European Journal of Molecular & Clinical Medicine

Background & Aims: Environmental air pollution including vehicular emissions remains a health hazard to those exposed including traffic policemen working in various metro and non-metro cities. The aim of this study is to evaluate the pulmonary functions of the traffic police officers posted at various traffic junctions throughout Pune city in order to ascertain whether prolonged exposure to environmental air pollution including vehicle exhausts have any adverse effects on the traffic police officers' lung functions.

ABSTRACT   Pheochromocytomas are catecholamine secreting tumours that arise from chromaffin cells of the sympathoadrenal system. They account for fewer than 0.1% of all cases of hypertension in adults but have lethal potential and are one of the few truly curable forms of hypertension. The symptoms with the greatest “pooled sensitivity” are hypertension, headache, palpitation, and diaphoresis. The diagnosis is based on these symptoms and high levels of plasma-free normetanephrine and/or metanephrine. This report is of the successful anaesthetic management of a 40-year-old female, a known case of hypertension for 10 years, with only low back ache, and vomiting as her presenting complaints, posted for excision of a retroperitoneal mass, whose intraoperative tumour manipulation led to a hypertensive crisis, showing its true colours! The histopathological report of resected specimen, obtained postoperatively, came to be consistent with pheochromocytoma. A high level of clinical suspicion of pheochromocytoma in such cases will turn out to be the saviour of the day, by prompting us to meticulously evaluate, appropriately optimise and adequately prepare for any intraoperative events in an otherwise “simple case abdominal mass excision!”

The importance of health to society cannot be overstated. A key consideration for assessing social development is health. India and other developing nations face health problems. Numerous programmes have been established by the Indian Government to address public health issues. However, rural Indians are unaware about the health programme. The goal of the current study is to determine how informed people are of health-related initiatives. With the help of a closed-ended questionnaire, we conducted the survey. The findings show that opinion leaders are essential in helping the Indian government's health awareness efforts reach Bihar's rural residents. Although the audience's level of awareness is appropriate, more effort must be put into promotion.

Controlled ventilation with an endotracheal tube (ETT) has been considered gold standard. However, ETI is associated with hemodynamic instability during laryngoscopy and intubation and post operative complications which can be overcome by using IGEL. As there are only limited studies comparing its ventilatory efficacy to ETT, our comparative study evaluated adequacy of ventilation and clinical performance.

In medical practise, an electrocardiogram (ECG) is a crucial indicator tool for assessing cardiovascular arrhythmias. In this study, a machine learning system is used to compare patient ECGs and perform programmed ECG arrhythmia identification. The system was previously tuned based on an overall image informational index. Arrhythmias are more prevalent in those over the age of 60. A convolutional neural network (particularly, Alex Net) is utilised to extract features, and the highlights are then passed via a basic back spread neural network to finish the classification. The fundamental purpose of this research is to provide a simple, effective, and relevant learning strategy for categorising the three types of heart conditions (cardiac defects) so that a diagnosis may be made. The findings showed that when a moving deep learning highlight extractor was combined with a standard back proliferation neural architecture, very elite rates could be achieved. In a comparative analysis, validation accuracy was shown to be 100 percent in Google Net, 94 percent in Squeeze Net, and about 97.33 percent in Alex Net.

Shoulder joint is a diarthrodial joint of ball and socket variety. Various components of shoulder joint start developing in early embryonic and foetal life at around 8 to 10 weeks. The present study aims to highlight the development of vascularity and cartilage canals around shoulder joint. Shoulder joint of 32 foetuses collected from areas in and around Jammu were dissected properly and decalcified in Gooding and Stewart’s solution. Sections were cut after obtaining blocks by paraffin wax embedding method. Slides were stained using Haematoxylin and Eosin and Masson’s trichrome and important findings were documented. Head of humerus is vascularised by cartilage canals by 10 weeks which arise from perichondrial vessels. In scapula, they develop around 12 weeks. Branching of cartilage canals is seen by 14 weeks. Synovial villi appear by 14 weeks and are vascularised by 16 weeks. Blood vessels enter joint in subcoracoid region. Epiphyseal vessels are seen to communicate with diaphyseal vessels at 17 weeks. Capillaries are seen in free margin of glenoid labrum by 12 to 12-1/2 weeks. Blood vessels are seen to develop in tendon of various muscles from 16 to 18 weeks.

 India stands second-biggest broadcast communications market on the   planet. As about   January 2021, all out endorser base in the nation was at 1,183.49 million, while Gross income about   telecom area remained at Rs.185 billion in the second quarter about   2022. Since most recent 6-years there are parcel about   issues ,  issues looked by little organizations who were ruthlessly squashed by telecom pioneer. paper is  endeavor to concentrate on the   monetary execution about   significant telecom organizations about   India after section about   Dependence JIO. The company commonly referred to as Dependence Jio is Dependence Jio Infocomm Restricted. Plan about Action About Dependence Jio also recalls MTS, Milicom, TeliaSonera, Orange, English Telecom, Rogers, Tim, and Deutsche Telecom as directing current focus in the most effective way inductive methodology has been used to the telecom industry. Additionally, interpretivism thinking has been accepted, a test with a sample size of around 10 chiefs employed by Dependence Jio has been attempted, and crucial information has been obtained with the aid of a poll among managers employed by Dependence Jio.

This research is based on comparative financial analysis of selected Public and Private Sector Banks using ratios, The banks are selected based on top five & bottom five market capital of the Public and Private sector banks, Earning ratios(Net Interest Margin, Yield on Advances, Return on Equity, Return on Asset), Debt coverage ratios(cash deposit ratio, Investment deposit ratio, Debt to equity ratio, Loan to deposit ratio), Efficiency ratios(Net Non-performing Asset, Cost to income ratio, Operating cost to Asset ratio, Cost of liabilities), Growth ratios(Advances growth, EPS growth, Operating income growth), Liquidity ratios(Credit to deposit ratio, Current and Saving Account ratio, Interest expended to Total fund, Interest income to total fund),Balance sheet ratios(Capital adequacy ratio, Advance/loan fund)Leverage ratio(Current ratio and Quick ratio) Profit and Loss ratios(Interest expended to Interest earned, Other income to Total Income, Operating expenses to Total income) and etc.., this are some ratios which is used in this research, A Graphical representation is used to rank the performance of the bank and T-test is used to comparative analysis of the Public and Private sector banks Regression is used to find out the relation & Predictability of Liquidity(Current ratio, Cash to Deposit ratio, Credit to Deposit ratio, Investment to Deposit ratio) and profitability(Return on Equity, Net Interest Margin) of both Private and Public banks . The ratio data is taken One Year (2019), and this study is mainly focus on to find out the best sector in banking sector.

Age being one of the primary characteristics in establishing the identity of the individual, its estimation becomes an important task for the forensic expert especially in developing countries where birth records are not well maintained. In living it is not only important for identification but also for various civil and criminal purposes. Even the courts in India accept the ossification test as the reliable indicator of age as compared to physical and dental assessment of age.
This study comprised of 250 female subjects from Puducherry region, India. The age group of the subjects ranged from 14 to 19 years. Radiographs of the right wrist joint with hand of these subjects were taken and the epiphyseal union of the centres at the wrist joint and hand were noted.

Age estimation plays a vital role in establishing the identity of the individual for the forensic expert especially in developing countries where birth records are not well maintained. In living it is not only important for identification but also for various civil and criminal purposes. Even the courts in India accept the ossification test as the reliable indicator of age as compared to physical and dental assessment of age.
This study comprised of 250 male subjects from Puducherry UT, India. The age group of the subjects ranged from 14 to 19 years. Radiographs of the right wrist joint with hand of these subjects were taken and the epiphyseal union of the centres at the wrist joint and hand were noted. The findings were compared with the recorded age given by various research workers.

Background & Objective - This study aimed to compare efficacy of nalbuphine and fentanyl as adjuvant to bupivacaine in providing intra-operative anesthesia and post-operative analgesia in lower limb orthopedic surgeries, and to compare the characteristic of sensory and motor block, hemodynamic parameter, time of first rescue analgesia and adverse effects between two groups.
Method- In this clinical trial, 80 patients undergoing elective lower limb orthopedic surgeries under spinal anesthesia were randomly allocated in two groups. In group BN, the patients received 0.5% 3ml (Heavy Bupivacaine + 800 mcg Nalbuphine. In group BF patients received 0.5% 3ml (Heavy Bupivacaine + 25mcg Fentanyl.
Result & interpretation- The Onset of motor block, maximum level of block and time to reach peak level of block was significantly faster in group BF.While duration of motor block and time for first rescue analgesia was significantly prolonged in BN group. However, there was no significant difference in time for two segment regression=0.157 (NS) and hemodynamic changes.
Conclusion- We conclude that combination of fentanyl as adjuvant to bupivacaine provides higher segmental level sensory blockage, faster sensory and motor blockage than nalbuphine. But nalbuphine gives longer time of post-operative analgesia than fentanyl.

INTRODUCTION - The posterior cruciate ligament (PCL) is a crucial component that helps keep the knee stable during flexion and rotation. Because the PCL is so robust, avulsion fractures at the PCL's attachment location are common. For complete restoration of PCL function, it is generally believed that avulsion fractures of the PCL should be anatomically reduced and fixed. Conservative therapies usually result in unsatisfactory outcomes, primarily due to functional disability and fracture non-union. Many surgeons think that the displaced or unstable tibial avulsion fracture of the PCL should be reduced and repaired anatomically using various techniques.

A vascular catheter may be saved if an intraluminal antibiotic lock treatment is used in the case of catheter-related bloodstream infections. These recently developed antibiotics were compared to the older antibiotics vancomycin and minocycline against methicillin-resistant Staphylococcus aureus (MRSA) embedded in biofilms in this in vitro study. We examined the emergence of MRSA after four hours of daily catheter lock therapy that was resistant to these antibiotics alone and with rifampin. Compared to linezolid, vancomycin, and the negative control, minocycline, daptomycin, and tigecycline are more effective at inhibiting MRSA in biofilms after the first day of exposure (P 0.001), with minocycline being the most active and daptomycin and tigecycline having weak activity, similar to the negative control. Among the antibiotics tested, daptomycin was the fastest in eliminating MRSA from biofilm after three days of exposure for 4-hour periods, followed by minocycline and tigecycline, which were faster than linezolid, rifampin, and vancomycin (P 0.001). After five days of exposure to MRSA continuously for four hours each day, rifampin alone was least effective at eradicating MRSA from biofilms because it promoted rifampin-resistant MRSA growth. It has been found that when rifampin is combined with additional antibiotics, the combination is far more effective at eliminating MRSA colonization than any single antibiotic alone. Daptomycin, minocycline, and tigecycline lock therapy also needs to be researched, as should the potential for rifampin's antistaphylococcal activity as a single agent, but not as a combined solution.

We have searched the literature for evidence of the pharmacokinetics (PK) effect of rifampin. Ambroxol co-administration was proven to be beneficial in the rat model, according to reports. A half-life increase in ambroxol levels in the lung tissue, leading to higher levels of rifampin in the lungs, [5] indicating a double increase in high concentration (Cmax) and an 80% increase in high concentration (Cmax) in mice. Any developments were evaluated in terms of their ability to develop literature. Drug-resistant and drug-resistant germs can be treated. Most pre-clinical trials use complete animals. Despite the fact that lung tissue levels are measured, most clinical studies rely on less invasive procedures such as sputum or bronchoalveolar lavage. In a pre-clinical study, Wiemeyer used mice given 50 mg / kg of oral ampicillin and amoxicillin. with or without oral ambroxol at a dose of 10 mg / kg, compared with the average human dose Ampicillin and amoxicillin tissue concentration increased by 23% and 27%, respectively, with combined ambroxol treatment. However, an increase in the level of antibiotics in the lung tissue is less likely to allow the treatment of antimicrobials, and many doses of antibiotics are already effective in the clinic, so improved effects of ambroxol combination therapy are also not possible. According to at least one clinical report of each class, bromhexine and ambroxol improve the levels of a variety of antimicrobial drugs in the lungs, including beta lactam, erythromycin, rifampin, and vancomycin. Aminoglycosides, fluoroquinolones, sulfonamides, and tetracyclines did not show the same increase, however it is unclear whether this is due to bias in the negative feedback reports or lack of research on these drugs.

The effectiveness of various imaging modalities in locating the mandibular canal was evaluated, including computed tomography (CT), panoramic radiography, and tomography. Cone-beam computed tomography (CBCT), a recently established imaging technique, appears to be a promising one that, when compared to conventional CT, also significantly lowers patient exposure. There are no studies in the literature comparing its performance with other conventional imaging modalities in such delicate tasks as mandibular-canal identification. This study compared digital panoramic photos and CBCT-reformatted panoramic images to identify the mandibular canal as part of preimplant evaluation.

Road Traffic Accident (RTA) is described as "an occurrence that takes place on a route or street open to public traffic; resulting in one or more individuals being hurt or killed, when at least one moving vehicle is involved”. The rapid growth of individualised means of transportation, the mix of slow- and fast-moving cars, a lack of roadside discipline, drunk driving, and cell phone usage while driving are the main contributors to RTA in our nation.
Aims and objectives
1. To study the dynamics of accident and site of injury in the victims
2. To identify the common type of vehicles and injuries produced in a road traffic accident.
Materials and Methods: The hospital based descriptive study was conducted in the Department of Forensic Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry during a period of one year from May 2013 to June 2014. Among 781 patients were taken during the study period. After obtaining informed consent, the principal investigator was collected the data using structured questionnaire contain basic characteristics like, age, gender, history of alcohol consumption, Dynamics of accident, Site of the injury and types of vehicles used at the time of injury.
Results: The median age of the study participant was 31.00 (IQR 23 – 43) years. Among 781 cases, 664 (85.01%) were males and 117(14.98%) were females. Skid and fall from two wheeler is the most common type of accident which constitutes to about 32.1% of all types of accidents. Head is the most common part injured (24.0%), followed by lower limb (16.9%), and followed by upper limbs (16%). Most of the cased had two wheeler accident.
Conclusion: These dynamics, accident sites, and accident types may shed light on it, and the nation may need to enact stricter laws and raise awareness of the issue.

Aim: Acute nonspecific abdominal pain (NSAP) is frequently encountered in the daily medical practice. This prospective study was performed to elucidate the role of early laparoscopy in the management of NSAP and to compare it with active clinical observation in such cases.
Methodology: A total of 100 cases with acute NSAP were randomly divided into two groups: early diagnostic laparoscopy (EDL) group included 50 cases who underwent EDL, and observational group included the remaining 50 cases who were closely observed. Outcome measures included the definitive diagnosis, operative time, duration of hospitalization, and postoperative morbidity.
Results: No statistically significant difference was noticed between the study groups regarding demographics. However, the duration of symptoms showed significant prolongation in the observation group. Regarding the final definitive diagnosis, no significant difference was noticed between the two groups (P <0.001). No definite diagnosis was reached in 12 and 52% of cases in the EDL and observation groups, respectively. In the observation group, 18 cases underwent laparoscopic assessment after admission (36%). The duration of hospitalization was significantly prolonged in the observational group. In addition, both recurrence and readmission were more reported in the same group during 15-day and 6-month follow-up visits.
Conclusion: Diagnostic laparoscopy appears to be a reliable tool to reach a definite diagnosis in patients with NSAP because of its superior diagnostic ability, better visualization, low complications, and the ability to manage the pathology in the same setting.

Aim: To assess and grade the degree of difficulty in laparoscopic cholecystectomy and their postoperative outcome using intra operative scoring system devised.
Methodology: One hundred three consecutive patients who underwent elective laparoscopic cholecystectomy in our institute, were included in the study. Inclusion criteria was all the cases of elective laparoscopic cholecystectomy and exclusion criteria was cases in which directly open cholecystectomy was performed. Intraoperative findings were assessed on the basis of five key aspects which includes: 1) Gallbladder appearance and amount of adhesions; 2) Degree of distension/ contraction of the gallbladder; 3) Ease of access; 4) Local/septic complications; and 5) Time taken to identify the cystic artery and duct.
Results: Total 103 patients of laparoscopic cholecystectomy were included in this study. The severity score was between 2-4 in 63 (61.16%) patients and between 5-7 in 20 (19.41%) patients. Mild to moderate degree of difficulty was encountered in 80 (77.66%), severe degree in 20 (19.41%) and extreme degree of difficulty in 03 (2.91%) patients in performing cholecystectomy and conversion to open surgery were done in 08 (7.76%) patients with score between 6 to 8
Conclusion: This scoring system is useful and reliable. If the intraoperative severity score is more, the severity of cholecystitis increases and then it is more difficult to perform laparoscopic cholecystectomy

Aim: Purpose of the present study was to evaluate the risk in cases of laproscopic cholecystectomy
Methodology: A Medline search was conducted to review all published English literatures relevant to difficult cholecystectomy through 2009 to 2022. The search words were “laparoscopic cholecystectomy,” “difficult cholecystectomy,” “difficult laparoscopy,” “subtotal laparoscopiccholecystectomy,” “fundus first cholecystectomy,” and “causes of conversion of laparoscopic cholecystectomy.”
Results: Sixty-seven studies, which included 324,553 patients, were selected for this review. Five major categories of difficulty were identified. Conversion rate and iatrogenic injuries during laparoscopic cholecystectomy are still high despite significant improvement over the last 10 years. Depending on the technique of cholecystectomy, the degree of gall bladder inflammation, patient comorbidities, and surgical experience, the conversion rate was reported between 0.18% and 30%, whereas the incidence of iatrogenic injuries was from 0% to 0.6%. Subtotal cholecystectomy, antegrade and fundus first techniques, and pre-operative cholangiogram were associated with lower complications and conversion rate. Risk factors for difficulty were male sex, increased age, acute and thick wall chronic cholecystitis, wide and short cystic duct, cholecysto-digestive fistula, previous upper abdominal surgery, obesity, liver cirrhosis, anatomic variation, cholangiocarcinoma, and low surgeon’s caseload.
Conclusion: No consensus is found among surgeons on how to manage difficult laparoscopic cholecystectomy. Iatrogenic injuries and conversion rate can be reduced depending on the surgeon’s experience, special techniques, and intraoperative investigations

Aim: The purpose of the present study was to evaluate the incidence as well as prevalence of perforation peritonitis in a tertiary care centre.
Methodology: This descriptive cross-sectional study was conducted from 2021 to 2022 with a sample size of 30 patients. All details of the patients including clinical history, examination findings, laboratory and radiological investigations, intra-operative findings, and post-operative complications were studied.
Results: Perforation peritonitis had a male: female ratio of 3.29:1; and was more commonly seen between the age group of 21-30 years, whereas peptic ulcer perforation had a bimodal distribution (21-30 years and 51-60 years). Commonest aetiology was peptic ulcer perforation, followed by appendicitis and enteric fever. Majority of patients presented after 48 hours, in the stage of established generalised peritonitis. The diagnosis was possible by pneumoperitoneum on X-ray abdomen standing in 70% and only a few needed CT for diagnosis. Laparotomy followed by primary closure of perforation with or without live omental patch was the commonest procedure.
Conclusion: E. coli was the most common peritoneal contaminating organism followed by Klebsiella and Proteus mirabilis. The post-operative complication rate was 53.3% (wound infection 30%) and the mortality rate was 3.3%. Appendicectomy was done in appendicular perforation whereas occasionally, resection anastomosis of involved small bowel segment was required.

Aim: The purpose of the present research was to assess the pediatric burn cases describing time of injury, first aid provided and time taken to present in the specialized burn unit.
Methodology: A Retrospective study was conducted in Osmania general Hospital, Hyderabad, Andhra Pradesh, India, over a period of  24 months from January 2011 to January 2013.Paediatric burns comprise 12.99% of the total burns. All male, female in-Patients belonging to paediatric age group (0-15years), admitted in Burns Unit of our Hospital were included in the study. Maintenance fluids were given at hourly rate of 4ml/kg for first 10kg body weight+ 2ml/kg for second 10kg body weight+ 1ml/kg for >20kg body wt. Collagen was applied to all children with superficial burns and partial thickness burns that come before 24- 48hr from the time of incident.
Results: 2-5 years children were commonly affected followed by age group between 11-15, next in order by 6-10 years. Meal times (especially lunch, 11a.m.-2 p.m. and dinner 6p.m -9 p.m.) clearly had the highest number of burn accidents. Most of the children with burns were reported to the hospital within 24 hours because of increased public awareness (370 children -81.2%). Most of the children received first-aid in the form of Water (328 children-72%).
Conclusion: Most important step in prevention is public education and availability of good burn care facilities in all public institutions as near to the place of accident as possible.

Aim: The purpose of the present study was to assess paediatric burn cases based on variables like- Total body surface area (TSBA) involved, parents literacy rates as well their employment status.
Methodology: A Retrospective study was conducted in Osmania general Hospital, Hyderabad, Andhra Pradesh, India,over a period of 24 months from January 2011 to January 2013.Paediatric burns comprise 12.99% of the total burns. All male, female in-Patients belonging to paediatric age group (0-15years), admitted in Burns Unit of our Hospital were included in the study. Maintenance fluids were given at hourly rate of 4ml/kg for first 10kg body weight+ 2ml/kg for second 10kg body weight+ 1ml/kg for >20kg body wt. Collagen was applied to all children with superficial burns and partial thickness burns that come before 24- 48hr from the time of incident.
Results: Burns occurred commonly in children with illiterate (76.48%) and unemployed (69.21%) parents. Dinner time (35%) and colder months of the year were more prone timings. Most of the burns were accidental (98.56%). Flame burns predominated (47.79%) scalds (37.5%). Most of the children sustained burns of 11-30% TBSA (40.56%).
Conclusion: It was evident that literacy as well as being employed helped prevent burn incidents in pediatric cases.

Background: Lateral Epicondylitis also known as Tennis elbow is a very prevalent condition of our country frequently involving the low socio-economic profile population of laborers in males and housewife in females. The study was conducted to evaluate for additional effects of Platelet rich plasma over usual conventional conservative therapy in these patients.
Materials and method: A prospective analytical study, of total 56 patients of age between 18 -60 years were included in the study and all the patients were given the usual conventional conservative therapy of Rest, hot fomentation, NSAIDs, physiotherapy and orthoses. These were grouped randomly (systematic random sampling) into 2 groups with patients presenting at ODD numbers (1,3,5 and so on) receiving an additional single injection of PRP.  All the patients were followed up at 1st, 2nd, and 3rd month by measuring the VAS Pain score and DASH functional score. Paired and Unpaired T-tests were used for statistical analyses at every follow up.
Results: 37 male & 19 females of total 56 patients, with a mean duration of 3 months presented to us, where PRP was given in 1 group of 28 patients along with conventional conservative therapy, contrary to the other group of 28 patients who recieved only conventional conservative therapy. Both, the PRP and conservative groups had individually significant result with time in terms of VAS & DASH score improvement, at all the 3 monthly follow up. On comparison between the groups, highly statistically significant pain relief and functional improvement in PRP group was observed in all follow ups with nil side effect profile.
Conclusion: Over a short term follow up of 3 months, an additional injection of PRP when given along with usual conventional conservative therapy gives better pain relief and functional improvement in the patients of lateral epicondylitis.

Introduction :
Tooth failure generally results in a lack of bone volume in the vertical and horizontal direction. In attempts to reduce this alveolar bone resorption in order to preserve periodontal construction, implant placement is advised immediately after tooth extraction.
 
 
Materials and method :
A retrospective analysis was performed for patients attending a private hospital in Chennai, India. The aim of the study is to study the prevalence of immediate implant placement in private dental institutions. Patients who have undergone immediate implant placement from June 2019 to March 2021 were included in the study. Total sample size was 25 patients. The data was then entered into Microsoft Excel and tabulated. Following which data was imported into the SPSS software by IBM. Data analysis was performed in the statistical software SPSS and data were analyzed by descriptive analysis and chi-square correlation.
 
Results :
After statistical analysis, it is found that 13% were males and 12% were females, 9% of the immediate implant placement was in first quadrant, 15% in second quadrant and 1% in fourth quadrant. There was no incidence of immediate implant placement in the third quadrant.
 
Conclusion :
It is observed that the prevalence of immediate implant was more in males and was most common in the second quadrant.

This study was conducted to compare continuous suturing technique with interrupted method for the procedure of Episiotomy and second degree perineal tear following vaginal delivery. It was a comparative prospective study conducted in department of Obstetrics & Gynecology of M.K.C.G. Medical college, Berhampur , Odisha, India, from November 2021 to November 2022. Patients were randomized into two groups; One group (A) was repaired with  continuous, non-locking sutures involving the vaginal mucosa, perineal muscles and subcutaneous tissues for skin following delivery. The other group (B) with the same match had continuous locking sutures of vaginal mucosa, interrupted sutures in the perineal muscles and interrupted transcutaneous sutures for skin. The sutures used were absorbable (chromic catgut) and identical in both the groups. The participants were asked about pain in sitting position and during movement, the use of analgesics on the 2^nd, 10th day and 6weeks postpartum. A total of 700  women underwent vaginal deliveries with episiotomies and/or with second degree perineal tear. Less repair time (five minute - p=0.0001) was noted in continuous technique group and suture material consumed was also less (1 suture RR 3.10, 95% CI: 2.63-3.65). The comparison of pain on the 2nd, 10th day showed that continuous suture techniques compared with interrupted sutures for perineal closure are associated with less pain for up to 10 days postpartum (RR 1.61, 95% CI: 1.39-1.87 for 2^nd day and RR-1.23, CI:1.15-1.33 for 10^th day). There was no difference between the severity of pain in long term period [6weeks postpartum] [RR-1.0, CI: 0.98-1.03] in both the techniques. Repair with continuous suturing was quicker and less suture material was used in comparison with interrupted suturing. There was less pain in short term periodin continuous technique and no difference between the severities of pain in long term period in both  the techniques.

Schwannoma is also known as a neurinoma or neurilemoma. Schwann cells, which provide the insulating layer around the peripheral nerves, cause this specific type of nerve sheath tumour to develop. They may spread to nerve roots or nearby peripheral nerves. A Twenty-nine years old male presented to the OPD of general surgery with an asymptomatic retroperitoneal mass that was found during a regular medical check-up and imaging studies. Patient had given complaints of right lower abdominal pain 3 months ago which was initially judged as subacute appendicitis. No complaints of nausea/vomitings. No bowel/bladder complaints. Investigations revealed the presence of an enhancing solid mass lesion in right iliac region inferior to the caecum, most likely a benign neurogenic spindle cell tumor/ mesenchymal tumour arising from lateral femoral cutaneous nerve of thigh. He underwent successful Laparoscopic resection of retroperitoneal schwannoma with appendicectomy.

C-MAC videolaryngoscope works best amongst airway armamentarium for anticipated difficult airways. However, tube manipulation in anterior glottic apertures even under good visualization requires adjuncts. This study aimed at comparing 60° and 90° angled stylets for endotracheal intubation using C-MAC videolaryngoscope in terms of time taken and first-pass success rate (primary outcomes) as well as hemodynamic response and side-effects associated with intubation (secondary outcome).
METHODS: This prospective, randomized study was conducted in the department of Anesthesiology, Maharishi Markandashwar University, Amabala, Haryana, India, after ethical committee clearance in 60 ASA status I and II patients within the age group of 18-65yrs, randomly divided into two groups- Group I (n=30): intubated with 60° angled malleable stylet, Group II (n=30):intubated with hockey shaped stylet (90° angle). All data was represented in mean ± standard deviation or proportions. Chi-square test was used for statistical analysis of quantitative data while Student t-test for qualitative data where p value<0.05 was taken significant.
RESULTS: First-pass success rate was 90% in group I versus 83% in group II (p value > 0.05). Mean intubation time was less in group I (33s) compared to group II (39.57), p-value 0.000 (highly significant). There was no significant change in haemodynamics in both the groups. Sore throat was seen more in group I (20.0%) and (3.3%), p-value<0.05.
CONCLUSION: Use of 60° angulated stylet significantly reduces time for intubation and has relatively more first-pass success rate in comparison to 90° styletted ETT in adults intubated with C-MAC VLS, although the incidence of sore throat is higher.

The aim of the present study was to evaluate the patient and to assess the severity of Buerger’s disease.
MATERIAL & METHODS: A Randomized control trial includes Forty patients in the age group of 20-50 years who were smokers, presenting with symptoms of ischemia in limbs and were admitted in Gandhi Medical College and Hospital were taken up for study for the period of 27 months The treatment of each patient was individualized with the aim to achieve limb salvage wherever feasible. A record of patient’s progress and response to various modalities of treatment was made to evaluate severity of disease, in long term prognosis and also evaluate the efficacy of treatment. Patients who returned for follow up were followed up for minimum of six months during each follow up detailed history was taken and progress of the disease was assessed.
RESULTS: Among the 40 patients studied 65% of patients were diagnosed in the third decade and 9 cases were diagnosed after the age of 40 years. Out of 40 patients 75% were from low socio-economic status, shows that there is predisposition of TAO in patients of lower socio-economic status. Heavy smokers, constituting 90% who smoked more than 20-25 beedis per day and 10% were moderate smokers who smoked between 10-20 beedis / day were diagnosed with this disease. Out of the 40 cases studied gangrene was present in 75% & ulceration was present in 25% patients.
CONCLUSION: Thromboangiitis obliterans is a peripheral vascular disease which usually affects young males, involves predominantly the lower limbs than upper limbs mainly occurs  in the third decade with lower socio-economic strata  & smokers are commonly involved.

Mamata Scheme is conditional cash transfer maternity benefit scheme given to address maternal and infant under nutrition in Odisha.
Objective: To assess the knowledge and perception of pregnant women and mothers with child less than 1 yr of age regarding Mamata Scheme.
Methodology: Community based cross sectional study was conducted from 2021 to 2022 in a field practice area of Dept. Of Community Medicine, PRM Medical College, Baripada. The study subjects included all pregnant women with at least six months of completed gestation and all lactating mothers having child less than 1 yr of age registered at AWCs / Mini AWCs during the study period. A pre-tested, pre-designed questionnaire were used for data collection. Data was analyzed using MS Excel.
Results: Out of 157 study subjects, all the mothers were aware about the amount paid Rs.5000 in two installments under Mamata Scheme. Ante-natal registration and dT vaccination required as the criteria for 1^st installment was known to all the participants. 149 (94.90%) had knowledge regarding the intake of IFA & 97 (61.78%) had knowledge to attend one counselling session at the AWC for getting the 1^st installment. Knowledge regarding criteria for 2^nd installment, 138 (87.90%) mothers were known about the registration of the child after birth at AWC. Regarding the various vaccination status most of the mothers, 150 (95.5%) were known to OPV & Pentavalent vaccinations. Almost all the mothers 155(98.73%) had knowledge regarding the exclusive breast feeding followed by 148(94.27%) for complementary feeding. 139(88.53%) mothers had good perception towards Mamata Scheme.
Conclusion: The Knowledge and perceptions of mothers regarding the scheme needs to be enhanced further through IEC activities.

People who have been diagnosed with cancer have a significantly increased risk of suffering from depression and anxiety.The purpose of this research was to evaluate the levels of depression and anxiety that was found in cancer patients.
Material and Methods: Patients who had just been diagnosed with breast, colorectal, stomach, oesophageal, lung, or thyroid cancer and were planned for surgery, chemotherapy, radiotherapy, or combination therapy were evaluated as part of the study from the years 2020 to 2023. Ethical clearance was obtained and informed consent was obtained for initiation of study. Patients who have a previous diagnosis of a psychological condition were not allowed to participate in the trial. The size of the sample was determined to be 150 cases (based on an estimation of 30 percent anxiety or depression in cancer patients with a significance level of 0.05 and a standard deviation value of 0.20).
Results: During the course of the study, there were a total of 150 participants who had recently been diagnosed with breast, colorectal, stomach, oesophageal, lung, or thyroid cancer. Eighty-one (54%) patients had no clinical symptoms of anxiety, 44 (29.3%) mild anxiety, 25 (16.7%) with symptomatic anxiety and these rates were seen in 78 (52%), 40 (26.7%), 32 (21.3%) for depression, respectively.
Conclusion: Those suffering from cancers of the breast and stomach had the highest prevalence of anxiety and depression compared to patients suffering from other types of cancer.

: To investigate the prevalence of impacted teeth.
Materials and Methods: A retrospective study of the OPG x ray of 750 patients was done to rule out the impacted tooth in relation to angulation of tooth, age and sex.
Result: OPG x ray of 750 patients were examined from age 17 to 50 years. The Prevalence of impacted teeth were 67.2% among this age group found. Mandibular third molar teeth were encountered most common impacted tooth (62%) followed by maxillary third molar and others.
Conclusion: In our study impacted teeth was more commonly seen in younger population. The mandibular third molars were the most common impacted with mesio angular pattern

Role of color doppler in evaluation of portal hypertension.
Material and methods: All the patients visiting the institution during the study period with clinical features that is suggesting towards the portal hypertension are included in the study. We had included 50 patients and 50 subjects in our study. GE Voluson S8 USG Machine, and LOGIC P9 USG Machine Siemens Acuson 300 USG Machine curvilinear array low frequency (2-5 MHz) and linear array high frequency (5- 13MHz) transducer was used.
Results: The mean damping index in Class A patients was 0.56 ± 0.09, in Class B patients, it was 0.61 ± 0.05 and in Class C patients, it was 0.65 ± 0.03. The comparison of mean damping index among the Child Pugh Scores was done using One-Way ANOVA, which was found to be statistically significant (F value = 10.598, P value = 0.001), which shows that there is a significant variation in the mean damping index among the Child Pugh Scores. The mean damping index was lowest in Class A and highest in Class C. With the increase in the Child Pugh Score, the mean damping index also increases.
Conclusion: Child Pugh Score when conjunct with damping index can effectively predict the prognosis patient. Color doppler successfully recognized each of these traits.

The aim of this stud is to study role of ultrasonography and magnetic resonance imaging in evaluation of musculotendinous pathology of shoulder joint. The patients were then briefed about the procedure for the USG and MRI studies. All the USG scans of the shoulder were performed on GE S8 USG machine using a high density, multi frequency (6-15 MHz) linear array transducer. MRI scans of the shoulder in this study were performed using GE Signa 1.5 tesla explorer.
Result: Amongst the patients with tendonitis, USG could detect the condition in 75.0% patients. Amongst the patients with partial thickness tear, USG could detect the condition in 80.0% patients. Amongst the patients with full thickness tear, USG could detect the condition in 100.0% patients. There was a statistically significant strong agreement between findings of MRI and USG. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of USG as compared to standard (MRI) in detecting musculoskeletal pathologies/conditions of shoulder joint have been presented in above table. USG was found to have good sensitivity, specificity, and negative predictive value and predictive accuracy in detecting musculoskeletal pathologies/conditions of shoulder joint. The negative predictive value of USG was good for all the component except for supraspinatus.
Conclusion: Musculotendinous         pathologies      are       common          clinical problem, however their clinical presentation can be mimicked by other pathologies in the shoulder which may be present in isolation or in association with tendon pathologies. Clinical evaluation does not provide adequate insight into the patients‟ problem and hence is a poor guide to management protocols. Imaging evaluation is mandatory for the diagnosis and management of the patients. Ultrasound evaluation provides extensive information in patients with clinically suspected musculotendinous pathologies and shows a good correlation to MRI. As USG is a dynamic study, cost effective , and easily available so can be used as the initial imaging modality in these patients..MRI evaluation in patients with clinically suspected musculotendinous pathologies provides a more complete evaluation of all components of the shoulder joint. But due to its limitations like less availability, high cost and low patient compliance UGS overcomes all these limitations

In this paper, we propose a new measurement metric of love/attraction between a male and a female for getting married based on a few inputs by using fuzzy logic technology. A difference in physical attraction, social status and success in their respective fields are necessary to be measured for the calculation of love. As the behaviours and status of persons are full of uncertain, fuzzy logic technology is a perfect to be used in this context. In this paper, all the inputs are taken as fuzzy, and finally, the measurement metric of love is formulated by using a fuzzy inference system. A survey in a semi-urban place Tamluk, West Bengal, India is conducted, and their love value is calculated based on the proposed approach. Our new measurement metric of love value will replace the matchmakers in traditional marriage, especially in the survey place. We hope that this approach will also stimulate future studies on fuzzy logic based measurement metrics

Background: Dental clinic is a part of healthcare service. In the current scenario, there are over 13,000 registered dentists in Kerala, most of them set up independent clinics in different parts of the state. Therefore, there is high competition in the field of dental health care. Patient expectations and demand for quality services have increased, hence provision of quality services is important for patient retention referrals. Dental clinics should manage/ maintain, improve upon service quality to enhance patient satisfaction and for better patient care. An ideal clinic must quality services to its patients to improve their satisfaction. The rising literacy rate, higher levels of income, increasing awareness through media, has brought patients closer to demand quality dental health care. Thus, this study on service quality in the dental clinic provides feedback for clinicians for their patient oriented and patient-centric efforts in attracting and satisfying the patients.
Objectives: The main objectives are to identify the determinants of service quality, to assess the service quality experienced by the patient in the clinic and to identify 'gap' in expected and experienced service quality by the patients.
Methods: following are methods used in this study. Firstly ,conceptual phase,which is to  assess the service quality experienced by the patient’s questionnaire in the clinic and to assess the expectations of patients about the service quality.Secondly empirical phase,in which data collection using servqual questionnaire.Thirdly analytical phase,in which analysis of data collected and result interpretation and recommendations are also considered
Results: Service quality gap was least in the case of safety and communication aspects. Gap was minimum for behaviour of the staff instilling confidence in patients and for responsibility of the staff in providing right information to patients, also for communicating with the patients in a language they could follow.Quality gap was highest for physical facilities and convenience of operating hours

Aims and Objectives: Our goals are to determine how well educated female medical professionals are on HPV infections and vaccination.
Materials and Methods- An observational research was done to study the level of familiarity physicians have with HPV infection and vaccination. In order to study people's openness to and perspective on vaccination, as well as their familiarity with the illness and its symptoms, a survey was done.
Results: Three hundred doctors agreed to take part in the study. They're among the age group of 25 and 40, with an average age of 35.78. The fact that HPV is an STD is common knowledge among 201 professionals. About two-thirds (291) of doctors have cited HPV as a possible reason for cervical cancer. In fact, just 93 people (31% of the total) know that vaginal infections may raise the probability of developing cervical cancer. Only 70 of the doctors and nurses tested positive for Pap smears or HPV, and only 25 had ever been vaccinated against the virus.
Conclusion: Insufficient medical education could have negative effects on the health of the general public, as stated in the conclusion. Aspiring health educators must therefore be well-versed on HPV, cervical cancer, and preventative strategies.

Polycystic ovarian syndrome (PCOS) is a common endocrinopathy in women of reproductive age group and an incompletely understood enigmatic disorder of heterogenous nature. It starts appearing at 18 to 45 years of age and it may take years for its clinical presentation to appear. Anti-Mullerian hormone (AMH) has a glycoprotein dimer structure and is a member of the transforming growth factor-β (TGF-β) family. AMH is produced by the granulosa cells surrounding preantral and antral follicles and has an important role in the development and maturation of follicles. Ovulatory women with the polycystic morphology can have increased LH/ FSH ratios; however, a single blood sample can fail to detect an increased ratio. With this background, the present study was undertaken to identify and assess the biochemical test in the form of antimullerian hormone, LH/FSH ratio, serum prolactin levels in patients with clinical features of polycystic ovarian syndrome.

The aim of this study is to study Role of ultrasound and MRI in evaluation of pelvic inflammatory disease. Patients with clinically suggested pelvic inflammatory disease who were referred to the Department of Radio Diagnosis are included in this study. After obtaining permission from medical research ethics committee and informed consent from the patients, they were subjected to transvaginal ultrasonography and MRI scan.
Result: Free fluid is most common finding which is seen in 22 patients out of 100 patients. Cervicitis and pyosalpinx were seen in 18 and 17 patients respectively. Tubo-ovarian abscess was finding in 15 patients. Pyometra and hydrosalpinx as findings were seen in 11 patients each. Salpingi-Oophoritis as MRI findings was seen in nine (09) patients. Other findings seen on MRI included: salpingitis (06), endometritis (06), tubal torsion (05), endometrioma (03), free fluid in Pouch of Douglas (03), no gynecological disorder (02), simple cyst (02), peritonitis (02), and dermoid cyst (01) patients respectively. Both TVS and MRI was positive in 80 patients. TVS had findings of pelvic inflammatory disease in four (04) patients with no findings on MRI. The difference was found to be statistically significant (p = 0.00) by using Fisher’s Exact test.
Sensitivity of TVS for diagnosing PID who are truly having it was 91.9% while specificity was 69.2% in ruling out PID in those who didn’t have the disease in question. Similarly, the positive predictive value (PPV) for TVS was 95.2% and negative predictive value (NPV) was 56.2%. Overall, the accuracy of TVS for PID was 89%.
Conclusion: In women of reproductive age, pelvic inflammatory disease (PID) is a prevalent and significant disorder that can cause infertility, ectopic pregnancy, and chronic pelvic pain. Lower abdomen pain, fever, an elevated blood C-reactive protein level, and adnexal tenderness are common symptoms in patients, however the clinical diagnosis of PID has major drawbacks due to the wide range of symptoms and potential for atypical symptoms. PID may mimic gastrointestinal issues, urinary tract infections, and other gynecologic issues. Thus, making a clinical diagnosis of PID based solely on symptoms and physical characteristics is frequently incorrect. The danger of long-term problems rises when treatment is postponed. PID is becoming more common, especially in developing nations where there is a lack of understanding and hazardous sexual behavior.

Fertility is a complex equation of continuous hormonal changes. The present study was evaluation of ovarian volume, stromal blood flow and antral follicular count in case of infertility by spectral color doppler and transvaginal 3D ultrasonography. The present study was conducted to assess ovarian volume, stromal blood flow and antral follicular count in case of infertility by spectral color doppler and transvaginal 3d ultrasonography.
Materials & Methods: Patients between the ages of 20 and 40 years were included in both infertility (50) and pregnancy control groups (50). Basal ovarian volume and AFC are measured intravaginally. USG. Relevant clinical data and hormonal tests will be recorded for each patient. The machines used in this study are GE Voluson S8 USG-machine, Logiq p9 USG.
Results: Based on the criterion of >11 antral follicular count which gave sensitivity and specificity of 20% and 56% respectively that 43 subjects in the infertile group and 34 subjects in the control group had antral follicular count of less than 11 while seven (07) subjects in the infertile group and 34 subjects in the control group had antral follicular count of equal to or more than 11. The difference in between infertile and control group was found to be statistically significant (p = 0.03). Ovarian volume less than 11.75 cc was seen in 45 (90%) patients in infertile group and 33 (66%) patients in the control group. Ovarian volume (in cc) of more than or equal to 11.75 was seen in 05 (10%) of patients in the infertile group while 17 (34%) patients in the control group. The difference between the two group was found to be statistically significant (p = 0.004). The cut -off for ovarian volume at 11.75 cc was decided based on sensitivity and specificity of 12% and 66% respectively. PSV of less than 13 cm/sec was seen among 37 patients from infertile group while PSV of ≥13 cm/sec was seen among 13 patients from infertile group. In control group, 28 patients had PSV of <13 cm/sec while 22 patients had PSV of ≥13 cm/sec. However, the difference was not found to be statistically significant (p=0.05). The distribution was uniform across the infertile and control group and difference was not found to be statistically significant (p = 1).
Conclusion: AFC, ovarian volume, stromal blood flow (in terms of PSV and RI) can be used as predictors for determining infertility state among females of reproductive age group and further can be used in determining further management for the same. Although our study also showed that in fertile group, there was no positive correlation between AFC and ovarian volume, PSV. The mean AFC in our study population was different from that noted in other studies from different parts of the world and it could be due to racial, socio-economic and geographical factors. A cut-off value of 11 for AFC may be used as one of the factor in females undergoing infertility assessment. Other factors such as Ovarian volume, Stromal blood flow (in terms of PSV and RI) can also be used during assessment along with AFC for management of infertility among Indian women

Situs inversus totalis is rare condition with which one can live their life without any complications. Hence the diagnosis of the condition is usually incidental. The diagnosis of cholelithiasis in such patients in whom the underlying situs inversus has not been brought to light is not straight forward as the presenting complaint is usually on the opposite side. The management principles of cholelithiasis are the same as for a normal individual. The critical part of the management lies in the fact that conventional laparoscopic cholecystectomy, which is the definitive treatment of cholelithiasis, is suited for right handed surgeons for a gall bladder which is located in the right hypochondriac region. Since the gall bladder is located in the opposite side in above condition, safely carrying out the procedure has several challenges. This case report details the challenges faced in one such case of laparoscopic cholecystectomy in a case of situs inversus totalis.

Background:This study aimed to demonstrate the demographic characteristics for laparoscopic surgeries performed in all units of the Department of general surgery, Dr. D Y Patil Medical College Hospital in last one year. Purpose of study is to know clinical indications of rate of conversion of laparoscopic to open surgeries and compare with established scientific literature. Methods:Present clinical Study is a Retrospective study conducted over a period of 1 year from January 2021 to December 2021. Data analysis is done from OT records to find out the rate of conversion. Inclusion criteria – All patients under went laparoscopic surgery in the Department of General Surgery in a year 2021 with exclusion of urological and gynecological surgeries in Dr. D Y Patil Medical College Hospital and Research center, Pune, Maharashtra. Results:Total number of 270 laparoscopic surgeries were attempted, out of which 12 cases were converted from laparoscopy to open surgery. Total conversion rate in present study is 4.44%. Most of conversions occurred in laparoscopic cholecystectomy 3.73%, laparoscopic appendectomy 1.49 % and laparoscopic hernia repair with 6.66%.Conclusion:Over all conversion rates of laparoscopic procedure into open surgery is low when compared to other international studies. Most common causes of conversion in present study altered anatomy, adhesions and intra operative bleed. Conversion of laparoscopic surgery into open surgery resulted in decreased morbidity, complications and increase in duration of hospital stay.

Diabetics are more prone to have liver fibrosis and hence the study was conducted to find any linear correlation between Diabetes Mellitus and liver fibrosis.
MATERIALS AND METHODS: A observational study with 100 diabetic patients was done.  Detailed history was taken and examination done, patients were then subjected to various blood investigation and USG abdomen, after clearance from institutional scientific committee and after taking informed consent during the period of May 2022 to December 2022, in the Department of General Medicine, Index Medical College Hospital & Research Centre, Indore.
AIMS & OBJECTIVES: To establish the correlation of HBA1C with NAFLD in Type 2 DM.
RESULTS: Mean age group was 45 years, range 25 to 70 years. Out of 100 diabetic patients, 54% patients were positive for NAFLD. Out of 36% (65.5%) patients had higher HBA1c levels >8.5%. Thus, NAFLD leads to poor glycaemic controls and vice versa. In the study 62.9% had grade 1 fatty liver., suggesting slow progressive nature of disease. Most of the NAFLD patients (40%) were asymptomatic followed by dyspepsia. Elevated liver enzymes were found in stage 3 and 4 only.
CONCLUSION: The present study concludes that prevalence of NAFLD in DM is 54% being more in males than females with most common age of presentation is 45 to 55. NAFLD is now considered as liver manifestation of metabolic syndrome while NAFLD is associated with and responsible for poor glycaemic control (higher HBA1c levels) in diabetic patients The findings of fatty liver, even in a asymptomatic patients should prompt a thorough research for components of metabolic syndrome, and patients should advised regarding CVD risks, weight loss, smoking cessation, dietary modification, exercises and pharmacological therapies.

Aim: The purpose of the present research was to evaluate and assess the management of various cases of small bowel obstruction.
Methodology: Eighty cases of small bowel obstruction observed in this study presented with common symptoms of abdominal distension, absence of flatus and/or faeces.
Results: Abdominal tenderness was the commonest finding during per abdomen examination. Adhesion was the commonest aetiology observed in this study followed by obstructed hernia. General trend of reporting to the hospital was observed to be on the third day of onset. Higher incidence of small bowel obstruction was observed in cases in sixth decade of life. There was predominance among the males and in cases belonging to lower socio-economic class.
Conclusion: Adhesions and hernias are the most common causes of obstruction as well as of bowel ischemia, necrosis, and perforation.

Dynamic evaluation of high resolution ultrasound is non invasive and no radiation. The real time nature of sonography requires personal interaction with the patient, often resulting in a more directed examination specific for each individual. The aim of this study was to assess the role of high resolution ultrasound in rotator cuff tears.
Materials and Methods: This is a hospital based cross sectional study in which all patients referred to the department of Radio Diagnosis (Chettinad health city) with clinically suspected rotator cuff injuries in a period of January 2015 – May 2016 were assesed. 30 patients referred to the department of Radio Diagnosis (Chettinad health city) with clinically suspected rotator cuff injuries in a period of 2 years were included according to the inclusion criteria.
Results: In our study, most of the patients with rotator cuff injuries presented with shoulder pain (46.7%), followed by decreased range of shoulder movements (26.7%), shoulder pain and stiffness (13.3%), stiffness (10%) and shoulder pain and weakness (3.3%). In our study USG had a sensitivity of 63%, specificity of 82%, PPV of 100%, NPV of 33.5%, diagnostic accuracy of 68% and kappa degree of agreement of 0.34. These results suggest that USG is less reliable in detecting rotator cuff tears than previously reported and a positive sonographic reading is more reliable than a negative one.
Conclusion: No single test had both a high specificity and a high sensitivity, therefore diagnostic accuracy of shoulder examination is overestimated, and that these exams are only rarely useful to differentiate rotator cuff tears. USG is less reliable in detecting rotator cuff tears than previously reported and a positive sonographic reading is more reliable than a negative one.

Ample research has been published lately exploring the strengths and weaknesses of online teaching in medical education but very few have reported the students’ perception towards this shift. The current study was designed to evaluate the perception of medical undergraduates in Northern India of online teaching and their readiness and limitations towards its adoption. The knowledge summarized henceforth would help in identifying potential areas of improvement leading to an upgradation in the quality of online teaching and better medical education.
Material and Methods: A cross-sectional online survey in the form of a pre-validated self-administered Google form questionnaire consisting of 23 questions was carried out for a duration of two months. All medical undergraduate students (>18 years) studying in various academic years in three largest medical colleges in Jaipur, Rajasthan, willing to be a part of the study were invited to participate.
Results: After initiation of e-teaching, an enhancement in learning and knowledge was reported by around one-third respondents. 21.15% students were satisfied with e-learning, 27% recommended that e-learning methods should not be used at all and 44% suggested that e-learning methods may be regularly used in future.
Conclusion: Online teaching comes with its own set of merits and demerits. The students have provided a very mixed response to its utility. However, most agree that when imparted efficiently, it may prove to be an asset in imparting better medical education.

The goal of the current work was to develop a nanosuspension of the drug ketoprofen in order to boost the dissolution of poorly soluble class II drugs. Ketoprofen was employed as an example because it was found to increase oral bioavailability and invitro dissolution. It was made utilizing the Quassi Emulsification Solvent Diffusion process and a variety of drug, polymer, and stabilizer. Drug entrapment and dissolution are increased as well as reduced particle size in the formulation with a ratio of 1:2 (drug: polymer). Particle size of the formulations were evaluated utilizing SEM, Zeta potential analysis and IR& DSC were used for evaluation of in vitro drug release studies. The formulated nanosuspensions' particle sizes were found to range between 92.20nm and 100 nm.

The purpose of the present research was to evaluate and assess the management of various cases of small bowel obstruction.
Methodology: Eighty cases of small bowel obstruction observed in this study presented with common symptoms of abdominal distension, absence of flatus and/or faeces.
Results: Abdominal tenderness was the commonest finding during per abdomen examination. Adhesion was the commonest aetiology observed in this study followed by obstructed hernia. General trend of reporting to the hospital was observed to be on the third day of onset. Higher incidence of small bowel obstruction was observed in cases in sixth decade of life. There was predominance among the males and in cases belonging to lower socio-economic class.
Conclusion: Adhesions and hernias are the most common causes of obstruction as well as of bowel ischemia, necrosis, and perforation

The PI3K/Akt pathway, which is abnormally activated in the phosphatidylinositol 3-kinase (PI3K) malignancies and essential for many cellular functions, promotes the growth and development of tumours. It may be possible to fully understand the role of this pathway by looking at its upstream and downstream nodes. The development of new cancer drugs may benefit from techniques that target the pathway's primary constituents in light of mounting evidence.
Therefore, approaches combining pathway inhibitors and additional cancer therapies may be able to address the therapeutic conundrum. In this review, we cover the functions of the PI3K/Akt pathway in different cancer phenotypes, a status report on several PI3K/Akt inhibitors, and an introduction to combination therapies that combine signalling inhibitors with traditional cancer treatments. The evidence presented here demonstrates that the most successful approach to treating cancer involves cascade inhibitors of the PI3K/Akt signalling pathway, either alone or in conjunction with other medicines.

Microorganism resistance to synthetic antibiotics is an increasing public health challenge; therefore, Researchers are in strong interest to develop new antimicrobial agents from biological sources. It is well studied that mushrooms are being used since ancient time as a means of food and medicine. Mushrooms are potent source of various bioactive compounds. Antimicrobial activities have been discovered in a wide range of secondary metabolites, including tannins, terpenoids, alkaloids, and flavonoids. These natural compounds are of concern as a source of safer and more effective antibacterial agents than those produced synthetically. Different extracts of mushroom has a significant amount of bioactive compounds which may contribute to antibacterial properties. In present study we have evaluated the different phytochemicals in different extracts of mushroom “Clitocybe phaeophthalma”. The collected variety of mushroom were washed carefully, air dried and powdered for further downstream process. The prepared powder from mushroom was subjected to isolate different extracts using Soxhlet extractor, using different solvent system. Different crude drug extracts of the sample were used for biochemical analysis to detect the phytochemical constituents in the fungi. The results of the present study of showed the presence of different phyto-constituents such as flavonoids, terpenoids, and alkaloids etc. The Qualitative analysis has confirmed the presence of the antimicrobial phytochemicals  in the Clitocybe phaeophthalma

The globe today faces as epidemic of non-communicable diseases (NCD), which will soon surpass communicable diseases. Indian Diabetes Risk score developed by Madras Diabetes Research Foundation and Ramachandran A et al⁸ can be used as simple tool to screen the population in an area. Aim and objectives: Screening of diabetes mellitus in a rural area by using IDRS. Material and Methods: The cross sectional study was done in field practice area of rural health and training centre associated with a medical college. From the survey proforma four important factors like, age, abdominal obesity, family history of diabetes and physical activity were taken to calculate Indian diabetes Risk score- IDRS. The study tool which we have used in this study was IDRS - Indian Diabetes Risk Score - A simplified form of score for screening undiagnosed Diabetics. Results: Our study included 610 study participants in which majority 64.26% males, 73.77% belonging to nuclear family and majority were from lower and lower middle class of socioeconomic status. Risk factors calculated for IDRS show 29.18 % of participants were above 50 years and abdominal obesity measured in terms of waist circumference show higher level in males that is 43.11% males were having WC from 91-99 and 24.59% males were having above 100 waist circumference .as physical activity was assessed it shows majority that is 43% were doing moderate activity, 21.48 were doing mild physical activity and 13.44% were sedentary population.

After gynecological cancers of the breast, cervix, uterus, and ovaries, vulvar cancer is the sixth most common type. Epidermoid carcinoma is the most typical histological form. However, the vulva, which is histologically defined as a collection of different tissues (cutaneous, glandular, adipocytes, muscular, and mucous), can experience a variety of modifications that can lead to lesions of various histological types, some of which may be uncommon, such as the synovial sarcoma of the vulva. There aren't many cases mentioned in the literature. Despite its name, Synovial Sarcoma (SS) is not of synovial origin; rather, it is produced from multipotent stem cells that have the capacity to differentiate into mesenchymal and epithelial cells. The most typical symptom is a localized pain or discomfort during intercourse, and the median age at diagnosis is 50. Frequently, these lesions are misdiagnosed as cysts or Bartholin abscesses. The surgical removal of the lesion with healthy tissue margins is the mainstay of treatment for synovial sarcoma. The outlook is not good. At two years, there is a 50% chance of locoregional recurrence or metastasis of SS. Local lymph nodes, lungs, bones, and liver are where metastatic lesions most frequently appear. A case of a 28-year-old lady who had vulvar synovial sarcoma is described in the current case report. This tumor management calls for a multidisciplinary approach.

The purpose of the present research was to explore this biologic approach to treat OA, analysing and comparing results of hyaluronic acid (HA) versus platelet-rich plasma (PRP).
Methodology: A prospective study with randomised selection of 47 ( 80 knees) patients for the assessment of outcome of treatment of early Osteoarthrosis of knee with intra-articular infiltration of platelet rich plasma (PRP) versus hyaluronic acid (HA) was carried out in the department of orthopaedics at Jawaharlal Nehru Medical College & Acharya Vinoba Bhave Rural Hospital, Sawangi (M), Wardha from July 2012 to April 2014. The patients were grouped into two categories- where 40 knees were injected with intra-articular HA injections and rest was injected with PRP injections. The mean was compared using paired t- test or independent t- test depending on the distribution of samples. The proportions were analysed using Binominal and Chi Square Test.
Results: At 3 months there was significant reduction in VAS and WOMAC scores in both the groups as compared to baseline. At 6 months, the subjects treated with PRP showed a continuous improvement, whereas the subjects treated with HA showed a sharp worsening for both the scores. Although the mean VAS score was 3.50 in the PRP group (SD= 0.847), it was 4.73 in the HA group (SD= 1.219) whereas mean WOMAC score was 37.25 in the PRP group (SD= 5.54), it was 61.98 in the HA group (SD= 4.85).
Conclusion: Treatment with PRP show significantly better outcome compared with HA treatment.

Cervical cancer is the second most prevalent cancer among Indian women, accounting for 6-29% of all cancers among Indian women. Human Papillomavirus (HPV) is the disease-causing agent. Recent technological advancements have led to the development of a vaccination to prevent HPV infection. The purpose of this study was to determine the level of knowledge about human papillomavirus (HPV) infections and vaccination among female medical personnel at a tertiary teaching hospital.
Materials and methods: A cross-sectional study was conducted among female medical personnel of a teaching hospital of a tertiary care. They were assured confidentiality and given a questionnaire regarding HPV infection and HPV vaccine.
Results: About 94.3% of participants identified HPV as the cause of cervical cancer, whereas 5.7% of participants were unaware of the association. About 72.1% were aware of the availability of the vaccination to prevent HPV infection, while 3.3% answered incorrectly and 24.6% were unaware. 31% of participants understood the correct age of vaccine initiation, 23% answered incorrectly, and 45.9% of participants did not know the answer. Only 4.1% of participants have had the HPV vaccination. 63.9 percent of participants did not agree to get vaccinated against HPV because they believed it would give them a false feeling of security, and 68.8 percent of participants were opposed to the systematic vaccination of the young Indian population against HPV because sexual exposure happens at a later age. 73% of participants cited a vaccination age of >25 years.
Conclusion: Insufficient medical personnel understanding leads to ignorance among public. Therefore, health personnel must be educated on the numerous components of HPV, cervical malignancies, and their prevention.

Purpose of the present research was to evaluate the clinical considerations as well as the outcome of laproscopic myomectomy in various uterine myomas.
Methodology: This was an observational study in women who have undergone laparoscopic myomectomy (LM) because of single symptomatic myoma >4 cm in diameter. We collected data about general features, surgical outcomes, intraoperative/ postoperative complications and time to return to normal activity.
Results: A total of 200 patients (mean age 36.7 ± 6.4 years) resulted eligible for the study. Myomas sized between 8 and 12 cm were linked to an increased amount of blood loss (significantly higher in intramural than subserosal myoma). The removal of intramural myomas >8 cm and the subserosal ones >12 cm required a significant longer surgical time. Patients returned 17.9 ± 9.5 days after surgery to their personal activities. Six cases (1.35 %) required conversion to laparotomy, and only in two cases blood transfusion was necessary.
Conclusion: Myomas size and type represent the best predictors of surgical difficulties and possible intrapostoperative complications. Intramural myomas >8 cm and subserosal ones >12 cm should be considered as a challenging procedure. LM remains the gold standard approach

A case of a Burkinabe woman who was 41 years old admitted to ER with right sided chest pain on & off, and shortness of breath with increasing intensity is described here. she revealed that she had been experiencing similar episodes of recurrent ride sided chest pain during menstruation for a few months. She had no menstrual problems. but decreased breath sounds on the right side, lower zone. Impaired percussion on the right lower lobe and hyper-resonance in the right axilla.  On evaluation her Chest X-ray showed pleural effusion. When the CT was done it was evident of a pleural honeycombing, right sided moderate hydropneumothorax with mild contralateral mediastinal shift. Pleural biopsy showed that HPE revealed content of hemorrhage and fibrin deposits. Infiltration by mononuclear inflammatory cells, occasional neutrophils and hemosiderin laden macrophages with endometrial epithelium.The immunohistochemical study showed CD10, P63, CA125- positive concluded Pleural endometriosis

In recent years, extensive research has indicated that, in addition to the traditional process of neurodegenerative disease, neurodegeneration can also be caused by a variety of unconventional pathways. One of these is type 2 diabetes mellitus, a dysmetabolic condition that has been widely investigated. The majority of our knowledge of glucose metabolic dysfunction in neurodegeneration comes from investigations in Alzheimer's disease (AD) models. Type 3 diabetes is a term given to Alzheimer's disease since it is significantly associated with hyperglycemia. The pathophysiology of Alzheimer's disease is first discussed., from the aspects of typical protein aggregation and the newer T2DM-dependent pathways, which are validated by evidence from T2DM patients such as epidemiological, neuroimaging, and pathological evaluations. Second, we analyzed the several routes through which neurodegeneration is exacerbated in diabetic conditions, taking Alzheimer's disease as an instance. Finally, recent scientific advancements in metabolic disorders-driven neurodegeneration are highlighted, as well as some of the major developments in AD management.
Methods: We reviewed the literatures that are found in PubMed and google scholar searches.
Results: Aside from the established causes of Alzheimer's disease, T2DM sheds new light on the disease's pathophysiology in a variety of ways. It's a two-way interplay whose molecular and signaling mechanisms only have recently been explored. This is our attempt to reconcile them all together to derive a comprehensive molecular explanation for T2DM neurodegeneration.
Conclusion: The relation within T2DM and Alzheimer's disease has been observed and investigated thoroughly. It's encouraging to learn that these investigations have resulted in some advancements in the treatment of AD.

Tuberculosis (TB) has been a major cause of suffering and death since time immemorial. Despite microbiological cure of TB infection, many patients develop long term lung impairment and functional disability which leads to their continued suffering. A proportion of treated TB patients suffer from Obstructive Airway Disease (OAD) which is usually attributed to structural lung damage like cavitation, bronchiectasis, lung fibrosis, bronchial stenosis, emphysema and resorptive collapse. However, in our clinical practice, we are observing many patients with history of pulmonary tuberculosis presenting with symptoms of airflow limitation despite no chest radiograph abnormality.

The current study's objective was to examine any possible antibacterial activity of the biopolymer (Dextran) against clinical isolates of Enterococcus faecalis. All 30 strains of E. faecalis confirmed positive for resistance to vancomycin(VAN), whereas 24 strains (80%) tested positive for resistance to teicoplanin(TEC) in antimicrobial susceptibility testing. The minimum inhibitory concentration (MIC) had been detected by evaluating the antibacterial activity using the broth microdilution technique; the findings revealed that the MIC was between (25-50) mg/ml against isolates of E. faecalis. All experiments were done in triplicate

An important mechanism responsible for increased cardiovascular risks in chronic excessive alcohol use is the pro-oxidant effects of alcohol. There are some emerging risk factors like: lipoprotein, High-sensitivity C-reactive protein (hs-CRP), Lipid profile, Prothrombotic and pro-inflammatory factors that play an important role in the pathogenesis of atherosclerosis. So we investigated the relation between the levels of cardiovascular biomarkers & the degree of alcohol intake in alcoholic subjects.
Materials and Methods: The present study was carried out in the Department of Psychiatry and in association with the Department of Biochemistry, Tertiary Care Teaching Hospital over a period of 6 months. 90 Alcoholic subjects, in the age group 18-60 years, randomly selected from the areas and ward, in and around were included in the study. Estimation of Serum Level of hs-CRP & Lp (a) by turbidimetric immunoassay. Serum Cholesterol by CHOD-POD & Triglycerides by enzymatic colorimetric method. LDL cholesterol was calculated by Friedwald equation.
Results: The mean serum Total cholesterol levels showed no significant association across different alcohol drinking groups. The mean TG & LDLc levels were significantly (p<0.05) higher   in   occasional (175.50 ± 62.22), (131.15 ± 12.26) drinkers and heavy drinkers (177.49 ± 21.53), (115.35 ± 16.30) than that of low-moderate (193.47 ± 24.15), (34.46 ± 2.49) & moderate (176.48 ± 21.56), (111.11 ± 14.27) drinkers respectively. In the occasional drinkers (35.23 ± 6.21) the mean serum HDL cholesterol levels were significantly elevated as compared to the low-moderate (34.46 ± 2.49), moderate drinkers (35.30 ± 5.44) and heavy drinkers (31.25 ± 5.02).
Conclusion: Our study suggests that heavy drinking may lead to significant dyslipidemia and inflammatory changes and adversely affect the cardiovascular system but has shown a beneficial effect of occasional drinking on HDLc levels and moderate drinking on hs-CRP levels. However a large scale study needs to be done to confirm these beneficial effects of occasional to moderate drinking on the cardiovascular system

People who live an extremely active lifestyle, such as participating in sports or running for fitness, a properly positioned lower extremity is very important. The load distribution at the knee may be affected by lower extremity position, thus subjecting the anterior cruciate ligament to more stress. The current study is aimed at assessing the relationship between lower extremity alignments like the pelvic angle, genu recurvatum, and medial & lateral rotation of the hip in patients with osteoarthritis, and quadriceps tendinitis. The study included 150 asymptomatic (control) male and female patients as well as 150 patients with osteoarthritis, or quadriceps tendinitis. Clinical assessment was done to measure the pelvic angle, genu recurvatum, medial & lateral rotation of the hip by following standard procedures. The results of the study showed that there was a significant difference in the pelvic angle, but there was no significant difference in the genu recurvatum, medial & lateral rotation of the hip. The conclusion of the study was that the pelvic angle was affected, but the genu recurvatum and medial & lateral of the hip were not affected in the patients with osteoarthritis, quadriceps tendinitis.

Lung cancer is the leading cause of cancer death for men and women in the United States, accounting for 24% of all cancer deaths. Early detection is essential since survival is based on the stage of diagnosis: 59.8% of patients survive for 5 years while the disease is localized, but only 6.3% do so when it has spread to other organs. Unfortunately, only 18% of lung cancer cases are found early on, while 56% are found after cancer has spread to other body parts. The National Lung Screening Trial compared annual low-dose computed tomography (LDCT) screening for lung cancer with chest radiograph (CXR) screening in 2002; in 2011, they observed a 20% reduction in lung cancer mortality and a 6.7% reduction in total mortality.^1,2 In March 2013, the U.S. Preventive Services Task Force (USPSTF) published a grade B recommendation for annual LDCT screening in asymptomatic patients aged 55 to 80 with a 30-pack-year smoking history who are presently smoking or have quit smoking within 15 years, supported by this and another research. To fund preventive services under the Medicare program that met specific requirements, the Centers for Medicare and Medicaid Services introduced LDCT screening in February 2015. The age cutoff was lowered to 50, and the pack-year exposure to 20 in the USPSTF guideline, amended in March 2021.LDCT is highly effective but underutilized. Although LDCT screening has been known for more than ten years to reduce lung cancer mortality and has been advised for more than six years, utilization is still unacceptably low, with 19.2% of those eligible obtaining the test in 2018. Compared to colonoscopies, mammograms, and Papanicolaou testing, screening rates for other frequent cancer screenings are substantially higher, at about 80%, 70%, and 60%, respectively. The lesser use of LDCT relative to other cancer screening tests is due to several factors. Physicians might not be aware of the mortality benefit of LDCT screening. Both issues are false-positive results and following-up nodules in a healthcare system that does not support the practice. It's common to point to the expense of LDCT screening and the cumbersome insurance authorization procedures as barriers, particularly for people without insurance

Heart disease is a major cause of maternal mortality and morbidity during both the
antepartum and postpartum periods. Heart disease occurs less frequently than 1% of the time during pregnancy. Cardiovascular disorders complicate about 1% of all pregnancies.A thorough evaluation of the patient throughout the entire pregnancy may result in the early detection of heart disease. So, the present study was conducted with an aim to assess the effect of heart disease in pregnancy and its outcome.
Methods: This study was a cross-sectional study of the maternal-fetal outcomes of cardiac disease-related pregnancies over the last five years that were followed at tertiary care hospitals in North India. The study was carried out for three months after receiving institutional review board ethical approval. The study comprised pregnant patient files with pre-existing or newly diagnosed heart illness during pregnancy. Maternal age, parity,York Heart Association (NYHA) functional class, and materno-fetal outcome were among the variables that were recorded. The collected data was entered in the MS excel sheet. The variables were presented as frequency and percentages.
Results: In our study, a prevalence of 1.5% of heart disease was observed among pregnant women. Four fifth of pregnant women (80.0%) with heart disease were primigravida.Among enrolled pregnant women four fifth of the women were having rheumatic heart disease (84.2%). Among pregnant women with rheumatic heart disease (RHD), the single valvular lesions were seen in 28.7% of pregnant women (20.3% of mitral stenosis and 5.1% of mitral regurgitation).52.9% of pregnant women were having grade II functional class as per NYHA. Congestive cardiac failure as complication was observed in 15.7% of pregnant women. Among alive neonates, 29.2% of neonates were preterm, and 7.7% of neonates were having IUGR, 15.4% needed NICU admission
Conclusion: In underdeveloped nations, maternal and perinatal morbidity from rheumatic heart disease is high and accounts for a large portion of cardiac disease in pregnancy. When congenital heart disease is treated early in life, morbidity and mortality are reduced.

The Indian subcontinent's population is accustomed to smoking tobacco (cigarette, bidi, and hookah) or using smokeless tobacco (tobacco in pan, in gutkha, or khaini). Both chewing tobacco and smoking tobacco have negative impacts on human health because of harmful chemicals in them including tar, nicotine, and other substances that may change the myelination of peripheral neurons.
Materials and Methods: Participants were divided into three groups, 40 were male tobacco chewers and smokers (aged 20 to 60), 30 were tobacco smokers only, and 30 were tobacco chewers exclusively. The Physiolab-PL 2005was used to do the NCV. Subjects had their median and ulnar nerves' motor and sensory nerve conduction velocities (MNCV and SNCV) measured.
Results: We found statistically significant changes (p<0.05) in MNCV &SNCV of median and ulnar nerve between tobacco smokers& chewers and only tobacco chewers. While comparing with individuals of tobacco smoking and chewing habit and only tobacco smoking habit have statistically significant changes only in MNCV of median nerve.
Conclusion: From this study we conclude that individuals who were having a habit of smoking as well as chewing are on highest risk for reduction in conduction velocity in both motor as well as in sensory nerve. According to this study, both sensory and motor nerve conduction velocities showed statistically significant changes. Demyelinating neuropathies, such as those caused by smoking and chewing, typically result in reduce conduction velocity

Role of diffusion weighted magnetic resonance imaging in evaluation and differentiation of inflammatory and neoplastic brain lesions.
Material and methods: This was a prospective study conducted in the Department of Radiodiagnosis, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh. 50 patients with acute focal neurological deficit and manifestations suggestive of brain lesions which could be neoplastic or inflammatory in nature were included in this study. Data was collected using pre-structured proforma which included details such as name, age, gender, presenting complaints and findings were noted for MRI and DWI imaging.
Results: In our study, sensitivity, specificity of DWI was found to be 47.6% and 50% respectively. The accuracy for DWI for correctly diagnosing benign or malignant lesions on the basis of cut-off value of ADC was found to be 40% with 95% confidence interval of 27.61% to 53.82%. However, diffusion weighted imaging (DWI) was not able to differentiate between inflammatory (benign) and malignant lesions conclusively.
Conclusion: It can be concluded from our study that diffusion weighted imaging (DWI) along with its apparent diffusion coefficient (ADC) values was not able to conclusively differentiate between benign (inflammatory) and malignant (neoplastic) lesions of the brain and further imaging studies such as MR spectroscopy, MR perfusion study etc. can be used to further evaluate lesions and differentiate between them.

To evaluate the role of CT urography in investigating causes of hematuria.
2. To determine the sensitivity and specificity of CT urography in evaluation and differentiation of  the upper and lower urinary tract pathologies causing hematuria.
Material and methods: A prospective study of 75 patients with urinary Symptomatology was performed who presented at Index Medical College Hospital and Research Center, Indore (M.P.). The study was conducted during the period from JAN 2021 to JUL 2022.
75 patients were referred for CT Examination. Almost all these patients were symptomatic and many had multiple symptoms related to urinary tract. However, pain was the predominant symptom in as many as 54 cases. Patient registration in form of individual details, clinical history, past history. Recording of previous X-Ray, USG, IVU & other relevant laboratory reports whenever available for evaluation.
 
Results: Majority of the subjects 68% were male and 32% were female. Majority of the subjects 78.7% had macro hematuria and 21.3% had micro hematuria. Majority of the subjects 72% had hematuria with symptoms and 28% had hematuria without symptoms. Majority of the subjects 36% had Calculi followed by 20% of the subjects had Neoplasm, 16% had Infection, 8% had trauma and 8% had developmental anomaly. Among the subject who had infection as cause for hematuria 100% of subject had hematuria with symptoms. Majority of the subjects who had carcinoma as cause for hematuria had without symptoms. 87.1% of the subject who had macro hematuria had symptoms and 57.1% did not had symptoms. 12.9% of the subject who had micro hematuria had symptoms and 42.9% did not had symptoms. Majority of the subjects who had calculi 48.1% had            renal calculi followed by ureteric in 37% and vesical in 14.9%. Majority of the subjects who had developmental anomaly 33.3% had polycystic and ectopic kidney followed by horseshoe shaped kidney and duplication of ureter 16.7%. Equal number of the subjects who had trauma 33.3% had kidney, bladder and uretheral injury.

The aim of the present study was to investigate the level of satisfaction among indoor COVID positive patients at a private tertiary care specialty hospital and to determine the underlying causes of dissatisfaction.
Methods: The present study was done on patients of COVID-19 hospital part of CIMS hospital which is a tertiary care private hospital in Ahmedabad Gujarat. Hospital has treated more than 7000 patients so far for COVID-19. In this study, the number of patients studied from COVID-19 area in Hospital was 2408 out of which 10 were excluded due to incomplete data.
Results: 95.29% of the patients appear to agree that Reception service is good. While another 4.59% appear to agree that Reception service is very good. 31.90% of the patients appear to agree that Consultant service is good. While another 67.93% appear to agree that Consultant service is very good. 32.53% of the patients appear to agree that Medical service is good. While another 67.31% appear to agree that Medical service is very good. 31.19% of the patients appear to agree that Nursing service is good. While another 67.97%appear to agree that Nursing service is very good.
Conclusion: On the basis of patient feedback and observations, it can be concluded that maximum patients are satisfied with the services provided in the hospital especially Nurses, consultants and Front office. Only some patients were dissatisfied with supportive services like food services, Diagnostic services, Billing Services and discharge services. Therefore, by improving these services overall patient satisfaction can be improved.

Many patients with covid 19 infection have increased blood sugar at the time of admission. Some of them are not a known diabetic patients before. The covid infection and the use of steroids in treatment worsens the glygemic status of the patients. The hyperglycemia has a significant impact on the outcome . This study compares the management of hyperglycemia in covid 19 patients using subcutaneous insulin with the use of continuous insulin infusion.
Methods :
This is a single centered , prospective , case control study conducted in a tertiary care centre for a period of 6 months. Covid 19 patients with moderate and severe symptoms who are admitted with hyperglycemia are recruited for the study. They were randomised into Group A who were treated with continuous intravenous insulin infusion and Group B who were treated with subcutaneous insulin. The mortality , duration of hospital stay and the hypoglycemic events were studied as outcome.
Results :
During the study period 316 patients with admission blood sugar ≥ 200 mg/dl were recruited in the study. Of the 163 patients in group A who were treated with intravenous insulin infusion 12 patient died and of the 153 patients in group B who were treated with subcutaneous insulin 23 died. The mean duration of stay among the group A and and group B was 3.28 and 4.71 days respectively. The number of hypoglycemic events  in group A were 24 and in group B were 17 which was not statistically significant.
Conclusion :
The continuous intravenous insulin infusion strategy to treat hyperglycemia in covid 19 patients has a significant reduction in the mortality and duration of hospital stay without significant increase in hypoglycemic events

Dengue viral infection is a major public health problem in developing tropic countries. Thrombocytopenia and bleeding manifestations are commonly  associated with dengue patients. The need for platelet transfusion in dengue patients is not clearly defined in them. This study aims at evaluating the effects of prophylactic blood transfusion in dengue patients.
Materials and methods :
About 267 seropositive dengue patients with platelet counts < 20,000/cumm were randomized into two groups. Group A had 135 patients who received prophylactic blood transfusion and group B which had 132 patients who did not receive prophylactic blood transfusion. The outcomes were studied and compared  for statistical significance.
Results :
The patients who received prophylactic blood transfusion did not had a statistically significant reduction in major and minor bleeding  manifestations , transfer to Intensive Care Unit or recovery from thrombocytopenia.
Conclusion :
Prophylactic blood transfusion have no role in treatment of thrombocytopenia in adult dengue patients.

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

Hematopoetic stem cell transplantation (HSCT) is one of the most aggressive treatments for a variety of hematologic malignancies, blood disorders and rare genetic disorders. Infections in HSCT are amongst the major causes of morbidity and mortality in the post-transplant period.
Objectives: To study the characteristics of infectious complications and outcomes in patients after Allogeneic HSCT for thalassemia in a tertiary care centre.
Materials &Methods: This is an ambispective study and all children who underwent HSCT for thalassemia and had infection from 1st January 2017 to 31st July 2022 were included in the study.
Results:  Majority of the patients were males (n=65, 68.4%). Of the total 95 recipients, 40 recipients (42.10%) had documented infections after the transplant.19 recipients had bacterial infection, so the bacterial infections account for 47.5% of total infections. Of them gram-negative bacilli infection was present in 10 (52.63%), gram positive cocci infection was encountered in 9patients (47.37%). Total 18 recipients had viral infection; viral infections account for 45% of total infections. majority of them had Cytomegalovirus (CMV) infection (n=12, 66.67%), 4 had BK virus infection (22.22%), 1 recipient (5.56%) each had Varicella zoster virus (VZV) and Parvo-virus B19 infection. Three patients (7.5%) were infected by fungal infection.
Of the 40 patients with infection 14 patients died.
Conclusion:  Judicious clinical work up, strict asepsis measures and early diagnosis and intervention remain the key to good clinical outcome.

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

Infantile tremor syndrome (ITS) is a self–limiting disease in infants and young children (5 months to 3 years), most commonly seen in developing countries with poor socio-economic conditions such as Southeast Asia, Indian subcontinent and African countries. Many etiologies have been hypothesized ranging from it being on obscure infection of CNS to being a spectrum of PEM & neurodegenerative diseases
Materials and Methods: This was a cross-sectional and prospective study, Conducted in the department of Paediatrics, Mahatma Gandhi Medical College and Hospital, Jaipur and Department of Paediatrics, Jhalawar Medical College, Jhalawar. A record of clinical profile was made using predesigned proforma after obtaining consent
Results: A total of 50 Children with Infantile Tremor Syndrome enrolled in study, there was male dominancy (72%), Maximum subjects were having age <1 year (76%), exclusive breast feed babies dominate (78%).
Conclusion: Majority of kids were receving improper nutrition in the form of prolonged exclusive nursing without the right complementing foods.

The percentage of healthcare personnel suffering from anxiety and insomnia increased during the Covid -19 pandemic. The objective of the study is to assess insomnia and anxiety among healthcare personnel involved in the management of the Covid-19 pandemic in Delhi.
Materials and Methods: A cross-sectional study was carried out among healthcare personnel. Residents. 5 tertiary care hospitals were selected purposively in Delhi. 91 respondents were selected for the study. A questionnaire through google forms was distributed and some of the questions required hybrid mode so the interview was conducted in hybrid mode in person or telephonically.
Results: The study revealed an 88% prevalence of definite cases of anxiety and 44.6% of some insomnia. The chi-square test reported a linear-by-linear association of 0.002 between Anxiety, Insomnia, fear of infecting the family members, and feeling of agitation while wearing the PPE kits. The study found that healthcare personnel having direct contact through the treatment of the infected patients experienced an increase in their anxiety scores, compared to HCPs having no direct contact with infected patients.
Conclusion: The results of this survey indicate that mental health symptoms like anxiety and insomnia have increased during the COVID-19 outbreak among healthcare professionals. The study also identified the associated risk factors and causes of mental health problems. Therefore, governments should proactively help in implementing mental health intervention policies in the country for the health professionals at risk, particularly those working in the COVID-ward.

The aim of present study is to study Magnetic resonance imaging evaluation of meniscal injuries of knee joint with clinical profile. The number of knee pain or injury cases attending the outpatient and inpatient department of orthopaedics have not yet been estimated. So we took convenient sample size of 60 patients of knee pain or injury through random selection from the patients attending outpatient and inpatient department of orthopaedics.
Result: The above table shows distribution of study population according to history of acute trauma. It was observed that majority of patients were present with acute trauma (80%) and absent among 20 % patients. Among the study population, 43 (71 %) had anterior cruciate ligament tear, 6 (10%) had posterior cruciate ligament tear, 12 (20 %) had lateral cruciate ligament tear, among 7 (11%) had medial cruciate ligament tear.
Conclusion: MRI examination is a non-invasive and precise diagnostic technique to evaluate ligamentous and other soft tissue structures around the knee. Appropriate sequences and analysis of images in all three planes increases the diagnostic yield. Most of the injuries to ligaments and menisci can be diagnosed with increased level of confidence. Anatomical variants, artifacts and other pitfalls of imaging should be cautiously interpreted and differentiated from pathological entities.  It was observed that majority of patients were having Anterior cruciate ligament tear (71 %) followed by Posterior cruciate ligament tear (10%).