemic stroke, and 6 cases revealed haemorrhage. Clinical diagnosis had a sensitivity of 84.1% and a specificity of 83.3% in cases of ischemic stroke. Clinical diagnosis of hemorrhagic stroke had a Sensitivity of 83.3% and a Specificity of 84.1%. MCA territory was the most commonly involved blood vessel (78%).
Conclusion: In our study of 50 patients, hypertension was the frequent risk factor, and ischemic stroke was the most common type. In a significant number of cases, the clinical diagnosis of stroke was correct. As a result, preventing potentially modifiable risk factors for medical complications is an important aspect of early stroke management.

Background: A number of cells and cellular components are associated in the chronic inflammatory disorder of the airways known as asthma. In this study, we compared the percentage of peripheral eosinophils in individuals with clinically diagnosed asthma to non-asthmatic adults under the age of 70 and analyzed the various risk factors that contribute to asthma.
Method: This was a case-control research including 50 patients (asthmatic – 25, non-asthmatic – 25). The study was conducted under inclusion and exclusion criteria, and the data was entered into a Microsoft Excel sheet from 2010 and transferred to SPSS for Windows, version 24.0 of IBM's statistical tool for social sciences. The means of the two groups were compared using the T-test.
Results: Eosinophil means and standard deviations were 5.50±2.64 in asthmatic patients and 2.03 ± 1.59 in non-asthmatic individuals. Eosinophil percentage in asthmatics and non-asthmatics differed statistically.
Conclusion: Since no patients in this trial had severe, chronic asthma, it was not included in the analysis. Both asthmatic and non-asthmatic adults had routine tests like complete blood counts, haemoglobin, white blood cells, eosinophil percentages, and absolute eosinophil counts. Adult asthmatic patients had considerably higher absolute eosinophil counts and eosinophil percentages than non-asthmatic individuals. Asthma early signs include blood eosinophil percentage and absolute eosinophil count

Aim: Using ultrasound to examine individuals with type 2 diabetes having fatty liver disease and cardiovascular diseases.
Methods: The prospective and observational study was carried out during a nine-month period in the Radiology Department of the MGM Medical College, Kishanganj, Bihar. A total of 300 patients with type 2 diabetes who had abdominal ultrasonography that revealed no other co-morbid conditions and fatty alterations in the liver were included. According to how long the patients had been diagnosed with diabetes, the patients were separated into three groups. Interview schedule questionnaire, OPD records, bedside tickets, physical examination, and laboratory measures made up the study's methodology.
Results: 145 (48.3%) of the 300 patients were men, and 155 (51.7%) were women. The majority (39%) of the patients were between the ages of 50 and 60, while 25.7% of them were between the ages of 40 and 50. 18.3% of the population was between 60 and 70 years old, 10.7% was under 40, and 6.3% was older than 70. 75 (25%) of the 300 cases had non-fatty liver, while 225 (75%) of the cases had fatty liver. 33.4% (100) of the patients who were included belonged to group A, 40% (120) to group B, and 26.6% (80) to group C. The majority of patients (230, 76.7%) did not show ischemia alterations, however 70 (23.3%) cases out of 300 patients did.
Conclusion: Every patient with newly diagnosed type 2 diabetes should consider having a liver ultrasound because NAFLD is particularly common in this population of patients. It may be claimed that in those with type 2 diabetes, there was a correlation between cardiovascular risk factors and NAFLD.

Background: Pediatric dermatoses are disorder in children comprising the skin disease during their infant ages. Objectives: To assess the disease pattern and prevalence of various skin disorders in the infant age group at tertiary hospital. Material and Methods: Infants with skin dermatoses pf age group of 1-5 years attending the outpatient were enrolled in the study. A detailed history was taken in the report form of all the enrolled patients. The clinical examination and laboratory reports were done to confirm the diagnosis of the patients. Results: In the study the total number of 250 patients were included. The most seen skin disease pattern is infections and infestations infestation (42%), Eczema (14 %), Papulosquamous disorder (6%), pigmentary disorder, hypersensitivity disorder, keratinization disorder, nutritional disorder, scabies, urticaria, other types of infection were seen. Conclusion: The detailed knowledge in the infants about the pattern of dermatoses will help in implementing essential changes in health education and disease control strategies in the concerned area.

Background: Guillain-Barré syndrome (GBS) is said to be most common cause of acute flaccid paralysis worldwide. It is also one of the important life-threatening emergencies requiring critical cares in neurology. There are many subtypes of GBS like acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonopathy (AMAN) and acute motor sensoryaxonopathy (AMSAN).  GBS shows a lot of variation in the demographic variables like gender distribution and seasonal variation as seen in different studies. The frequency of different variants of GBS is also quite variable. AIDP is more common in Europe and North America whereas axonal subtypes are more often seen in Asia and South America. We conducted this study over a period of Two years to determine these features of GBS in our population.
Material and Methods:92 patients comprising of 49 male and 43 female patients were included in this study. All these patients were admitted in our hospital and were evaluated as per the established protocol. Baseline investigations were done in all the patients. Neurophysiology and CSF analysis was also done.
Results: In our study we found that most of the patients had AIDP. A preceding precipitating event was present in 31 patients. There was a significant seasonal variation in our population with majority of the cases occurring in spring season.  We also found that there were a significant number of patients who presented to us in postpartum period.
Conclusion: This study shows that knowing the demographic variations of GBS patients of a region is important so as to prepare the healthcare facilities for better management of such cases.

Background- Hearing loss and ear diseases can present at birth or acquired as a result of illness, middle-ear disease, injury, age, ototoxic medications, and/or induced by exposure to loud sound. People living with hearing impairment face problems in language acquisition, education, employment and overall wellbeing.
Objectives - This study aimed to assess the prevalence and profile of middle ear diseases in patients coming to tertiary care centre and teaching hospital in Varanasi district of Uttar Pradesh.
Methods -A retrospective study was carried out at a tertiary care centre and teaching hospital in Varanasi. The study involved patients of all age groups with ear disease coming to Ear Nose Throat Out Patient Department whose records were registered. Patients with external ear disease, inner ear disease, and those coming to emergency with trauma were excluded from the study. Institutional Review Committee clearance was taken.
Result -A total of 4514 patients aged between 10 months and 88 years underwent examinations including otoscopy, examination under microscope, pure tone audiometry and impedance audiometry. Out of these 4514 patients, 453 were diagnosed with middle ear diseases which is 10.06 % of patients attending ENT OPD.
Conclusion -In this study it is seen that chronic otitis media (mucosal type) is the most common among middle ear diseases and most patients were of age group 16-30 years

Introduction: Obstructive jaundice is one of the most frequent symptoms of hepatobiliary disease and caused by various diseases. So, it is mandatory to determine pre-operatively the existence, the nature and level of obstruction because an ill chosen therapeutic approach can be dangerous. MRCP demonstrates details anatomy and pathology of the biliary and pancreatic ducts. Ultrasonography still remains the first imaging modality for obstructive jaundice. Hence, aim of the present study was to evaluate the diagnostic efficacy of ultrasonography (USG) against magnetic resonance cholangiopancreatography (MRCP) in obstructive biliopathy in detection and characterization in patients suspected with pancreatic and biliary system pathologies.
Material and methods: This study was conducted among sixty patients suffering from obstructive jaundice of all age groups. All the patients in the study underwent ultrasonography and MRCP. The result so obtained was expressed as percentages and variables as required.
Results: In our study, the most common cause of obstructive jaundice was common bile duct stones (55%) followed by tumors (22%) then benign strictures (7%), choledochal cyst (7%), chronic pancreatitis with pseudocysts (7%) and Mirizzi syndrome (3.33%). Diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP findings as gold standard revealed sensitivity, specificity and diagnostic accuracy in benign cases as 97%, 67% and 97.4% and in malignant cases as 86%, 100% and 87.5% respectively.
Conclusion: USG has a high potential efficacy in diagnosing causes of obstructive jaundice. So, it is considered as an initial screening modality to confirm or exclude biliary dilatation & to choose patients for MRCP examination

Background: The thymus is the lymphoid organ of greatest importance. It is structurally separated lobules through the tissue of the connective septa. That lobule has a cortex and a medulla in it. Many studies of this organ related to the histology of early fetuses are focused on animals. The present study focuses on certain features relating to the histogenesis of the thymus and adolescent fetuses.
 
Materials and Methods: This is a prospective and observational study conducted in the Department of Anatomy, Ayaan Institute of Medical Sciences Teaching Hospital and Research Center has been undertaken on thymus specimens of 18 fetuses of different age corporations starting from the crown - rump length (CRL) of these fetuses have been to challenge to morphometry and histometry. The acquired fetuses were set in formalin of 10 per cent. They have been exposed to dissection after correct fixation. The specimens acquired had been processed through a well-known paraffin block making process. Sections were taken with haematoxylin & eosin, and painted. The stained sections had been tested using 40x and 100x optical magnifications and pictures taken under light microscopy.
 
Results:  The histometric analysis of parenchyma (cortex and medulla) and connective tissue indicates that there was no significant variation in their ratio. These corpuscles were frequently seen in thymuses of the early gestational period which were called as Solid Hassall Corpuscle (SHC) and were located at the periphery of the medulla within the age group of the present study. Their size ranged from 25-35 μm with a mean of 27.156 μm. This epithelial capsule was separated from the central mass by a subcapsular space that gave a cyst like an appearance hence named primary cystic Hassall’s corpuscle (CHC I). Their size varied from 35-70 μm with a mean of 48.153 μm thickness Externally the whole structure was surrounded by an epithelial capsule as found in CHC I, hence named as secondary cystic corpuscles (CHC II). They were mainly observed in the central core of the medulla. Their size ranged from 50-100 μm with a mean of 74.171 μm thickness late stages were noticed.
 
Conclusion: Thymus gland involution, pondered in its anatomy and histology, will serve as a basis for becoming conscious of pathological conditions. Within the first 18 weeks of gestation, all structural changes viz. cortico-medullary differentiation, lobulation, and maturity of the hassall's corpuscles happened.

Background: India is a large nation with a population of more than 140 crore people. Due to this fact, the equitable distribution of health care services has proven to be a major challenge. Most of the health facilities and doctors are concentrated in large cities and towns away from rural areas where more than half of the population resides.
Objective: To assess knowledge about telemedicine among MBBS students of I & II Prof.
Study Design: Cross sectional
Material and methods: A pretested semi-structured questionnaire on google form will be used to take interview Data will be collected by interviewing the MBBS I and II prof students after taking consent. Statistical Analysis Plan: Data will be analysed using MS Excel2010. Appropriate statistical test will be a applied. This cross-sectional study will be conducted in Govt. Bundelkhand Medical College, Sagar on MBBS I& II Prof Students of the institution.
Result - our study reveals the exact Knowledge of the Telemedicine is very low among medical student the familiarity with telemedicine is common among medical student but the most participants have participation up to some extent only.
Conclusion-: It is crucial to assess the knowledge of medical students regarding telemedicine to comprehend, and evaluate their attitude as future doctors who can play a significant role in establishing telemedicine services in the health care system.

Background: Incisional hernia is a frequent surgical disease, with a frequency that has been found to range anywhere from 5% to 11% of patients who have undergone abdominal procedures. The purpose of this study is to evaluate the severity of this issue and the various approaches that can be done to surgically repair by mesh in our particular environment.
Methods: This is a prospective study of thirty patients diagnosed with incisional hernia who sought treatment in the outpatient department (OPD) and General Surgery Department, Govt Medical College & Hospital Mahabubnagar between the months of May 2021 and May 2022. The patients volunteered their information to be used in the study. All of the patient documentation, including identification, history, clinical findings, investigative tests, operation findings, operative procedures, and complications during the patient's stay in the hospital and during the subsequent follow-up period, was recorded in a proforma that had been especially prepared. In order to determine whether or not any of the patients were fit for surgery, routine blood and radiological tests were performed on every one of them. Every patient had mesh repair, the extent of which was determined by the size of the lesion. Patients were monitored for any issues that may have arisen immediately after surgery.
Results: The majority of the patients had an incisional hernia in the sub umbilical region at the time of their presentation. Two of the patients who had undergone inlay mesh repair experienced a recurrence of their incisional hernia, while the patients who had undergone overlay mesh repair did not experience a recurrence. In light of the fact that there was no recurrence during the comparative follow-up period of three to twelve months, overlay mesh repair appears to be unquestionably superior to inlay repair.
Conclusions: According to the findings of the research, overlay mesh repair is preferable than inlay mesh repair for the treatment of incisional hernias.
 

Background: Cervical cancer is the world's fourth most prevalent malignancy among women. This study examines cervical cancer incidence and mortality in India and its states over the past three decades to follow the success of preventative and control efforts. Cervical cancer is highest among 15-29-year-old women. India, HPV 16 and 18 cause it. One of the outcomes of viral genomic integration (E7) into the host cell (RB) is increased expression of p16INK4A, a cyclin-dependent kinase inhibitor. E6 suppresses p53-mediated apoptosis, prolonging the survival of injured and altered cells and raising Ki-67 (a proliferation marker). p16INK4A and Ki 67 may be employed as surrogate markers in identifying and evaluating cervical neoplasms.
Objectives
1)      Study the histo-morphological features of cervical punch biopsies with the help of immune markers P16 and Ki 67.
2)      To assess the utility value of p16 and ki 67 in diagnosing and grading the cervical neoplasm.
Materials and Methods: The study included 80 cervical punch biopsy specimens (22 normal cervical tissue samples, 25 low-grade squamous intraepithelial lesions (LSIL), 13 high-grade squamous intraepithelial neoplasia lesions (HSIL), 17 squamous cell carcinomas and 3 adenocarcinomas). 80 formalin-fixed, paraffin-embedded, H&E-stained tissue slides were histopathologically evaluated. After antigen retrieval, p16INK4A expression and Ki 67 were analysed using mouse monoclonal antibodies. P16INK4A staining was scored 0-8 and Ki 67 0-3. Statistical analysis was done.
Results: P16INK4A immunoreactivity was absent in all normal cervical tissues examined and Ki 67 was basally positive. There is upregulation of these biomarkers in SILs and cervical carcinoma. 16/25 cases of CIN I (LSIL) showed positivity of p16, 19/25 for ki 67. All cases of HSIL (10/10 CIN II and 3/3 CIN III) and invasive cervical carcinoma (17/17SCC and 3/3 adenocarcinoma) were positive for p16INK4A expression and Ki 67 and exhibited a higher score.
Conclusion: These studies indicate that p16INK4a and Ki 67 are specific biomarkers that can detect dysplastic and malignant cervical epithelium in sections of cervical biopsy samples, which helps in the identifying and grading of cervical neoplasms.

Aims and Objective: To study the histomorphological spectrum of non-neoplastic and neoplastic lesions of the Prostatic TURP specimens and analyse the utility of immunohistochemical marker P504S in various lesions of prostate.
Methods: This two-year prospective study on 65 transurethral resection specimens of prostate, was carried out in the Department of pathology, Dr B R Ambedkar Medical College, Bangalore. Immunohistochemical marker P504S was used and its expression in various lesions was analysed.
Results: Out of 65 cases studied, 52 (80%) were benign prostatic hypertrophy (BPH), 3 (4.6%) were non-specific granulomatous prostatitis, 1(1.5%) was prostatic abscess, 7(10.8%) were prostatic adenocarcinoma, 1(1.5%) case was urothelial carcinoma and 1 case (1.5%) had both prostatic adenocarcinoma and urothelial carcinoma. Low grade PIN was identified in 8 (12.3%) cases and all of these wereassociated with BPH. High grade PIN was seen in 9 (13.8%) cases and 7 of them were associated with adenocarcinoma. P504S marker was positive in all (100%) adenocarcinoma and 8 cases (88.9%) of High-grade PIN. Benign glands in BPH was negative for P504S.
Conclusion: BPH is the most common lesion of the prostate in the elderly and adenocarcinoma is the commonest type of prostatic carcinoma. P504S is of great value in differentiating HGPIN and malignant glands from benign glands.

Introduction: Growth factor and hormonal growth spurt are additive factors to be considered for growth, along with availability of food and type of food, which is major cause beyond the hidden genetic factors. Various multi-centric studies were conducted to develop the growth charts, few of them were extremely appreciating as ICMR, still faced many controversies. One of the major setbacks faced were urban and rural growth study of children, featuring urgent requirement of growth charts for every nation.
Objectives: To assess and compare the anthropometric nutritional assessment (height, weight, BMI, mid arm circumference) of government and private high school children.
Methods: The study is a cross sectional study, in which students of (age 11-18 years) class VI-X of government school (n= 104) and private school (n=151) were taken for assessing height, weight, mid arm circumference and BMI. Data was entered on MS Excel sheets and unpaired‘t’ test was applied. P value of < 0.05 was considered significant.
Results: Unpaired t test results revealed no significant difference in the anthropometric indices, except for in 9^th standard where significant difference was found in height, weight, MAC and BMI and the magnitude was greater in private than in government. MAC of 8^th standard was also found higher in private school and significant difference was appreciated.
Conclusion: There is an urgent need for developing and integrating a nutritional assessment screening program for high school children in terms of anthropometric measurement to counter and prevent the malnutrition. This will in turn develop reference growth charts for the nation.
 

Background: Tranexamic acid (TXA) is a well-known antifibrinolytic drug that can be taken by mouth, injected into the muscle, or given through a vein. But there isn't much evidence that IV TXA helps reduce the need for blood transfusions during spinal surgery.
Method: We used electronic PubMed, Cochrane Central Register of Controlled Trials, and Embase databases to do a meta-analysis of randomized controlled trials (RCTs) and quasi-randomized trials (qi-RCTs) that included patients who had different spinal surgeries, such as adolescent scoliosis surgery given with perioperative IV TXA. Two independent researchers looked for more journal articles and conference proceedings by hand.
Results: There were a total of 9 studies, and 581 patients were used as samples. Mean blood loss was cut by 128.28 ml during surgery (range: 33.84-222.73 ml), 98.49 ml after surgery (range: 83.22–113.77 ml), and 389.21 ml all together in patients who were given perioperative IV TXA (ranging from 177.83 to 600.60 ml). The average amount of packed cells that were given as a transfusion was cut by 134.55 ml (range: 51.64-217.46 ml; 95% CI; P = 0.0001). Overall, 35% fewer patients treated with TXA needed blood transfusions than patients treated with the comparator (RR = 0.65; 95% CI = 0.53 to 0.85; P = 0.0001; I2 = 0%). It was seen that TXA had a positive effect and subgroup and sensitivity analyses confirmed this. Seven studies gave information about DVT. The study with only one DVT case was not added to the other ones.
Conclusions: With IV TXA treatment before and after spinal surgery, patients lost less blood. Also, there was a big drop in the number of spinal surgery patients who needed blood transfusions. Before TXA can be used safely on people having spine surgery, our findings need to be confirmed by more research.

Background: Transversus abdominis plane block (TAPB) is a regional anaesthesia technique. Analgesia is given following lower abdomen surgery, especially if parietal wall pain is a significant cause of suffering. Local anaesthetic deposition can be used to visually block the skin of the lower abdominal wall and the muscles over the Transversus Abdominis muscle. The goal of the investigation was to determine the efficacy of 0.25 percent Levobupivacaine and 0.5 percent Ropivacaine as analgesics in the Transversus Abdominis Plane Block for Post-Surgical Analgesia after Lower Abdominal Surgery.
Material and Methods: 60 patients between the ages of 18 and 60 who underwent elective lower abdominal surgery and had an ASA grade I or II were included in the study. The TAP block was given using a double pop technique with an 18 gauge hypodermic needle. Rescue analgesia was provided postoperatively for a VAS of greater than 4. The drug of choice for treating pain was injection Tramadol. The criteria for rescue analgesia were also examined.
Results: Both categories were equal in the demographic information. The diagnosis and the procedures carried out were the same in both courses. The drop in VAS score was equivalent in both classes. (P> 0.05). In the postoperative stage, rescue analgesia was required in both classes.
Conclusion: Following lower abdominal surgery, Levobupivacaine and Ropivacaine produce comparable analgesia in the Transversus Abdominis Plane Block for Post-Surgical Analgesia.

Background: It has long been known that a critical level of urine albumin excretion is a reliable indicator of cardiovascular events in hypertension patients. Except for cardiovascular events, very few studies have been done to date showing a relationship between microalbuminuria and target organ damage in patients with essential hypertension. In individuals with essential hypertension, we looked at the frequency of microalbuminuria and how it related to organ damage.
Methods: 120 patients with essential hypertension in total were investigated. Analysis was done on the prevalence of urine albumin excretion and its relationship to stroke, retinopathy, and left ventricular hypertrophy as target organ damage. Turbidimetry was used to measure the excretion of urinary albumin, and the urine albumin to creatinine ratio was used to measure the presence of microalbuminuria.
Results: In 57.7% of the patients, microalbuminuria was discovered to be present. In 62.5% (75 patients) of the cases, the target organ was damaged, and in 78.66% of these cases, microalbuminuria was also present (p 0.05). Among these, patients with longer durations and more severe forms of hypertension, elevated body mass indexes, and dyslipidemia showed higher prevalence.
Conclusions: A crucial diagnostic for determining the extent of target organ damage in hypertensive individuals is the examination of microalbuminuria. Reduced risk of microalbuminuria results with optimal hypertension management, weight control, and maintenance of normal lipid levels.

Background: Heterotopic pregnancy (HP) is a rare condition where at least two pregnancies are present simultaneously at different implantation sites and one of them located in the uterine cavity. Its prevalence varies from 1 to 30 000 in a natural cycle to around 1 in 100 in an assisted one.
Case presentations: In the current study, we presented four cases of first trimester heterotopic pregnancy diagnosed by ultrasound (US).
Conclusion: However, heterotopic is a rare condition, any pregnant woman presenting with alarming abdominal pain and adnexal abnormality; heterotopic pregnancy should be among the differential diagnosis possibilities. The patient should be thoroughly investigated using 3D ultrasound if needed, to exclude this rare diagnosis and allow on-time proper management.

Objectives: This study aimed to assess the prevalence of various risks associated with bipolar disorders.
Methods: The cross-sectional observational study was conducted on 200 patients of bipolar affective disorders of age 18-60 years. Ram Manohar Lohia Risk Assessment Interview (RML-RAI) was done for identifying risk of violence, self-harming, self neglect, fire risk, risk of coming to harm, risk to others, risk from others, and others risk.
Results: The mean age of patients was 36.36 (±12.7) years with 64.50% males and 35.50% females. In our study,76.00% of patients had risk of violence followed by risk of coming to harm (42.50%), self-neglect (29.00%), self-harming (28.00%), risk to others (26.50%), risk from others (12.00%) and fire risk (2.00%). The individual risks showed significant association with history of substance abuse, mental state changes, stress levels and compliance to treatment. (p<0.05)
Conclusion: Bipolar disease patients in addition to having depression and mania carry a potential of risk of violence, risk of coming to harm, risk of self-neglect, risk of self-harming, risk to others, risk from others, and fire risk in decreasing frequency.
 

Background: The prevalence and incidence of heart failure (HF), a prevalent cardiovascular illness, have recently been rising. The prevention and management of it are more difficult due to the multiple risk factors that contribute to its genesis.
The current study's objective was to evaluate the clinical characteristics of heart failure patients.
Methods: Between September 2021 and July 2022, a prospective observational study was conducted among the patients hospitalised to the SKMCH's Department of Medicine in Muzaffarpur, Bihar. The study comprised patients who met the European Society of Cardiology (ESC) HF criteria. Based on a population study and hospital OPD, the prevalence of congestive heart failure was assessed.
Results: The major causes of HF were smoking, drunkenness, ischemic heart disease, and hypertension. Breathlessness (100%), foot edoema (92.3%), cough (57.7%), and palpitation (50%) were the patients' most frequent symptoms. The patients' primary symptoms included oedematous feet (100%), basal crepitations (80.3%), increased jugular venous distention (JVD) (57.7%), and S3. Chest X-ray (CXR) results show that increased Cardiothoracic ratio was reported by 76.9% of the patients. Left Ventricular Hypertrophy (LVH) and arrhythmias (predominantly AF-19.2%) each accounted for 26.9% of the total. According to estimates, the prevalence of HF ranges from 0.51 to 27.27, respectively.
Conclusion: Apart from smoking and drunkenness, ischemic heart disease and hypertension were the main risk factors, and the treatment of concomitant illnesses may have a significant impact on clinical care.

Introduction: Children with chronic physical illnesses are generally considered at increased risk for behavior difficulties.

Introduction: Acute appendicitis is one of the commonest causes of acute abdomen encountered in surgical practice, requiring emergency surgery. Open appendicectomy by Grid Iron incision had been gold standard for many years. Laparoscopic technique provided an opportunity to explore new method of management of the suspected cases of the acute appendicitis.

Introduction: The regional anaesthesia for cataract surgery is associated with lesser respiratory and hemodynamic events and quick recovery of function than general anaesthesia.

Introduction: Asymptomatic bladder infection that is detected by a positive urine culture is also common among diabetes mellitus patient which progress to symptomatic infection and subsequent complication. Therefore, it becomes essential to screen urinary tract infection in diabetes mellitus patient so that its progress to complication can be prevented. Hence present study has been designated to know the prevalence of asymptomatic bacteriuria among females affected with diabetes mellitus.

Introduction: Despite numerous advances, compound fractures of long bones continue to be a challenge for the treating surgeons. The aim of our study is to effectively monitor the treatment outcome in cases of complex bone leg fractures treated by VAC following primary stabilization of fracture

Background: Rotator cuff tears are often the cause of incapacitating shoulder pain, reduced shoulder function, and compromised joint mechanics with clinical manifestations of shoulder stiffness, weakness, instability and roughness. The present study was conducted to determineshoulder function after Arthroscopic Rotator Cuff Repair Using University Of California And Los Angeles Score.

Aims: To evaluate the effectiveness of pedicle screw fixation for thoraco-lumbar injuries.

Signet Ring Cell type Adenocarcinoma (SRCC) of Duodenum is a rare pathological entity to occur and most of these tumors which have been reported in surgical literature known to occur in ampullary region of second part of duodenum. These are extremely rare to occur in non-ampullary regions of duodenum and only few cases have been reported in English literature so far across the world. We are submitting a rare case report of an elderly lady who presented to our institution with clinical profile consistent with gastric outlet obstruction. An esophagogastroduodenoscopy revealed a circumferential growth at D1-D2 junction with deep ulcer. Histopathological examination from biopsied specimen revealed poorly differentiated adenocarcinomaSignet Ring cell type. On CT imaging she was found to have localized resectable disease and subsequently underwent standard Whipple’s pancreaticoduodenectomy. She had uneventful post-operative recovery. Final Histopathology confirmed poorly differentiated adenocarcinoma -signet ring cell type. We conclude that SRCC nonampullary region remains extremely rare entity. These tumors are usually diagnosed with advanced disease on presentation and can be managed well with surgical resection, by Whipples Pancreaticoduodenectomy in majority, which are localized.

Introduction: Both clonidine and dexmedetomidine are alpha-2 adrenergic agonists that have analgesic as well as sedative properties and are being tried as newer adjuvants for analgesia. In addition to this, both have been shown to reduce the requirements of local anesthetics and enhance the analgesic effects without increasing the incidence of side effects.Thus, the present study was undertaken to compare postoperative analgesia according to VAS with dexmedetomidine and clonidine and assessment of Ramsay sedation score after complication of surgery with each drug.

Introduction: ovary being complex and unique organ include wide spectrum of neoplasm involving a variety of histological pattern.

Background:Organophosphate (OP) poisoning is an important cause of poisoning all over the world. Prompt recognition and aggressive management of acute intoxication are essential to minimize the morbidity and mortality from these potentially lethal compounds. Present study was aimed to study correlation of serum amylase with outcome in acute organophosphorous poisoning at a tertiary hospital.

Aim: The present study was evaluated for assessing absolute eosinophil count in allergic rhinitis Patients.

Introduction: Inflammation of joints caused by pyogenic bacteria causes septic arthritis. This is an emergency that requires immediate diagnosis and treatment. Delay causes cartilage and joint destruction, leading to significant morbidity and mortality. The prevalence of patients with septic arthritis who present to the emergency department varies widely between studies. Immunocompromised patients and those with artificial joints have a higher incidence of septic arthritis. Because x-rays are widely available, they are commonly used for imaging joints. MRI provides more accurate information about joint and adjacent soft tissue involvement.

Background and Objectives: Salivary gland swellings are frequently encountered in OPD. Being situated in accessible location, Fine Needle Aspiration Cytology (FNAC) is awell‑established technique for evaluation of theselesions. A prospective study done in patients presenting with swelling of salivary glands, FNAC was performed with 23G needle, smears were stained with H&E. Clinical data, radiological findings were noted. Cytological features were evaluated and classified. Total 50 cases were evaluated. Distribution of cases into different categories was as follows ND (2%), NN (60%), AUS (2%), NB (20%), SUMP (2%), SM (2%)and M (12%). Non-neoplastic lesions were the most common cases observed in this study, whereas Pleomorphic adenoma and Mucoepidermoid carcinoma were the common benign and malignant lesions respectively.

Peripheral blood examination and other routine laboratory investigations do not always provide enough information for diagnosis of hematological disease. In such cases evaluation of the bone marrow is required for confirmation of a suspected clinical diagnosis or monitoring the course of therapy. Total numbers of 75 cases were evaluated for bone marrow examination. Clinical data was recorded including physical examination,complete hematological study along with other relevant investigations and proforma filled. Bone marrow aspiration slides were stained with leishman stain. Special stains were performed whenever required.A total of 75 patients were evaluated with a mean age of 38.8years. The most common presentingcomplaintandphysicalfindingswerefever(62.7%)andpallor (90.7%) respectively. The hemoglobin values ranged from 3-13 g/dl, total leukocyte count ranged from 1300-61700/mm3, platelet count ranged from 30000-700000/mm3. The commonest peripheral smear finding was Normocytic hypochromic and Microcytic hypochromic blood picture each in 13 cases (17.3%), followedbyDimorphicblood picture in 10 cases (13.3%). The most common bone marrow finding was Erythroid hyperplasia (29.3%).

Treating pain in the newborn is essential for many reasons: pain can be harmful due to decreased oxygenation, hemodynamic instability, and increased intracranial pressure.The International Evidence-Based Group for Neonatal Pain recommends that the combination of a variety of pharmacological and behavioral interventions during painful procedures has synergistic effects. Data were collected duringheel lance and venipuncture performed as part of routine clinical care for the estimation of glucose and bilirubin,thyroid function tests respectively. The infants in the control group (n=64) received 10% dextrose. In the experimental group, 24% sucrose solution was used. When compared to 10% dextrose, no. of babies who received sucrose and fall into NIPS score <4 category at 1 min and 3 min during the procedure were more. Hence 24% sucrose has better analgesic effect than 10% dextrose. However statistically when Fischer exact test was applied between the groups there were no significant differences between 24% sucrose and 10% dextrose.

Causes of CAP include bacteria, viruses, fungi, and parasites. After achieving a correctdiagnosis,thesecondstepistodefineifthepatientwill receive outpatient treatment or hospitalization. Ours was a clinical, prospective, observational and open study. The study subjects were community acquired Pneumonia patients admitted with signs and symptoms suggestive of Pneumonia. After obtaining a detailed history, complete general physical examination and clinical examination the patients were subjected to relevant investigations. The complete data was collected in specially designed case recording form and transferred into a Master chart which is then subjected to statistical analysis.We studied 100 cases of Pneumonia, out of which 5 patients presented with Confusion, 69 patients presented with raised Blood Urea Nitrogen,11 patients with raised Respiratory rate, and 9 patients with Hypotension. CURB AGE score of 0 was observed in 26 patients, score 1 in 22 patients, score 2 in 24 patients, score 3 in 20 patients, score 4 in 2 patients, score 5 in 4 patients and score 6 in 2 patients. Prognosis was good in patients aged less than 50 years and those without any comorbidity. Fever was the most common symptom of presentation.

Background: The present study was undertaken to determine the role of noncontrast MRI and diffusion weighted imaging in particular along with the corresponding ADC values in the identification and characterization of the focal liver lesions. The study proposes to set forth a cut off ADC value for quickly differentiating between benign and malignant hepatic focal lesions.
Materials and Methods: 70 patients who were referred to our department with strong clinical suspicion of focal liver lesion and those diagnosed by ultrasonography followed by multiphasic contrast enhanced CT underwent non-contrast Magnetic Resonance Imaging evaluation of abdomen using 1.5 T 8 channel MRI. The MRI scans were then reviewed and various focal liver lesions were identified.
Results: The MRI and DWI picked up more focal lesions compared to both USG and Multiphasic CT alone. Ultrasonography shows a sensitivity of 73% though its specificity was a good 88% in predicting malignancy. Multi phasicCT shows a sensitivity of 88% and specificity of 93% in differentiating benign from malignant focal lesion. DWI and ADC values have very good sensitivity and NPV of 97% and 98% respectively for malignant focal liver lesions. The drop in specificity and PPV of ADC values when compared to combined MRI findings of 93% and 91% is mainly due to the low ADC values obtained for abscess. A cut off ADC value of 1.4 x 10-3 mm2/s is considered for differentiating benign from malignant lesions. Difference in mean ADC values of malignant and nonmalignant lesions is highly significant.[P=0.00001].
Conclusion: The sensitivity of noncontrast MRI with DWI and ADC values was very high and more than both USG and contrast enhanced Multiphasic CT. The specificity of MRI was comparable to that of CE- Multiphasic CT in diagnosing malignant focal liver lesions. A cut off ADC value of 1.4 x 10-3 mm2/s was found to be a superior, noninvasive tool for differentiating malignant from benign lesions without the risk of radiation, contrast media and invasiveness. Hence, MRI with DWI in particular is a very valuable noninvasive tool for the identification and characterization of focal liver lesions.

Background: The reported prevalence of colour vision deficiency in the world is 1 in 12 men (8%) and 1 in 200 women. The perception of colour is an integral part of clinical diagnosis, laboratory investigations and follows up of patients in the medical profession. We aimed to find the prevalence of colour vision deficiency (CVD) among medical students and identify the problems faced by them in their training. A cross sectional observational study conducted over 6 month’s duration in a medical college.
Materials and Methods: 600 medical students aged 18-25 years were in included in this study. After obtaining informed consent, and a complete ocular examination, colour vision testing was done on Ishihara’s chart and students were asked to fill a questionnaire related to the problems faced by them during various stages of their training.Statistical analysis was done on JASP software. Categorical data was analyzed using Chi square test and a p < 0.50 was considered significant.
Results: Of the 600 students examined, 17 (2.8%) were found to have CVD, 14 males (5.3%) and 3 females (0.9%). 8 students reported minor difficulties in assessing some clinical signs, the rest were able to manage quite well.
Conclusion: The presence of colour vision deficiency, although rare, could pose a challenge to medical students in identifying important signs and lead to possible errors in diagnosis. There is a need for screening and specialised training modalities to help them overcome this difficulty.

Background: Intestinal parasitic infections are a major public health problem in developing countries like India. The prevalence and distribution of parasites vary from region to region within a country. Stool routine examination is a great tool in identifying various parasitic and nonparasitic causes in patients presenting with diarrhea to a health facility. Knowledge of the prevalence and distribution of different parasites causing infection in a particular region helps to devise appropriate prevention and control measures.
Aim and Objectives: The aim of this study was to analyzediarrheic stools submitted to the parasitology lab by stool routine examination& to identify the prevalence and distribution of intestinal parasites causing infection in this particular region.
Material & Methods: A total of 545 stool samples received in the parasitology lab for stool routine examination were evaluated for gross and microscopic findings with an emphasis on the detection of intestinal parasites. Stool samples were evaluated with normal saline and iodine mounts.
Results: A total of 545 stool samples were examined out of which 40 were found to have intestinal parasitic infection with a prevalence rate of 7.6%. Parasitosis was seen more in males (8.2%) as compared to females (6.4%). Parasitosis was found to be mostly prevalent in the age group 11- 20 years followed by 31-40 years (9.5%). Cyst of Giardia lamblia (35%) was the most commonly detected protozoa followed by cyst & trophozoite of Entamoeba histolytica (22.5%).
Conclusion: Intestinal protozoal infections are more prevalent than helminthic infections. Improvement in drinking water quality and personal and food hygiene will help in reducing parasitic infections.

Aim
The purpose of the present research was to assess the knowledge as well as preference related to material of choice amongst various dental practitioners between titanium and zirconia.
Methodology
The cross-sectional study was conducted where a set of questions was designed by the research group to form a questionnaire that covers the knowledge of the participants and their preferred material in various scenarios. The questionnaires were distributed online, electronically using Google forms to the dental practitioners and dental students. Dental students, interns, general practitioners, post-graduate students, specialists and consultants were included in the sample of this study. Statistical analysis was conducted where comparisons between the various groups were done utilizing the Chi-square test.
Results
308 (80.2%) participants chose Titanium implants while only 26 (6.8%) participants chose Zirconia, and 40 (10.4%) participants didn’t know, while the remaining 2.6% chose other materials. Comparing the biocompatibility of the Titanium and the Zirconia implants, 174 (45.3%) participants chose that both materials have the same biocompatibility, 77 (20.1%) chose Titanium as being more biocompatible, and only 45 (11.7%) chose Zirconia as being more biocompatible.
Conclusion
Titanium was the top choice for every given scenario except if the implant was to be placed in the anterior esthetic zone; which indicates the awareness of the participants of the esthetic benefits that Zirconia implants

Aim: The purpose of this systematic review was to evaluate clinical studies on the follow-up survival of implants inserted in the zygomatic bone for maxillary rehabilitation for maxillofacial defects.
Methodology: A comprehensive search of studies published from 2000 to July 2022 and listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases was performed in accordance with the PRISMA statement. Relevant studies were selected according to predetermined inclusion and exclusion criteria. The initial database search yielded 751 titles. After filtering, 313 abstracts were selected, culminating in 42 full text articles. Application of eligibility criteria led to the elimination of 17 articles. Hence 25 full-text articles were considered clinically relevant and were included.
Results: Calculations of the interval survival rates and cumulative survival rates of implants could be carried out on the data extracted from the final list of included studies for the different time intervals. These studies reported the insertion of a total of 1541 zygomatic implants and 33 implant failures. Failure generally occurred during the first year interval and was related to clinical complications, such as recurrent acute and chronic sinusitis. After a 36-month follow-up, the survival rate was 97.86%.
Conclusion: Additional studies with longer follow-up periods, including the number of zygomatic implants inserted and details of the variations in the surgical techniques used and the impact of the maxillary morphology are still required

Introduction: Diabetes is a common disease of the current population and its most common complication is recurrent urinary tract infection. Recurrent infections are treated with recurrent antibiotic therapy which leads to emergence of resistant strains of bacteria like ESBL, which can prove to be fatal.
Materials and Methods: Patients with confirmed cases of diabetes were selected based o inclusion and exclusion criteria. The urine samples of all patients were analyzed for bacterial isolates and further analyzed for ESBL producing organisms. ESBL producing strains were tested for their antibiotic sensitivity   
Results: A total of 164 patients comprising of 82 males patients and 82 female patients of both genders in the age groups of 30-60yrs were selected. Out of this 58 females and 32 males had recurrent UTI. 45.73% urine samples showed gram negative isolates and among them 25.33% were found to be positive for ESBL isolates using combination disc method. The predominant micro organism was found to be E coli (33%) in urine samples of both genders. E coli was the largest producer of EBSL (57.9%) followed by K pneumoniae (21.1%). We found a strong association between increasing years of diabetes with ESBL production. 
Conclusion: We found that recurrent UTI in diabetics was most common in sixth decade of life and was noted to be more in female population. E coli and K pneumoniae were the most common GNB isolates as well as ESBL producers respectively. They were resistant to 3rd generation cephalosporin but were highly sensitive to amaikacin and nitrofurantoin.

Aim: The aim of the present study was to determine value of MR Enterography in small bowel disease and to correlate the findings with endoscopy, histopathology and laboratory findings.
Methods: The present study was conducted Department of Radiodiagnosis at Aster CMI Hospital, Bengaluru, Karnataka. The study population was patient who came to Aster CMI OPD with bowel complaints from January 2019 to December 2019. Patients who were admitted in the ward, patients who came to OPD with recurrent episodes colicky abdominal pain, diarrhoea, weight loss and anaemia were enrolled in the study.
Results: In the present study, minimum age was 15 and maximum age was 79 years of age. There were 35 (70%) males in the present study as compared to females 15 (30%). Among 50 total subjects, 13 subjects have normal MR enterography study and 37 subjects have abnormal MR enterography findings. In the present study, 74% were abnormal and 26% were normal. In the present study, among 40 patients having abnormality, diagnosis made in MR enterography are Crohn’s disease in 31 patients (62% of total subjects), Nonspecific imaging findings in 2 patients (4%), Ulcerative colitis in 2 patients (4%), Polyps in 2 patients (4%), Celiac disease in 2 patients (4%) and TB in 1 patient (2%).
Conclusion: MR enterography is a great problem-solving diagnostic imaging modality in patients suspected to have small bowel disease. Particularly young subjects with chronic symptoms, MR enterography is modality of choice as there is no radiation risk involved. As patients often refuse invasive procedure as a screening tool, MR enterography can be used as a screening tool in those patients.

Background: Chronic otitis media is a common condition in ENT, resulting in hearing loss. Myringoplasty, tympanoplasty with or without mastoidectomy is done to improve hearing and to make the ear dry. Aim of this study was to correlate pure tone audiometric findings with intraoperative findings in patients of chronic otitis media. By doing this correlation we will be able to counsel the patients regarding: Expected postoperative hearing outcome, need for ossiculoplasty and expected cost of surgery.
Objectives of study: To do ear examination including otoscopic examination.
To do Tuning fork test and Pure tone audiometry to assess degree as well as type of hearing loss.
To correlate the preoperative hearing assessment with intraoperative tympanic membrane and middle ear changes.
Methods and Materials
Study area: Tertiary care Hospital having a specialized step up dedicated for ENT.
It has a good influx of patients presenting to the ENT OPD, referred from various rural and urban primary and secondary centers.
Study time: January 2021 till October 2021 is the time frame for collection of data. Four months were used to conduct the analysis of data.
Study population: Patients visiting ENT OPD, both males and females, both urban and rural diagnosed a case of chronic otitis media and undergoing tympanoplasty with or without mastoidectomy.
Sample Size and Sample technique: 80 cases, all the cases diagnosed as chronic otitis media and undergoing tympanoplasty with or without mastoidectomy, fulfilling the inclusion criteria were taken as samples.
Data analysis: The descriptive summaries of variables were presented through frequency distribution as well as mean± Sd. Quantitative variables were expressed as mean ± sd and compared between groups ANOVA/Kruskal-wall is test and unpaired t-test/Mann Whitney Test. Qualitative variables were compared using Chi-square test/Fisher's exact test. A p-value <0/05 was considered statistically significant. The data was tabulated in MS excel and analysis performed using R programming software.
Results: The age range was between 15 and 55. The majority of the cases in our study were between the ages of 21 and 30, with a mean age of 30. 29. This may be because hearing loss
 
 
 
 
impairs one's ability to work effectively, prompting older folks to seek medical help. The average age of patients with ossicular erosion was 36.79 years old. There were more female patients than male patients. Although bilateral illness was not infrequent, unilateral disease affected the majority of individuals. The average number of years with ear discharge was 11.34. Patients with ossicular erosion had a mean history of ear discharge for 18.74 years, compared to patients without ossicular erosion for a difference of 9.03 years that was statistically significant. Ossicular erosion was discovered in 10 of the 34 individuals that underwent surgery on the left ear. 9 of the 46 individuals whose right ear was operated on developed ossicular erosion.
Discussion: Hearing loss was observed to increase with perforation size, although it was found that patients with attic perforations had the most severe hearing loss. When compared to cases where there was no perforation in these sites, it was discovered that cases with attic perforation and posterosuperior perforation had considerable hearing loss. In every instance where there was attic penetration, osseous degradation was visible. Ossicular erosion was found in 19 cases (23.75%) out of 80 patients. The incus was the most often eroded ossicle, followed by the malleus and the stapes. It was discovered that the mean PTA, which is statistically significant, was 48 dB in instances with ossicular erosion and 32.98 dB in patients with intact ossicles. In none of the tympanosclerosis patients was there ossicular erosion. Ossicular erosion and the presence of granulation tissue were strongly correlated.
Conclusion: One of the likely conclusions that can be derived from our study's results is that there is a connection between the length of an ear discharge and a higher risk of ossicular erosion. The amount of hearing loss that develops is inversely related to the size of the hole that has been created in the tympanic membrane. Patients with substantial hearing loss had holes in both the attic and the poster superior, in contrast to cases where neither site had a perforation. Both of these locations were free of perforations in patients who did not have a substantial hearing loss.
 

Background: Lymph nodes enlargement are easily accessible on fine needle aspiration and hence it is a very simple and important diagnostic tool for lymph node lesions. Enlargement of lymph nodes in our country are predominantly infective in nature. It plays a significant role in developing countries like India, as it is cheap procedure, simple to perform and has almost no complications. The objective was to study the diagnosis of the underlying pathological variants, the incidence of the tuberculosis & malignancies, presenting with cervical lymphadenitis and also to diagnose various etiologies of cervical lymphadenitis in all age groups.
Aim: To highlight role of FNAC as a diagnostic tool in enlarged cervical lymphadenopathy.
Method: This study was conducted over Eight-month period from 1 January 2022 to 31 August 2022. The study material was taken from patients have enlarged cervical lymph nodes.
Results: This study has shown that the incidence of tubercular lymphadenitis is more in the age group of 1st and 2nd decade and in low socioeconomic status while Metastasis are more common in the elderly age group.
Conclusion: FNAC of lymph node is a very useful and simple tool in the diagnosis of lymph node enlargement. it may be more reliable tool in the diagnosis of infective lesion in the lymph nodes.

The understanding of the neonatal disorders seems to have lagged behind until recently among the branches in the field of paediatrics. Birth injuries contribute as the third major cause of the neonatal mortality in most of developing countries much more so in our country. Very little work has been done in our country on birth injuries and its relation to various factors such as abnormal presentation, parity, etc. The study consists of 100 cases of birth trauma noticed among 850 consecutives viable birth during the study period of 1 ½ years. Proforma contains details of the health status of the mother, antenatal, intranatal and postnatal particulars including the age, sex, weight, mode of delivery, type of presentation and nature of the birth injury in different modes of delivery and type of presentation of the baby. Each new born baby was examined thoroughly according to the Proforma and also previous obstetric history, details of delivery, antenatal check-up etc., were obtained. Asphyxia forms the major group which were noted in 45 of total 100 injured babies. Cephalohematoma was the next common injury being noted in 32 cases. 18 babies had soft tissue injuries and 4 babies have neurological injuries. As seen from the study proper antenatal check-up, good obstetric care and management of toxaemia would go a long way in bringing down incidence of birth injuries which is malady in the life of the growing child resulting in both physical and mental handicaps.
 

Acute appendicitis is one of the most common surgical emergencies in the world and has some well-known signs and symptoms, like increased leukocyte count and right lower quadrant pain. However, these predictors are not constant and their accuracy is questionable. Hence, it is necessary to improve the accuracy of diagnosis of acute appendicitis to prevent negative appendicectomies. In this study, we suggest that calculation of the NLR may provide a sensitive parameter in the preoperative prediction of AA and may help preoperatively to differentiate complicated from non-complicated appendicitis. A total of 108 patients who came with complaints of right iliac fossa pain and clinically diagnosed to have acute appendicitis were considered. Clinical diagnosis was established by means of history, physical examination, laboratory investigations and radiological investigations. In our study, it was noted 5.6% of the patients’ histopathology showed a normal appendix, 59.3% showed acute uncomplicated appendicitis and 35.2% showed acute complicated appendicitis. NLR with a cutoff value of 3.17 was estimated to differentiate normal appendix and acute appendicitis with a sensitivity of 86.8% and specificity of 60%. The cut-off value for NLR to differentiate between acute appendicitis and acute complicated appendicitis was taken as 3.87, with a sensitivity of 84.2% and 63.9%.

The majority of pregnancies result in the birth of a mature vigorous infant showing little evidence of any untoward effects from the stress of labour and delivery. Nevertheless about 5-10% of births are accompanied by signs suggestive of fetal distress during labour and even a higher percentage by depression of the newborn infant, indicating that this phase of intra uterine life is not without potential danger. The study consists of 100 cases of birth trauma noticed among 850 consecutives viable birth during the study period of 1½ years. Proforma contains the details of the health status of the mother, antenatal, intranatal and postnatal particulars including the age, sex, weight, mode of delivery, type of presentation and nature of the birth injury in different modes of delivery and type of presentations of the baby. 29% of babies delivered during the study period had signs of asphyxia. Apgar scoring was the basis for asphyxia. Cephalohematoma was noted in 32 cases (3.76%), 4 (0.47%) of the babies had neurological injuries. Among facial nerve palsy 4 (0.47%), subaponeurotic hemorrhage was noted in only one baby. No fractures were noted among the babies.
 

Introduction: According to WHO, 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis is considered as post COVID-19 syndrome or long COVID.
Objective: Objective of this study was to evaluate the prevalence various symptoms in post COVID syndrome/long COVID cases within 3 months from the recovery or infection.
Methods: This multicentric hospital based cross sectional study was done among 113 Long COVID cases of 567 previously infected COVID-19 subjects at COVID clinics in Telangana (Hyderabad, Nalgonda) and Madya Pradesh (Indore), India for 1 year during January to December 2021. Data was entered into Microsoft exceland results were displayed by numbers and frequencies only.
Results: Among long COVID study population the mean age was 43 years, with male predominance (57.5%) and more than half of subjects were having co-morbidities, hypertension being the commonest (35.4%). Majority had moderate illness (40.7%) managed at home (60.2%) initially. Fatigue (67.3%), body pains (38.1%) and shortness of breath (29.2%) were common post COVID symptoms.
Conclusion: Present study found that, increasing age, co-morbidities and initial severity of the disease are found to be risk factors for post COVID complications.
 

Background: Diabetic macular edema (DME) is a leading cause of visual impairment and its treatment is a public health challenge. Antiangiogenic agents are the gold standard treatment, but they are not ideal, and subthreshold laser (SL) is a viable and promising treatment in certain cases. The purpose of this study was to evaluate its usefulness in a real-world environment.
Methods: A retrospective case series of 54 eyes of 32DME patients admitted to the center treated with SL monotherapy. Treatment was performed using the EasyRet® photocoagulator with the following parameters in one session: 5% duty cycle, 200 ms pulse duration, 160 µm spot size, and barely visible.Output at 50% of threshold. A high-density pattern was then applied across the edematous region using multi-spot mode. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline and approximately 3 months after treatment.
Results: 54 eyes of 32 patients were included (38% female, mean age 63.8 years). The mean time from treatment date to follow-up visit was 12±6 weeks. BCVA (Snellen transformed to logMAR) was 0.59±0.32 and 0.43±0.25 at baseline and follow-up, respectively (p=0.002). 32% had previously undergone pan-retinal photocoagulation (p = 0.011). The average laser power was 555 ± 150 mW and the number of spots was 1,109 ± 580. Intraretinal and subretinal fluid (SRF) were observed in 96 and 41% of eyes at baseline and improved in 35 and 74% of eyes, respectively, after treatment. Quantitative analysis of changes in central macular thickness (CMT) was performed in a subset of 23 eyes, of which 43% showed a greater than 10% reduction in CMT after treatment.
Conclusions: Subthreshold laser therapy is known to have RPE function as a major target that normalizes heat shock protein activation and cytokine expression. In the present study, cases of DME associated with SRF showed excellent physiological responses, whereas laser monotherapy did not respond to a reduction of intraretinal edema. BCVA and macular thickness showed a mild response, suggesting the need for combined treatment in most patients. may be a viable treatment option.

Background: Large number of pulmonary tuberculosis Patients (PTB) irrespective of their anti-tubercular treatment profile, presenting with symptoms of active pulmonary tuberculosis but their sputum smear for AFB by Zeihl Neelson technique is negative or who are unable to expectorate sputum in spite of best coughing technique. Such type of patients may require alternative methods to early diagnose and appropriate line of treatment to check further transmission of tuberculosis in the community.

Introduction: Polycystic ovarian syndrome (PCOS) is an endocrine disorder with multiple etiology and affecting women in reproductive age group. It has become a major problem in modern era and requires a multimodality of treatment.
Material and methods: The study was conducted on 100 PCOS patients attending PGIMS, Rohtak outpatient department to compare the efficacy of combined oral contraceptives (COCs) and cyperoterone acetate-ethinyl estradiol (CPA-EE) combination on metabolic parameters. This was a prospective interventional study conducted for one and half year. Patients were followed at one, three and six months of treatment and comparison was made from baseline to six months of treatment.
Results: Both the drugs did not change the waist circumference and blood pressures of the patients, while improved fasting blood sugars from third month of treatment. COCs were found to deteriorate the sugar levels more significantly when compared to CPA-EE. Both the drugs significantly derange the triglyceride and high density lipoprotein levels, CPA-EE being more than COCs.
Conclusion: Any of the drug can be used in the treatment of PCOS patients but with caution in diabetic and hyperlipidemic patients.
Keywords: Polycystic ovarian syndrome (PCOS), combined oral contraceptives (COCs), cyperoterone acetate-ethinyl estradiol (CPA-EE), metabolic syndrome, diabetes, hyperlipidemia.
Synopsis: Both the drugs are equally effective in improving the metabolic parameters but derange the blood sugars and lipid profile

The primary goal of the study is to evaluate the manner of delivery in cases of preterm membrane rupture caused by induction of labour. The secondary goal is to evaluate the maternal and foetal outcomes. From January 2018 to December 31, 2019, a prospective cohort of pregnant women admitted to the Department of Obstetrics and Gynecology at KIMS hospital over gestational age 34 weeks with PROM was studied. Compared to 68 percent in the Expectant Management group, 75 percent of women had normal vaginal deliveries. In the Immediate Delivery group, 25% of women experienced LSCS/instrumental delivery, compared to 31% in the Expectant Management group. The mode of delivery difference between the two groups was not statistically significant.

Introduction: The colour flow Doppler imaging is already being used to analyse abnormal vascular flow patterns in intrauterine growth restriction and high-risk pregnancies. The study used middle cerebral artery and umbilical artery blood flow to link Doppler findings with perinatal outcome and IUGR in high-risk pregnancies.
Methods: Fortwo years, 100 women with singleton pregnancies with vertex presentation between 28 and 40 weeks of gestation complicated by preeclampsia and IUGR were examined for umbilical artery and middle cerebral artery Doppler waveforms at Jagannath Gupta Institute of Medical Science and Hospital, Kolkata, West Bengal, India. Perinatal outcome data were captured and statistically analysed using the percentage and Chi-square test.
Results: In our investigation, 57% of the umbilical artery wave shapes had the highest LSCS for foetal distress. The umbilical artery PI offers the highest sensitivity for detecting IUGR (82.2%). Umbilical RI also predicted APGAR<48 hours with 100% sensitivity. Perinatal mortality was highest with abnormal PI (41.8%), followed by abnormal RI (34%), and abnormal S/D (31%). The aberrant PI group had the highest LSCS for foetal distress, at 30.2%. Perinatal death was 31.5% in those with a CPR of 48 hours and 100% sensitivity in predicting foetuses with APGAR.
Conclusion: Non-invasive techniques such as colour Doppler velocimetry is a useful method for assessing foetal well-being.

Introduction: Patients are frequently admitted to ICU (intensive care units) because of sepsis significant morbidity and death occur in intensive care unit patients with severe sepsis or shock. Sepsis has a mortality rate of 30-40%. Despite breakthroughs in sepsis treatment during the last two decades, mortality remains stable.
Aims and objectives: To study the clinical profile of sepsis cases by monitoring the clinical parameters & latest scoring systems (SOFA &qSOFA) for critically ill patients.
Materials and methods:This was a prospective observational study conducted at Sri Aurobindo Institute of Medical Sciences and PGI, Indore on 100 patients.
Results: The distribution of patients according to comorbidities. Majority of the patients were having DM (62%) followed by HTN (45%) and IHD (9).Less number of patients were having Cyanotic heart disease (1), CLD (1), CVA (1), RA (1), and sickle cell anemia (1)
The SOFA score, developed by the European Society of Intensive Care Medicine (ESICM) Working Group on Sepsis-Related Problems, can represent both individual and multiple organ failure. The effectiveness of the   SOFA score has already been examined in large cohorts of critically sick patients. Due to its ease of use and ability to incorporate easily available clinical and laboratory data, the SOFA score has a number of benefits in the emergency department.
Conclusion: Majority of the patients having age group between 51-60 years followed by 61-70 years. Least number of the patients were found in age > 70 years. Majority of the patients were having DM followed by HTN and IHD. Less number of patients were having Cyanotic heart disease, CLD, CVA, RA, and sickle cell anemia.

Background: Gynecomastia is a common cosmetic problem encountered in Plastic Surgery practice. The surgery for gynecomastia is becoming popular owing to less invasive procedures, advances in anaesthesia and day care nature of these procedures. These procedures are performed under local anaesthesia with sedation, tumescent anaesthesia and general anaesthesia.
Methods: Authors studied 20 cases operated by a single surgeon; those were operated from January 2021 to December 2021 retrospectively. Ten of them were operated under tumescent anaesthesia and another ten under general anaesthesia. They were analyzed for post-operative aesthetic outcome, completeness of glandular excision, intra-operative comfort.
Results: All the ten patients had complete glandular excision and there was no contour irregularity and all of them preferred to undergo further procedures under general anaesthesia. Among the ten patients who had undergone surgery under tumescent anaesthesia, one had a small residual gland; another one had minor surface irregularity and five of them preferred to not to undergo further surgeries under tumescent anaesthesia in future as they felt some kind of discomfort during the procedure.
Conclusion: Our study shows that our patients preferred to undergo gynecomastia surgery under general anaesthesia due to the increasing safety and comfort. The authors also feel it’s more comfortable to do these surgeries under general anaesthesia.

Background: TXA or Tranexamic acid has gained in significance in reducing blood loss in various gynaecological, oncological and orthopaedic surgeries. Its role in plastic surgical procedures is relatively new. TXA in reducing blood loss and ecchymosis in gynecomastia surgeries specifically has not been studied and no enough literature exists.
Methods: Authors studied 20 consecutive cases operated by a single surgeon retrospectively, ten of whom had received TXA and other had not. The peri-operative blood loss by seeing the lipo-aspirate and ecchymosis were looked for on post-operative day.
Results: The lipo-aspirate was clearer in TXA group and bloodier in non TXA group. None of the TXA group had ecchymosis while 3 had ecchymosis in non TXA group.
Conclusion: TXA appears to reduce blood loss and chances of ecchymosis in gynecomastia surgeries.

Infertility is a common condition with important psychological, economic, medical and demographic implications. The prevalence of infertility ranges from 6.9% to 9.3% in developing countries. Female infertility can occur due to variety of causes, ranging from hormonal imbalance to congenital anomalies or infections or other pathologies involving uterus, FT, external genitalia or even error of coitus. Detailed history was taken, physical examination was done and relevant investigations were carried out. Cases requiring Hysterolaparoscopy were chosen. The latter procedure was carried out during the follicular phase of the menstrual cycle between days 5 and 10. Hysteroscopy revealed normal findings in 85.7% cases of primary infertility and 70% cases of secondary infertility. Abnormal findings noted Fibroid uterus, endometrial polyp, tubal ostial block, bicornuate uterus etc. On Laparoscopy Abnormal findings included PCOS, Ovarian cyst, Hydrosalpinx, Fimbrial abnormalities etc. On CPT, bilateral tubal block was seen in 18.4% cases and unilateral block in 10.5% cases. Combined Hysterolaparoscopy provides the best approach to diagnose organic causes of female infertility in cases who don‘t conceive following basic investigation and preliminary treatment. Endometrial biopsy is further helpful in management of some such cases.

Introduction: Multimodal analgesia through different techniques is associated with superior pain relief. Opioids as epidural adjunct to local anesthetics have been in use for long and α2 agonists are being increasingly used for same. The present study aims at comparing the hemodynamic, sedative and analgesic effects of epidurally administered fentanyl and dexmedetomidine when combined with bupivacaine.
Methods: A comparative randomized double‑blind study consisting 60 patients with ASA physical status I and II of either sex between 20 and 50 years scheduled for lower limb orthopedic surgeries under epidural block were randomly divided into two Groups (n = 30) D and F. After epidural block with 15 ml of 0.5% Bupivacaine, Group D received 1 µg/kg of Dexmedetomidine and Group F received 1 µg/kg of Fentanyl. Time to request for the first postoperative analgesia were recorded.
Results: Mean duration of analgesia was 340.8 minutes with SD of 13.098 in dexmedetomidine group and 263.97 minutes with SD of 10.778 in fentanyl group Duration of sensory and motor blockade were prolonged in group D compared to group F.
Conclusion: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant due to prolonged postoperative analgesia and lower consumption of rescue analgesia.

Background: This study is designed to compare the degree of attenuation of hemodynamic response to induction, laryngoscopy and endotracheal intubation of etomidate with those of propofol in patients undergoing noncardiac surgical procedures.
Material and Methods: The present study conducted in Non Cardiac Surgeries in the Department of Anaesthesiology, NMCH, Patna, Bihar. The present study was conducted on 60   patients of ASA Grade I and II of either sex, aged 18 to 60 years, scheduled for a variety of non-cardiac surgical procedures requiring general anaesthesia.
Conclusion: Etomidate provides a more stable hemodynamics during general anesthesia as compared to propofol.

Background: The proseal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff to improve seal and a draining tube to provide a channel for regurgitated fluid and gastric tube placement. Since PLMA insertion doesn’t require laryngoscopy, it causes less pharyngeal wall stimulation, and less incidence of postoperative sore throat in comparison with endotracheal intubation.
Methods: 100 patients of either sex, age group of 18-60 years, ASA I & II, posted for elective surgeries, to whom general anaesthesia was administered were selected. They were randomly divided into two group (n=50 each). For group A, airway was severed with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart Rate and Blood pressure, Oxygen saturation of hemoglobin, postoperative sore throat and abdominal girth were recorded at base line, before induction, after induction, 1^st min, 3^rd min, 5^th min, 10^th min after endotracheal intubation or PLMA insertion and after extubation or removal of PLMA. Conclusion: The hemodynamic response produced when PLMA was used as the method of securing airway was less than the laryngoscopy and endotracheal intubation used for the same. SPO₂ was same in both groups and gastric insufflation was minimal in both groups. Incidence of postoperative sore throat, were more with ETT. Thus PLMA provide a better alternative to ETT in paralysed anaesthetized patients.

Background: UTI(Urinary tract infection) remains one of the most common infectious diseases diagnosed by clinicians in everyday practice in developing countries with an estimating global incidence of at least 250 million, of which 50% of the people will suffer once in their lifetime. UTI is common among both genders, but its prevalence is more common in women than in men at a ratio of 8:1 due to anatomical and physiological factors. Mostly around 80 to 90% of the UTI is caused by a single microbe. Widespread use of antibiotics against uropathogens has led to the emergence of antibiotic resistant strains which makes the treatment of UTIs more complex. The UTI can affect any part of the urinary system producing high fever with chills, pelvic pain, frequent painful micturition and in the elderly confusion in addition to the above symptoms. Hence the purpose of this study is to know the antibiogram of uropathogens isolated in our tertiary care hospital and guide the clinicians to select the appropriate antibiotics for treating the urinary tract infections. This study also evaluates the patterns of various symptoms and the uropathogens in various age groups.
Material and Methods: This is a Cross-sectional study was conducted to find out the prevalence of common micro-organisms causing UTI and to determine the antimicrobial sensitivity pattern among the patients attending in the department of microbiology, ACS Medical college & Hospital from May 2022 to July 2022. Inclusion criteria: All patients clinically suspected of having UTI from various wards and OPDs.The anti-microbial profile in the urinary pathogens were conducted in 348 consecutive urine samples received in laboratory. Samples were collected from patients presented to the out patients and those who were admitted.
Results:  A total of E. Coli (N=42) (12.06%) , enterococcus(N=25) (7.18%), CONs (N=9) (2.58),Klebsiella (N=8) (2.29), Pseudomonas.A (N=6)(1.72%)Candida (N=5) (1.43%) were commonly isolated from the urine samples analyzed in this study. The isolates were resistant to amoxicillin, sulphamethoxazole-trimethoprim, ceftazidime, amoxicillin-clavulanic acid, ceftriaxone, ofloxacin, aztreonam and nalidixic acid; and they were found to be multi-drug resistant to the antibiotics. Most of the isolates were sensitive to Amikacin and Nitrofurantoin.
 Conclusion: Overenthusiastic use of antibiotic has resulted in emergence of drug resistant bacterial strains in UTI patients. Hence, antibiotic susceptibility testing is essential and aids to diagnose and treat the drug resistant UTI cases.

Introduction: Balanoposthitis is a common condition affecting approximately 3-12% of male genitourinary clinic attendees.^1-4 It is inflammation of the non-keratinized epithelium of the glans penis (i.e. Balanitis) and that of prepuce (i.e. posthitis) together.⁵ Aim: to find out the burden of balanoposthitis amongst patients attending the Dermatology OPD. Method: An observational cross-sectional study conducted over a period of eight months, and all males presenting to out-patient-department of Dermatology and STD clinic with complaints of prepuce and/or glans were included in the study. Results: In our study, 1.8% (129) had balanoposthitis. Mean  age was 39.35±15.15 years (range 2-72 years). Conclusion: Balanoposthitis, despite its frequency, has received scant attention. It is predominantly a disease of uncircumcised man.

Background: Laryngoscopy and intubation induce huge spectrum of stress responses such as tachycardia and hypertension. Those are in association with the surge of plasma adrenaline concentration following intubation. This study was performed to compare the efficacy of an accurate bolus dose of esmolol and bolus dose of dexmedetomidine in attenuating the pressor response to laryngoscopy and endotracheal intubation in general anaesthesia.
Materials and Methods: Randomised, comparative and double blinded study in which 30 patients were recruited in both the groups, Group D received injection Dexmedetomidine and Group Ereceived injection Esmolol assesment done for change in Heart rate, Systolic, Diastolic and mean blood pressurewith any adverse effects.
Results and Observations: Heart rate, SBP, DBP and MAP was lower in Group D as compared to Group E. No patients in either group required treatment for bradycardia and hypotension. No other adverse effects were noted in any patient.
Conclusion: Dexmedetomidine is effective in attenuating hemodynamic response to laryngoscopy and tracheal intubation without any side effect.

Background: Hyponatremia is a common electrolyte imbalance which occurs in children with pneumonia. Many studies have reported the incidence of hyponatremia around 40 to 45%.Presence of hyponatremia adds to the morbidity apart from the disease itself. Hence the present study was taken up to find the incidence of hyponatremia in pneumonia.
Methods: This prospective observational study involved 122 children admitted to the paediatric ward and PICU of  PMCH, Patna. Children diagnosed as pneumonia as per WHO guidelines between 1 to 5 years were included. Beside other relevant blood investigations, blood samples for electrolytes were analysed using automated analyser that uses ISE (ion selective electrode) technology for sodium determination.
Conclusion: Hyponatremia is common electrolyte imbalance found in community acquired pneumonia and more commonly seen in severe pneumonia.

Background: Brachial plexus block is a safe, effective, low cost anaesthesia with good postoperative analgesia. Adjuvants to local anaesthetics may enhance the quality and duration of analgesia. The aim of the study was to study the efficacy of combination of 0.25% bupivacaine and dexmedetomodine versus 0.25% bupivacaine alone in brachial plexus block by supraclavicular approach.  
Methods: This is a prospective double blind study conducted on sixty patients of ASA1 and ASA 2 posted for upper limb surgeries, randomized in double blind fashion into two groups. Group A (N-30) received 34ml of 0.25% bupivacaine with 0.5ml of distilled water and group B (N-30) received 0.5ml dexmedetomidine (50 µg) with 34ml of 0.25% bupivacaine as supraclavicular brachial plexus block with help of nerve stimulator. Onset and recovery time of sensory and motor block, duration of analgesia, sedation scores, quality of block and side effects compared in both groups.
Results: Baseline characteristics were well matched in both groups. Intraoperative hemodynamic recording was done at 15 min time intervals from administration of the drugs. There was reduction in heart rate, systolic blood pressure and diastolic blood pressure 30 mins onwards in both groups ( p < 0.05). There was no significant difference in onset of sensory and motor block.
Conclusion: This double blind Randomized Controlled study showing the combination of dexmedetomidine 50 µg with 34ml of 0.25% bupivacaine is better than 0.5ml of distilled water with 34ml of 0.25% bupivacaine in duration of sensory and motor block, with better sedation and quality of analgesia with good safety profile in brachial plexus block by supraclavicular approach

Background: Common bile duct stones occur in 7-12 % of all the patients with symptomatic cholelithiasis. In this study, we are presenting our experience of dealing with common bile duct and gallbladder stones by open surgical methods. The objective of the study was to study the open surgical approach to common bile duct and gallbladder calculi.
Methods: The study comprised of 22 out of 71 patients admitted for choledocholithiasis  in surgical wards at AIMSR, Hyderabad from October 2018 to October 2022 who underwent open surgical approach. Rate of CBD clearance, post op bile flow, hospital stay and morbidity were assessed.
Results: Out of the 22 cases, 18 cases were subjected to open Cholecystectomy, CBD exploration and T-tube drainage, 2 patients underwent choledochoduodenostomy,  one case choledochojejunostomy was performed and in one case  hepaticojejunostomy was done due to CBD stricture.   All 22 cases survived and were followed up for combined hospital stay, expenses, CBD clearance and morbidity related to anesthesia and surgery.
Conclusion: Open surgical approach remains a feasible and excellent option for patients with choledocholithiasis in view of CBD clearance, post op bile flow, hospital stay, morbidity in the absence of advance technical facilities and expertise

Background: Primary bone tumors account for 0.2-0.5% of all malignancies, are rare and mostly benign in nature. The overall incidence of benign bone tumors is debatable because majority of the patients are without symptom and their clinical manifestations are unspecific thus these tumors remain largely undiagnosed. In addition to radiography, CT and MRI are very helpful in the diagnosis of solitary bone lesions.
Objective: To retrospectively evaluate epidemiology and distribution of newly diagnosed benign bone tumors in Department of Radiodiagnosis, Katihar Medical College & Hospital.
Materials and Methods: Computed tomography (CT) and/or magnetic resonance imaging (MRI) examinations performed between 1^st January 2018 and 31^st December 2019 in musculoskeletal radiology section of the department of radiodiagnosis were reevaluated by an experienced radiologist.
Inclusion Criteria – All CT and/or MRI examinations performed between 1^st January 2018 and 31^st December 2019 in musculoskeletal radiology section of the department of radiodiagnosis, Katihar Medical College & Hospital. Exclusion Criteria – CT and/or MRI of Benign bone lesions of the axial skeleton.
Result: During study period, 300 patients (132 females, 168 males) aged between 10 and 66 years (mean age 31.48 ± 14.8 years) with benign bone tumors and tumor-like lesions were diagnosed for the first time. Osteochondroma was diagnosed in 40% of the patients. Osteochondroma lesions were most commonly located around knee joint. Enchondroma, Fibroxanthoma and Osteoid Osteoma were diagnosed in descending order of prevalence respectively. Male predominance was seen in all cases except in Enchondroma where female predominance in prevalence of cases was seen.
Conclusion:- Benign bone tumours and tumor-like lesions are most frequently seen in children and young adults, although they may also present in later stages of life. Although plain radiography is essential for diagnosis, CT and MRI examinations provide additional information. Treatment is indicated for symptomatic patients and for the patients with arisk of pathological fracture or deformity

Objectives: To find the Risk of malignancy index 4 among women with ovarian masses and to evaluate its ability to discriminate benign mass from a malignant mass.

Background: In children, an inflammatory illness known as paediatric chronic rhinosinusitis (CRS) can affect both the nose and the paranasal sinuses. The presence of two or more of the following symptoms, nasal blockage, face pain, purulent rhinorrhea or cough for at least 12 weeks is required in order to make a diagnosis of paediatric CRS

Background: Since ancient times, seizures have affected individuals worldwide. Up to 10% of the population will have a seizure in their lifetime, most often in early childhood and late adulthood. Adult seizures have a distinct aetiology than childhood seizures and require special attention. Head trauma, CNS infections, space-occupying lesions, cerebrovascular accident, metabolic diseases, and medications are possible causes of adult-onset seizures

Background: Diabetes mellitus, a common somatic ailment that can have psychological ramifications, is caused when insulin does not operate as well as it should. Diabetes is caused by insulin not working as effectively as it should. It is gradually gaining a reputation as a possible epidemic on a scale that encompasses the entire of the world.

Background: In the course of any living thing's existence, ageing is a normal and expected component of the process of development. There is very nothing that can be done to slow down the ageing process, as it is a natural part of life. It is not merely a biological phenomenon, but also has psychological and social ramifications for humans.

Background: The term "obesity" refers to an abnormal expansion of the adipose tissue that can be caused by an increase in the number of fat cells (hyperplastic obesity), an increase in the size of the fat cells themselves (hypertrophic obesity), or a combination of both of these factors. The body mass index (BMI) is frequently used as a measurement of obesity.

Background and Objectives: To study the clinical manifestation, laboratory and radiological findings pertaining to Dengue fever. To obtain the sociodemographic profile of patients. To evaluate the clinical features observed in dengue patients. To carry of comparative study of clinical features with the laboratory and radiological findings in dengue patients

Background: Parotid lymph node (LN) metastasis occurs most frequently from squamous cell carcinoma (SCC) of the head and neck. In SCC of the head and neck, metastatic involvement of the parotid gland is associated with a poor prognosis but the parotid LN remains an uncommon site of metastasis for oral squamous cell carcinoma. The management of tongue carcinoma is primarily surgical, with radiation also having an important role mainly in advanced disease, poor surgical candidates, unresectable disease, and importantly, as an adjuvant to surgery in some cases. Unless there is a clear contraindication for surgery or the tumor is unresectable, surgery should be offered as primary treatment for tongue squamous cell carcinoma.

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

Background: To assess the pattern of covid-19 manifestations in group of patients visiting tertiary care hospital.

Introduction: Shoulder pain is the most common complaints in medicine and disorders attributed to the rotator cuff are the most common cause of shoulder pain. More than 50% of all shoulder pains are considered to be that related to tendinopathies of the rotator cuff, as supraspinatus in complete thickness tears and tendinosis1. Platelet rich plasma (PRP) is a preparation of concentrated autologous platelets containing growth factors and bio active substances essential to musculoskeletal healing. It involves minimum risk of immune reactions and transmission of infectious and contagious disease. With this we need assess the efficacy of PRP shoulder.

Introduction:Tibial plateau fractures have always been difficult to treat because of thesubcutaneous location of its anteromedial surface. These days significant attention hasbeen paid to the condition of soft tissue envelope. Study aims and objectives were to evaluate functional outcome of tibial plateau fracture treated by Locking compression plate in regards to Knee range of movements and complications.

Background: Pyogenic granuloma (PG) is benign vascular tumour presenting as small, friable, reddish papule or nodule. Bleeding tendency of PGs warrants their removal.Various available treatment options require local anesthesia, cause pain, local side effects, scarring and become undesirable for treating children. Hence, topical beta blocker (timolol 0.5%) becomes a valuable option for treating PG in children.

Introduction: Pulmonary hypertension is a complex disease that presents with a broad spectrum of morphological and hemodynamic findings of varying severity, which has a major impact on morbidity and mortality.

Aim: To establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery.

Aim: To study the efficacy of laparoscopic appendectomy as well as conversion rate of laparoscopic appendectomy to open appendectomy.

Background: Lockdown due to COVID-19, forcibly moving educational activity to the online environment allows for flexibility in teaching and learning because courses are easily accessed. The online learning environment varies profoundly from the traditional classroom situation when it comes to learner’s motivation, satisfaction, and interaction.Present study was aimed to study impact of online learning on student’s physical and mental health amidst covid19 pandemic in school at UrunIslampur, Maharashtra, India.

Background::Hypertension is a major public health problem among India. It is a important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications.

Background: Diabetes mellitus (DM) is a chronic, debilitating disease constitutes a global health threat and burden, especially in developing countries. The objective of the study was to assess the prevalence of diabetes mellitus type-2 and its associated risk factors.

Aim: To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with obstructive jaundice.

Aim: To compare modalities like ultrasonography (USG) and computed tomography (CT) in the evaluation of suspicious ovarian masses.

Background: Ageing is a complex process and comes with increased risk of acquiring hematologic and no hematologic disorders. Bone marrow examinationis an important modality in diagnosing these conditions in the elderly and helps guide therapy.
Objective: This study was therefore conducted to study the indications and morphological features of bone marrow examination in geriatric population.
Materials methods: The study was conducted over a period of 5 years in pathology laboratory in department of Belgaum institute of medical sciences, Belagavi from 1^st January 2015 to 31^st December 2019. A total of 156 bone marrow examination cases above 60 years were reviewed and s were recorded.
Results: Anemia was the commonest indication (37%) followed by bicytopenia/ pancytopenia (29%) Suspicion of leukaemia was an indication in 17% of cases. Megaloblastic anemia was the commonest diagnosis (39%). Iron deficiency anemia and combined deficiency was diagnosed in 14% and 8% cases respectively.  Acute leukemia was seen in 11 cases (7%). 10 cases (6%) each of chronic myeloid leukemia and normal bone study were noted.
Conclusion: Bone marrow aspiration and trephine biopsy are complimentary tools in diagnosis of hematologic and non henatologic disorders in the geriatric papopulation

Background: Breast lesions are not a single entity rather they represent heterogenous group of disease with marked clinic morphological diversity, varied disease aggressiveness and response to treatment. Myoepithelial markers help to distinguish invasive carcinomas from benign neoplasms with similar morphological appearance. In breast, p63 antibody is a myoepithelial marker that exclusively stains the nuclei of myoepithelial cells and is not expressed in vascular smooth muscles, stromal myofibroblasts and in surrounding adipocytes. This makes p63 more specific and superior to other myoepithelial markers.
Materials and Methods: The present study was done on total of 53 breast specimens received in the Department of Pathology. All specimens were routinely processed and stained with H &E and then subjected to p63immunohistochemical staining using normal breast tissue as positive control.
Results: Out of 53 cases, 30 cases were benign, 05 cases were premalignant and 18 cases were malignant. All malignant cases were negative for p63 expression,  all benign and premalignant cases were positive for p63 with varied pattern of expression. Benign non proliferative lesions were continuous positive (score-3), proliferative lesions showed less continuous positive (score-2) and premalignant lesions like ductal carcinoma in situ were discontinuously positive (score-1) with well-defined two or more nuclear spaces between two positive p63 nuclei.
Conclusion: There is considerable interobserver disagreement in the interpretation of difficult breast lesions based on histopathology alone. Myoepithelial markers like p63 are useful in helping to distinguish invasive carcinomas from benign proliferative lesions and most premalignant lesions with an intact myoepithelium.

Background: Healthcare education with the use of QR (quick response) Codes has a great impact on knowledge and learning skills. A QR code (or quick response code) is a type of matrix barcode or two-dimensional barcode that contains data to identify, track, or locate a website or application. This study was conducted to assess the feasibility of the Quick Response (QR) codes as a New Era Learning method in Undergraduate Medical Students in the Department of Pharmacology.

Background: Hair loss is a frequent complaint, diseases that result in hair loss lead to low self-esteem and impaired psychosocial interactions. Present study was aimed to study trichoscopic relevance in the differential diagnosis of alopecia in tertiary care center.
Material and Methods: Present study was single-center, a cross‑sectional observational study, conducted in patients attending dermatology OPD, with complaint of hair loss.
Results: In present study, 228 patients of alopecia were studied. Majority were from 21-30 years age group (29.82 %) followed by > 41 years age (25.88 %) & 31-40 years age (21.49 %). Male patients (65.35 %) were more than female (34.65 %).  Among patients of Androgenetic alopecia (male) (66 cases), common trichoscopic findings were yellow dots (100.00 %), diameter diversity>20% (96.97 %), thin hair (93.94 %), vellus hair (54.55 %) & honeycomb pigment network (25.76 %).  In patients of female pattern hair loss (41 cases), common trichoscopic findings were diameter diversity>20% (85.37 %), thin hair (73.17 %), yellow dots (39.02 %), vellus hair (26.83 %) & honeycomb pigment network (14.63 %). Among patients of alopecia areata (52 cases), common trichoscopic findings were yellow dots (88.46 %), black dots (82.69 %), exclamation mark hair (65.38 %), vellus hair 53.85 %) & thin hair (42.31 %). In patients of telogen effluvium (45 cases), common trichoscopic findings were thin hair (77.78 %) & yellow dots (44.44 %).
Conclusion: Along with clinical and histopathological findings, trichoscopy is valuable, noninvasive, useful, low‑cost technique & relevant investigation in the differential diagnosis of alopecia.

Background: The tibial intra-articular fracture refers to soft tissues envelope and often known as pillion fracture. The goal of treatment involves healed, well-aligned, functional range of motion of ankle joint. To offer the treatment the approach of fracture reduction has been successful in treating the complex fracture.
Aim: The research paper aims to analyze the outcome of communited intraarticular fractures of distal tibia treated with an external fixator.
Material and Methods: The current study is an observational study that is being conducted in….from…... For the study, the researcher has selected 30 people that involve 23 males and 7 females. The mean age of these participants was 53 years (range between 26-72 years). The patients were selected focusing on the inclusion and exclusion criteria.
Results: The clinical result of study involves the mean score of 81.5 points that range between 58-100. The first requirement of arthrodesis of the ankle and this patient scored 9 points for reduction quality. The clinical results have identified that the patient was facing the issues related to A5 valgus deformity that also occurred with diabetes. The consideration of results focusing on the approach of external treatment was found good and applied for the other clinical studies of the patients.
Conclusion: From the study, it has been carried out that that external fixator treatment for communited intraarticular fractures of the distal tibia is beneficial and having a positive impact on the process of offering the required support to the patients.

Background: Histopathological studies of the cervix along with clinical correlation is very important for definitive diagnosis in diseases of the cervix. The present study was conducted to assess non neoplastic and neoplastic lesions of uterine cervix.
Materials & Methods: 78 specimens received from hysterectomy, cervical biopsy, cervical polypectomy from department of obstetrics & gynecology were formalin fixed & paraffin embedded tissue sections were used for microscopic study. Microscopic findings were recorded and histopathological diagnoses were made.
Results: Cervical specimens were 13 cervical biopsy, 60 hysterectomy and 5 polypectomies. The difference was significant (P< 0.05). Non- neoplastic inflammatory lesions were seen in 55 and non-neoplastic cervical glandular lesions in 10. Neoplastic lesions were benign in 8, precursor lesions in 3 and malignant lesions in 2 cases. The difference was significant (P< 0.05). Inflammatory lesions were acute cervicitis in 5, chronic non- specific cervicitis in 30 and chronic papillary endocervicitis in 20 cases. Benign lesions were endocervical polyp in 4, fibroepithelial polyp in 2 and leiomyomatous polyp in 2 cases. The difference was significant (P< 0.05).
Conclusion: Histopathological examination of biopsy specimen is gold standard for the diagnosis. Cervical malignancies are most common malignancies of female genital tract

Introduction: Traditional treatment for inferior pole patella fractures is excision of the comminuted pole and Repair of a ruptured patellar tendon with the use of sutures that are passed through intraosseous tunnels within the patella. Difficulty with this technique is that Beath pin may penetrate the articular surface or may unduly injure the quadriceps through multiple passes. Obliquely oriented bony tunnels may cause abnormal patellar tilt, leading to uneven force distribution. This technique reports use of suture anchors for inferior pole patella fractures. Retrospective analysis of four cases of patients doing well at follow-up of one year. Materials and Methods: Four patients treated using suture anchors for repair of comminuted inferior pole fractures of patella between June 2020 to September 2020 (range 22 years-38 years).

Context: Contrast enhanced MRI scans with addition of arterial and venous sequences are the most important studies to evaluate Intracranial Meningiomas. MRI is being utilized to determine the histological subtypes and biologic behavior of meninigiomas

Background & Aim: Chronic Otitis Media (COM) is a common curable cause for hearing impairment in developing countries. Eradication of disease from middle ear and repair of tympanic membrane perforation reduces the progression of hearing loss due to infection induced osteitis of ossicles. Tympanoplasty is usually done in quiescent stage of COM. Eustachian tube function, allergies and duration of disease affect the outcome of surgery. Our study aimed to assess middle ear mucosa for microbiological flora in COM Mucosal disease Inactive stage and its influence on outcome.

Objectives:Diabetes is a chronic disease with increasing morbidity and mortality. Microalbuminuria is seen in diabetic patients due to nephropathy. Patients with microalbuminuria are at high risk for atherosclerosis. It is thought that comparing the carotid artery, which is most frequently affected by atherosclerosis, by measuring and comparing the renal resistive index, may be beneficial for early diagnosis and treatment of diabeticcomplications.

Objectives:To evaluate the perinatal fetal outcome in correspondence with the second-trimester scan umbilical artery coiling index in uncomplicated singleton pregnancies.

Objective: The objective was to assess serum vitamin D [25(OH)D] levels in patients with acne vulgaris and investigate the possibility of a relationship between low serum vitamin D levels and acne severity ordinary.

Introduction: Transfusion of Blood & Blood Components is one of the four recognized modes of Hepatitis B virus infection and HBsAg or Australia Antigen in the serum is the earliest marker of active HBV infection (acute/chronic) being detectable even before elimination of transaminases and onset of clinical illness. Various strategies are being used to reduce this transfusion transmitted infection
Material and methods: The retrospective study was conducted on apparently healthy blood donors over a period of 2 years from January,2020  to December,2021 at Blood Bank, Department of Pathology, Sir. T. Hospital, Bhavnagar in order to assess the prevalence of hepatitis B virus infection. A total number of 34,555 blood donors were included in this study. HBsAg  ELISA test were used for this study purpose.
Results: Out of 34555 donors,12476  (36.104%) were in-house donors and 22079 (63.89%) were outdoor-camp donors. Out of 34555 donors 33403 (96.66 %) were male donors and 1152 (3.33%) were female donors. Out of 34555 blood units, 4096(11.8%) were discarded and out of them 188 (0.54%) were HBsAg reactive. The Seroprevalence of HBsAg was found to be 0.54%.
Conclusion: Blood Donors are often found to be reactive for Australia Antigen and others. In order to reduce this Seroprevalence, more sensitive screening assays and appropriate donor selection are must.

Introduction: Vitiligo has a worldwide prevalence of 0.5-2%. Treatment of vitiligo at any age remains a challenge for clinicians, more so during childhood. Understanding the clinical profile in children paves way for early diagnosis and management of this disorder which ultimately ensures better outcomes.

Introduction: The purpose of this study is to determine the clinical profile, demographics, and behavioral risk factors for patients with psoriasis entering higher tertiary care hospital.

Background: Peripheral vertigo can result from various causes, among which Benign peripheral paroxysmalvertigo (BPPV) is most common. Diagnosis of vertigo is usually made by a good clinical history, neurological, otological examination and radiological investigations. Video-nystagmography (VNG) tests are most accurate among all. Treatment consists of medical management along with various adaptation exercises according involved canal.The aim is to study the evaluation andprognosis of peripheral vertigo.

Background: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person’s mobility by making it difficult and painful to walk. Present study was aimed outcome of Ponseti technique for the management of congenital talipes equinovarus at a district hospital. Material and Methods: This prospective, observational study, conducted in children age <1- year, idiopathic clubfoot (unilateral or bilateral), underwent treatment by Ponseti method. Results: In present study, 48 infants with 80 clubfeet were studied. Majority were brought at less than 3 months of age (62.5 %), followed by at 6-9 months of age (16.67 %), 3-6 months of age (12.5 %) & at 9-12 months of age (8.33 %). Male infants (60.42 %) were more as compared to female (39.58 %). Mean age of presentation 3.6 ± 1.9 months. Only 5 feet (6.33 %) required percutaneous tendoachilles tenotomy. Mean number of casts applied for achievement of correction was 6.9 ± 2.1. Modified Pirani score before treatment was 5.1 ± 2.3 as compared to 0.56 ± 0.21 score at follow up of 1 year. Conclusion: Ponseti method of manipulation and casting is an excellent method for the correction of all four deformities associated with congenital talipes equinovarus & can achieve painless, plantigrade, normal looking foot, after proper follow-up & good compliance.

Background: Caesarean section or caesarean delivery is defined as the birth of a fetus through incisions in the abdominal wall (Laparotomy) and the uterine wall (Hysterotomy). This definition does not include removal of the fetus from the abdominal cavity in the case of rupture of uterus or in case of an abdominal pregnancy. Caesarean section can be considered one the earliest forms of modern birth technology Aim & Objective: 1.To study the maternal morbidity, mortality, perinatal outcome in patients, undergoing elective and emergency C-section. 2.To compare the maternal morbidity, mortality, perinatal outcome in patients, undergoing elective and emergency Csection. Method: Study design: Prospective study. Study setting: Department of Obstetrics and Gynecology at tertiary care centre. Study duration:……..Study population: The study population included all the women undergoing elective c-section and emergency c-section. Sample size: Results: In Group A: 44% of patients are in the age group of 18-24years and in Group B: 74% of patients are in the age group of 18-24years. A statistically significant value of P=0.01, is obtained suggesting most of the patients undergoing C-section (elective/emergency) are in age group of 18-24years. Strongly significant (P value: P<0.01). The most common risk factor is Previous LSCS. 14(28%) patients had previous LSCS in Group A (Elective C-Section) and 7(14%) patients had previous LSCS in Group B (Emergency C-Section). From the above graph, it can be observed that the patients with risk factor of Previous LSCS are more common with Elective C-Section group compared to Emergency C-Section group. Post-operative complications in Caesarean section were more in Emergency Caesarean Section when compared to Elective caesarean section. PPH is the most common in Emergency group when compared to Elective group. Wound infection is the 2nd most common complication in Emergency group. Conclusions: The factors associated with caesarean section are age, parity, multiple pregnancy, maternal weight gain, and birth weight. Including these factors, the caesarean section is justified under certain circumstances such as cephalo pelvic disproportion and contracted pelvis, dystocia due to soft parts, inadequate uterine forces, antepartum hemorrhage, pre- eclamptic toxemia, eclampsia, fetal distress and prolapse of the cord, malpresentation, maternal distresses such as heart problems, bad obstetric history, habitual intrauterine death of the fetus and elderly primigravida.

Introduction: Securing airway with laryngeal mask airway is the preferred technique in modern world. We compared Ambu Auragain with Laryngeal Mask Airway Supreme in this study for controlled ventilation under general anesthesia.
Material and Methods: Fifty patients of ASA-I and II of American Society of Anesthesiologists, of either gender aged 18 to 50 years, weight 30 to 70 kg, with MPG -I/II posted for elective surgeries under general anesthesia held in supine position were included in the study. They were randomly divided patients into 2 groups of 25 patients each. In present study we observed the ease and attempt of insertion, time taken for insertion, ease of gastric tube insertion, pharyngeal leak pressure and the hemodynamic stability for both Ambu Auragain and laryngeal mask airway supreme.
Result: Ambu Auragain and Laryngeal Mask Airway Supreme both are statistically comparable in relation to ease of insertion, time of insertion and number of attempts for placement. Ambu Auragain has higher pharyngeal leak pressure compared to Laryngeal Mask Airway Supreme. Both of these provided stable hemodynamics during surgery.
Conclusion: Ambu Auragain can be a better alternative to Laryngeal Mask Airway Supreme for controlled ventilation under general anesthesia as pharyngeal leak pressure is higher in Ambu Auragain.

Context: Computer Vision Syndrome (CVS) refers to ocular symptoms which occur as a result of prolonged use of digital devices.
Aims: The main objective was to understand the effects of continuous online classes due to the COVID-19 pandemic on the ocular health of medical students.
Materials and Methods: This quantitative study used data from a survey questionnaire administered to 200 medical students at Tbilisi State Medical University in Georgia. The questions mainly comprised symptoms related to CVS and digital device use patterns. As a part of the research, 200 students between the ages of 18 and 26 were surveyed.
Results: After the pandemic, 33.8% of students recorded a 3 to 5-hour increase in their screen time while 29.4% reported an increase by 1 to 2 hours. Eye strain and dry eyes as a result of the pandemic saw a significant increase in affected individuals from 69 to 84 and 47 to 60 respectively. Among other non-visual ailments, there was an increase in symptoms like headaches (from 90 to 100 students), backaches (from 50 to 78), and neck pains (from 37 to 75 students).
Conclusion: It was concluded that the prevalence of symptoms related to Computer Vision Syndrome in medical students had seen a rise resulting from the online classes due to the pandemic. Awareness of CVS and the prevention of symptoms is necessary, especially among students.

Background: Diabetes mellitus (DM) is associated with adverse clinical outcomes and high mortality in patients with corona virus disease 2019 (COVID-19). The relationship between diabetes and COVID-19 is known to be bidirectional.
Aim:To analyze the rate of new-onset diabetes in COVID-19 patients and assess theclinical outcomes of new-onset diabetes and hyperglycemia among COVID-19 patients
Methods:This cross sectional study has enrolled those individuals admitted with COVID-19 and has newly diagnosed diabetes mellitus. (DM; based on laboratory diagnoses).
Results:Analysis showed that 13.7% (84/610) of COVID-19 patients had newly diagnosed DM. Majority of the newly diagnosed diabetic patient was male (58.3%), most of them (33.3%) were 51-60 year age group. Higher incidence of DM was reported in urban population (54.8%). The significant risk factors of diabetes were found family history of diabetes, (53.6%) and obesity (72.6%). Hypertension was the most common (61.7%) comorbidity associated with the DM.
Conclusions:Diabetes diagnosed at COVID-19 presentation is associated with lower glucose but higher inflammatory markers and ICU admission, suggesting stress hyperglycemia as a major physiologic mechanism.

Background: Most common cardio vascular disease events after COVID-19 were hypertension, pulmonary embolism, acute coronary syndrome, myocarditis, stress-Cardiomyopathy, arrhythmias, carcinogenic shock, and cardiac arrest.
AIM:To evaluate cardio vascular disease events in patients recovered from COVID-19 in central Indian population
Methods: This retrospective observational study was carried out in the department of medicine in a tertiary care hospital, central India. Assess all the participants for post covid cardiovascular events, detailed history, clinical examination and all necessary investigation was done
Results: in our study Post COVID 19 cardiovascular events had occured in 17.6%. Majority of the patient were male (69.3%), most common age group was 51-60 years. Higher incidence of cardio vascular disease were reported in obese person. Common cardiovascular diseases found after COVID 19 infection were hypertension (35.3%), pulmonary embolism (23.5%), Myocarditis (20.6%), myocardial infarction (11.8%) and Arrhythmias were in 8.8% cases.
Conclusion: Overall observations indicate an increased incidence of hypertension and CVDs post recovery from COVID‑19. A dual therapy of ARBs was the preferred choice for management of hypertension. Regular follow‑up and close monitoring of symptoms to prevent further CV complications in COVID‑19 recovered patients is recommended.
 

Mucormycosis is a fungal infection primarily affecting immunocompromised individuals. We have observed sudden rise of mucormycosis cases in post COVID 19 patients. Here we have reported 600 cases of mucormycosis associated with COVID 19.Liposomal amphotericin B was compared with conventional amphotericin B for antifungal therapy in mucormycosis, double-blind, multicentre trial.The two drugs were equivalent in overall efficacy. However, the liposomal amphotericin B treatment group had fewer proven fungal infections, fewer infusion-related side effects and less nephrotoxicity. Patient data from that study were analysed to compare the pharmacoeconomics of liposomal versus conventional amphotericin B therapy.Data from 600 patients were collected and analysed. Hospital costs from first dose were significantly higher for all patients who received liposomal amphotericin B. The mean duration of therapy was 10.8 days for liposomal amphotericin B (300 patients) and 10.3 days for conventional amphotericin B (300 patients). The composite rates of successful treatment were similar (50 percent for liposomal amphotericin B and 49 percent for conventional amphotericin B. The outcomes were similar with liposomal amphotericin B and conventional amphotericin B with respect to survival (93 percent and 90 percent, respectively. With the liposomal preparation significantly, fewer patients had infusion-related fever (17 percent vs. 46 percent), chills or rigors (18 percent vs. 55 percent), and other reactions, including hypotension, hypertension, and hypoxia. Nephrotoxic effects (defined by a serum creatinine level two times the upper limit of normal) were significantly less frequent among patients treated with liposomal amphotericin B (18 percent) than among those treated with conventional amphotericin B (37 percent, p<0.001).

Background &Objective: Medical profession is believed to be one of most stressful profession. Present study was done to evaluate current scenario of masked and white coat hypertension among medical professional in Bundelkhand region. Methods: This cross-sectional observational study was conducted at department of Medicine, M.L.B. Medical College, Jhansi, over a period between Jan 2014 to June 2015 on 300 medical professionals which included undergraduates, PG students, Consultants, Nursing staff and ministerial staffs. All patients underwent history taking, physical examination, laboratory analysis, office BP and ABPM. Results: 4 groups were identified based on office and ambulatory blood pressure monitoring: i) True normotensive patients (BPs are normal both clinically and by ABPM) 197 (65.7%). ii) True hypertensive patients (both office and ABPM were high 23 (7.7%)). iii) White coat hypertensive patients (clinical BP were above limits, but ABPM were normal) 73 (24.3%). iv) Masked hypertensive patients (clinical BP were normal, but ABPM were high 7 (2.3%). Out of 300 subjects, there were 158 UG students, 49 PG students, 6 consultants, 66 nursing staff and 21 ministerial staff. White coat hypertension was more prevalent in undergraduates. Out of total 147 subjects, who were pre-hypertensives by office blood pressure, 140 subjects (95.2%) were true normotensive and 7 (4.8%) were having masked hypertension. None of the pre-hypertensive subject was having true hypertension. Out of total 96 subjects, who were hypertensives by office blood pressure, only 23 (23.9%) subjects were true hypertensive and majority of 73 subjects (76.1%) were having white coat hypertension. Conclusion: White coat hypertension was more prevalent in undergraduates and masked hypertension was more seen in nursing staff in this study. We did not find any target organ damage in white coat hypertensives and masked hypertensives. They don’t warrant antihypertensive treatment at this stage. These subjects may develop hypertension and target organ damage in upcoming years but earlier than the normal subjects. These subjects should be followed for development of hypertension and target organ damage.

Background: Healthcare workers (HCWs) are the frontline warriors in dealing with the COVID-19 pandemic and similar health crises. In developing countries, HCWs face high stress because they have to deal with the increased patient load and limited infrastructure. Long-term exposure to stress, anxiety, and depression may lead to impaired mental health in HCWs. It is, therefore, essential to assess the mental health of HCWs as a part of their annual health check-up. Objective: The present cross-sectional observational study was aimed to assess the mental health of HCWs by analysing the stress, anxiety and depression during their annual health check-up at a tertiary care hospital in North India. Methods: Total 200 participants, including the consultants, and junior and senior resident doctors, were included in the study. The stress level was analyzed using PSS-10, and anxiety and depression were analyzed using GAD-7 and PHQ-9 respectively. Results: The mean PSS-10 score was 9.39 ± 8.53, indicating low stress among HCWs; the mean GAD-7 score was 5.20 ± 4.19, indicating mild anxiety in HCWs and the mean PHQ-9 score was 3.41 ± 3.59, indicating minimal depression among HCWs. Conclusion: The present study revealed that the HCWs faced minimal to mild stress, anxiety, and depression. It is therefore recommended that the mental health check-up should be made a regular part of the annual health check-up in HCWs so that adequate, timely steps are taken to address the same.

Introduction: Awareness of anatomical variations in lungs is essential during segmental or lobar resections of lungs. The knowledge of variations in the lobar and hilar anatomy of the lung presented in this study is clinically important while interpreting the radiological images and performing surgical procedures.
Methodology: We studied the variations of fissures, lobes and hilar structures in 65 right and 73 left isolated lungs from the dissection hall, Dept Of Anatomy in RVRS Medical College, Bhilwara.
Result: Horizontal fissure was absent in 3.07% and incomplete in 35.38% of right lungs. 4.61% of right lungs had 3 fissures and 4 lobes. 3.07% of right lungs had 3 arteries, 67.69% had 2 arteries, and 29.23% had only one artery in the hilum. 63.07% of right lungs had two veins in the hilum; 32.30% had 3 veins in the hilum; and 4.61% had more than 3 veins in the hilum. 98.46% of right lungs showed 2 bronchi in the hilum, and 1.53% of them showed 3 bronchi in the hilum. Two of the right lungs (3.07%) had an artery passing across the oblique fissure. 15.06% of left lungs showed incomplete oblique fissure and 2.73% showed 2 fissures and 3 lobes. 5.47% of left lungs showed 2 arteries and 94.52% had only one artery in the hilum. 80.82% of left lungs had two veins in the hilum and 19.17% had 3 veins in the hilum. 21.91% of left lungs had 2 bronchi and 78.08% had only one bronchus in the hilum.

Introduction: The ultrasound is a sound wave beyond the audible range of frequency. Clinical application of ultrasound in obstetrics was introduced and popularized by Donald & Glasgow in 1958, the advantage being that the ultrasound is a noninvasive technique causing minimum discomfort to the patient and practically no side effect on the fetus.
Materials and Methods: In present study an analysis will also be made of the variation in the gestational period, associated with the fibular length and socioeconomic, physical and medical factors recorded from obstetric and gynecological records. The patients included in this study were of 13 weeks to 40 weeks of fetal gestational age as diagnosed during the antenatal examination by gynecologist. The present study was conducted in the Department of Anatomy, in coordination with the Department of Radiodiagnosis, LLRM Medical College, Meerut, in pregnant women a during 2^ndand 3^rd trimester. Ultrasonographic measurement of fibular length was done in Radio diagnosis Department of LLRM Medical College, Meerut.
Results: At the 14 weeks of the gestation the mean calculated fibula length was 15.7mm and at 20 weeks was 29.33 mm. The mean fetal fibular length of 51.92 mm was recorded at the age of 30 weeks of gestation whereas the same was 74.51mm at 40 weeks of gestation.
Conclusions: Dating of fetus by fetal fibular length is more accurate than the other fetal parameters and it was found more predictive than other fetal parameters.

Neonatal period is the most susceptible period of life as diseases occurring during this period are majorly preventable. Nearly two third of infant deaths occur within first 28 days of life¹, out of which maximum deaths occur within first week of life ². Nearly 98% of total deaths in neonatal period are mainly caused by infection, asphyxia, LBW and prematuriy².
Objectives:
1)     To study the morbidity patterns and treatment outcomes in neonates managed in Sick Newborn Care Units of Lucknow.
2)     To suggest measures (if, any) to improve the services provided for management of neonates in Sick Newborn Care Units.
Methods: A descriptive cross-sectional study was conducted among 360 neonates managed in Sick Newborn Care Units of district Lucknow. Out of 5 government SNCUs in Lucknow, 3 were randomly chosen. The schedule was pretested on 10 percent of the total sample of neonates admitted to SNCU.
Results: Out of 360 neonates, 65.8% were directly admitted with presenting complain of low birth weight. Majority (88.1%) of neonates were successfully discharged, while 3.1% got expired. Most of the deaths were reported due to respiratory distress syndrome.
Conclusions: The results of the study indicated that all health care providers need to be extensively trained on sick newborn care. Women need to be educated more on neonatal and early neonatal care. The community needs to be informed and made aware of Sick Newborn Care Units.

 
Introduction: The rate of maternal and perinatal complications increases after 39 weeks’ gestation.^[1] Growing body of evidence supports improved or not worsened birth outcomes with non-medically indicated induction of labor at 39 weeks gestation compared with expectant management. This evidence includes 2 recent randomized control trials.^[2-4] This study was conducted to evaluate whether induction of labor at 39 weeks improves perinatal and maternal outcomes in women with low risk pregnancy compared with  induction of labor at 40 + weeks.
Materials and Methods: This was a retrospective observational study in a rural teaching hospital in Mandya, Karnataka, India. The study population was 280 low risk women with an uncomplicated singleton pregnancy induced at 39 weeks (Group A, n=141) versus induction at 40 completed weeks of gestation (Group B, n=139). The data was retrieved from medical records department from January 2021 to April 2022. Mode of birth and other maternal and perinatal outcomes were described in each group, for women who underwent induction of labor at 39 weeks, and for women who gave birth from 40 completed weeks onward. The primary outcome included various modes of delivery. Secondary outcomes included maternal outcome and neonatal morbidity.
Results: In the current study, elective induction at 39 weeks gestation versus elective induction at 40 weeks gestation was compared. Induction at 39 weeks was associated with a decreased likelihood of cesarean birth (17.7% versus 23.7%) and a comparable increase in rate of operative vaginal birth (9.2% vs 10.7%)(p value<0.001). Indication for cesarean delivery in the majority of the study participants in Group A 44% was non-reassuring fetal status while in Group B 45.45% was secondary arrest of cervical dilatation (p value<0.001). An increased incidence of meconium stained amniotic fluid was noted in 19.4% among Group B participants compared to 14.1% in Group A (p value <0.001). In Group A 95.7% of the babies had an APGAR score of 7 at birth and in Group B 90.6% had an APGAR score of 7 at birth (p value <0.001). There was 1.4% neonatal NICU admission in Group A with 0.7% requiring respiratory support (p value<0.001). There was 5.03% neonatal NICU admission in Group B with 2.8% requiring respiratory support (p value<0.001). Term elective induction was associated with a statistically significant decrease in adverse newborn infant outcomes.
Conclusion: Elective induction of labor at 39 weeks gestation is associated with a decrease in cesarean birth and operative delivery and improved neonatal outcomes.

Background: Necrotizing soft tissue infections (NSTIs) are a quickly deadly illness whose prognosis is dependent on early detection and treatment.
Methods: The study included 626 patients, 378 of whom were men and 248 of whom were women, ranging in age from 19 to 67 years. The research was carried out at Department of General Surgery, LSK Hospital, Kishanganj, Bihar for 5 years. The study's samples were taken from patients who came to the hospital with Necrotizing fasciitis. These individuals are undergoing clinical, radiological, and laboratory examinations. Tissue samples are taken for bacterial culture and sent to a laboratory for identification and antibiotic sensitivity testing. The area was examined using X-rays and CT scans. Blood samples were also obtained and sent to a laboratory for a full blood analysis.
Results: In compared to the control group, severe cases have the lowest mean value of WBC (7.1806±1.95788), the lowest mean value of haemoglobin (6.9260±2.25653), and the highest blood levels of creatinine (145.9758±2.33841), glucose (13.8547±1.71067), and the lowest serum sodium (94.0986±0.22220). At the 0.05 level, the mean difference is significant (P<0.05).
Conclusion: A necrotising soft tissue infection is a fatal disorder. It is critical to focus on the aetiology of such a problem in order to begin treatment as soon as possible in order to avoid mortality.

Background: The study of coagulation can be traced back to about 400 BC and to the father of Medicine, Hippocrates. Liver is an important organ of the body having functions of synthesis of plasma proteins and a range of blood clotting factors being produced, some of them exclusively in the organ. All of them are deranged in various liver disorders .Liver plays a predominant role in the regulation of haemostasis. Both cellular and plasmatic coagulation are defective, representing a hallmark of advanced liver disease. Laboratory tests, coagulation tests and liver function tests are useful in the evaluation, management and assessment of prognosis. They provide a sensitive, noninvasive method of screening for the presence of liver dysfunction.
Aim & Objective: 1.To study the proportion of coagulative abnormalities among liver disease patients admitted in medicine wards.2.To study the association of coagulation abnormalities with the extent or severity of liver disease. 3. To predict severity in cirrhosis patients by using Child-Pugh-Turcotte score.
Methods: Study design: Prospective Cross sectional study. Study setting: Department of pathology of tertiary care center. Study duration: April 2021 to April 2022.
Study population: All patients of acute and chronic liver disease admitted to medicine wards in tertiary care hospital such cases included in the study.
Sample size: 200
Results: Majority of cases found in age group of 31-40yrs of age, i.e., 32% of total patients. 174 (87%) were male population and 26 (13%) were female population.78(39%) cases of cirrhosis, 46(23%) cases of hepatitis, 44(22%) cases of Alcoholic liver disease, and 32(16%) cases of other liver diseases. patients showed coagulation abnormalities considering different parameters i.e., PT, APTT, Platelet count individually or in combinations, and 11(5.5%) patients showed normal test results. About 87% (174/200) had prolonged PT. Mean PT in present study was 28.33±22.29. P value was <0.05 i.e., 0.013 which was statistically significant
Conclusions: Majority of cases presented with cirrhosis. The PT was most abnormal test among all tests performed. The platelet count and APTT was the least frequently abnormal test. Hence PT was most significant coagulation test among other tests. The proportion of raised PT was highest in alcoholic liver disease and lowest in case of other liver diseases. Coagulation abnormalities were significantly associated with the extent of liver diseases.

Background: Firefighters work to reduce threats and minimize the potential harm from fire hazards. The nature of firefighters’ work is demanding, often unpredictable and in stressful environments where they are routinely exposed to both mental and physical occupational hazards. This cross-sectional study was conducted to assess prevalence of occupational injuries and the morbidity profile of firefighters in a single metropolitan city.
Methods: In this study, 253 firefighters from the area under Municipal Corporation of Greater Mumbai (MCGM) were included using stratified random sampling method. All consenting firefighters were interviewed in office located in fire brigade using a pre-validated interview schedule and the data was analyzed using SPSS version 22.
Results: From the study, it was found out that abrasion was the most common occupational injury among firefighters. Pre-hypertension and Body Mass Index (BMI) in the overweight category were prevalent findings among firefighters. Association between cadre and years of service with occupational injuries was found out to be statistically significant. Also, the association between diabetes mellitus (DM) and hypertension (HTN) with occupational injuries was found out to be statistically significant. There was no clear association between ages of firefighters and BMI with occupational injuries.
Conclusion: There is a need to conduct more studies in Indian setup on occupational hazards and injuries amongst firefighters. Awareness about normal BMI, management of DM and HTN, healthy food practices, aerobic exercises, prevention and treatment of addictions, a drive for Hepatitis B vaccination, appropriate management of injuries and health insurance will serve a bigger role in diminishing morbidity in this occupation.

INTRODUCTION.: Chronic Obstructive Pulmonary Diseases (COPD) is a common preventable and treatable diseases. An Exacerbation of COPD is an acute worsening of respiratory symptoms beyond normal day-to-day variations. It’s not only presents with respiratory symptoms, but also with many extra pulmonary manifestations. Disturbance in serum electrolytes is one of an extra pulmonary manifestation. The objective of the study was to find out these serum electrolytes (sodium, potassium) abnormalities in Acute Exacerbation of Chronic Obstructive Pulmonary Diseases (AE COPD) patients.
AIM.: To Study Dyselectrolytemia in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients.
MATERIAL AND METHODS.: The present study was a Observational Cross-sectional study was conducted for a period of one and half year in Respiratory Medicine department. In our Tertiary care Centre. 50 patients with AE COPD in age group more than 40 years, Patients diagnosed with COPD based on GOLD guidelines, on history, clinical examination and spirometry, PEFR were included. Detailed history and demographic data of all patients were taken and relevant clinical and laboratory along with Serum Electrolytes (Sodium & Potassium)tests was performed. The values were analysed using statistical software.
RESULTS.: The present study shows sodium and potassium levels below normal limits in patients with AE COPD. The mean Serum Sodium Level in our study was 130.50 ± 3.74 mmol/L and Serum Potassium Level was 3.26 ± 0.37 mEq/L.54%. It was also seen that serum sodium and serum potassium levels were significantly lower in very severe cases. An improvement in PEFR was seen with increase in serum sodium levels whereas no such relation with serum potassium levels.
CONCLUSION.: Dyselectrolytemia (Sodium & Potassium) was commonly encountered in patients presenting with acute exacerbation of COPD. Significant correlation was seen between serum electrolytes and various indicators of severity of acute exacerbation of COPD like spirometry for lung function, GOLD index, PEFR. Early detection and specific management will be helpful for prevention of such abnormality

Aim: The purpose of the present study was to compare sedative, analgesic and cardiovascular effects and safety profile of clonidine and dexmedetomidine for patients requiring short-term sedation in ICU.
Methods: The present prospective randomized clinical study was carried out among 50 patients of either sex conducted in the department of anesthesia after approval from the Institutional Review Board and informed written consent. Over a period of 6 months, 50 patients were enrolled in the study to receive sedation with either dexmedetomidine (n = 25) or clonidine (n = 25). These included 38 postsurgical, 7 medical and 5 polytrauma patients evenly distributed in each group.
Results: The mean ± SD maintenance infusion dose was 0.47 ± 0.27 µg/kg/h for dexmedetomidine and 1.67 ± 8.6 µg/kg/h for clonidine. Bradycardia occurred in 2 of the 25 patients in Group I and 3 of the 25 patients in Group II (P = 0.84). Hypotension occurred in 7 of the 25 patients in Group I and 4 of the 25 patients in Group II (P = 0.01). About 50% of the hypotensive episodes occurred within 2-4 h in Group I and at 2 h in Group II. No patient experienced hypotension after 14 h in Group I and after 6 h in Group II.
Conclusion: Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.

Introduction: COVID-19 infection is expected to be associated with an increased likelihood of sexual dysfunction in males and females in both rural and urban population. Considering high transmission rate of COVID-19, sexual dysfunction can be a concern for the population.
Objective: To assess the sexual dysfunction in COVID-19 recovered patients.
Methods: This cross-sectional study was carried out among 120 patients to assess the sexual dysfunction in COVID-19 recovered patients in IIMSR Medical College and Noor Hospital, Badnapur Dist. Jalna, Maharashtra during the period of January to June 2021.Patients recovered from COVID-19 was contacted after 2 months of recovery. Participants were contacted on telephone for questioning and Sexual Dysfunction Questionnaire (SDQ) was filled as per information provided by the participants. The collected data was entered in Microsoft excel sheet and analyzed by using appropriate statistical tests whenever necessary.
Results: Out of 120 COVID-19 recovered patients who participated in the study, sexual dysfunction was seen in 54 (45%) participants. Total of 72 males participated in the study, of which 36 of them had score more than 45(50%), while from 48 female participants 18 had score more than 45(37.5%).
Conclusion: Exposure to the COVID-19 pandemic and its consequences was associated with increased sexual dysfunctions. Both male and female population with different age groups were affected but in variable degrees.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease, that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to gases or noxious particles. Over the past decade, RDW has been associated with incipient myocardial infarction and heart failure in the general population has emerged as the one of the strongest predictor of poor survival in patients with established heart failure and coronary artery disease.¹² RDW has also been proposed as marker of immune activation correlating with levels of tumour necrosis factor alpha and interleukin-6.The process of inflammation and dysregulated hematopoiesis may be linked, since interleukin6 is important for production of hepcidin in liver and thus may indirectly regulate iron metabolism.^13,14 Hence this study was conducted to observe Red Blood Cell Distribution Width in Patients with chronic obstructive pulmonary disease.
Materials and Methods: Hospital based case control study was conducted on 50 cases each of COPD with and without PH in Sardar Patel Medical College, Bikaner, Rajasthan. Complete blood count and 2D-echocardiography were done, RDW-CV value and pulmonary artery systolic pressure (PASP) were observed.
Conclusion: As the mean RDW-CV values were significantly higher in subjects of COPD with PH than those of COPD without PH in all age groups and both sexes, so we conclude that RDW-CV value can be used as marker to predict PH in patients with COPD in absence of other co-morbidities. Moreover, RDW-CV value also correlates with severity of PH. However, this is a small study and further studies are required on this subject.
 

Introduction: Children are the future of a developing nation, and their health is a vital indicator of their growth. School going children belonging to slums are more disposed to diseases due to unacceptable and unsatisfactory living conditions. Hence, there is a need to identify them and their health problems so that proper interventions can be installed to improve their quality of life.
Aim: To asses the morbidity pattern of children living in an urban slum. 
Materials and Methods: A community-based cross-sectional study was conducted among children in the age group of 0–18 years in one of the urban slums of Aurangabad, Maharashtra. The total population of the urban slum named Misarwadi is 20,400 with ten wards. The total number of houses is 6306, which has a 0–18 year old population of 7621. The baseline survey was conducted with the help of paramedical workers about the demographic composition of the slum area. A total duration of six months (October 2021 to March 2022) was required for doing this study. The calculated sample size required for performing this study was 261. A total of 300 children between 0 and 18 years of age were enrolled in the study, consisting of 170(56.66%) males and 130(43.34%) females.
 Results: The overall prevalence of morbidity among these children was found to be 49.67% (149/300). Malnutrition was the paramount morbidity found in 81(27%) children, followed by dental caries 43(14.33), ARI 14(4.66%), viral fever 8(2.66%), eye problems (4 conjunctivitis and 3 squint) 7(2.33), worm infestation 6 (2%), and diarrhoea 5(1.66%). We also observed other morbidities like gingivitis, injury, dysmenorrhoea, juvenile diabetes mellitus, and tonsillitis. Comparatively, the prevalence of morbidity among females was significantly higher than that among males.
Conclusion: The overall prevalence of various morbidities were found to be higher among children residing in an urban slum. Regular health surveys, medical camps and treatment facilities for children in slum areas are important, with special attention to the needs of female children.

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first described during a pneumonia outbreak in Wuhan, has attracted tremendous attention in a short period of time as the death toll and the number of confirmed cases is growing unceasingly. Although molecular testing is the gold standard method of SARS-CoV-2 detection, the existence of the false-negative results presents a major limitation to this method.
Materials and Methods: Our present study aimed to determine the relationship between NLR and COVID-19 patients underwent treatment. The study was an analytical observational with a cross-sectional approach from May 2021 to January 2022 at the SMMH Medical College, Saharanpur, Uttar Pradesh.
Results: COVID-19 infection is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Diabetes mellitus and heart disease comorbid have high morbidity and mortality. Increased Neutrophils to Lymphocyte Ratio (NLR) assist in early screening of disease severity, especially patients admitted in the Intensive Care Unit (ICU). There was a correlation between NLR in COVID-19 patients who were severely ill and admitted in the ICU with p=0.012.
Conclusion: Increased NLR of COVID-19 patients occurs due to infiltration of the innate and adaptive immune system in infected tissue, resulting in decreased circulating lymphocytes. This subsequently increases NLR in COVID-19 patients. This study found a moderate positive correlation between NLR in COVID-19 patients who were severely ill.

Introduction: Vitamin D deficiency is one of the most common nutritional deficiencies in the world with approximately one billion people at risk. It is on the rise in developed countries, even in Australia where there is an abundance of sunlight. Additional risk factors among newly settled refugees include veiling, dietary deficiencies, darker skin colour and unfamiliarity with the local healthcare system. More specifically, in Australian children with vitamin D deficiency rickets, risk factors include dark skin and maternal veiling with 96-98% of these being children migrants or born to a migrant parent.
Materials & Methods: This study was conducted in a tertiary centre, of Karnataka, India., randomized controlled study was conducted at a tertiary care, between Jan 2018 and Dec 2019. We aimed to compare the efficacy of daily vs. low dose depot oral vitamin D3 for treating nutritional rickets. We conducted a randomised controlled trial in the department of paediatrics of a tertiary care hospital catering to semi-urban and rural population in Karnataka, India. We randomised 30 children, aged 3 months to 5 years with nutritional rickets to receive either daily oral vitamin D3 drops (3-12 months: 2000 IU; > 12 months to 5 years: 4000 IU; n 33) for 12 weeks duration or a single oral depot dose of vitamin D3 granules (3-12 months: 60 000 IU; > 12 months to 5 years: 150 000 IU; n 33). Participants in both groups had comparable demographic characteristics, laboratory features and radiological severity of rickets.

Background: India is one of the fastest vaccination drives in the world which is globally acknowledged for its well-structured immunization program with high vaccination coverage include technical guidance to the government of India in all areas of the pandemic response. This study determined the knowledge, attitudes, practice and concerns regarding COVID-19 vaccine and assess key areas for vaccination programme.
Method: A web based cross-sectional survey was conducted from 1st to 30 December 2021. The study sample size was estimated at 388 at 50% response distribution. A validated KAPC questionnaire set up via Google Forms and access link was then shared via online platforms. The volunteering participants in this survey submitted completed questionnaire and simple descriptive analyses, including frequencies and percentages were computed by using SPSS software version 21.
Results: The demographic findings of this study showed that major participants were from upper class (66.4%), graduated (76.9%) and from urban area (71.4%). About 17.6% respondents showed their fear about the fast progression of vaccine, while 79.6 % participants showed willingness to take vaccine and only 7.6% participants concerned about serious side effects after taking vaccination.
Conclusion: Community participation for effective vaccination programme can be possible with right knowledge for taking informed decision which includes clear, accurate, consistent strategic communication.

Aim: Comparative study between diagnostic nasal endoscopy and computed tomographic scan paranasal sinuses.
Methods: This prospective comparative study was carried out in the Department of ENT, Shri Shankaracharya Institute of Medical Sciences (SSIMS), Bhilai, India, for the period of 1 year, after taking the approval of the protocol review committee and institutional ethics committee. 100 patients who visited the ENT OPD, those suffering from at least two of the symptoms of chronic rhinosinusitis and not responding to 3 weeks of medical treatment were selected.
Results: Most common symptom experienced was nasal obstruction 91%, followed by nasal discharge 83%, facial pain/headache 77%, anosmia/hyposmia 37%, sneezing 33%, nasal bleeding 9%. Among 100 patients who underwent for nasal endoscopy, oedematous mucosa was found in 45% patients, among them 15% had mild oedema and 30% had severe oedema. According to scoring system 91% patients were diagnosed on CT scan and 85% patients were diagnosed on nasal endoscopy. 9% and 15% were not diagnosed on CT scan and nasal endoscopy respectively. So, by considering CT scan as accurate diagnostic procedure, the accuracy of nasal endoscopy was calculated. The sensitivity of nasal endoscopy is 89.88%. So, the probability of diagnosing CRS when it is present is 89.88%. The specificity is 61%. So, NE has 61% ability to exclude the disease. The chi square value at degree of freedom 1 was 8.12 and p value was 0.0041, which was significant at p<0.05, indicates that CT PNS was more accurate than diagnostic nasal endoscopy in diagnosing chronic rhinosinusitis.
Conclusion: Nasal endoscopy should be performed in all patients who meet diagnostic criteria of chronic rhinosinusitis as an early diagnostic tool as it has an advantage of being harmless, no radiation exposure, less cost, less time consuming and is an OPD based procedure.
 

Background: SARS-CoV-2 (Severe acute respiratory syndrome corona virus 2) seroprevalence studies are being conducted all over the world to identify the level of exposure to the virus, thus giving us a true estimate of the hidden burden of infection in undiagnosed asymptomatic subjects.
Aim: To determine the serological status for SARS CoV 2 among unvaccinated frontline health care workers in a Covid designated hospital.
Materials and methods - A mono-centric, retrospective, observational, cross sectional study was carried out with the institutional ethical committee approval (CTRI/2021/03/031933). 269 HCW were tested for SARS COV-2 antibodies. Out of these, 250 were frontline HCWs posted in Covid wards. Their data on demographics and symptomology was collected through validated Questionnaires. HCWswith active symptoms and a positive RT-PCR history of less than 14 days at the time of testing were excluded. IgG antibodies were detected by CLIA with 100% sensitivity and 99.8% specificity. A p value of Results: Data regarding RT-PCR and serological status was collected from all the 250 subjects, but only 174 questionnaires which were completed was analyzed statistically. Among the 250 subjects, 43(17.2%, 95%CI: 0.125,0.219) were seropositive and 14(5.6%) were positive for RTPCR. 70%(n=30) of the seropositive HCWs were totally asymptomatic. About 84% of the asymptomatic seropositive subjects were RT-PCR negative, thus reflecting the hidden burden of the infection. Further statistical analysis on the background characteristics was done only for 174 individuals out of the 250 HCWs. 19% of the medical staff were reactive compared to 37.7% of reactivity among the non-medical staff and this was the only statistical significance observed(p=0.008). No significant difference was noted with respect to gender, age, department, BCG vaccination, use of immune boosters or HCQ, no of days of exposure.
Conclusion: This analysis helped us generate a pre vaccination baseline information regarding the proportion of asymptomatic / symptomatic frontline workers with respect to serological status. If asymptomatic, they remain undiagnosed, thus playing a significant role in  Covid transmission and crippling the healthcare system, and emphasize on educating our non-medical staff on the importance of PPE use, provides an opportunity for generating a database and data comparison of this newly emerged viral disease, thus helping in predicting and monitoring the future course of the pandemic.

Purpose
▪         To identify the stress‑related physiological parameters of ophthalmic surgeons during complicated cataract surgeries and compare the same factors with uncomplicated routine cataract surgery and study the variations between the two groups.
Method: Patients attending the Karnataka Institute of Medical Sciences ophthalmology OPD were considered for the study. The patients included in this study ranged between 45 and 80 years of age, they were grouped into two groups of 50 patients each and divided into complicated and uncomplicated cases. Group 1 included patients having cataracts corresponding to nuclear sclerosis ≤ Grade 4, posterior subcapsular cataract, and cataract with good pupillary dilatation (>7 mm) and no other ocular comorbidities. Group 2 included patients with mature, hypermature cataract, posterior polar cataract, traumatic cataract, cataract with poor pupillary dilatation (<5 mm), one‑eyed patients, pseudo‑exfoliative syndrome, patients with chronic or recurrent uveitis, floppy iris syndrome, and systemic comorbidities (cognitive disorder, Parkinson’s disease, Alzheimer’s disease, patients on tamsulosin). All patients underwent manual small incision cataract surgery with intraocular lens implantation. The outcomes measured were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and saturation of peripheral oxygen (SpO2). The surgeons were required to answer a set of questions to assess any external factors adding to stress during surgeries.
Results: In this study, we noted that the mean systolic blood pressure (SBP) pre-surgery and post-surgery was 135.8 ±5.38mm Hg and 131.8 ± 4.85 mm Hg respectively in uncomplicated cases. The mean SBP pre-surgery and post-surgery in complicated cases was 141.64 ± 6.4 mm Hg and 138.12 ± 8.21mm Hg respectively in uncomplicated cases. These were statistically significant (p = <0.005). Mean Arterial Pressure (MAP) showed significant changes. It ranged between 100.63 ± 3.83mm Hg pre-surgery and 99.27 ± 2.84mm Hg post-surgery in the uncomplicated group. While it ranged between 104.71 ± 4.27mm Hg and 101.29 ± 4.52mm Hg pre and post-surgery in the complicated surgery. The heart rate (HR) showed significant variation post-surgery in both groups between 87 ±1.01 and 86.16 ± 0.55  in group 1 and 2 respectively. The oxygen saturation (SPO₂) varied between 97.98 ± 0.14% pre and post-surgery in group 1. In group 2 it varied between 97.5 ± 0.51% post-surgery which was significant (<0.005). There was a significant change in post op DBP, MAP and heart rate in complicated groups compared to uncomplicated groups. In uncomplicated cases a decrease in the heart rate was noted but the same was significant after a complicated case. In order to identify other factors that lead to a decrease in heart rate a linear regression study was done by comparing it with PSAQ scores. Even in this measurement there was a significant reduction of heart rate in complicated cases and in those case with a PSAQ score of 3.
Conclusion: A surgeon being the most important factor for a successful surgery bears the pressures of imparting his best in each case. Physiological parameters such as heart rate, systolic and diastolic blood pressures, mean arterial pressures fluctuate with different levels of stress. This study helps to identify these variations while performing a complicated case compared to that of a routine case. As the differences in these vary significantly controlling these might help in the betterment of a surgeons’ mental health which is directly proportional to a better visual outcomes in the patients. This study also enables a surgeon to undertake steps to overcome a chronic burnout in the form of meticulous planning of the cases, exercise and relaxation techniques.
 

 
In empyema, white blood cells migrate to infected pleural space causing release of fibrinogen and its conversion to fibrin, which causes tissue surfaces to adhere and this will trap micro-organisms and prevent host defence mechanisms and antibiotics from reaching the site of infection. ICTD with antibiotics remains the cornerstone in management of pediatric empyema. But ICTD is hampered by presence of either thick pus which tends to block tube or fibrin deposition causing multiple loculations that cannot be drained by single chest tube. Decision for insertion of ICD was taken depending upon clinical condition of the patient, radiological and laboratory evidence. Single dose of Inj. Streptokinase, 15,000 IU/kg body wt. was dissolved in 100ml normal saline and instilled in pleural cavity through ICD over a period of 1 hour and tube was clamped for 4 hours. Patient was asked to frequently change position, so that Streptokinase could thoroughly spread in pleural cavity. 25/27 (92.5%) in ICD group had good lung expansion on follow-up. Two had persistent collapse who improved further on physiotherapy. All patients in ICD with SK group had good lung expansion.
 

Introduction: Meningitis is a serious infection of the meninges, the membranes covering the brain and spinal cord. It is a devastating disease and remains a major public health challenge. Acute bacterial meningitis (ABM) remains a serious global health threat with high mortality and morbidity, despite advances in antibiotic therapy and modern vaccination strategies. Tuberculosis (TB) remains the major cause of ill health, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent.
Methods and Methodology: A hospital-based simple prospective observational study was carried out among 56 cases, between the age groups 2 months to 14 years, who fit into clinical diagnosis of bacterial meningitis.
Results: A total of 56 cases of meningitis were included &analyzed for the study. Mean CSF cell count was significantly higher in ABM group as compared to TBM (374.67±252.55 vs 175±78.64). Lymphocyte predominance is seen in all the TBM cases and Neutrophils predominance is seen in majority of ABM cases (p<0.05). CSF ADA >8 is seen significantly in all the TBM cases compared to ABM cases (p<0.05). CSF CBNAAT was positive significantly in TBM cases compared to ABM (p<0.05). Mean CSF protein count was significantly higher in TBM group as compared to ABM (219.4±55.64 vs 108.44±33.04).
Conclusion: CBNAAT should be used in preference to conventional methods as the initial diagnostic test for patients suspected of having TB. CBNAAT positivity shows significant association with positive Mantoux test and CSF analysis suggestive of TBM.

The most common type of HAIs in children is bloodstream infections, pneumonia (ventilator-associated VAP), urinary tract infections (UTI), skin and surgical site infections. Organisms such as gram-negative bacilli, coagulase-negative staphylococci, coagulase-positive staphylococci, Pseudomonas spp., and streptococcus are the main causes of HAIs. Children diagnosed to have Community acquired nosocomial infections in the pediatric intensive care unit stay of more than 48 hours between the age group of 1 month to 12 years admitted in PICU of Tertiary care Hospital, who fulfilled the inclusion criteria. The age, sex, nutritional status, incidence of anaemia and site of nosocomial infections of dead and discharged patients was comparable and statistically not significant as per Chi-Square test (p>0.05). The mean duration of PICU stay (10.77 ± 3.80 days vs. 7.63 ± 4.27 days), requirement of mechanical ventilation (86.4% vs. 35.9%) and requirement of reintubation (13.6% vs. 0%) was significantly higher in dead patients compared to discharged patients (p<0.05).

The incidence of nosocomial infections in Intensive Care Units (ICU) is showing a rising trend mainly because of increasing invasive procedures performed in the ICU. The therapeutic interventions that have been recognized as associated with infectious complications include-indwelling urinary catheters, sophisticated life support, intravenous fluid therapy, cardiovascular prosthetic devices, implantable orthopedic prosthesis, immunosuppressive therapy etc. All the patients in the age group of 1 month to 12 years admitted in PICU with stay of more than 48 hours were daily monitored for fever or any other symptoms or sign suggestive of any infection. The patients who developed the same 48 hours after admission, which was not present at the time of admission, were included. Centers for Disease Control and Prevention definitions of nosocomial infections, used as criteria for diagnosis of infections. The most common site of nosocomial infections was blood stream infection (62.1%) followed by ventilator associated pneumonia (17.2%), skin infection (6.9%), urinary tract infection (6.9%) and surgical site infection (6.9%).
 

Half a million people die every year due to COPD in India, about over 4 times the number in USA & Europe. Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals. The subjects recruited directly from the department of pulmonary medicine based on the inclusion and exclusion criteria. Minimum 60 subjects needed for the study. The parameters of lung volumes (SVC, FVC, FEV1, FEV1/FVC%, FEV1/SVC%) recorded by ATS standardized MEDISOFT® spirometry. FEV1/SVC diagnosed obstruction in 36 out of 38 patients (94.74%) compared to FEV1/FVC which diagnosed obstruction in 27 out of 38 patients (71.05%) with statistical significance (p= 0.009). The discrepancy is 23.69%.

Asthmatic symptoms characteristically come and go, with a time course of hours to days, resolving spontaneously with removal from the triggering stimulus or in response to antiasthmatic medications. Patients with asthma may remain asymptomatic for long periods of time. Report of symptoms that occur or worsen at night is a feature of asthma. The subjects recruited directly from the department of pulmonary medicine based on the inclusion and
exclusion criteria. Minimum 60 subjects needed for the study. The parameters of lung volumes (SVC, FVC, FEV1, FEV1/FVC%, FEV1/SVC%) recorded by ATS standardized MEDISOFT® spirometry. FEV1/SVC diagnosed obstruction in 33 out of 41 patients (80.49%) compared to FEV1/FVC which diagnosed obstruction in 16 out of 41 patients (39.02%) with statistical significance (p=0.000). The discrepancy is 41.47%.

The prevalence of COPD is expected to rise over the next 30 years because of the increasing prevalence of smoking in developing countries, and aging populations in high- income countries. It has been predicted that by the year 2030, 4.5 million COPD related deaths occur annually. The subjects recruited directly from the department of pulmonary medicine based on the inclusion and exclusion criteria. Minimum 60 subjects needed for the study. The parameters of lung volumes (SVC, FVC, FEV1, FEV1/FVC%, FEV1/SVC%) recorded by ATS standardized MEDISOFT® spirometry. Out of 38 patients, 32 patients were smokers (84.21%), 5 patients who exposed to bio mass fuel were females (13.16%) and 1 patient had occupational exposure (2.63%). Out of 41 patients, 35 were having allergy (85.4%), 6 were not having allergy (14.6%).