European Journal of Molecular & Clinical Medicine

Health care-associated infections (HCAIs) are infections that occur while receiving health care developed in a hospital or other health care facility¹. HAIs are associated with increase in the cost of treatment, adverse patient outcomes, social impact, morbidity and mortality. DAIs continues to be one of the major threats to the patient safety, particularly in m of low-and middle-income countries^2,3,4,5. There are four major types of healthcare associated infections which were commonly encountered. Catheter associated urinary tract infections (CAUTI), Central line associated blood stream infections (CLABSI), Ventilator associated pneumonia (VAP) and surgical site infection. Among these first three are known as device associated infections (DAIs). Around, 15-25% of hospitalized patients require urinary catheterization. The risk of developing CA-bacteriuria increases with time; with an average risk of 3-10% per catheter days to 25% at the end of one week and to nearly all cases in one month⁶.
For the diagnosis of CAUTI, a patient with a urinary catheter in place must meet one of two criteria: one or more of the given signs and symptoms with no other recognized causes; such as fever (temperature ≥ 38 degree Celsius), urgency, suprapubic tenderness, and urine culture positive for ≥105 cfu/mL, with no more than two microorganisms isolated; and positive dipstick analysis for leukocyte esterase or nitrate and pyuria (≥10 leukocytes/mL) with no other recognized cause. Catheter-associated urinary tract infections (CAUTIs) have accounted for as much as 40% of all nosocomial infections in the United States, affecting an estimated 800,000 patients per year. The incidence of nosocomial UTI among the 25% of hospitalized patients, who have a urinary catheter, is approximately 5% per day, with virtually all patients developing bacteriuria by 30 days of catheterization⁷. One of the recent study found that most catheter-associated bacteriuria was asymptomatic⁸. But silent catheter-associated UTIs may represent a large pool of antibiotic-resistant pathogens⁹ and drive a great deal of generally unnecessary antibiotic therapy. These infections increase the length of stay, hospital cost, and mortality.¹⁰According to Centre for disease control and prevention-National Healthcare Safety Network-2013 report, the mean incidence of CAUTI per 1000 catheterized days was 0-5.3% in critical care units and 0-3.1% in inpatient wards¹¹. In India the incidence of CAUTI is 1.63-2.1 per 1000 catheter days^{12, 13}. Broad range of bacteria can cause CAUTI. In short term catheterized patients it is monomicrobial such as gram negative bacilli like Escherichia coli, Klebsiella, Serratia, Citrobacter, and Enterobacter, Pseudomonas and Acinetobacter and gram positive cocci like Coagulase negative staphylococcus and Enterococcus. In long term catheterized patients it is polymicrobial. In addition to the pathogens of short term catheterization, it is caused by Proteus, Providencia and Morganella.⁶The significant risk factors for CAUTI include age, uncontrolled diabetes and long hospital stay¹⁴. Other risk factors are female gender, impaired immunity and length of duration ofcatheterization^15.

Background: Psoriasis is a systemic immune-mediated disease accompanied by arthritis in a significant percentage of patients called psoriatic arthritis. The present study was conducted to compare methotrexate and acitretin in cases of psoriasis.
Materials & Methods: 80 patients of palmoplantar psoriasis of both genderswere divided into 2 groups of 40 each. Group I patients were given oral acitretin 0.5mg/kg daily for 3 months and group II were given oral methotrexate15mg/week for 3 months. Modified psoriasis area severity index (MPASI)score was recorded. Improvement was graded as: no change, slight improvement, moderate, marked and almost cleared.
Results: There were 15 males and 25 females in group I and 20 males and 20 females in group II. The mean MASI score at baseline, 1 month, 2 months and 3 months was in group I was 61.2, 41.4, 31.2 and 21.6 and in group II was 58.4, 39.2, 24.5 and 15.4. The difference was significant (P< 0.05).
Conclusion: Both oral methotrexate and acitretin were highly effective in treating palmoplantar psoriasis. The reduction of Psoriasis lesions with Oral methotrexate was faster than acitretin.

Background: In a densely populate, demographically diverse and vast country like India, the identity establishment of a dead person assumes great medico-legal importance. It also poses a true challenge to the forensic pathologist working in an environment where decomposition and taphonomic process are highly rapid and variable. One of the important pillars for identification is the stature. The estimation of age, sex and stature are vital for skeletal samples, when found from sites in mixed lot. So, a technique is urgently needed for reconstruction of total length of long bones from their fragments. This investigation was designed to estimate the total length of ulnas using its fragmentary bone length in a population specific study. In addition to this, the goal was to deploy them in stature formulae for population specific cases and lastly to estimate the stature of the individual.
Materials and Methods: After getting institutional ethical committee clearance, the study over 50 Ulna Bone revealed linear equation where total length of ulna was used as dependent variable and the different fragmentary length being the independent variables.
Results: The measurements of both sides (left and right) were grouped and noted separately but the results were pooled to obtain the regression equation. This was done because no significant difference in measurement between the left and right side in the sample of 50 ulna bones. The following Regression Equation was obtained:-
TOTAL LENGTH OF ULNA = 3.85+ 4.53QR +0.71ST +1.81PQ+0.32 TU
R SQUARED VALUE = 0.97.
Conclusion: This study was a preliminary work and a pilot project for estimating the regression equation to reconstruct the total length of ulna from its fragmentary lengths in a population specific sample (Eastern Indian population). Being population specific, it can be applied in disputed cases of identification of mutilated and fragmentary human remains of that geographic region and can be of immense help in future, especially for the law enforcement agencies in the case of mass disasters.

With consistently expanding advancement  in  innovation, utilization about Computerized Advertising, Online Entertainment Promoting, & Web search tool Showcasing is additionally expanding. Advanced Advertising is utilized by advertisers to advance labor & products to commercial center. Computerized Promoting places   significant job  in  expanding deals about labor & products. motivation behind this exploration is to concentrate on  effect about Computerized Promoting, how it's   significant device as two advertisers & buyers. We have additionally concentrated on  effect about Computerized Showcasing & its impact on  shopper purchasing conduct. This exploration was finished on  base about an organized poll as essential information & example size is 100 respondents

Shared Assets is an arising speculation vehicle that is covered with   pool about assets assembled from numerous financial backers. Common assets are assuming part about monetary go-betweens between banks and financial backers who needs to put resources into an offer market. fundamental point about shared reserves is to broaden gamble about financial backers. Larger part about businesses putting their sum current common assets for dealing with gamble about their monetary resources. There is   gathering about protections which is known as   portfolio that assists with choosing security current view about presentation. These colossal measures about cash current shared assets are worked by venture proficient called an asset supervisor or cash chief or portfolio director. This asset chief's responsibility is to put asset's resources current various protections like gold, stock, and different resources for make expected capital additions or pay. Shared reserves give open doors perpetually little and individual financial backers to get to expertly kept up with arrangement about protections like bonds, values, and different protections. Thusly, addition or misfortune emerging from such speculation can be shared aggregately among financial backers with respect to their commitment to asset.   shared asset's scope about speculation is organized and worked to satisfy venture targets.

Most budget summary examinations center around firms having a place with ventures that either contribute essentially to monetary figures or set in a profoundly serious business climate. target  about this paper is an investigation done to see degree to which an organization has executed utilizing rules monetary execution is great also right. This study researches execution  about business banking area for time  about April-2011 to Spring - 2014. Budget summaries  about Pivot bank, ICICI bank, Government bank also HDFC bank for demonstrated periods were gotten from data set, for example, CMIE, Ability, cash control also hurray finance. outcomes have impacted their monetary execution, also thus, point  about this proposition is to show impacts  about outflow outrage to Volkswagen's fiscal summaries, contrast distinctions with BMW's presentation during concentrated on time  about 2012-2016, also propose suggestion that would their proficiency in a consistently creating climate. exact piece  about this proposal was done, by utilizing near budget summary examination, to find contrasts in organizations' resource also capital designs, development, resource also work utilization effectiveness, liquidity, productivity, benefit per representative also relative power. As a general rule, it was established that, BMW was more beneficial for most part because  about more proficient administration  about money change cycle, as well as higher working benefit per representative, return on deals also work efficiency. They likewise had better also manageable resource also capital design, contrasted with Volkswagen. Important data got from these budget reports were summed up also used to process monetary proportions for four-year time frame. Monetary proportions are devices used to gauge productivity, liquidity also dissolvability execution  about four significant Indian business banks. This examination is to investigate fiscal reports  about these banks utilizing liquidity proportions, movement proportions, influence proportions, benefit proportions, a nd market esteem proportions. For liquidity, accompanying proportions were utilized: current proportion, fast or basic analysis proportion. For movement, Stock turnover proportion, debt holder turnover proportion also working capital turnover proportions were utilized. For influence, accompanying proportions were utilized for example obligation proportion, value proportion, also interest inclusion proportion. For productivity, overall revenue, net revenue, return on resources, return on investor's value, also income per share were utilized. For market esteem, cost profit proportion also procuring per share proportions were utilized.

Introduction: Obesity has become the leading global health problem. In numerous large population-based studies-Higher BMI associated with presence and development of low estimated GFR and many other renal diseases.
Objective: To study the renal functions in obese adults of rural area.
To do comparative analysis of renal functions with age and sex matched non obese adults.
Material and Methods: The present cross-sectional study was carried out in the General Medicine OPD of BPS GMC for Women, Khanpur Kalan, Sonipat, Haryana. A sample of convenient 100 obese patients were taken. A total of 200 patients attending General Medicine OPD were taken, out of which 100 were obese and 100 were non obese.
Results: Statistically significant P values were obtained for Blood Urea, Serum Creatinine, Serum Calcium, Serum Phosphorus, and urine albumin among obese and non-obese adults. Study shows no significant gender differences between obese and non-obese. Statistical analysis shows some age-related differences among obese and non-obese large population studies-showing positive association of BMI with chronic kidney disease.

Eosinophilic cholecystitis is regarded as ther are presentation of gallbladder infection that has similar presentation as acute cholecystitis. It presents with symptoms similar to that of cholecystitis with infiltration of excessive esnophils within the gallbladder. Eosinophilic cholecystitis can occur alone or most of the times in combination with eosinophilic inflammation gastrointestinal tract and rarely associated with inflammation of airway

Background: Excruciating pain is a common consequence following breast surgery and can be efficiently managed with double path PECS I and II blocks. Pectoral plane blocks (PECs) are being utilised more frequently in analgesia for patients undergoing breast surgery.
Methods: Sixty patients undergoing breast surgery were randomly assigned into two groups: Single path and double path. Performance time of technique, the onset and length of the sensory block, visual analogue pain ratings (VAS), postoperative analgesic requirements and success rate were the outcomes.
Results: A single-path block performed more quickly. With the exception of 10 hours postoperatively, where the double-path group had lower pain scores, other time points saw equal pain scores. The sensory block lasted longer and started sooner in the double path block.
Conclusions: The use of double-path pectoral blocks was a beneficial approach, as it was associated with a faster onset, and a longer duration of analgesia.

Aim: A study to observe the cases of abdominal wound dehiscence in patients undergoing emergency laparotomy with midline incision.
Objectives: To calculate the frequency of abdominal wound dehiscence in patients undergoing emergency laparotomies subjected to midline incision and to determine hypoproteinemia, anemia and surgical site infection as contributing factors for abdominal wound dehiscence in emergency laparotomies with midline incision.
Materials and Methods: Observational cohort study carried out in the department of General Surgery at Sri Guru Ram Das University of Health Sciences, Vallah, Sri Amritsar on 60 patients who underwent emergency laparotomy with midline incision.
Results: In our study, patients belonging to various kinds of age group and socio economic background were included in the study irrespective of the gender. Amongst the 60 patients included, abdominal wound dehiscence was seen in 36 patients corresponding to 60% of the sample size. This study was endeavoured to delineate the role of anemia, hypoalbuminaemia and SSI (surgical site infection) in the dehiscence seen in these patients and it was observed that majority of the patients undergoing abdominal wound dehiscence had hypoalbuminaemia thus, making it the most significant risk factor followed by anemia and surgical site infection.
Conclusion: In this study we concluded that Abdominal wound dehiscence is a serious sequel of impaired wound healing. Many factors can predispose to this grave complication of which anemia, hypoproteinaemia and surgical site infection carry enormous significance. Patients with these risk factors require more attention and special care to minimize the risk of occurrence. Postoperative abdominal wound dehiscence can be prevented by improving the nutritional status of the patient, strict aseptic precautions, optimization of patient's hemodynamic losses and by proper surgical technique. Early diagnosis of burst abdomen and aggressive treatment helps in reducing morbidity and mortality. Some of the major factors like the ones mentioned in this study must be vigilantly looked for and treated to prevent this catastrophic complication.

Objectives: To compare Clinical outcome of degenerative lumbar single level spine diseases treated by minimally invasive unilateral pedicle screw stabilization versus minimally invasive bilateral pedicle screws stabilization for TLIF procedures assessed by VAS, ODI SCORE AND SF 36 and to compare the radiological outcome by Beck index, fusion index, vertebral alignment, proper placement of cage. To compare intraoperative blood loss, duration of surgery, length of hospital stays between the mentioned two groups.
Materials and Methods: A total of 30 patients were randomized into two groups. Group 1 underwent minimally invasive unilateral pedicle screw stabilization -TLIF (15patients) and group 2 underwent minimally invasive bilateral pedicle stabilization -TLIF (15 patients) from the period between July 2020 to July 2022 and were followed up for mean duration of 18 months. Degenerative lumbar single level involvement with spinal canal stenosis grade 2, 3 and spondylolisthesis grade 1, 2 were involved. Clinical assessment was measured with visual analogue score (VAS score), Oswestry disability index (ODI) Score and Short form health survey -36 (SF36). Radiological assessment was done with Briedwell interbody fusion index, placement of cage. And were followed up at 3 months,6 months, 12 months and 18 months after surgery.
Results: The mean Age (Years) was 52.73 ± 11.92. Out of 30 participants 15 (50.0%) had Group: MISS- U/L instrumentation –TLIF. 15 (50.0%) of the participants had Group: MISS -B/L instrumentation TLIF. Majority of them were l4-l5 involvement. There was a significant difference between the 2 groups in terms of Duration of Surgery (Minutes) (W = 0.000, p = <0.001) and intraoperative blood loss (W = 3.500, p = <0.001), with the median Duration of Surgery (Minutes) being highest in the Group: B/L TLIF group. With the median Blood Loss (mL) being highest in the Group: B/L TLIF group. There was statistically significant improvement in the trend of VAS Score, ODI score, SF-36 over time in each group after surgery but there were no statistically significant changes between these 2 groups. There were no statistically significant changes in terms of fusion and cobbs’ angle between these 2 groups.
Conclusion: MISS TLIF with unilateral pedicle screw fixation in a single level degenerative disc diseases is similar to bilateral pedicle screw fixation with added advantages of shorter operative time, lesser intraoperative blood loss, similar days of hospital stay, no statistical significant difference in post operative changes in VAS score, ODI score, SF 36 score, briedwell fusion index, cobbs angle when compared to bilateral pedicle screw instrumentation leading to early mobilization, easy rehabilitation and return to activities of daily living.

Background: Subacromial Impingement Syndrome is the common cause for shoulder pain caused due to pathology in one or more of the structures present in the Subacromial area. The discomfort is linked to a loss of shoulder function and difficulty performing regular everyday activities. The pathophysiology is not entirely understood. The Subacromial injection was developed to reach a high drug concentration at the site of pathology while using a less overall drug to avoid systemic side effects. Triamcinolone Acetonide produces both anti-inflammatory and direct analgesic benefits in the shoulder.
Material and Methods: This study included 55 patients with Age more than 20 and Pain during Shoulder Arc of Motion, Positive Neer’s Sign and Hawkin’s Test. Pain during Shoulder Arc of motion, Visual Analogue Scale Score and Shoulder Pain and Disability Index was calculated pre injection and post injection at 2,6 and 12 weeks. Data was collected and analyzed statistically.
Results: 55 cases were worked up on OPD Basis. Mean age was 50.69, Male dominance. Pain during Shoulder Arc of Motion which was initially present in all 55 patients decreased over the follow-ups and at the end of 12 weeks only 3 patients had persistent pain. Visual Analogue Scale Median at 0 weeks was 9 which decreased to 0 at 12 weeks, Shoulder Pain and Disability Index Median at 0 weeks was 82.3 which decreased to 3.07 at 12 weeks. All these changes were significant with p value < 0.001.
Conclusion: We conclude that in our patients suffering from Subacromial Impingement Syndrome post subacromial injection under C-ARM guidance with Triamcinolone Acetonide, the results measured by Pain during Shoulder Arc of Motion, VAS Score and SPADI showed significant improvement. Thus, We support that Subacromial injection of Triamcinolone Acetonide is safe, economical and effective in the treatment of patients suffering from Subacromial Impingement Syndrome

Background: India is the world's largest TB epidemic country, with approximately 2-3 million new cases of TB. Diabetes mellitus (DM) is an emerging chronic health condition of developed and developing countries. It increases the risk of developing active TB by a factor of 2–3 compared with normal population. Materials And Methods: Patients with sputum smear positive pulmonary tuberculosis with diabetes mellitus were enrolled for a prospective observational study at GMC Jammu in India. Diagnosis of Diabetes Mellitus was based on the following criteria: Blood Sugar Fasting > 126 mg/dl, Blood Sugar (after 2 hrs during OGTT) > 200mg/dl and HbA1C > 6.5%. Results: Persons with diabetes mellitus (DM) have a 3-fold increased risk of developing tuberculosis. The median age of the Diabetic patients was significantly higher than the non-diabetics. Magee et al reported that TB–DM patients were significantly more likely to be older. After 2 months of treatment, the sputum positivity decreased in both the groups. There were significantly more Diabetics (28%) as compared to non- diabetics for AFB (P<0.05).  Conclusion: After anti-TB treatment, the sputum positivity decreased in both the diabetics and non-diabetics. However, decrease was less in diabetic patients at 2 months of treatment. Increasing age was an independent risk factor of increased risk of symptoms. Patients having both tuberculosis and DM should be screened for TB in early stages.

Background: Laparoscopic cholecystectomy is the preferred surgical technique for uncomplicated cholecystectomy. Recommended approach for post operative pain management is to initiate the treatment with analgesics such as paracetamol, NSAIDS followed by adjunctive use of opioids to treat more acute pain symptoms. Present study was aimed to compare intravenous paracetamol versus intravenous diclofenac for postoperative pain relief in elective laparoscopic cholecystectomy.
Material and Methods: Present study was prospective double blinded Randomised controlled study, conducted patients between 18 - 65 years, ASA physical status I/II, posted for laparoscopic cholecystectomy. 80 cases were randomly divided as Group A (75 mg Diclofenac: 40 cases) & Group B (1 gm Paracetamol: 40 cases).
Results: In present study difference in VAS score in group A & group B at all points was statistically not significant except at 6 Hours where difference in VAS score in both group was statistically significant (P value 0.02). After comparing the Visual Rating Scale (VRS) scores of both groups to assess postoperative pain, it was found that VRS score in group A was higher than group B at 15 minutes, 30 minutes & 6 hours and was statistically significant. It was found that 26 (65%) of patients in group A required rescue analgesic whereas 18(45%) in group B required rescue analgesic. However, the difference observed was statistically not significant (P= 0.072). It was found that 3 (7.5%) of patients in group B experienced an adverse effect whereas 6 (15%) in group A had an adverse effect. The difference was statistically not significant. (P=0.061).
Conclusion: Paracetamol is considered superior to diclofenac in laparoscopic cholecystectomy as paracetamol gives better & prolonged analgesia than Diclofenac as evidenced low VAS & VRS score and also lesser requirement of rescue analgesia.

Background: Venous malformations are a type of vascular malformation with abnormally developed vein, venules and venous capillaries bunching together to produce soft cystic reducible masses containing venous blood. They account for about two third of vascular malformations. It may involve skin, mucosa or any other part of the body. The aim of this study was to evaluate the efficacy and safety of intralesional bleomycin sclerotherapy in low flow venous malformations.
Materials and Methods: During 2019- 2022, 213 patients with cutaneous venous malformations were treated with bleomycin sclerotherapy at a tertiary care hospital. The diagnosis of venous malformation was made on the basis of clinical history and physical examination and confirmed by doppler ultrasonographic examination Only patients with low flow venous malformations were treated with intralesional bleomycin sclerotherapy.
Results: All were treated with intralesional bleomycin (0.1 I.U/ kg body weight) on an outpatient basis. Complete resolution (grade 4) was observed in 76(35.6%) patients and almost complete resolution (grade 3) with very minimal residual lesion or pigmentation was seen in 89(41.7%) patients thus producing a complete or near complete response in 77.3% patients.
Conclusion: Intralesional bleomycin sclerotherapy is an excellent treatment modality for the management of low flow venous malformations with very low procedural morbidity.

Background: To compare absorbable with non- absorbable sutures in closure of laparotomy incisions.
Materials and Methods: Sixty patients of both genders were divided into 2 groups of 30 each. In group I, fascia was closed with Prolene and in group II, fascia was closed with Vicryl. Using continuous suturing technique, fascia was closed with same size suture in both groups. Length of suture in both groups was constant 4:1. Post-operative infection at 3rd, 5th, 7th and 9th days was recorded.
Results: Group I had 15 males and 15 females and group II had 16 males and 14 females. Procedure was elective performed in 17 in group I and 18 in group II and emergency 13 in group I and 12 in group II. Diagnosis was hemoperitoneum 11 in group I and 12 in group II, blunt trauma abdomen 6 in group I and 3 in group II, gut gangrene 3 in group I and 2 in group II, mass abdomen 2 in group I and 3 in group II, intestinal perforation seen in 5 in group I and 6 in group II and intestinal obstruction 3 in group I and 4 in group II. The difference was significant (P< 0.05). Wound dehiscence was seen in 7 in group I and 12 in group II. The difference was significant (P< 0.05).
Conclusion: Prolene as compared to absorbable Vicryl suture had less wound dehiscence and better outcome.

Background: Autopsy (necropsy, post mortem examination, thanatopsy) is the examination of a person’s body after death. An autopsy is of different types. But among them Medicolegal autopsy is the concern of the forensic pathologist in India. Study of weight of human body organs plays a significant role in almost all the branches of medical sciences including forensic medicine, as any deviation in weight from the normal range suggests some pathological change in the organ. Recording of organ weights is one of regular criteria by the forensic experts during an autopsy. The findings were compared to what is standard or average of a specific organ for a specific age range and particular sex. The determination of weights of abdominal organs in particular has significant clinical value.
Materials and Methods: After getting institutional ethical committee clearance, the study done over the body of the 570 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria.
Results: Total 570 cases were selected after following the inclusion and exclusion criteria out of which 362 were males and 208 were females. Among the studied 570 cases, 362 (63.5 %) were male and 208 (36.5 %) were female. In this study the discussion was mainly on relation of age, sex, body weight, and body length upon the weights of thoracic viscera.
Conclusion: A database can be formed from this study regarding normal range of the weight of various organs and their relation with external parameters of the subjects which can be applicable on the population of this region for future reference. In severely mutilated bodies found in mass disasters or in homicidal killing, weights of isolated organs may give an idea about the stature, built and age of the victims helping in identification.

Background: To compare Rockwood pins and dynamic compression plating in management of displaced and shortened mid-clavicle fractures.
Materials and Methods: Clavicular fractures patients were divided into two groups of 35 each. Group I patients were treated with Rockwood clavicle pins and group II patients were treated with dynamic compression plate. Parameters such as mode of injury, and the functional outcome was evaluated using the American Shoulder and Elbow Surgeons (ASES) score and Constant score.
Results: There were 20 male and 15 females in group I and 22 male and 13 females in group II. The mode of injury was fall seen in 7 in group I and 5 in group II followed by road traffic accident seen in 20 in group I and 21 in group II and physical violence in 8 in group I and 9 in group II. A significant difference in both groups was observed (P< 0.05). ASES score subjective pain value was 9.7 in group I and 8.7 in group II, activity score was 28.4 in group I and 27.3 in group II. A significant difference was seen in both groups (P< 0.05). ASES score objective range of motion was 41.9 degree in group I and 40.2 degree in group II, strength was 20.9 in group I and 20.1 in group II. A significant difference was seen in both groups (P< 0.05).
Conclusion: Rockwood clavicle pins were superior as compared to dynamic compression plate in patients with displaced and shortened mid-clavicle fractures.

Background: To assess type of headache in children.
Materials and Methods: One hundred ten children age ranged 4 years to 10 years of both genders were selected. A thorough clinical examination and type of headache was recorded in case history proforma. A detailed neurological examination including ophthalmoscopy was performed on children with headache.
Results: Out of 110 patients, boys were 50 (45.4%) and girls were 60 (54.6%). Age group 4-6 years had 38, 6-8 years had 32 and 8-10 years had 40 patients. The difference was significant (P< 0.05). Type of headache was tension headache in 10, migraine in 46, migraine-like headache in 42, and non-specific headache in 12 patients. The difference was significant (P< 0.05).
Conclusion: The most common type of headache was migraine. Maximum number of pediatric headache was seen in 8-10 years of age.

To evaluate and compare the functional outcome of Lumbar disc herniations treated by open microscopic discectomy and endoscopic lumbar discectomy assesed by VAS AND ODI AND SF-36 score.To compare intraoperative blood loss, duration of surgery, length of hospital stays between the mentioned two groups.
Methods: Our study consists of 30 cases of lumbar disc herniations operated with microdiscectomy / endoscopic lumbar discectomy at Sanjay Gandhi institute of trauma and orthopaedics Bengalore. from december 2020 to december 2022 with follow up period of 12months for each patient after the surgery. Functional outcome was assessed through VAS AND ODI AND SF-36 score in every visit.
Results: The mean Age (Years) was 35.67 ± 6.36. out of 30 patients 15 (50.0%) of the participants had Group: OLM. 15 (50.0%) of the participants had Group: ELD. (46.7%) of the betweenthe2groupsintermsofDurationofSurgery (Minutes)(W=212.000,p=<0.001),with the median Duration Of Surgery (Minutes) being highest in the Group: OLM group.There was a significant difference between the 2 groups in terms of Blood Loss (mL) (W = 222.500, p = <0.001), with the median Blood Loss (mL) being highest in the Group: OLM group. there was a significant difference between the 2 groups in terms of improvement in VAS,ODI, and SF-36 score during the first 3 months of postoperative follow up. But after 3 months there Were no statistically significant changes between these 2 groups.
Interpretation and conclusion: The clinical results of endoscopic discectomy are similar to those of microdiscectomy in regard to improvement in radiated pain and disability but offer an advantage in relationit causes lesser soft tissue dissection, preservation of bony structures and allows early recovary of the patients,and it could lead to less surgical time, and blood loss. Endoscopic discectomy is a safe and effective technique,representing an alternative to the gold standard microdiscectomy.

Smoke inhaled from factories, wildfires, factories, motorbikes, and wood stoves has an impact on household pollution and its effects. The effects of smoke pollution have been studied.
Method: From December 2021 to November 2022, a thorough assessment of papers and reports conducted utilising the accessible resources to identify possible health concerns associated with smoke pollution in homes by Department of Community Medicine, TRR Institute of Medical Sciences, Warangal, India. Researchers gathered 125 publications and reports, 15 investigations were chosen.
Result: Lower respiratory ailments, heart disease, liver and kidney damage, pneumonia, asthma, and harm to the brain have all been linked to smoke pollution. Homelessness may worsen due to the increased burden of illnesses brought on by harmful pollutants in the atmosphere from smoke pollution, including dwarfed crops, water shortages, and water running dry. In many countries, it may also become impossible to pay for the costs of collective medication. The hazards are partially attributed to the combustion of biofuels like wood, manure, or coal, which affects the mechanisms that influence the accumulation of greenhouse gas emissions, particularly carbon dioxide, and the associated changing weather.
Conclusion: Our study suggests enduring new policies that advance public health and quality of life all throughout the globe.

Gallstones represent a significant public health problem in
modern societies, affecting 10% to 15% of the adult population. The types of gallstones
include mixed, cholesterol and pigment stones. This study was aimed to evaluate the serum
lipid profile and common bile duct diameter in patients with gallstones pre-operatively and
post operatively and to establish the effect of cholecystectomy on lipid profile and common
bile duct dimensions.
Materials and Methods: The study was conducted in Narayana Medical College and
Hospital, Nellore, Andhra Pradesh, India. This was a prospective observational study carried
out from August 2019 to March 2020.
Results: Out of total 50 cases, 29 cases (58%) were female and remaining 21cases (42%)
were male.Highest number of cases were in the age group 30-40 years (38%) followed by
30% between 40 to 50 years of age.In the present study, there was decrease in Total
Cholesterol levels, Low density lipoprotein (LDL) and Very low density lipoprotein (VLDL)
levels 1 week after surgery, 1 and 3 months after surgery. Triglycerides (TG) levels initially
increased after 1 week and decreased significantly 1 and 3 months after surgery. Significant
increase in HDL levels are seen after 1week which continued till 3months after surgery.
The current study showed an significant increase in CBD diameter of 0.53, 0.76 and 1.07 mm
in 1week, 1month and 3 months respectively after surgery.
Conclusion: It can be concluded from this study that cholecystectomy results in
normalization of lipid levels.And also increases the diameter of Common bile duct but within
physiological limits of that age and sex group

IoT based advanced solution for monitoring the soil conditions and atmosphere for efficient crop growth is presented. It also capable of monitoring temperature, humidity, soil moisture level using NodeMCU and several sensors connected to it. The system uses sensors which gives the amount of moisture in the soil, the humidity and temperature of the region, and a rain detecting sensor which and PIR sensor is using for motion activity can be used in deciding whether the crop is suitable for growing. All these sensors along with Arduino UNO are connected to the internet and a smartphone.

The United Nations Food and Agriculture Organization asserts that the whole world’s population would rise by an additional 2 billion in 2050, whereas at that time, the increased land area for farming will solely account for 4%. In the aforementioned situation, more coherent cultivation practices need to be accomplished by utilizing modern technological advancements and unravel the ongoing barriers in farming. An undeviating use of Artificial Intelligence and its subsets in agriculture can serve to be an embodiment of a shift in the way that farming is exercised during the present time. The agricultural domain faces countless obstacles for instance disease, improper soil analysis, pest infestation, irrigation, and inadequate drainage, and a lot more. These challenges lead to dangerous environmental hazards and intense crop loss as a result of using redundant chemicals. The realm of Artificial Intelligence along with its meticulous learning abilities has evolved to form akey approach for dealing with diverse
European Journal of Molecular &Clinical Medicine
ISSN2515-8260 Volume10, Issue 02,2023
185
farming-related issues. This paper emphasizes the applications of Artificial Intelligence practices in different domains of agricultural science, the industry insights, and the challenges to adopting AI in agriculture.

Although artificial neural networks can represent a variety of complex systems with a high degree of accuracy, these connectionist models are difficult to interpret. This significantly limits the applicability of neural networks in practice, especially where a premium is placed on the comprehensibility or reliability of systems. A novel artificial neural-network decision tree algorithm (ANN-DT) is therefore proposed, which extracts binary decision trees from a trained neural network. The ANN-DT algorithm uses the neural network to generate outputs for samples interpolated from the training data set. In contrast to existing techniques, ANN-DT can extract rules from feedforward neural networks with continuous outputs. These rules are extracted from the neural network without making assumptions about the internal structure of the neural network or the features of the data. A novel attribute selection criterion based on a significance analysis of the variables on the neural-network output is examined. It is shown to have significant benefits in certain cases when compared.

Modern deep learning techniques outperform cutting-edge signal processing techniques in image restoration applications. However, these CNNS still perform poorly if a picture has a lot of patterns and structures. Here, we offer a unique feature space deep residuary learning technique that outperforms the current residual learning method to handle this problem. The main concept is derived from the finding that a learning algorithm performs better if the input and/or label manifolds may be topologically simplified by an analytical planning to a feature space. Our in-depth numerical analyses utilizing denoising tests and the single-image super-resolution (SISR) rivalry show that proposed space residual learning surpasses the present atatus of the workmanship methods. Furthermore, our algorithm placed third in the NTIRE competition with a computational time that was 5–10 times quicker than that of the top-placed teams.

Huge volumes of healthcare data are gathered by the industry, but regrettably they are not "mined" to reveal hidden information for efficient analysis, diagnosis, and decision-making. Finding hidden patterns and linkages frequently involves idle. Advanced data mining methods can assist and offer a solution to deal with this scenario. The technique of extracting hidden information from a large dataset is known as data mining. Clustering, classification, association analysis, regression, and other data mining techniques summarization, analysis of time series and sequences, etc. Data mining methods are important a crucial part in several fields including text mining, graph mining, medical mining, Web mining and mining of multimedia. The goal of this research project is to forecast renal Utilizing Artificial Neural Networks (ANN) and Support Vector Machine (SVM). This study compares the accuracy and execution times of these two algorithms in order to assess how well they function. According to the experimental findings, the ANN performs better than the alternative approach.

Data is a valuable resource in this digital age, and there was a tonne of data being generated across all fields. Health care industry data comprises contains information about the patient as well as information on the ailment. The use of machine learning and medical data will assist us in doing data analysis to uncover hidden illness patterns and develop individualized treatments for the patient and utilized to forecast the illness. A generic architecture for illness prediction has been presented in this work in the field of medicine. Using an improved SVM-Radial bias kernel method, this system was tested using a smaller set of features from the Chronic Kidney Disease, Diabetes, and Heart Disease dataset. It was also compared to other machine learning methods such as SVM-
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Linear, SVMPolynomial, Random forest, and Decision tree in R studio. All of these machine learning algorithms have been assessed based on their performance

A major challenge in the search for a cure for cancer is predicting the illness status of the disease. For instance, distinguishing between benign and malignant tumours helps doctors diagnose cancer more accurately. Although technology advancements produced data on patients with various illness stages, it would be crucial to assess how well machine learning algorithms accomplish predictions. In this article, we suggest employing machine learning algorithms such a variation of AdaBoost, deepboost, xgboost, and support vector machines. We then analyse them using area under curve and accuracyon actual clinical data linked to thyroid cancer, colon cancer, and liver cancer. Results from experiments demonstrate the SVM's strong performance.

This graphic was published by Gartner, Inc. as part of a larger research document and should be evaluated in the context of the entire document. TheGartner document is available upon request from Microsoft. 2022 Gartner Magic Quadrant for Analytics and Business Intelligence Platforms, Austin Kronz, Kurt Schlegel, Julian Sun, David Pidsley, AnirudhGaneshan, 22 March 2022. Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.Turn your data into a competitive advantage by using Power BI and Azure together to connect, combine, and analyse your entire data estate. Enable business analysts, IT professionals, and data scientists to collaborate seamlessly, providing a single version of data truth that delivers insights across your organization. "Nowwe have a single consolidated source of truth that everyone uses, and we can increasingly automate our analysis for a deeper diveinto the intricacies of the data."

Stroke is a medical disorder that harms the brain by rupturing the blood vessels there. It can also happen when the passage of blood and other nutrients to the brain is interrupted The World Health Organization (WHO) claims that stroke is the main global cause of mortality and disability. The prediction of heart attacks has been studied, however likelihood of a brain stroke is depicted in very few works. Due to this evertheless, numerous machine learning models are created to forecast the potential for a brain stroke. This essay contains a variety of physiological variables with machine learning techniques, such as Decision Tree Classification, Random Forest, and Logistic Regression K-Nearest Neighbors, support vector machines, and classification likewise Naive Bayes.

Medical database data can be mined for knowledge using machine learning techniques. Various machine learning methods were employed in our application to extract diagnostic information to support judgments regarding the diagnosis of sports injuries.

In the field of computer vision, human behaviour identification is a vital area of research with important applications in several fields, including as intelligent surveillance, smart homes, and virtual reality. The requirements for high recognition accuracy and applicability in the modern complex environment are difficult for traditional manual procedures to achieve. The advent of deep learning has created new opportunities for behaviour recognition research. The primary goal of this paper is behaviour recognition using convolutional neural networks (CNN). The study context and significance of behaviour recognition are initially discussed before delving into and examining the classical learning methods and deep learning methods of behaviour recognition. We build a convolution neural network-based algorithm based on the distinctive human behaviour in public spaces.

Android is a savvy versatile terminal working stage center on Linux. Be that as it may, because of its open-source programming and programmable structure character, it drives the Android framework helpless against get infection assaults. This paper has profoundly inquired about from the Linux framework security system, Android explicit security instruments and other assurance components. Also, on this premise, Android gadgets have accomplished firmly watched on ordinary state. With the goal that aggressors cannot utilize the portion module or center library to get most elevated access consent and be assaulted. In the mean time, to additionally reinforce the security of Android gadgets, it empowers them to appropriately deal with the high-hazard danger. This paper likewise fortified interruption identification framework (HIDS) in light of the host so as to identify noxious programming and reinforce the Android framework level access control.

Background:After Covid-19 Pandemic, there are many elements including academic stress that contribute to psychological problems among medical students. Most importantly, these psychological elements may have an impact on how satisfied they are with their academic success.Aim and Objectives:To study the association between academic stress and academic self-efficacy on academic performance among MBBS and nursing students in the post-COVID-19 pandemic.Methodology:This is a cross‑sectional study and it was conducted via Google Form survey completed by students studying MBBS and nursing students in Erode district.A self-report format was used to collect data from students regarding academic stress, academic self-efficacy, and academic performance.Results:A total of 295 students(33.9% male, 66.1% female) had completed survey. MBBS and nursing students had a moderate level of academic self-efficacy (69.9%), a high level of academic stress.Students' academic stress, self-efficacy, and academic performance were found to be positively correlated (p < .05). The results show that significantly MBBS students’ academic self-efficacy mean score significantly higher than Nursing students (P <0.05). Conclusion:There is a significant association was observed on the levels of Academic Self efficacy versus MBBS and Nursing course students (P<0.05).

Background: To assess cases of tympanic membrane perforation.
Materials and Methods: One hundred ten patients with dry perforations of tympanic membrane with no history of active middle ear disease were enrolled and the type, degree and frequency of hearing loss was determined by tuning fork test and pure tone audiometry. Clinical parameters such as cause of injury, side, site, complaints and type was recorded. The duration of disease was also recorded.
Results: Out of 110 patients, males were 65 (59.0%) and females were 45 (41%). Cause of perforation was RTA in 52, domestic assault in 38 and armed robbery in 20. Type was penetrating in 66 and non- penetrating in 44. The difference was significant (P< 0.05). Side involved was left in 46 and right side in 64. Site was anterior in 53, posterior in 41 and undefined in 16. Complaint was otalgia in 62, otorrhoea in 75, vertigo in 27 and tinnitus in 27. The difference was non- significant (P> 0.05). The mean hearing loss in 0-9 mm³ perforation was 24.1 dB, in 9-30 mm³was 36.7 dB and >30 mm³was 47.5 mm³. The difference was significant (P< 0.05).
Conclusion: Commoncause of perforation was RTA, domestic assault and armed robbery. Type was penetrating and non- penetrating. Complaint was otalgia, otorrhoea, vertigo and tinnitus.

Background: To assess cases of biliary leakage after cholecystectomy.
Materials and Methods: We selected 1000 cases in four years from 2019- 2022 of laparoscopic cholecystectomy of both genders. 20 patients of biliary leakage after cholecystectomy of both genders were enrolled and site of bile leak and management were recorded.
Results: Out of 1000 patients of laparoscopic cholecystectomy, males were 450 (45.0%) and females were 550 (55.0%). Out of 20 patients of biliary leak, males were 8 (40%) and females were 12 (60%). Site of injury was CBD in 3 cases, CHD in 8, GB Bed in 5 and cystic duct in 4 cases. The difference was significant (P< 0.05). Management performed was primary suturing in 4, hepaticojejunostomy in 5, conservative with controlled external fistula in 8 and suturing of cystic duct in 3 cases. The difference was significant (P< 0.05).
Conclusion: Bile leak from major bile duct injury should be managed promptly and requires skilled surgical intervention. Management included primary suturing, hepaticojejunostomy, conservative with controlled external fistula in and suturing of cystic duct.

        A summary of existing work on the use of machine learning and deep learning       methods in biometrics is presented here. Biometrics traits covered include physiological (image, voice) as well as behavioral (gait, signature) features. This study shows that machine learning has a high potential to improve the performance of biometrics systems due to ML’s ability to mine, search and analyze big sets of data, performing matching tasks more quickly and reliably than the conventional methods. At the end some key challenges in use of adopting ML in biometrics systems are pointed out.

Much attention has been paid to the usage of handwritten mathematical equations and symbols, including pattern recognition industry consolidation Using a novel and sophisticated algorithm, it is now possible to identify the handwritten characters, a more diverse variety of handwritten digits is now visible. A number of machine learning algorithms, including conventional Neural Networks, Support Vector Machines, and Multilayer Perception. Finding the most effective and efficient approach for pattern recognition is the key goal or objective. Paper displays the accuracy of various classification methods varies. The Bayesian Network makes a "rough" classification of a binary image. The use of neural networks for classification contents.

This research aims to design and implement a home security system with human detection capability. Traditional home security systems, i.e., Closed-Circuit Television (CCTV) can only capture and record videos without the ability of giving warning feedback if there is any suspicious object. Therefore, an additional object detection and warning method is required. The proposed design is implemented using Raspberry Pi 3 and Arduino, that is connected by USB cable. The PIR sensor is installed on Arduino and webcam is mounted on Raspberry Pi 3. The Raspberry Pi 3 is used to process inputs from sensors and process images for human detection. PIR sensor detects the movement around the sensor to activate the webcam to capture a picture. Then, the object recognition is performed using Histogram of Oriented Gradients (HOG) and Support Vector Machine (SVM) to detect the suspicious object.

IoT The rapid growth in the E-Commerce industry has led to an exponential increase in the use of credit cards for online purchases and consequently they have been surging in the fraud related to it. In recent years, it has become very difficult to detect fraud in credit card systems. For predicting these transactions banks make use of various machine learning methodologies, past data has been collected and new features are being used for enhancing the predictive power. The performance of fraud detecting in credit card transactions is greatly affected by the sampling approach on dataset, selection of variables and detection techniques used. This paper investigates the performance of logistic regression, decision tree and random forest for credit card fraud detection. The three techniques are applied for the dataset and work is implemented in R language.

Number Plate Recognition technique is widely used in identifying vehicle identity across the world where a standard plate size and font are maintained which makes recognition easy. For implementing number plate recognition specifically in India a lot number of issue comes up like hundreds of different forms of fonts being used, size of plate not maintained, five different color number plate, double line number plate etc. All these problems are being taken care while developing a software for Indian number plate recognition and is tested in real Indian road conditions. Support Vector machines are trained & used for detection of number plate contours. ANN is used for character recognition from number plate and various algorithm for plate enhancement, noise reduction and ultimately neural networks are most efficient for result with erasing lot of camera constraints. The ANPR software is designed in C++ using Qt for GUI designing, OpenCV as image processing libraries and SQL as database management thereby making it a complete software implementation of idea.

Various electronic  equipment available for remote operation of grid control. However, the main disadvantage of is these systems that they can be operated only short ranges and also less reliable. Thus, to overcome the from above drawbacks, we are using one of the wireless communication techniques i.e., GSM (Global System for Mobile communications) is a digital cellular communications system which has rapidly gained acceptance and market share.world wide. The development of GSM is the first step towards a true personal communication system that will allow us to communicate anywhere, anytime and with anyone. GSM (Global Systems for Mobile Communication) is vastly used because of its simplicity in both transmitter and receiver design, can operate at 900 or 1800 MHZ band, faster, more reliable and globally network.

Due to the large number of deaths and car accidents caused by the driver's lack of attention, car manufacturers are trying to integrate ADAS systems with artificial intelligence and CV. One function that helps the driver is traffic sign recognition (TSR). This is a technology with which a vehicle is able to recognize road signs placed on the road, e.g. "speed limit" or "give way" or "stop" all this being possible with the help of computer vision and Convolutional Neural Networks. In this article we propose an implementation based on LeNet architecture for traffic sign recognition using CNN. We preferred the deep learning approach for this challenge as methods like shape based or color based share a common weakness in factors as light changes, scale change, rotation. The paper presents implementation of the network architecture based on LeNet5 using Keras and TensorFlow library, how we trained the CNN using the GTSRB dataset, and what results we obtained training and using the network for real time applications using only CPU power, with Intel i7 7700K. The experimental results showed a 95% accuracy in recognizing traffic signs. Keywords – Artificial Intelligence, AI, Convolutional neural network, deep learning, LeNet architecture, traffic signs recognition.

Speech recognition is one of the fastest-growing engineering technologies. It has several applications in different areas, and provides many potential benefits. A lot of people are unable to communicate due to language barriers. We aim to reduce this barrier via our project, which was designed and developed to achieve systems in particular cases to provide significant help so people can share information by operating a computer using voice input. This project keeps that factor in mind, and an effort is made to ensure our project is able to recognize speech and convert input audio into text; it also enables a user to perform file operations like Save, Open, or Exit from voice-only input. We design a system that can recognize the human voice as well as audio clips, and translate between English and Hindi. The output is in text form, and we provide options to convert audio from one language to the other. Going forward, we expect to add functionality that provides dictionary meanings for Hindi and English words. Neural machine translation is the primary algorithm used in the industry to perform machine translation.

              The security of our data on the Internet is MYTH now a day’s. Regularly we are using lots of services and applications to accomplish a small task   or works. Like converting documents to PDF, playing online games knowingly / unknowingly we are giving permissions to the apps for accessing our data   by using options like the sign in with Google or sign in with Facebook. Most people are not aware that these apps can access all the information available on that particular platform this user and they can use it for customizing applications and to provide a better experience to the user. 

Major industries throught the world are being transformed by the artificial intelligence (AI) revolution. Many engineers and scientists are interested in AI because it makes correct inferences. After careful consideration, it appears that hardware- in- the-loop (HIL) emulation may choose to use this kind of modeling approach as one of the choices. In this article, a method for simulating power electronic motor drive transients for advanced transportation applications (ATAs) without a conventional circuit- oriented transient solver is proposed. To verify the realtime emulation application-specific labs, the more electric aircraft (MEA) power system is used as a case study. MLBs have used neural networks (NNs) to create component-, device-, and system-level models for diverse pieces of machinery. These models have been successfully trained in a cluster and are now being used with field-programmable gates. Based hardware platform (FPGA). The results of the MLBB emulation are then contrasted
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with those obtained by PSCAD/EMTDC for the system level and SaberRD for the device level. The
which has been applied in the areas of face verification , image resolution processing , human results of the comparison revealed great consistency for modelcorrectness and high speed-up forhardware execution.

Image colorization is a fascinating and challenging topic in image-to-image translation. Image Colorization is the process of coloring a grayscale image by using a black and white image known as a grayscale image as input and obtaining the output in RGB format simply known as a color image. The fundamental aim is to convince the spectator that the outcome is genuine. Many cameras, such as surveillance cameras and satellite cameras, still capture grayscale images which are kind of hard to analyze. Over the last 20 years, a wide range of colorization methods have been created, ranging from algorithmically simple yet time- and energy-consuming procedures due to unavoidable human participation to more difficult but also more automated methods. Image colorization by hand is time-consuming and prone to human error. Automatic conversion has evolved into a difficult field that combines machine learning and deep learning with art. In this project, we built an image colorization framework based on a deep learning method known as Generative Adversarial Networks, or GANs for short. GANs are a type of generative modelling that employs deep learning techniques such as convolutional neural networks.

The project's primary goal is to improve the shopping experience for women while buying cosmetics.There are websites that have many brands in the market and products for every sort of client; nevertheless, these products do not always reach the people who need them the most, and some products are overpriced or not worth the hype. Additionally, some websites' user interfaces are not particularly excellent. Some websites don't offer simple return policies, and the tracking ID isn't updated promptly. User information is misused, and the services are not continuous. No FAQs or question areas, which are essential for a general audience that relies on these websites.The project's major goal is to provide ideas based on user problems, display the best products that are reasonably priced on the screen

This paper describes the design of smart Education Institute using Internet of Things Technology (IoT). Smart Educational Institute can be also known as the smart campus, developing of smart educational institute leads to smart campus development. Through smart campus, it is possible that a campus is connected via online by the outside entity. So that the teaching entity will be done technology in real time. The study of smart campus consist of smartroom, smart parking and smart education. By the study of this paper we can able to design the smart campus by which we can save time, power, etc.

Communication plays a crucial role in every field in one’s life. It is an integration of the communicating technologies with the help of internet. But this facility is not for blind people. Hence, we aimed to develop an Android based email application that can facilitate visually challenged people to use email services for communication. The application will work solely on voice commands spoken by the user which will enable them to communicate with the world. They can send and receive any mails whether it is a text document, picture, audio, video, etc. using this system using the internet. By providing the platform in which they can speak the operation and can able to send and receive the messages. The system will be build using Google Text-to-Speech and Speech-to-Text APIs, which will make it efficient, accurate to a certain limit and user friendly. We describe the Voicemail system architecture that can be used by a Blind person to access eMails easily and efficiently. The contribution made by this research has enabled the Blind people to send and receive voice based e-Mail messages in their native language with the help of a computer.

Various electronic equipment available for remote operation of grid control. However, the main disadvantage of is these systems that they can be operated only short ranges and also less reliable. Thus, to overcome the from above drawbacks, we are using one of the wireless communication techniques i.e., GSM (Global System for Mobile communications) is a digital cellular communications system which has rapidly gained acceptance and market share.world wide. The development of GSM is the first step towards a true personal communication system that will allow us to communicate anywhere, anytime and with anyone. GSM (Global Systems for Mobile Communication) is vastly used because of its simplicity in both transmitter and receiver design, can operate at 900 or 1800 MHZ band, faster, more reliable and globally network.

During data transmission, data can be transmitted in the form of text, image, audio and video, hence securing all kinds of data is most essential in today’s era. With the advent of internet technology, the number of unauthorized users to access the data increases.so, the transmission of information through imagesbecomes more. And it also becomes a more reliable form to transmit data. There are a number of algorithms available to solve this problem. One of the efficient methods is to use the AES (Advanced Encryption Standard) algorithm, the most notable and extensively used cryptographic algorithm because itis six times faster than 3- DES and much faster than the RSA algorithm. In this paper we proposed an image encryption and decryption algorithm using AES in which encryption contains a random image and decryption contains the original image. The efficiency of AES is compared using image and text and it is analyzed. The result thus shows that the sharing of information through image is much more reliable and efficient than sharing information as text. Index Terms: AES, Cryptography, Decryption, Encryption, Image.

The use of Radio Frequency Identification (RFID) systems in industrial technologies, health, agriculture, transportation, etc. has suddenly increased in recent days. The internet of things is flourishing.With the help of the Raspberry Pi 3 and RFID Technology, the attendance management system uses the Internet of Things to speed up the time-consuming process of documenting daily attendance in schools and other institutions. Thus, everything in this place becomes mechanised. The creation of an Android application (app) to enable students to view their attendance from any location has also been attempted.

Human being has lot of virtual mask in their behaviour (mind or brain). By the way of probability study alone, be able to find a person’s loyalty through their emotions, stress of speech, way of expressions and so on. It is not a novel technique to this world. The judgement and the hearings are finalizing in accordance to passed parameters (questions, transparent as well hidden test) and the result. Artificial Neural Network (ANN) is one of the best methods meant for speech stress analysing based cheap lie detection for the loyalty test. To show the results, polygraph is a comprehensible demonstration oriented approach. These methods are already used by the insurance fraud investigations and police. Through an individual’s stress (stress percentage or else range) voice as well their emotions are able to detect the loyalty. Lie detection techniques require being extremely confidential and dynamic. For the reason that voice stress analysis (VSA) parameters have to be an encrypted for avoiding speech practise with testing tool. Here this paper, outlooks by using for predicting the liars through Speech VSA

Lung Cancer detection making use of medical imaging is still a challenging task for radiologist. The objective of this researchis to classify the types of lung tumours for extracted and selected features using learning algorithms. In this paper, an experimental study is conducted on 100 cases of lung cancer to evaluate the performance of learning classifiers (DNN, SVM,Random Forest, Decision Tree, Naïve Bayes) with different medical Imaging (DICOM) features to identify the two types ofLung cancer (Benign and Malignant). The proposed methodology intends to automate the entire procedure of diagnosis byautomatically detecting the tumor, measuring the required values such as diameter, perimeter, area, centroid, roundness,indentations and calcification. Experiment is conducted in to two phases: In the first phase, identify the most significantfeature used in lung cancer analysis by CT scan and perform the mapping to computer related format. In the second phase,feature selection and extraction is performed to machine learning algorithms. To evaluate the performance of classifiers interm of classification accuracy and improving the false positive rate, every stage of evolution is divided into four differentphases: single phase module, single slice testing, series testing and testing of learning algorithms. Experimental resultsshow significant improvement in false positive rate up to 30% for both Benign and Malignant. Whereas, Deep NeuralNetwork (DNN) demonstrate high values in term of classification accuracy in comparison with other classifiers.

Medical images (Magnetic Resonance Imaging scans) are used by doctors and medical specialists to determine the possibility that a cancer is present in the lungs of a patient. We are using these images, along with Deep Neural Network algorithms to help doctors with image diagnostics by training the Deep Neural Network (DNN) to recognize lung cancer. Our Deep Neural Network introduces novelty by making extensive search by adding additional layers of convolution and max pooling. Moreover, we are using images from slow progressing lung cancer to determine the threshold or at which point in the progression, our Deep Neural Network, will diagnose the cancer. Using this, doctors will have additional help in early phase lung cancer detection and early treatment. These are the main purposes of our research, which includes thorough search of possibilities of lung cancer and early detection.

With the continuous development of information technology in China, it has become an indispensable part in the daily life and production. As an economic model based on extended information technology, E-commerce technology has gradually been accepted by the public, from the traditional passive acceptance to active cooperation and active use, which serves as an opportunity as well as a challenge for e-commerce enterprises. They must ensure good performance in marketing, such as website marketing. Website marketing is an essential part of the e-commerce marketing process, and its level will directly determine the overall operation quality and efficiency of e-commerce enterprises. Therefore, the relevant staff must conduct in-depth research on it, optimize and innovate traditional marketing methods in the context of new media technology, improve the level of website marketing, to improve the influence of enterprises in all aspects and enable them to obtain a certain share in the e- commerce market. Based on this, this thesis makes an in-depth analysis of e-commerce website marketing against the backdrop of new media and formulates corresponding marketing strategies according to its characteristics.

Communication is the main channel between people to communicate with each other. In the recent years, there has been rapid increase in the number of deaf and dumb victims due to birth defects, accidents and oral diseases. Since deaf and dumb people cannot communicate with normal person so they have to depend on some sort of visual communication. Sometimes people interpret these messages wrongly either through sign language or lip. Hand gesture is one of the method used in sign language for non- verbal communication. It is most commonly used by deaf & dumb people who have hearing or speech problems to communicate among themselves or with normal people. Various sign language systems has been developed by many makers around the world but they are neither flexible nor cost-effective for the end users. Hence in this paper introduced software which presents a system prototype that is able to automatically recognize sign language to help deaf and dumb people to communicate more effectively with each other or normal people. Pattern recognition and Gesture recognition are the developing fields of research. Being a significant part in nonverbal communication hand gestures are playing key role in our daily life.

Cloud is used in various fields like industry, military, college, etc. for various services and storage of huge amount of data. Data stored in this cloud can be accessed or retrieved on the users request without direct access to the server computer. But the major concern regarding storage of data online that is on the cloud is the Security. This Security concern can be solved using various ways, the most commonly used techniques are cryptography and steganography. But sometimes a single technique or algorithm alone cannot provide high-level security. So we have introduces a new security mechanism that uses a combination of multiple cryptographic algorithms of symmetrickey and steganography. In this proposed system 3DES (Triple Data Encryption Standard), RC6 (Rivest Cipher 6) and AES (Advanced Encryption Standard) algorithms are used to provide security to data. All the algorithms use 128-bit keys. LSB steganography technique is used to securely store the key information.

The security of our data on the Internet is MYTH now a day’s. Regularly we are using lots of services and applications to accomplish small tasks or work. Like converting documents to PDF, and playing online games knowingly / unknowingly we are giving permissions to those apps for accessing our data by using options like the sign in with Google or signing in with Facebook. Most people are not aware that these apps can access all the information available on that particular platform of this user and they can use it for customizing applications and to provide a better experience to the user.In some cases, the app does not require all the information about the user but collects it. And users don't want to share the information with a particular website or app which they don't trust. So to overcome the scenario we came up with a user verification alternative (Secure Login Authentication System). Where the user can provide his full name, mobile number, email address, date of birth, and password. Apart from this, we will not collect any other information so that if that app tries to access the information it will be available on the server. Users who don't like to share their information online can use this alternative (Secure Login Authentication System) to verify themselves and share as much as less data.

Skin diseases are one of the common health problems that can be diagnosed by examining the physical structure of diseases and history. At present, diagnosis of skin disease is done by invasive techniques like clinical examination and histopathology. The tests are very efficient and helpful. But these methods require subject experts, more time, and have less data reproducibility. Since diagnosis needs an expert, making it reachable to all places is difficult. So this research came up with a solution using a clinical feature-based diagnosis tool to diagnose certain skin diseases. The tool was developed with the help of image processing and deep learning algorithms.

As technology developed, new business-making mechanisms emerged in the financial sector. One of them is the credit card system. But due to several flaws in this method, numerous issues are raised in this system by credit card frauds. The industry as well as customers who use credit cards is suffering greatly as a result. Lessons on investigating actual credit card figures in relation to privacy concerns are lacking. In the publication, an effort has been made to uncover credit card fraud using algorithms that used machine learning approaches. In this regard, two algorithms are used via Fraud Detection in credit card using Decision Tree and Fraud Detection using Random Forest. Some available online data can be used as a sample to determine the model's efficacy. Then, a financial institution's genuine globe credit card details group is analyzed . Additionally, additional noise is added to the data samples in order to auxiliary assess the systems' durability. The first approach in the study is significant since it builds a tree against the user's behaviors, and by utilizing this tree, frauds will be detected. In the second way, a user activity-based forest will be built, and it will be attempted to identify the suspect using this forest. The findings of the analysis unequivocally demonstrate that the common elective method detects credit card fraud situations with respectable degrees of precision.

To maintain the attendance record with day to day activities is a challenging task. The conventional method of calling name of each student is time consuming and there is always a chance of proxy attendance. The following system is based on face recognition to maintain the attendance record of students. The daily attendance of students is recorded subject wise which is stored already by the administrator. As the time for corresponding subject arrives the system automatically starts taking snaps and then apply face detection and recognition technique to the given image and the recognize students are marked as present and their attendance update with corresponding time and subject id. We have used deep learning techniques to develop this system, histogram of oriented gradient method is used to detect faces in images and deep learning method is used to compute and compare feature facial of students to recognize them. Our system is capable to identify multiple faces in real time.

Improper activities appear nowadays for the human (i.e.) falling without aware, and numerous techniques had been developed to reduce them. In this essay, critically analysis of the various proposed methodologies by comparing their strength and their weakness. The complexity and diversity of actions make it difficult to recognise them. The conventional (CCTV) method is ineffective and expensive for monitoring patient activities by using sensor based is also difficult due to drained battery life. So we need real time system for activity recognition with more efficiency and accuracy to avoid people from morality problems or it may lead to causes to major injuries. By comparing various algorithm Support vector machine (SVM) is a discriminative classifier belonging to supervised learning. Recurrent neural network (RNN) is one of the concepts in deep neural network. The main intention of the RNN is to minimize the preprocessing. This application will seem like visual imagery analysis. The convolutional neural network (CNN) it is more cost expensive compared wearable and ambience based

Metal nanoparticles (MNPs) Medical imaging, bioengineering, photoelectricity, antibacterial, anticancer, and catalysis are just a few of the many areas where their unique physical and chemical properties have been extensively utilized. In the conventional MNP synthesis method, toxic chemicals are typically used as reducing and stabilizing agents. This method is extremely harmful to the environment and takes a long time. Because of this, environmentally friendly MNPs synthesis has recently received a lot of attention. Utilizing plant extracts as reductants and stabilizers enables MNP synthesis to be simple, cost-effective, and long-lasting. In addition, unlike their conventional counterparts, the as-synthesized MNPs are uniform in size, less toxic, and more stable. Green preparation methods are becoming an increasingly important focus in MNPs synthesis research. This systematic review provides a summary of the most recent developments in the utilization of plant extracts as reductants and stabilizers in the green synthesis of MNPs. The potential applications of MNPs made from plant extracts have also been studied in greater detail.

Placenta is a functional unit between the mother and the foetus. Only eutherian mammals possess placenta. Human placenta is discoid, deciduate, haemochorial, chorioallantoic, labyrinthine and endocrine gland which connects developing embryo by umbilical cord to the endometrium of mother’s uterus. It develops from two sources. The fetal component which is the principal component develops from chorion frondosum and the maternal component from decidua basalis. The fetal surface is smooth, covered by amnion and presents the attachment of the umbilical cord close to its centre. The maternal surface is rough, irregular and spongy and is mapped out into 15-20 convex polygonal areas known as lobes or cotyledons which are limited by fissures

Placenta is a functional unit between the mother and the foetus. Only eutherian mammals possess placenta. Human placenta is discoid, deciduate, haemochorial, chorioallantoic, labyrinthine and endocrine gland which connects developing embryo by umbilical cord to the endometrium of mother’s uterus. It develops from two sources. The fetal component which is the principal component develops from chorion frondosum and the maternal component from decidua basalis. The fetal surface is smooth, covered by amnion and presents the attachment of the umbilical cord close to its centre. The maternal surface is rough, irregular and spongy and is mapped out into 15-20 convex polygonal areas known as lobes or cotyledons which are limited by fissures

Introduction: Diabetes mellitus being a chronic metabolic disease responds well to self-care practices. Improper self-care and insomnia have been associated with poor glycemic status with its associated micro and macrovascular complications.
Materials and methods: The data regarding self-care and insomnia were collected from 90 consecutive adult patients with type 2 diabetes at a tertiary care teaching hospital, using Diabetes Self-Management Questionnaire and Insomnia Severity Index questionnaire. Glycated haemoglobin was used as a measure of glycemic status.
Results: There was a significant association between poor self-care with insomnia (p=0.001) and glycemic status (p=0.03), but there was no association between insomnia and glycemic status (0.95). Conclusion: Poor self-care is associated with poor glycemic status and insomnia.

Aim: This study was made to determine the efficacy of visualization of hepatic artery without contrast and to determine the branching patterns of biliary tract by using MRCP. Methods: This was an observational cross sectional study in the department of Radio- diagnosis, Dr. D.Y. Patil Medical College and Hospital, Pune. All the patients who were referred to the Radiology department for routine MRCP were considered as study population. The data collection for the study was done from January 2021 to June 2022. Consecutive sampling was done and the sample size achieved was 30. Results: The normal course of common hepatic duct was found in 80% of patients where the remaining 20% were variants formed by RAHD and LHD and the other being RPHD and LHD. Considering the cystic duct, the normal lateral insertion was found in 76.7% of the study population whereas medial insertion was found in 13.3%. In case of hepatic artery, Michel’s type I was found in 86.7% of the study population. Other variants found are Michel’s type III and IX. In 6.7% of subjects, the hepatic artery could not be visualized. Normal anatomy of left hepatic duct was seen in 66.7% of females and 33.3% of males with a significant p value of 0.0135. Right hepatic duct was normal in 69.6% females and 30.4% of males with a significant p value of 0.05. The lateral insertion of cystic duct which is considered normal is found in 52.2% of females and 47.8% of males with a significant p value of 0.56. Michel’s type I variant was observed in 61.5% of females and 38.5% of males with a p value of 0.5. Conclusion: Our study described the prevalence of anatomical variations of biliary tract in our study population and also delineated the hepatic artery and its variations to some extent without using contrast.

Objectives: This present study was aimed to compare the clinical outcomes of the two treatment modalities:percutaneous ultrasound guided needle aspirations versus incision and drainage inthe management of breast abscesses.
Methods: A total of 50 breast abscess patients were enrolled in this study. All the patients were randomized and allocated into 2 groups of 25 patients each.25 patients in one group were subjected topercutaneous ultrasound guided needle aspiration (Group A) under local anaesthesia and 25 patients in another group to incision and drainage (Group B) under general anaesthesia respectively. A detailed history and clinical examination was done for all the patients and multiple clinical variables were recorded prospectively to evaluate the differences in theclinical outcomes of the two modalities used for the management of breast abscesses.

A young male with no known comorbidities, posted for an uncomplicated ENT procedure, had his tooth missing immediately post extubation from Anesthesia. In this case report we explore the possibilities and expected complications of a missing foreign body in the oropharynx, the need for vigilance and immediate action to prevent further injury to the patient.

Many businesses today aim to provide useful product suggestions to online users in order to increase their consumption on websites. People usually choose or buy a new product based on the recommendations of friends, comparisons of similar products, or feedback from other users. A recommender system must be implemented in order for all of these tasks to be completed automatically. Recommender systems are tools that provide suggestions that best suit the client's needs, even if the client is unaware of it.Personalized content offers are based on past behaviour, and they entice customers to return to the website. A web series recommendation mechanism for Netflix/Prime/Disney plus Hotstar will be built in this paper. The dataset used in this study contains over 5 K web series and 500 K+ customers. Popularity, Collaborative Filtering, Content-based Filtering, and Hybrid Approaches are the four main types of recommender algorithms. This paper will introduce all of them. We will choose the algorithms that best fit the data, implement them, and compare them

The efficiency with which a business manages its working capital determines how well it can fulfil its operating expenses and its short-term debt obligations. It is important for businesses to balance the demands of effective working capital management with their overall financial and operational health. It is anticipated that the strong financial performance will be supported by an effective Working Capital Management. This research set out to learn how effective management of a company's working capital can boost its bottom line. Working capital management effectiveness was studied by analysing the cash conversion cycle. Here, we ask, "To what extent does the management of working capital affect the financial results of trading firms?" ― Working capital management is found to have a significant impact on bottom line results, according to the literature. The assumption was that a company's bottom line would benefit from better attention to its working capital. The relationship between the key performance indicator return on assets and the controllable factor of working capital management was studied.

BACKGROUND:
Preoperative management of the patient is the liability of a medical attendance. An understanding of risk factors before general anaesthesia [GA] is an important factor for preoperative management.The present study was aimed at assessing the airway of patients undergoing oral surgical procedures under general anaesthesia in our institution.
 
MATERIAL AND METHODS:
The study was performed under a university setting where all the data of patients who underwent oral and maxillofacial surgical procedure under general anaesthesia.The collected data was compiled, reviewed , tabulated and entered in SPSS software and statistically analysed.
 
RESULTS:
55% of the patients were males and the rest (45%) were females. Airway assessment in patients according to mallampati classification revealed that 57% were of class I, 38% were of class II , 3% were of class III and less than 1% were class IV. Patients who underwent FMR (40%) and cleft lip/palate (14%) had class I airway. Patients who underwent ORIF and enucleation both had class I (19.5%), class II (3.5%) airways and class I (4%), class II (1%) airways respectively. Patients who underwent orthognathic surgery had class I (11%) and class II (3.5%) airways. Patients undergoing TMJ surgery including ankylosis release, surgery for Oral submucous fibrosis had predominantly class III (1%) and class IV (2.5%) airways. Difficult airways (class III, Class IV) were present in patients undergoing procedures like TMJ ankylosis release, and surgery for oral submucous fibrosis.The association between the mallampati classification and the treatment [oral and maxillofacial surgical procedures] done under GA was statistically significant with p=0.025 (p<0.05) [chi square test].
 
CONCLUSION:
Assessing airway is crucial before any surgical treatment. The modified Mallampati test is easy to perform, more accurate and is commonly used to assess the airway of patients undergoing oral and maxillofacial procedures under general anesthesia. Complications might not occur if the pre operative assessment of the airway of the patient is done properly using this classification, and the surgery is planned accordingly.

The theoretical foundation of dietary recommendations in family practice is covered in this paper. Nutrition counseling is an essential aspect of everyday practice due to the many conditions and disorders encountered in family medicine about which nutrition and diet are effective therapies. The advantages of the family doctor, including the patient-centered methodology that allows for different goals and consistency of care, which gives the family doctor multiple contacts over time to current and reinforce advice, must be linked to the success of diet-related suggestions and counseling in family practice. From this stance, family doctors should encounter their patients with guidance and counseling in "ready bits" that fit the time restrictions of routine consultations. They should also ensure that these portions are consistent throughout the years and identify particular patients' value systems and barriers to changing their eating habits. Individuals' indicated willingness to alter orientation can serve as a model for patient-centeredness. The benefits of family medicine should be highlighted in primary care nutritional recommendations. The first part looks at some of the traits of public health, family medicine, and the communities in which family medicine is practiced. This then leads to exploring several food, nutritional, and consumption goals that establish the background for family physicians' work. These schedules outline the range of nutritional advice provided by family doctors. They imply that the existing nutritional objectives are just one option among several. Ultimately, several potential actions are suggested to enhance family doctors' influence on patients' lives.

A global field of study called emergency medicine (EM) offers both primary and secondary illness prevention. It is a laterally intelligent approach in emergency care that includes patient access to EM care, EM care delivery in the area and during the level of mobility, and EM care delivery in the admitting facility or hospital ED. EM can provide a variety of methods to enhance public healthcare. Such tools encompass primary preventative medicine, drug abuse and violence-related treatments, safety skills training, epidemiologic studies monitoring, patient enrolment in acute intervention-focused clinical research trials, education and medical experience of healthcare professionals, and involvement in local and regional disaster relief efforts. Advocates for public health and healthcare decision-makers may profit from EM's prospects and contribute to overcoming its difficulties. In addition to enhancing the capacities of EM for primary and second-line prevention for the benefit of general health, promoting the advancement and acceptance of the speciality of EM on a global scale can positively affect education programs.

Over the past few decades, environmental modifications (lower availability to sunlight owing to operating indoors or use of protective clothing and sunblock; food modifications) have been mainly blamed for vitamin D and inadequacy in the wider public. Being overweight, living in the inner-city and having African American ancestry are possible causes for asthma and vitamin D insufficiency. While the musculoskeletal effects of chronic insufficiency of vitamin D are very well recognized, a variety of other illnesses, particularly respiratory problems, have recently been related to vitamin D insufficiency. The potential significance of vitamin D as an increasing mediator that supports lung health is becoming well understood. In children with asthma, vitamin D insufficiency appears to be more common. According to epidemiological data, children with asthma with low blood levels of vitamin D suffer from more pain, exacerbations, lung damage, medication usage, and severe illness. Research published in vitro has shown that adult asthmatics' steroid sensitivity is improved by vitamin D. By preventing disease, in particular by retaining regulatory T cells, and by directly inducing intrinsic antimicrobial systems, vitamin D may have a significant impact on lung health. To resolve the diagnosis and treatment significance vitamin D could have in treating asthma in the long term, more investigations are essential to completely comprehend the impacts of vitamin D in preserving airway homeostasis. Along with prospective defence mechanisms like antiviral impacts and augmented steroid attentiveness, considerable uncertainty concerning the impacts of vitamin D insufficiency and inadequacies in kids with asthma and a thorough analysis of present experimental and observational studies substantiation of relationship among vitamin D levels and asthma or bronchitis comorbidities.

According to this article, incentives for conducting family medicine investigations should be scientific and rationalistic, focusing on objectives like scientific discipline and development. Indirect incentives, or the "personal agendas" of investigation, do exist, though, and they have the potential to affect the goals, strategies, and findings. Furthermore, the development of interpretations specific to a highly emotional activity like a study complicates its varied forms. Three of these symbolic connotations are highlighted in this article: legitimacy and belonging, maturity and competence, and goal and earnestness. This article explores the role of behavioral scientists in contributing to a research agenda for the discipline and emphasizes qualitative data as a methodology consistent with many of family medicine's theoretical and philosophical underpinnings. 

This is a case of a patient that presented to the outpatient department with a large chronic iliac artery aneurysm and the anesthetic complications that occurred during the surgical resection of the swelling and associated management of massive blood loss, and hemodynamic changes that occurred during the cross clamping and unclamping of the aorta. In this case report we discuss the importance of being prepared for the expected and unexpected complications, accepted ischemia time, need for inotropic supports, and then the management of associated hypotension during the unclamping of the aorta, and most importantly, a vigilant anesthetist!

Introduction: One of the most serious complications of diabetes is diabetic nephropathy, which is also known to increase the risk of cardiovascular events. Patients with diabetic nephropathy have abnormal lipid levels, which raises their risk of cardiovascular problems. In this study, type 2 diabetes mellitus (T2DM) patients with and without nephropathy had their levels of dyslipidemia compared, and the causes of nephropathy were examined.
Method: Patients with T2DM who had overt nephropathy were included in the study group and those without nephropathy were included in the control group in this retrospective analysis. Age and diabetes duration were matched between the two groups. The case sheets were used to gather information on total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea, and creatinine. Equations were used to compute the TG/HDL-C ratio, a proxy for small, dense LDL particles (sdLDL), and the estimated glomerular filtrationrate (eGFR). The variables linked to eGFR were identified using multivariate analysis.
Result: 56.51% of control individuals and 75.28% of nephropathy subjects both had dyslipidemia (P=0.011). In comparison to controls, people with nephropathy had a higher percentage of subjects with atherogenic dyslipidemia (high TG+low HDL-C+sdLDL) at 14.60 than controls did at 14.12. Despite there being no discernible differences in serum creatinine, patients with nephropathy had significantly lower mean eGFR values (P=0.001). Multivariate analysis revealed that TC (P=0.007) and HDL-C (P=0.05) were linked to eGFR among the participants in our study.
Conclusion: According to our findings, dyslipidemia was very common in nephropathy patients. Regular testing for dyslipidemia may help diabetic nephropathy patients reduce their risk of adverse outcomes.

Background: Pseudomonas species is responsible for 10% of nosocomial infections particularly in patients with burns and in an ICU environment. The most frequent mechanism of resistance to carbapenem, the most widely used medication to treat Pseudomonas, is the synthesis of metallo-β-lactamases (MBL). Both microbiologists and clinicians need to know the incidence of MBL-producing Pseudomonas in their area in order to develop an infection control plan for hospitals. The current study aimed to identify the incidence of MBL among clinical isolates of Pseudomonas species in a tertiary care hospital.
Methods: The samples include blood, urine, pus, body fluids, and catheter tips.  The samples were cultivated on Blood agar, MacConkey's agar, and Thioglycolate broth, except for blood and urine samples. Brain Heart Infusion broth was used to culture blood. Blood and MacConkey's agar were used to culture urine. All culture plates were incubated overnight at 37°C. Identification of organisms was done by standard laboratory technique based on colony characteristics, Gram staining, and biochemical tests.
Results: All n=50 pseudomonas isolates were tested for antibiotic sensitivity testing by using the Kirby-Bauer disk diffusion method. Among the n=50 isolates n=45 isolates showed resistance to imipenem remaining n=5 isolates were intermediate sensitive. The highest sensitivity was noted to Polymyxin-B (100%) followed by Piperacillin+tazobactam (70%), Amikacin (50%), Cefoperazone+Sulbactam (36%), Gentamycin (28%), Netilmycin (26%), Cefotaxime (12%), Ciprofloxacin (10%) and Ceftazidime (2%). Pseudomonas aeruginosa isolates tested for metallo β-lactamases by using imipenem-EDTA combined disk method (CDT). N=18 (36%) isolates were shown positive results and the remaining n=32 (64%) isolates were shown negative results.
Conclusion: The development of MBL genes and their proliferation among bacterial pathogens are a topic of concern concerning the future of antimicrobial therapy since more and more MBL-producing Pseudomonas aeruginosa isolates are being identified as a major source of nosocomial infections. To conclude there are 36% of metallo beta-lactamase-producing pseudomonas aeruginosa prevalent in our area. Therefore, detection of these MBL-producing P. aeruginosa is crucial for the optimal treatment of critically ill patients and to prevent the spread of resistance.

Background and objectives: Epidural analgesia is a safe technique for post-operative pain relief and equivalent to traditional analgesic methods. Epidural narcotics have been extensively used for post- operative analgesia. In a quest to find a better and safer alternative to older drugs like morphine this study was undertaken to compare the safety and efficacy of postoperative analgesia with epidural butorphanol and epidural tramadol in patients undergoing orthopaedic lower limb surgeries.
Methods: A total of 100 patients of either sex, belonging to 20-60 yrs of age, ASA grade I and II admitted for orthopedic lower limb surgeries in the department of Anesthesiology, DMCH Darbhanga. were selected randomly for the study. Combined spinal-epidural was administered to all the patients. Postoperatively when patient complained of pain (Visual Analog Scale > 4), either butorphanol 1mg or tramadol 50mg diluted to 10ml was given epidurally and all the parameters were recorded.
Conclusion: Epidural butorphanol (1mg) is a safe and efficacious drug for post-operative analgesia. Epidural butorphanol provides a rapid, excellent but shorter duration of analgesia when compared to epidural tramadol. It has mild sedation which is advantageous in the postoperative period.

Background: The main aim of our study was to compare the intraoperative and postoperative outcomes of general anaesthesia and epidural anaesthesia in single level lumbar microdiscectomies.
Methods & materials: 40 ASA I and II, both male and female patients, posted for single level lumbar microdiscectomies were chosen for the study. Group GA underwent the operation under general anaesthesia and group EA underwent the surgery under epidural anaesthesia. Patients were observed in the recovery room for 24hrs.
Conclusion: Epidural anaesthesia may be used as an alternative to general anaesthesia in single level lumbar microdiscectomies.

Introduction: Nephrotic Syndrome is characterised by nephrotic range proteinuria and the triad of clinical findings i.e., hypoalbuminemia, edema and hyperlipidemia. Glucocorticoid-sensitive nephrotic syndrome remits completely and quickly in response to glucocorticoids. Steroids are known to cause osteoporosis and loss of bone mineral density in NS patients.  So, we decided to study requirement of vitamin D in nephrotic syndrome in patients who are on remission during steroid therapy and Comparison of normal and high dose of vitamin D supplementation to achieve normal vitamin D level in nephrotic syndrome patient, in remission on prednisolone therapy.
Material And Methods: The present descriptive observational study, was conducted amongst 31 patients from August 2014 to August 2016 in the pediatric department of tertiary care centre on both indoor (IPD) and outdoor (OPD) patients of Nephrotic syndrome those who are in remission on steroid. Patients having normal 25 OH Vitamin D level were included in study. These patients were randomly divided in two groups using random sampling by lottery method. a. First group was given vitamin D therapy as 20, 000 IU/month (600IU/day) for three months b. Second group was given 60,000 IU /month (2000IU/day) for three month.
Results: Out of 31 patients in this study, mean age at inclusion in group A was 5.4 years whereas, it was 7.2 years in group B. Majority 12 of the patients were having SDNS as diagnosis. Both the groups showed elevated levels of 25(OH) after supplementation.  The levels of serum ionic calcium levels were not affected in both the groups, but the mean values of serum Ionic Calcium was found to be on higher side after Calcium supplementation especially in group B. The serum values were not affected in both groups.
Conclusion: The results concludes that there is no need for vitamin D supplementation in higher doses in steroid-sensitive nephrotic syndrome in patients those who are in remission and on minimal dose of steroids. So, dosage of vitamin D should be according to Recommended Dietary Allowances (RDA) when patient is on minimal dose of steroids.

Purpose: The purpose of this study was to determine the hemodynamic effect of intravenous lornoxicam during laryngoscopy and endotracheal intubation and to determine whether intravenous lornoxicam is effective in reducing the hemodynamic stress response to laryngoscopy and endotracheal intubation.
Methods: It was a double blind randomized control trial to investigate the effect of lornoxicam on the change in blood pressure, heart rate observed during laryngoscopy and tracheal intubation in 50 ASA class I and II patients. 50 patients with similar characteristics were divided into groups of 25 each. One group received lornoxicam, while the other received a placebo.
Results: Blood pressure and heart rate was recorded at various intervals during laryngoscopy and endotracheal intubation.  It was observed that there was a significant attenuation in heart rate and blood pressure response to laryngoscopy and intubation for the lornoxicam group.
Conclusion: The use of IV lornoxicam during laryngoscopy and intubation can save lives since it significantly lowers the hemodynamic reactions to intubation when administered 30 minutes prior to the surgery.

Objectives:

To estimate IgE and histamine levels in patients with drug allergy and with past history of drug     allergy.
Compare these levels with that of normal individuals
Assess the association of demographic factors, nature of drugs and clinical presentation with IgE and histamine levels. 

Methodology: 113 potential participants were totally interviewed. 66 selected based on selection criteria. 22 had current allergy (CA), 22 past history of allergy (PA) and 22 without any allergy (NA). Study was initiated after getting IHEC approval and informed consent from each participant. Estimation of serum IgE and histamine was done using ELISA kits. Demographic details, details of drugs and clinical presentation were recorded. Time interval between onset of allergy and estimation of IgE and histamine was recorded for patients with PA. Results were analyzed using ANOVA and student t test. p<0.05 was considered significant. 
Results: IgE and histamine levels were significantly higher in CA compared to NA and PA subjects.
Normal mean level IgE was 72.6 IU/ml and histamine 42.53 ng/ml. In PA levels were higher than that of NA but lower than CA. Males and civil workers had a higher level than females. Age related difference in the levels was not observed. NSAIDs induced allergy resulted in maximum elevation of IgE (538.74
IU/ml) and histamine (158.32 ng/ml) followed by antimicrobials (IgE 395.97 IU/ml) and histamine
(133.42 ng/ml ).Patients who developed maculopapular rashes had maximum level of IgE (627.87 IU/ml) and histamine (182.25 ng/ml). The time dependent decline in both the levels was observed in PA.
Higher IgE level was associated with higher level of histamine in all the groups.
Conclusion: In CA, NSAIDs and maculopapular rashes resulted in maximum elevation of IgE and histamine. In PA, IgE level was higher than NA group. Whether estimation of IgE would indicate past allergy or the tendency to develop allergy has to be assessed by further studies with large samples.

Now a days the use of social media has grown exponentially over time with the growth of the Internet and has become the most powerful networking platform in the 21st century. However, theimporvement of social connectivity often creates negative impacts on society that contribute to a couple of bad phenomena such as online abuse, harassment, cybercrime and online trolling. Cyber crime leads to serious mental and physical distress, particularly for women and children, and even sometimes force them to attempt suicide. Some kind of fake message can impact women to consider as suicide. Online harassment attracts attention due to its strong negative social impact. Many incidents have recently occurred worldwide due to online harassment, such as sharing private chats, rumours, and sexual remarks. Therefore, the identification of bullying text or message on social media has gained a growing amount of attention among researchers. The purpose of this research is to design and develop an effective technique to detect online abusive and bullying messages.

Preservative free Chloroprocaine (CP) seems like a promising alternative, being a short acting agent of increasing popularity in recent years. While Chloroprocaine was withdrawn from the market in the 1980s because of concerns about neurotoxicity a new formulation without preservatives that has no longer been associated with neurotoxicity was introduced in clinical routine. After taking informed and written consent, 40 patients of either sex, aged between 18-60years, belonging to American Society of Anaesthesiologists Physical status I to III, undergoing elective perianal surgeries under spinal anaesthesia enrolled in this observational study. Our study showed mean time of onset of motor block was 8.38±1.25 minutes, mean time to achieve maximum motor block 9.45±0.71 minutes and mean time for motor regression to bromage scale 0 was 65.68±15.19 minutes. The time to void was 98.32±15.80 min and time to ambulation was 89±15.30 min the time of first postoperative analgesic requirements was 96.32±12.83 min.

Ultrasound guidance in anaesthesia is becoming an important tool in Anaesthesiologists. Sonography helps in addressing a variety of consequences such as patient safety, economic burden, duration of the procedure and success rates associated with invasive anaesthesia procedures. Consent from 50 patients were obtained in their own understandable language. After thorough pre-anaesthetic evaluation and overnight fasting, patients shifted to operation theatre and following monitors are connected. (Pulse oximeter, electrocardiogram, capnograph and non-invasive Blood pressure) Patients were randomly allocated into 2 groups (Group D and Group S) as per computer generated randomization table. The average diastolic blood pressure in both the groups was maintained from the baseline till 24 hours of observation. There was neither clinical nor statistical significant variation found. We did not find any clinical variations in the heart rate, SBP, DBP, MAP, RR of the patients preoperatively, intra and also postoperative period. All the recruited patients had maintained oxygen saturation >95% throughout the surgery.

Introduction: Patients undergoing cesarean sections frequently have hypotension following spinal anesthesia; maternal hypotension occurs 60%–70% of the time. By giving intravenous fluid boluses, hypotension brought on by spinal anesthesia can be treated or avoided. The purpose of this study was to assess the efficacy of crystalloid fluid preloading and co-loading in reducing the occurrence of hypotension following spinal anesthesia in cesarean delivery.
Method: There were 54 participants total who took part in this investigation. Subjects chosen through successive sampling who met the inclusion criteria for elective cesarean sections under spinal anesthesia were gravida individuals between the ages of 15 and 41 with an ASA 1 or ASA 2 physical condition. Three groups- the preloading group, the co-loading group, and the control group- were formed from the participants. Mean arterial pressure (MAP), pulse rates, and systolic and diastolic blood pressure are assessed in resting conditions and 2, 3, 5, 7, 9, 11, 13, 15, and 25 minutes following spinal anesthesia. The Repeated Measured Multivariate Analysis of Variance (MANOVA) test was used in the statistical analysis to see how the three groups of patients differed in terms of several hemodynamic parameters. The variations in hemodynamic parameters between each group were compared using the Bonferonni post hoc test.
Results: Results of the Bonferroni post hoc test revealed significant differences in the decline in systolic, diastolic, and MAP blood pressure between the co-loading group with the preloading group and the control group (P < 0.002); the co-loading group experienced the lowest decline.
Conclusion: Compared to the preloading and control groups, crystalloid fluid co-loading dramatically reduced the incidence of hypotension following spinal anesthesia in cesarean delivery.

General traffic administration as well as infrastructure design may benefit from real-time vehicle surveillance on motorways, roads, and streets. This study introduces Traffic Detector ,a technology that makes use of deep learning methods to automatically monitor and classify vehicles on roads using a precise and stable camera. Despite being a well-established area visual programming research, improvements in neural networks for object recognition and categorization, particularly in the last years, made this area even more intriguing owing to efficacy of these methods. It is concentrated on region-based approaches like R-CNN (Region-based Convolutional Neural Network) and regression-based methods like YOLO (You Only Look Once) and also provided each enhanced versions in the subject of motor identification is being tackled by the quickly expanding domain of supervised learning approaches. Last but not least, we have a traffic offence detection module in place that examines traffic patterns and identifies various traffic offences in real-time. The Deep Neural Network (DNN) module of OpenCV accustomed implement the complete system. With excellent accuracy, We have indeed been fortunate in locating automobiles on the roads using YOLOv4. We used a quick YOLOv4-tiny model for motorcycle riders without helmets. Real-time vehicle tracking is accomplished using Deep SORT algorithm. For vehicle detection, YOLOv4 achieves a precision of 89%, while for helmet detection, YOLOv4-tiny achieves a delicacy of 96%. YOLOv6 97%. The backbone, neck, and head are the three crucial components the majority recent iteration, known as YOLOv5.YOLOv7 is anticipated to overtake YOLO v4This review paper aims to advance sophisticated deep learning frameworks for real-time vehicle detection.

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of postoperative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

The issue of choosing appearance features for multiple object tracking (MOT) in urban scenes is addressed in this paper. Numerous features have been employed for MOT over the years. Whether some of them are superior to others is unclear, though. Colour histograms, histograms of oriented gradients, deep features from convolutional neural networks, and re-identification (ReID) features are examples of frequently used features. In this study, we evaluate the performance of these features in urban scene tracking scenarios to distinguish objects from a bounding box. Several affinity measures, including the Rank-1 counts, the cosine similarity, the L1, L2, and Bhattacharyya distances, are also evaluated for their effect on the discriminative power of the features. . Results from several datasets demonstrate that, regardless of the detector quality, features from ReID networks are the best at differentiating between instances. Colour histograms may be chosen in the absence of a ReID model if the detector has a good recall and few occlusions; otherwise, deep features are more resistant to detectors with lower recall. An picture's colour histogram shows how the colours are distributed throughout the image. The number of pixels in each type of colour and the various colour variations are displayed. Re-identification is a general term for any process that re-establishes the relationship between data and the subject to which the data refer.

Background: To assess increased first trimester serum uric acid as a predictor of gestational diabetes mellitus.
Materials and Methods: Seventy- six antenatal women in first trimester were selected for the study. Approval from ethical review committee was obtained. Patients’ consent was obtained before starting the study. 5 ml venous blood sample was taken from antenatal women of less than 12 weeks of gestation. Venous sample was measured after fasting, one hour and two hours and assessed for GDM using ADA criteria.
Results: Age group 20-25 years had 11, 26- 30 years had 34, 31-35 years had 20, 36-40 years had 6 and 41-45 years had 5 patients. The difference was significant (P< 0.05). Parity found to be primi in 46 and multi in 30. GTT was normal in 68 and positive in 8. Serum uric acid was elevated in 27 and normal in 49 cases. The difference was significant (P< 0.05). Out of 27 patients with elevated uric acid, 26 had normal GTT and out of 49 normal uric acid patients, 42 had normal GTT.
Conclusion: There was increase in the risk of development of GDM with increased levels of serum uric acid in the first trimester.

The reconstruction of extensive traumatic lower limb defects need free flaps for covering the
defects when no local flaps are available for covering the defects. Free ALT flap is one of the
most commonly used flaps for reconstruction of extensive lower limb defects. This is a
prospective study of the thirty seven patients who had undergone Free ALT flap cover for the
extensive traumatic lower limb wound defects between January 2018 to April 2021 at our
Trauma care Hospital. One hundred and thirty patients had undergone reconstruction of
traumatic lower limb with one of the flap surgery. Thirty seven of this patients had underwent
a free ALT flap surgery for limb reconstruction. Only traumatic lower limb wound defects
were included in the study. Non traumatic wounds like diabetic limb wounds or cancer
wound defects were excluded. All the patient data including (age, sex and comorbidities),
mode of injury (Road traffic accident, Fall of heavy object, Crush injury), wound defect data
(site, size, underlying fracture and exposed structures), presence of any vascular injury in the
limb, the micro vascular flap data, postoperative complications and management data, follow
up data were recorded. Among patients who were managed with ALT flap, 62.6% of patients
presented with Post traumatic raw area, 25% of patients presented with Heel pad avulsion,
6.2% of patients presented with Post fasciotomy wound and 6.2% of patients presented with
Ankle contracture. Among patients who were managed with ALT flap, the success rate was
found to be 81.2%, 9.4% of patients had partial flap necrosis and 9.4% of patients had
complete flap necrosis.

Gall stones are found in middle aged females who with higher BMI. In younger patients with gall stones, hemolytic diseases should be considered. Inpatients admitted in General Surgery Department, who underwent laparoscopic Cholecystectomy were the study subjects. All the patients were scored pre-operatively according to history, clinical examination, biochemical parameters, and sonological findings. Out of 60 patients, 44 patients had history of gall bladder disease with symptoms of which 24 patients had easy surgery and 20 had difficult surgery. Out of 60 patients, 18 patients had tenderness in right hypochondrium of which 6 patients had difficult surgery.

In order to screen for defective placentation and related consequences such pre-eclampsia, intrauterine growth restriction, and infant death, doppler examination of the placental circulation is crucial.
Methods: From August 2021 to July 2022, the study was carried out in the Department of Obstetrics & Gynecology, Owaisi Hospital and Research Centre, Hyderabad, Telangana, India. Prospective observational study conducted in a hospital involving 100 patients.
Results: Any gestational age after 32 weeks where REDV is detected should warrant consideration for an urgent delivery. Guidelines from the Society for Maternal-Fetal Medicine, which suggest intensive fetal monitoring of these fetuses and continuing expectant treatment until 32 weeks as long as fetal monitoring is still reassuring, support this.
Conclusion: Doppler velocimetry can be a valuable addition to standard antepartum surveillance procedures in patients with IUGR fetuses. If other antepartum surveillance tests are reassuring, an abnormal Doppler should not necessitate an obstetric intervention. When an aberrant Doppler finding is discovered, the obstetrician is made aware of the potential problems, and the delivery should be scheduled at a tertiary care center with good neonatal facilities.

With increasing number of COVID infections, more and more pregnant women were affected and hence more vertical transmissions to newborns were reported. There was scarcity of dedicated studies in newborns related to clinical profile and outcome in COVID. This study was aimed at estimating the prevalence of COVID-19 positive babies born of COVID-19 infected Mothers and to describe the early clinical outcome in their COVID positive babies.
Methods: The study was done as a cross sectional study conducted at a tertiary care dedicated COVID treatment Centre in a sample of 388 babies of COVID positive mothers. Along with the prevalence of COVID positive babies, the early clinical outcome at 48 hours after birth was also evaluated.
Results: A total of 388 COVID positive mothers were studied and among them 85 babies were found to be COVID positive. The COVID positivity rate was 21.9% (95% CI 17.83 -25.97). Out of 85 babies 34(40%) babies were male and 51(60) babies were female. The proportion of LBW was 13(15.2%), proportion of preterm babies was 13 (15.3%) and only 19(22%) babies required NICU admission. Among the maternal variables of COVID positive babies, 38 (44.7%) were primi gravida and 46(54%) mothers had vaginal delivery. Regarding the COVID clinical status, 70(82.4%) mothers were asymptomatic and 15(17.6%) were symptomatic. After the subgroup analysis, 22(25.8%) babies were symptomatic and 63(74.1%) babies were asymptomatic. Out of 22 symptomatic babies 13(59.1%) were male and 9(40.9%) female babies (P value 0.03). The mean birth weight in symptomatic and asymptomatic babies was 2.96 kg and 2.98kg respectively (P value 0.687).
Conclusion: The newborn COVID positivity rate was found to be around 22% and majority had good early clinical outcome. The findings from this study helped to assess the burden of COVID pandemic in newborn babies and would help in the higher level of analytical research.

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of post-operative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

To compare the sensitivity of blood cultures on Day 1(24 Hours) Day 3 (72 Hours) & Day 5(120 Hours) in neonatal sepsis.
Materials and Methods: The study was a hospital based observational study conducted in the neonatal ICU, Dept. of Paediatrics and Dept. Of Microbiology, SKIMS, Srinagar, from 1st January 2016 to 1st June 2017. All those neonates with features of sepsis like lethargy, refusal of feeds, irritability, fever, seizure and deranged lab values like CRP, Procalcitonin, and CBC were considered in study. Before drawing blood culture samples, neonates already on antibiotics were excluded from the study. In addition, participants with incomplete details were also excluded from the study.
Results: In our study 1060 cultures were sent from neonates suspected to have sepsis. A total of 85 cultures were found to be positive with an overall culture positivity of 8%. Out of them 64 (75.3%) were positive within 24 hours of incubation (subsequently referred to as culture positive on day 1), 17 (20.0%) were culture positive on day 3 (within 72 hours of incubation, but not within 24 hours) and 4 (4.7%) were culture positive on day 5 (within 120 hours of incubation but not within 72 hours of incubation).
Conclusion: We recommend incubating cultures for 5 days to pick up additional 5% cases of neonatal sepsis.

Chronic increase and high level of glucose results in a metabolic disorder termed as Diabetes Mellitus. Diabetes occurs as a result of some genetic factors, namely the mutations of single gene. Permanent neonatal diabetes is very rare form of disorder, termed as monogenic diabetes. This type of rare diabetes presentation is seen in the child of age less than 6 months.
Presenting the single case of neonatal diabetes reported from Chennai. A 2 month old female child is actually diagnosed with permanent neonatal diabetes-4 because of the heterozygous mutation of INS gene present in chromosome 11p15.
Though the occurrence of permanent neonatal diabetes is very rare, this diagnosis has to be made when the infants are presenting with features of persistent hyperglycaemia and also in need of the insulin therapy. Children with the INS mutation will exhibit overall good prognosis when they are adequately managed with insulin therapy

Pulmonary tuberculosis is respiratory infection caused by M.tuberculosis bacilli which occur via
aerosol. First line drugs used in the treatment of TB are Isoniazid (H), Rifampicin (R),
Pyrazinamide (Z) and Ethambutol (E). Use of multidrug regimens has been associated with
increased incidence of adverse drug reactions, involving all the major organs. However the
frequency of occurrence of ADRs to ATT involving major organs are not well known, so in this
study we tried to find out the most commonly affected organ due to ATT.

Background: To assess effect of body mass index on fetal outcome in pregnancy.
Materials and Methods: One hundred ten first trimester women were selected. Parameters such as BMI, gestational age at delivery (in weeks), birth weight (in kg) APGAR Score, meconium- stained liquor, NICU admission etc. was recoded.
Results: There were 30 underweight, 40 normal and 40 overweight patients. The difference was non- significant (P> 0.05). The mean APGAR score 1t 1 minute in underweight patients was 6.8, in normal was 6.2 and in overweight patients was 6.4. At 5 minutes was 8.9 in underweight, 8.7 in normal and 8.4 in overweight patients. The difference was non- significant (P> 0.05). 11% underweight and 34% overweight required NICU admission. The difference was significant (P< 0.05). 12% underweight and 38% overweight had meconium- stained liquor. The difference was significant (P< 0.05). 76% underweight, 91% normal and 100% overweight had >36 weeks gestational age. 40% underweight, 50% normal and 45% overweight had 2.5- 3 kgs birth weight. Apgar score at 1 min was seen in 90%, 92% and 88%, NICU admission in 11%, 0% and 34% and meconium- stained liquor in 12%, 14% and 38% underweight, normal and overweight babies respectively. The difference was significant (P< 0.05).

Conclusion: Underweight and obese mothers had increased risk of adverse perinatal outcome

Background: To assess asymptomatic bacteriuria in pregnant women and treatment effect on outcome of pregnancy.
Materials and Methods: One hundred five pregnant women of age group 18 – 45 years were involved. Collection of clean catch, mid- stream urine sample was done. Urine routine and microscopy was done. Maternal and fetal outcomes was recorded.
Results: Significant bacteriuria was seen in 25, insignificant growth in 10 and negative in 70 cases. There were 10%, 6% and 0 pre- term, 81%, 90% and 100% term and 9%, 90% and 100% post- term birth in patients with significant bacteriuria, insignificant growth and negative bacteriuria. In significant bacteriuria patients, 86% patients had >2.5 kg weight and 14% had <2.5 kg weight. In insignificant growth patients, 91% had >2.5 kg weight and 9% had <2.5 kgs weight. 100% in negative growth patients had >2.5 kgs weight of babies. 91%, 93% and 100% patients had APGAR score between 9-10 at 1 minute and 95%, 99% and 100% had between 9-10 respectively. 10%, 5% and 0 required NICU admission respectively.

Conclusion: Significant bacteriuria was seen in 25 patients. Maximum were term and normal vaginal delivery. Maximum babies were with birth weight of >2.5 Kg and APGAR score of 9 and 10 was seen in patients with significant bacteriuria with minimum NICU admission

The incidence of Nephrotic Syndrome is 2-7 cases per 1, 00,000 children per year and prevalence is nearly 16 cases per 1,00,000. Various infections are considered as most important complications of Nephrotic Syndrome associated with high mortality. Loss of complement factors in urine is one of the major factors in etiopathogenesis of infections. Acute Renal Failure was also described as one of the complications of Nephrotic Syndrome. The present study was carried out to study the incidence and severity of infections in Nephrotic Syndrome with respect to various parameters like the age of patients, number of relapses, duration of disease and mortality. Methods: The present descriptive observational study was conducted in indoor (IPD) and outdoor (OPD) patients in the pediatric department of tertiary care center amongst 82 Nephrotic syndrome patients visiting for various infectious complications from August 2013 to August 2015. Results: Maximum incidence was found in the age of 1-3 years (37%) and male predominance (61%) was seen.Commonest symptom was generalised swelling/facial puffiness (92%), followed by fever (58%), cough (48%). Anasarca was commonest sign (92%), followed by pallor (39%), Scrotal/Vulval edema (22%). 31% were infrequent relapsers and 22% were frequent relpasers.On Ultrasonography, ascites was the commonest finding in 42% of patients and on Chest radiographs, perihilar opacities were seen in 40% of patients. 49% of patients had respiratory tract infections and 34% of patients had Urinary Tract Infections. Conclusions: From our study we concluded that infections are found to be common complication of Nephrotic Syndrome amongst of which respiratory tract infection appears to be the commonest infection. WhileSerum Albumin and Serum Immunoglobulin levels are considerably low while serum cholesterol level is considerably high in severe infections requiring hospitalization.

Water-based and pilates exercises are commonly used exercises and rehabilitation methods. The aim of this study is to investigated  the effect of water-based and pilates exercises on pain threshold according to anthropometric, motor properties, and posture position in sedentary women. A total of 45 volunteer women participated in this research, 15 (33.3%) of whom performed water-based exercises, 15 (33.3%) performed pilates exercises, and 15 (33.3%) served as a control group. The average age of participants in the water-based group was (59.6±7.55) (41-71), the average age of participants in the pilates group was (61.13±6.94) (50-72) and the average age of participants in the sedentary group was (53.93±7.4) (41-68) made up of sedentary women. Body composition analysis was determined using the bioelectrical impedance method. Body weight (bw) and height, waist, hip, chest, thigh measurements, and pain threshold measurements were taken before and after the study for all subjects. For statistical analysis, the paired sample t-test and the Wilcoxon signed-rank test were used.  When the pre- and post-exercise values of the groups were compared, significant differences were found in weight, BMI, FAT, FFM, berg balance, and water in the body in the weight, BMI, FAT, FFM, balance variables in the sedentary group (P>0.05), but no significant differences were found in the pilates group. In the pilates group, statistically significant differences were found in the chest, waist, hip, and thigh variables between pre-and post-test values, whereas no statistically significant differences were found between pre-and post-test values (P>0.05). Upon evaluating the comparisons between groups, statistically, significant differences were found in the change values of weight, BMI, FAT, FFM, chest, waist, hip, thigh, and berg balance variables between pre-and post-test measurements in the research groups. When the intra-group comparisons were evaluated, statistically significant differences were found in the occiput and medial knee variables between pre-and post-test values in the water, pilates, and sedentary groups. Statistically significant differences were found in the upper trapezius variable between pre-and post-test values in the pilates and sedentary groups. However, statistically, significant differences were not found in the upper trapezius variable between pre-and post-test values in the water group. Statistically significant differences were not found in the supraspinatus variable between pre-and post-test values in the water, pilates, and sedentary groups. Statistically significant differences were found in the cervical variable between pre-and post-test values in the pilates group, while no statistically significant differences were found in the cervical variable between pre-and post-test values in the water and sedentary groups.

Asymptomatic bacteriuria (ASB) is common during pregnancy and must be identified and treated to prevent poor maternal and obstetric outcomes. This study aims to determine the prevalence of asymptomatic bacteriuria among pregnant women in our antenatal clinic. The study also looks at any associated factors predisposing to the development of ASB, to identify the causative pathogens and their antibiotic susceptibility profile. Methods: It is a hospital based observational study involving 100 pregnant women with no symptoms of UTI at various gestational age. ASB was identified by urine culture and sensitivity studies. Results: 15% of the participants were found to have ASB. There was no significant difference in the prevalence of ASB based on age groups, number of pregnancies, gestational age or presence of anemia. Gram negative organisms were the cause of ASB in two thirds of cases. Escherichia coli is the most common isolate followed by Staphylococci. Gentamycin, cefotaxime and nitrofurantoin were the most efficacious of the antibiotics studied. Conclusion: ASB is quite prevalent in the pregnant population. E.coli continues to be the leading cause of ASB over the decades but Gram positive organisms are increasingly being recognized as pathogens responsible for ASB during pregnancy. Antibiotic susceptibility pattern differ widely among different study populations and antibiotic stewardship is a must for appropriate treatment and to prevent resistance development.

Granulomatous Mastitis is chronic inflammatory disease of breast which almost always mimics cancer in young individuals. Although Histopathology remains gold standard for the correct diagnosis, FNAC plays a pivotal role in the early diagnosis of GM as a minimally invasive, simple and cost effective outpatient treatment.
Material and Method: In present study cases reported as GM during period of 2018-2019 (2 year period) were retrospectively searched. In all cases, FNAC of the breast were performed by the pathologist using 22 or 23 gauge needle. Smears stained with H and E stain, Pap stain, giemsa stain and ZN stain. In cases of Pus material TB PCR run on CBNEET machine.
Result: In the present study 19 cases of GM were obtained over period of 2 years. Out of 19 cases 4 cases were diagnosed as TBM (21.05) bases on positive AFB staining and positive Gene Expert for tuberculosis (CBNAAT). Remaining 15 cases were labelled as IGM (78.94%) because of negative culture from pus discharge, negative PAS and AFB staining. In all patients there were no history of other causes of GM like sarcoidosis, fungal infection, previous trauma or surgery, autoimmune disease. So our study consists of TBM and IGM patients. All patients of TBM and IGM were female and presented with breast lump.
Conclusion: Granulomatous Mastitis including NGM and TBM are an uncommon chronic inflammatory disease of breast which almost always mimics cancer in young individuals and have overlapping clinical and cytological finding. FNAC along with proper clinical history help in differentiating these two entities.

Rabies is widely prevalent in India. Estimated annual death in India due to rabies is 20000. Prompt and adequate treatment of animal bite is of utmost important in the prevention of rabies. Wound infiltration with RIG in Cat-III animal bite cases is to neutralize the virus at the wound site. It is to be infiltrate thoroughly in all sides of the wound with minimum tissue damage. With this background the present study was conducted with the following objectives.
Objectives

To assess the proper method of administration of RIG in Cat-III animal bite cases.
To assess the time lag between bite bite and RIG administration.
To assess the availability, accessibility, acceptability and adverse effect of RIG among patients.

Study Design: Cross-sectional study.
Place of study: ARV Clinic of PRM Medical College & Hospital, Baripada, Mayurbhanj, Odisha.
Study Subjects: All new cases of Cat-III animal bite attending the ARV Clinic during the study period.
Study Period: September 2022 to November 2022.
Study Instrument: A per-designed pretested questionnaires.
Data analysis: It was analyzed with MS Excel.
Result: A total of 281 Cat-III new animal bite cases were participated, out of them 55(19.57%) were belong to pediatric age group (<14 year) and 226(80.43%) study subjects were more than 14 years. Regarding the reporting time to the health facility after animal bite, most of the cases 253(90.04%) reported to the ARV Clinic within 24 hrs & less numbers 28(9.96%) reported more than 48 hrs. All the Cat-III bites had given anti rabies vaccination along with Rabies Immunoglobulin. Out of 281 study subjects Paediatrics age group 55(19.57%) were administered human rabies immunoglobulin (HRIG) & 226(80.43%) administered equine rabies immunoglobulin (ERIG). In all the cases RIG was administered as per the WHO recommendation with respect to dose & method of administration. ERIG was administered after doing skin sensitive test. There were no side effects among the study subjects after RIG administration. All the Cat-III bites had given the vaccine and RIG for the animal bite management on the day of their visit to the ARV clinic. During the study period both HRIG & ERIG were available in the ARV clinic which was free of cost for the patients. No side effects were reported among the study subjects after RIG administration

Soil-transmitted helminthic (STH) infection is a significant public health concern in India and a leading cause of morbidity, particularly in resource-constrained regions. Human transmission occurs through eggs or larvae in faeces, which contaminate soil in areas with poor sanitation. Infection results in intestinal blood loss leading to iron deficiency anaemia and protein malnutrition, impaired physical and cognitive development, abdominal pain and diarrhoea.
Aims & Objectives: To study the six-year prevalence trend of STH infections in middle  and upper Assam region from the records of patients attending JMCH.
Materials & Methods: This retrospective cross-sectional study was done by collecting data from records of STH isolates from January 2017 to November 2022. Data were analyzed using EpiInfo and chi square test to analyze the association between different variables using p value < 0.05 as statistically significant.
Results: From a total of 1352 stool samples received over 6 years, 200 (14.8%) were positive for intestinal parasites among which STH were 102 (51%). Six different parasites were reported with Ancylostoma duodenalae       being the predominant (59.8%) followed by Trichuris trichura (22.5%) and Ascaris lumbricoides (19.6%). Further, 2% recorded co-infection with 3 parasites and 6.5% with 2 parasites. The prevalence was higher in males (86%) than females (14%) (p=1.27) and 40-60 years age group showed highest prevalence.
Conclusion: Intestinal infection due to Hookworm was the most common STH identified in this study. Improvement in sanitation, periodical deworming and health education schemes are indispensable for the prevention and control of STH

Background: To assess asymptomatic bacteriuria in pregnant women and treatment effect on outcome of pregnancy.
Materials and Methods: One hundred five pregnant women of age group 18 – 45 years were involved. Collection of clean catch, mid- stream urine sample was done. Urine routine and microscopy was done. Maternal and fetal outcomes was recorded.
Results: Significant bacteriuria was seen in 25, insignificant growth in 10 and negative in 70 cases. There were 10%, 6% and 0 pre- term, 81%, 90% and 100% term and 9%, 90% and 100% post- term birth in patients with significant bacteriuria, insignificant growth and negative bacteriuria. In significant bacteriuria patients, 86% patients had >2.5 kg weight and 14% had <2.5 kg weight. In insignificant growth patients, 91% had >2.5 kg weight and 9% had <2.5 kgs weight. 100% in negative growth patients had >2.5 kgs weight of babies. 91%, 93% and 100% patients had APGAR score between 9-10 at 1 minute and 95%, 99% and 100% had between 9-10 respectively. 10%, 5% and 0 required NICU admission respectively.

Conclusion: Significant bacteriuria was seen in 25 patients. Maximum were term and normal vaginal delivery. Maximum babies were with birth weight of >2.5 Kg and APGAR score of 9 and 10 was seen in patients with significant bacteriuria with minimum NICU admission

Background:  The present study was carried out to describe the clinical profile of tuberculosis in cases with type 2 diabetes mellitus
Methods- After obtaining the consent, a detailed investigation reports were collected from the study population like CBC, ESR, FBS, PPBS, HBA1C, HIV, Chest x-ray and Sputum for acid-fast bacilli, sputum culture and sensitivity, tissue for biopsy. Histopathological, Hematological and Radiological data were assessed and recorded. Sampling method was purposive sampling method and sample size was 106.Data were analyzed using SPSS (Version 19).Descriptive statistics, Chi-square test, and independent sample t-test were done appropriately. p-value <0.05 was considered statistically significant.
Conclusion
In this study, the common presenting complaints noticed were fever (82%) and  cough (78%) and 13% of the participants had a history of contact with TB cases and 1.6% of the cases were HIV status positive.
The prevalence of Tuberculosis among cases with diabetes mellitus in this study  was 24.1%. Among all the tuberculosis cases, 77.4% were pulmonary tuberculosis cases and 22.6% were extra-pulmonary tuberculosis cases.
Significant associations were noted between socio-economic status, duration of symptoms suggestive of tuberculosis, the habit of smoking, history of contact with TB case, history of COPD, history of HIV with the presence of tuberculosis.

Context: Sepsis is one of the leading causes of death in hospital settings. Timely administration of rational and effective antimicrobial therapy, as per hospital’s antibiotic policy, is one of the components of antimicrobial stewardship program. In absence of definitive pathogen identification and susceptibility pattern, initial antibiotic regimen is selected which is defined as empirical antibiotic therapy. Although an empirical antimicrobial policy is in place at our institute, it has not been evaluated since its inception for its effectiveness.
Aims: To assess the adherence to the empirical antimicrobial policy for sepsis and to evaluate its effectiveness on clinical outcome of sepsis in adult critical care patients.
Setting and study design: A prospective, cross-sectional study was conducted in adult non covid critical care units of Shree Krishna Hospital.
Methodology: Following approval from Institutional Ethics Committee, prospective cross-sectional study was conducted from 1^st August-2021 to 31st July-2022 at non-covid intensive care units. The adherence to the empirical antibiotic policy was calculated as percentage of patients with sepsis in whom antimicrobial agent was started as per the policy. The effectiveness of the antimicrobial policy was assessed on the basis of the improvement in the clinical and laboratory parameters as well as Sequential organ failure assessment (SOFA) score of the patient over a period of five days.
Statistical analysis: Microsoft Excel 2019, Version 2209 was used for data entry and data analysis. Proportions were calculated using descriptive analysis. Data was analysed using Chi-square calculation. Significance was considered at P-value <0.05.
Results: The adherence to the antimicrobial policy in sepsis was 59.80%, (n = 61 out of 102) whereas adherence to initiation of antimicrobial agent within one hour of diagnosis of clinical sepsis was 96.07% (n =98 out of 102). The antimicrobial agent started as per antibiotic policy was susceptible in culture report in 55.31% (n = 26 out of 47) of patients. Effectiveness of empirical antimicrobial policy in patients with sepsis in adult critical care units based on improvement of SOFA score after five days of diagnosis of clinical sepsis was 51.06%, (n=24 out of 47). There was no significant correlation (P ≥0.05) found between age groups, gender, risk stratification categories, type of blood stream infections and type of organisms isolated, i.e., Gram negative and Gram positive with regards to effectiveness of empirical antimicrobial policy. There was no significant difference noted between improvement in SOFA score of the patients in whom antimicrobial agent was started as per policy and in whom the antimicrobial agent was not started as per policy (P = 0.72).
Conclusion: The adherence to antimicrobial policy for sepsis was low and further studies to evaluate the reasons for low compliance need to be conducted. Although the effectiveness was not significantly different when the antimicrobial agent was started as per policy compared to when it was not started as per policy, we still recommend using antimicrobial agent as per policy in order to avoid non uniformity in prescriptions and development of antimicrobial resistance.

Introduction: Ropivacaine, a newer long acting amide local anaesthetic and it has lesser side effects compared to Bupivacaine and is increasingly replacing Bupivacaine because of its similar analgesic profile and lesser cardiotoxicity. Tramadol hydrochloride is a weak centrally acting analgesic commonly used as adjuvant with local anaesthetic agents in epidural analgesia. Aims and objectives: The aim of this study was to compare the hemodynamic changes of 0.125% Bupivacaine with that of 0.125% Ropivacaine along with tramadol in patients undergoing intra abdominal surgery for post-operative analgesia. Material and Methods: Total 60 patients were taken scheduled for intra operative surgery ranging from 18-55 years in ASA grade I and II. They were randomly allocated to two groups of 30 each. Group R (n = 30) received an Epidural loading dose of 10ml 0.125% of Ropivacaine with 50mg tramadol. Group B (n =30) received an Epidural loading dose of 10ml 0.125% Bupivacaine with 50mg tramadol. Patients were assessed post-operatively every 15 min for heart rate, blood pressure, SPO2 for first hour and then after every 30 min till patient complained of pain. Result: Hemodynamically, patients in both the groups, were equally stable. Group-R (412 ± 46.56 min) was having much longer duration of post-operative analgesia as compared to Group-B (348 ± 48.31 min, p < 0.001). Conclusion: Ropivacaine and Bupivacaine shows a similar hemodynamic profile. Thus, Ropivacaine can be used as an alternative to Bupivacaine for postoperative pain relief through the epidural route in patients undergoing intra abdominal surgeries ,as a safe and effective agent

Chronic kidney disease (CKD) is a common health problem worldwide. Cardiovascular disease is the most common cause of morbidity and mortality in CKD. In CKD patients, use of Echocardiography can help in establishing a diagnosis of acute decompensated heart failure. Present study was aimed to assessment of left ventricular filling pressure and its correlation with severity of chronic kidney disease. Material and Methods: Present study was single-center, prospective, observational study, conducted patients aged >18 years, either gender, diagnosed cases of CKD as per KIDGO criteria underwent resting 2-D transthoracic echocardiography. Results: In present study, 80 cases of CKD underwent 2-D transthoracic echocardiography evaluation. Majority were from 50-59 years age group (53.75 %), male (66.75 %). In present study majority were from CKD stage 2 (53.75 %) followed by CKD stage 3 (28.75 %), CKD stage 4 (22.5 %) & CKD stage 5 (13.75 %). Among study patients, 45 patients (56.25 %) had normal LVFP, while 27 patients (33.75 %) had 9-13 LVFP & increase in LVFP (> 13) was noted in 8 patients (10 %).  Mean value of LVFP in CKD stage 2 was 8.68 ± 2.15, mean LVFP in CKD stage 3 was 10.34 ± 2.64, mean LVFP in CKD stage 4 was 12.92 ± 3.84 & mean LVFP in CKD stage 5 was 13.46 ± 3.23. We noted statistically significant association between increase in stage of CKD with progressive rise in mean LVFP value. Conclusion: The increase in left ventricular filling pressure is directly proportional to the CKD stage i.e., severity of renal failure. 
Chronic kidney disease (CKD) is a common health problem worldwide. Cardiovascular disease is the most common cause of morbidity and mortality in CKD. In CKD patients, use of Echocardiography can help in establishing a diagnosis of acute decompensated heart failure. Present study was aimed to assessment of left ventricular filling pressure and its correlation with severity of chronic kidney disease. Material and Methods: Present study was single-center, prospective, observational study, conducted patients aged >18 years, either gender, diagnosed cases of CKD as per KIDGO criteria underwent resting 2-D transthoracic echocardiography. Results: In present study, 80 cases of CKD underwent 2-D transthoracic echocardiography evaluation. Majority were from 50-59 years age group (53.75 %), male (66.75 %). In present study majority were from CKD stage 2 (53.75 %) followed by CKD stage 3 (28.75 %), CKD stage 4 (22.5 %) & CKD stage 5 (13.75 %). Among study patients, 45 patients (56.25 %) had normal LVFP, while 27 patients (33.75 %) had 9-13 LVFP & increase in LVFP (> 13) was noted in 8 patients (10 %).  Mean value of LVFP in CKD stage 2 was 8.68 ± 2.15, mean LVFP in CKD stage 3 was 10.34 ± 2.64, mean LVFP in CKD stage 4 was 12.92 ± 3.84 & mean LVFP in CKD stage 5 was 13.46 ± 3.23. We noted statistically significant association between increase in stage of CKD with progressive rise in mean LVFP value. Conclusion: The increase in left ventricular filling pressure is directly proportional to the CKD stage i.e., severity of renal failure. 

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. Present study was aimed to the study effectiveness of surgery in improvement of pain associated with endometriosis by comparison of preoperative and postoperative pain score at 3months and 6 months follow up. Material and Methods: Present study was single-center, prospective, observational study, conducted in women in the reproductive age group of 18-45 yrs, with laparoscopically confirmed endometriosis. The patients were followed at 3 months and 6months and evaluation of pain relief was done using Visual analogue scale as well as Bibergolu and Behrman score.  Results: Among 92 women, predominant age group in the study was 26-30 years (31.52%), mean age of the patients was 32.03 ± 5.969 years. Most of the patients 87 (94.57%) presented with dysmenorrhea, pain abdomen (61.96%), dyspareunia (59.78%), back pain (32.6%), infertility (27.17%), dyschezia (22.83%) & premenstrual gaseous distension (11.96%). On 3 months evaluation 26 (28.26%) patients improved in their bleeding pattern. On 6 months evaluation 32 (34.78%) patients improved in their bleeding pattern, this improvement in heavy menstrual bleeding was clinically significant (P value = 0.0001). At 6 months follow-up 35 (38.04%) had mild pain, 7 (7.61%) had moderate pain & no one had severe pain. The two-tailed P value was < 0.0001, difference was extremely statistically significant. As per Visual analogue scale, at 6 months follow-up 62 (67.40%) patients completely freed of pain, 32.60% (30) of patients had only mild pain. The two-tailed P value was < 0.0001, difference is considered to be extremely statistically significant. Conclusion: This study demonstrates significant decrease in pain scores (Bibergolu and Behrman scale and visual analog scale) at 3 and at 6 months follow up (P<0.05) when laparoscopic surgery was offered to patients.

We plan to study the prevalence of COVID infection in the health care
workers working both in COVID and non-COVID facility and also identify source of
infection, the demographic pattern, difference in infection rate in health care workers
working in COVID facility and non-COVID facility, compliance to use of PPE and
following social distancing norms.Material Method:The RT PCR Positive health care
workers were interviewed telephonically with informed consent for presence of
symptoms, source of infection, method of donning and doffing of PPE while working in
COVID and Non COVID facility, social distancing norms followed or not followed.
Result: 117 staffs got tested. 40 found positive by RT PCR. The infection rate was more
amongst staff working in non-COVID facility (65%) in comparison to COVID facility
(22.5%). Infection rate among nursing staff was the highest (40%), followed by Doctors
(35%), technicians and attendants. Male were more affected than females. 25 staffs
reported not wearing appropriate PPE, 16 staffs reported breaching social distancing
protocol. Conclusion: Though all health care workers are equally trained during
COVID pandemic, there is somehow low adherence to infection prevention practices
among the health care workers working in non-COVID facility, thereby increasing the
risk to infection. Non COVID facility staffs need to be specifically targeted for training
and implementation of infection prevention practices

Normal pressure hydrocephalus (NPH) is a syndrome found in the elderly, which is characterized by the clinical triad of gait disturbance, dementia, and urinary incontinence without overt signs and symptoms of elevated intracranial pressure. NPH has been estimated to account for upto10% of cases of dementia and is significant because it is treatable by ventriculoperitoneal shunting. NPH can be idiopathic or can be secondary. The secondary causes are: traumatic brain injury, meningitis, subarachnoid haemorrhage (SAH) or intracranial surgery. Patients with Idiopathic NPH respond better to treatment than secondary
Materials and Methods: It is a prospective cross-sectional study. Inpatients and outpatients of age group more than 40 years of age, of both gender (males and females) diagnosed with normal pressure hydrocephalus as per consensus criteria were referred to Department of Radiodiagnosis from the department of. The patients underwent Magnetic resonance imaging/computed tomography study of brain.
Results: A total 40 patients were included in this study according to consensus criteria. Computed tomography (CT) and Magnetic resonance imaging (MRI) show ventricular enlargement disproportionate to cerebral atrophy, with associated ballooning of frontal horns, periventricular hyperintensities, thinning and elevation of the corpus callosum and widening of temporal horns without evidence of hippocampal atrophy in NPH.
Conclusion: Although diagnosis can be made based on CT findings alone, MRI is more accurate for disclosing associated pathologies (such as cerebrovascular disease) and for detecting NPH typical signs of prognostic value, besides avoiding exposure to ionizing radiation. MRI is the best modality to image anatomical changes and can further support the diagnosis with CSF flow studies.
 

Acute pancreatitis is a significant cause of morbidity and mortality and is known to run an unpredictable course. Severe pancreatitis occurs in 20%-30% of all patients with acute pancreatitis and is characterized by a protracted clinical course, multiorgan failure, and pancreatic necrosis. Computed Tomography Severity Index (CTSI) andModified Computed Tomography Severity Index (MCTSI) is used as a scoring system in acute pancreatitis. This study aims to correlate the CTSI and MCTSI grading system with patient outcome in terms of organ failure, mortality and duration of hospital stay.
Materials and Methods: This was a prospective study conducted for a period of two years. 40 Cases diagnosed as acute pancreatitis were included in this study. These patients underwent contrast enhanced computed tomography (CECT) of the abdomen and pelvis. The findings were recorded as per the CT severity index and modified CT severity index.
Results: There was significant correlation between necessity of ICU admission and duration of hospital stay and grade of pancreatitis, positive correlation with duration of ward stay and strong correlation with total duration of hospital stay. Higher CT grade is positively associated with development of local complications and systemic complications.
Conclusion: Grading by modified CT severity index has a significant correlation with necessity of ICU admission and total duration of hospital stay. CT severity index and Modified CT severity index can be used to predict the possibility of developing local and systemic complications, the need for interventions and necessity of hospital stay.

Our study's objective is to assess the degree and type of brain edema, incidence of atypical and typical regions of involvement and unusual imaging manifestations as well as to assess the neuro imaging abnormalities in eclampsia patients with PRES.
Material and Method: This is a referral hospital-based prospective study of 50 consecutive cases of eclampsia who were subjected to MRI brain. All 50 women with eclampsia were treated with routine principles of management of eclampsia.
Results: We observed a combined pattern of typical and atypical PRES compared to individual findings. Among the atypical patterns of PRES, the holohemispheric atypical pattern was observed to be highly significant compared to other atypical patterns of PRES. 36% of patients were observed with postpartum eclampsia which is most common in duration of less than 48 hours. During follow-up, reversible eclampsia with PRES was highly observed compared to irreversible.
Conclusion: Magnetic resonance imaging  is a useful imaging technique that improves the diagnosis as well as differentiates the types of PRES .MRI could help early detection of PRES in eclampsia patients for better prognosis and overall improvement of maternal and child health.

Allergic rhinitis, is one of the most common respiratory problems encountered in the clinical practice. The treatment includes combination of allergen avoidance and pharmacotherapy i.e, antihistaminics, corticosteroids and mast cell stabilizers. Present study was aimed to compare intranasal steroids sprays alone v/s intranasal steroids with intranasal antihistamines sprays in patients with allergic rhinitis.
Material and Methods: Present study was conducted in patients from 18-45 years of age group, either gender, attending the ENT outpatient clinic, clinically diagnosed with allergic rhinitis. The patient was examined with the assessment scales for nasal congestion and obstruction using the Nasal obstruction Symptom Evaluation (NOSE) scale. 80 patients by computer generated chits randomly allocated to Group S (50 mcg of fluticasone propionate in each spray) and Group SA (Azelastine Hydrochloride 140 mcg, Fluticasone Propionate 50 mcg in each nasal spray). Results: Age and gender distribution was comparable among both groups and difference was not significant statistically. Group S had baseline NOSE score as 80.79 ± 12.22 and at 6 weeks score was 81.88 ± 10.49 and difference was statistically significant (p <0.001). Group SA had baseline NOSE score as 81.88 ± 10.49 and at 6 weeks score was 28.29 ± 8.21 and difference was statistically significant (p <0.001). At baseline NOSE score in group S was 80.79 ± 12.22 while in group SA was 81.88 ± 10.49, difference was not significant statistically (p - 0.078). After 6 weeks, NOSE score in group S was 53.32 ± 9.33 while in group SA was 28.29 ± 8.21, difference was statistically significant (p - 0.023). Conclusion: Combination of intranasal steroids with intranasal antihistamines sprays has significant reduction of symptoms when compared to intranasal steroids spray alone in the management of allergic rhinitis.

The aim was to study the clinical profile and predictors of in-hospital outcome in critically ill patients with T2DM admitted in MICU. It also aimed to study the predictive value of different critical care scoring systems in T2DM patients. A prospective, cross sectional and observational study was conducted in General Medicine Department, “Dr. D. Y. Patil Medical College and Research Centre, Pimpri, Pune, India,” between September 2020 to October 2022 with a sample size of 80 T2DM cases and 80 non-T2DM controls. Overall maximum number of study participants belong to the age group of 50-69 years, Patients with T2DM had higher chances of a prolonged ICU stay and a higher mortality rate due to their critical illness compared to the non-diabetic patients. However, their mortality rate was not associated with prolonged duration of ICU stay.All the major vital parameters and biochemical parameters including RFT, Serum electrolytes, Serum Lactate and Serum Pro-calcitonin were significantly worse in diabetic patients compared to non-diabetic patients at the time of admission to the MICU.APACHE IV, SAPS3 and SOFA scores were worse on the day of admission in the T2DM patients compared to the non-diabetic patients. Except MODS all scores on day 1 and on the day of outcome were worse in diabetic patients who died in the ICU. In conclusion APACHE IV has a good predictability over SAPS III, SOFA and MODS in critically ill T2DM patients.

The calcium ion (Ca2+) is a ubiquitous intracellular messenger during and immediately after an ischemic period. Clinical studies suggest that severity of clinical symptoms, prognosis and infarct volume are also associated with levels of serum calcium.
Aim: The aim of this study is to determine Serum calcium as a marker of severity in acute ischaemic stroke patients.
Methodology: This prospective observational study was conducted on 80 patients of acute ischemic stroke admitted in the department of medicine at Jhalawar medical college, Jhalawar during the period of 1 year. Adjusted serum calcium level was obtained within 72 hours from onset.
Results: Out of 80 patients of acute ischemic stroke, 49 (61.25%) had low serum calcium while 31 (38.75 %) participants had normal level of serum calcium. Most common age group was 61 to 70 years (36.7%). NIHSS score was higher with low serum calcium level. Out of the 49 patients who had low levels of calcium, 49% (24) had severe stroke with NIHSS score 21-42. Among 49 patients with low serum calcium, 91.5% (45) had poor outcome. MRS score was higher with low serum calcium level. Chi square analysis revealed lower adjusted serum calcium levels accompanied by poor outcome statistically significant (p= <0.0103).
Conclusion: Based on these results, we can conclude that low adjusted calcium levels in patients with acute ischemic stroke is an independent risk factor and have poor outcome than patients with normal serum adjusted calcium level

A seizure is a transient occurrence of signs and or symptoms from abnormal excessive or synchronous neuronal activity in the brain. The commonly used treatment for epilepsy is antiepileptic drugs; there is an increased oxidative stress in epilepsy patients, this study was to look for effectiveness of vitamin E in children with treatment resistant epilepsy in the form of improvement in frequency, duration of seizure, number of hospitalization, and EEG change.
Subject and Methods: Randomized control trail conducted in 32 children with treatment resistant epilepsy, with supplementation of vitamin E in upper limit of RDA and placebo in addition to antiepileptic drugs after randomization and allocation for 6 months’ duration with prior recording history related to seizure prior to 6 months of trail. Patient kept on follow up with number of seizures, number hospitalization, duration each seizure occurred, changes in antiepileptic drugs made, an EEG after 6 months of intervention.
Result: Reduction in seizure frequency, number of hospitalization and duration of seizures occurred in both group, significant difference was observed in number of Impending status seizure episode (p=0.037), there is no significant positive changes in observed.
Conclusion: Supplementation of vitamin E as per the upper limit of RDA is effective in reducing the number of impending status seizure, hence the severity of epilepsy in treatment-resistant epileptic patients of the pediatric age group.

To use Diffusion-weighted MRI to evaluate and differentiate space-occupying brain lesions in individuals whose conventional MRI (cMRI) assessment revealed aberrant imaging characteristics suggestive of space-occupying brain lesions.
Material and Method: We conducted prospective, observational study which enrolled 100 patients had different space occupying lesion detected with DWI. The study was performed on a whole body system at 1.5 Tesla MRI, using a dedicated head coil. Multiplanar T1- and T2-weighted, diffusion, gradient images, using spinecho sequences, post contrast study, and proton magnetic resonance spectroscopy were performed in all cases on single and multivoxels chemical shift imaging. All cases were correlated with histopathology and by follow-up studies after management.
Results: Study was done for a period of 1-year in patients of varying clinical symptoms subjected for MRI. Male subjects were more than females. 65% had intra axial whereas 35% had extra axial lesion among space occupying lesion. Abscess highly observed in intra axial whereas meningioma highly observed in extra axial lesions. In our study, tumors, infection, cystic lesions and demyelination type of etiology observed among patients. Tumors were most common overall etiology in our study.
Conclusion: Diffusion-weighted magnetic resonance is a useful imaging technique that helps in preoperative differential diagnosis of various space occupying lesions which helps in precise diagnosis and improves the prognosis of many patients with space-occupying lesions

The aim of this study is to evaluate perinatal outcome in hypertensive disorders of pregnancy. Registration details of all the patients including their OPD number, name, age, sex were noted. Consent of each patient was taken and details of clinical examination and all the tests report will also be included in to the proforma. A thorough history of each patient including age, parity, duration of pregnancy, obstetric history, family history and any complication she faced in present or past pregnancy.
Result: HDP patients, 14.0% (28/200) women had gestational hypertension (GH), 13.5% (27/200) women had mild pre-eclampsia (PE), 43.5% (87/200) had severe pre-eclampsia (PE) and 27.0% (54/200) women presented with eclampsia. Only four women had preeclampsia superimposed on chronic hypertension and hence this group was not included for statistical analysis and calculation of p value.
Conclusion: It is more common in multigravida that is not supported by various studies but due to increased age preeclampsia superimposed on chronic hypertension. Number of cesarean deliveries are more as compared to vaginal. Termination of pregnancy is the ultimate treatment for hypertensive disorders of pregnancy and various studies has done & shows that expectant management increases the poor maternal & perinatal outcome. Preterm rates are high & birth weight more in between1.5 to 2.4 kg but good neonatal & critical care unit increases the maternal & perinatal outcome & reduces the morbidity. Majority of the admissions in NICU in severe preeclampsia followed by gestational hypertension & then eclampsia.

To investigate and quantify the severity of COVID-19 infection on HRCT and to determine its relationship with clinical profile and outcome.
Material And Methods-
Study population- 95 COVID-19 positive patients who were hospitalised to J A
Group of Hospitals & SSH, Gwalior, M.P were taken for retrospective analysis , referred to Department of Radiodiagnosis for HRCT evaluation.
Results:
 In our study group most of patients were in fifth and sixth decade with mean age 47 year, majority of patients are male, (52.63%) patients  were symptomatic, whereas (13.68%) were asymptomatic.  Fever and cough were the most frequent presenting symptoms in symptomatic patients, followed by shortness of breath, chest pain and myalgia, sore throat and headache. Approx.  26.4% of patients had an underlying co-morbid condition with diabetes mellitus, hypertension were the most common co-morbidities seen. Along with ground glass opacity(GGO) , COVID-19 patients also showed some nonspecific findings like   pleural effusion,  mediastinal lymphadenopathy.
Conclusion-
The diverse COVID-19 spectrum included symptoms such as fever, coughing, shortness of breath, sore throat, etc. Major concomitant conditions were CAD, COPD/K-Chest, hypertension, diabetes mellitus, and hypertension. Positive CT findings were more noticeable in symptomatic patients and patients with co-morbid conditions, giving HRCT chest in COVID-19 patients significant diagnostic and prognostic significance. CT imaging is important for monitoring patients' clinical progress. The findings of this study supported the
importance of chest CT in the identification and treatment of COVID-19 infection.

To study the incidence of dry eye disease (DED) and its association with computer exposure time (CET) among IT professionals. Material/Methods: A cross sectional study was performed on 138 IT professionals who met inclusion criteria. Details regarding type of VDT use and duration of exposure to VDT (hours per day) were noted. A standard computer vision symptom scale (CVSS17) questionnaire was applied to all subjects. DED evaluation was performed which included tear film breakup time (TBUT), Schirmer’s test and ocular surface staining (OSS) with oxford grading scale. Results: Among 138 subjects (54.3% females) average age 28.7±7.8 years.  Majority subjects used laptop (n=56, 40.6%), had CET ≥8 hours/day (n=92, 66.7%), Level 3 CVS (n=47, 34.1%) according to CVSS17 score. Cumulative CET showed statistically significant correlation with DED. Ocular surface damage and signs of DED was evaluated. Overall, in our study we found 71(51.4%) showed positive OSS, 89(64.5%) subjects had TBUT ≤10 seconds and 39(28.3%) subjects had Schirmer’s value ≤ 10 mm. Conclusion: We found a higher incidence of DED and CVS among IT professionals with prolonged exposure time to VDT as major risk factor

Hepatitis A is one of the highly communicable diseases of mankind and remains one of the most common forms of acute viral hepatitis worldwide. Children with HAV most commonly present with nonspecific gastrointestinal symptoms in addition to fever. Present study was aimed to study clinical spectrum of hepatitis A in children at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients of age 0-14 years, either gender, with signs and symptoms of acute viral hepatitis with positive HAV IgM. Results: In present study, 100 children admitted with signs and symptoms of acute viral hepatitis (loss of appetite, jaundice, nausea, vomiting, pain abdomen and itching), with positive HAV IgM were included. Majority children were from 6-10 years age group (45 %), followed by ≤5 years age group (39 %) & 11-14 years age group (16 %). Mean age was 8.1 ± 3.9 years. Male (57 %) children were more as compared to Female (43 %). Common clinical manifestations noted were fever (79 %), loss of appetite (78 %), yellowness of the eyes (71 %), dark-colored urine (70 %), abdominal pain (61 %), vomiting (47 %) & nausea (45 %). Mean levels of various laboratory parameters were TLC (18,452 ± 6,345 /μL), total Bilirubin (2.6 ± 1.7 mg/dL), conjugated Bilirubin (2.1 ± 1.6 mg/dL), alanine Transaminase (ALT) (106 ± 71 IU/ml), aspartate transaminase (AST) (210 ± 98 IU/ml), albumin (3.9 ± 1.3 mg/dL) & prothrombin Time (14.6 ± 3.1 secs). Conclusion: Hepatitis A is one of the most common cause of acute viral hepatitis in pediatrics population. Common clinical manifestations noted were fever, loss of appetite, yellowness of the eyes, dark-colored urine, abdominal pain, vomiting & nausea.  

Triple negative breast cancers (TNBC) are defined as cancers lacking expression of estrogen receptor, progesterone receptor and Her-2-neu. The diagnosis is based on demonstration of negative receptor expression using immuno-histochemistry and/or Fluorescent in situ hybridization (FISH). The disease has an aggressive course with overall poor prognosis, so accurate and early diagnosis becomes all the more significant for management of these cancers.
Aim and Objectives: To assess the clinical and pathological characteristics of TNBC including clinical profile, histopathological type, tumor grade, Ki-67 proliferation index along with expression of estrogen receptor, progesterone receptor and Her-2-neu.
Material and Methods: A retrospective study was conducted over period of 3 years and 6 months and the above mentioned clinical and pathological findings were assessed for TNBCs. For estrogen and progesterone receptor evaluation, Allred scoring system was used and a total score of 0-2 was considered as negative. Her-2-neu was considered negative when the staining was negative/faint/barely perceptible in part of membranes (score of 0-1+). In equivocal cases of Her-2-neu expression (3 cases), FISH was done for definitive assessment. Observations: 48 cases of Triple negative breast cancers were studied. Cytological evaluation was done in all the cases with 35 cases being reported as confirmed for a malignant lesion. All the patients were female with mean age of presentation being 46.2 years. The most common clinical presentation was breast lump. Clinically, T2 was the most common tumor stage with 22 cases. All the cases were diagnosed as ‘Invasive Breast Carcinoma, No special type’ with mean Nottingham score of 7.6. The histopathological grade was Grade 2 in 16 cases and Grade 3 in 32 cases. The mean Ki-67 proliferation index was 55%.
Conclusion: TNBCs occur in a younger population in India. Majority of patients have histological grade III tumors with high proliferation activity which is one of the reasons for adverse prognosis in these cancers. In cases where immuno-histochemistry is equivocal for Her-2-neu expression, FISH can be used to ascertain the exact status

The aim of the present study was to determine the specificity, sensitivity and accuracy of the predictors of ADNEX for risk stratification in different adnexal tumour histology.
Methods: It was hospital based observational Prospective Study in the Department of Pathology, Akash Institute of Medical Sciences and Reasearch centre, Devanahalli and cases of tubo-ovarian lesions by salphingo-oophorectomy/ovariectomy with or without hysterectomy. Total cases of tubo-ovarian lesions by salphingo-oophorectomy /ovariectomy with or without hysterectomy in last year were 146 out of total histopathogical biopsies 3101 at our centre AIMS&RC. So prevalence of tubo-ovarian lesions in last year was 4.7%. Out of which, 119 were non-neoplastic and benign cases (3.54%) and 27 were malignant cases (0.87%). The Prospective single centre study was done from 1st April 2021 to 31st March 2022.
Results: Maximum number of percentage lies in the age group 31 years to 40 years. In this study of 77 women, maximum were premenopausal 72.73% (56) followed by perimenopausal 7.79% (6) and post-menopausal 19.48% (15). In the study of 77 women, 88.31% (68) of women presented with complaints of pain abdomen followed by mass per abdomen 2.60% (2). 9.09% (7) presented with bleeding problems.
Conclusion: It can be inferred that the ADNEX model can be used as a good alternative to subjective assessment in the estimation of risk of malignancy of adnexal masses. It has the potential to change management decisions for women with an adnexal tumor. This could impact considerably on the morbidity and mortality associated with adnexal pathology.

Men's most prevalent noncutaneous cancer is prostate. It causes 10% of male cancer deaths. The American Cancer Society predicts 186330 new prostate cancer cases and 26000 deaths in 2008. Prostate cancer rarely affects men under 40 or 50. Post-mortem autopsies may detect prostate cancer. Clinical cancer is rarer than latent or postmortem cancer. 80-year-olds may be 80%. Prostate cancer diagnosis and therapy evolve.
Methods: From May, 2021 to April, 2022, researchers probed potential future events. In order to enroll patients in the study, all patients over the age of 55 who reported to the, at the Department of Radiology, Kamineni Academy of Medical Sciences and Research Centre (KAMSRC),Hyderabad,abnormal digital rectal examination, PSA, 4 ng/ml were assessed.
Results: Laterally oriented base and midgland bilateral cores enhanced cancer detection from 80% to 96% compared to standard sextant. Different strategies have been implemented in an attempt to increase the TRUS biopsy detection rate. Neovascular assessment in prostate cancer patients using power Doppler ultrasonography is also provided.
Conclusion: Doppler-targeted biopsy techniques have been shown in a large number of trials to significantly improve cancer detection rates. In order to gain an idea of how people in India feel about Doppler-directed targeted biopsy techniques, we chose to look into how well power Doppler ultrasonography can spot prostate cancer.

Lower-extremity artery disease is a major contributor to morbidity and mortality in the middle-aged and elderly. Atheromatous narrowing or blockage of a leg artery or arteries is a common cause of this condition. Possible symptoms include claudication episodes, pain during rest, sores, and even gangrene.
Methods: In this prospective study, we will evaluate the precision of Duplex Ultrasound to that of MDCT angiography. Thirty-four patients with unilateral or bilateral lower limb ischemia illness who presented to the radiology division for CT angiography made up the study population. Department of Radiology, Kamineni Academy of Medical Sciences and Research Centre (KAMSRC),Hyderabad,was the location of the study and study between June, 2021 to May, 2022.
Results: Thirty individuals were enrolled in the study. Twenty-six patients were 40 or older, while another six were 60 or older. Two patients needed below-knee amputations. Even though 830 artery segments from 67 limbs were analysed using the two approaches, only 806 were available for comparison.
Conclusion: Therefore, due to its lack of danger, low cost, non-invasiveness, widespread availability, and excellent diagnostic accuracy, Duplex Ultrasound is an essential tool in the study of peripheral vascular disease

Analysis of ascitic fluid is useful for diagnosing ascites, one of the most prevalent issues a doctor faces in practice. Traditionally, ascites has been divided into two types exudative and transudative based on an estimate of the AFTP.
Methods: 50 patients admitted to the medical ward of the General Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, participated in a study comparing the serum ascitic fluid albumin gradient with the ascitic fluid total protein in hepatic and non-hepatic causes of ascites. The research period covered the years of June, 2021 to May 2022.
Results: The diagnostic accuracy of SAAG against AFTP was evaluated for determining the etiological causes of ascites in patients, and the results showed that SAAG -Serum Ascitic Fluid Albumin Gradient was superior to AFTP.
Conclusion: In determining the cause of ascites, the SAAG is preferred over the previously used AFTP classification system. The ascites is divided into two categories, high SAAG and low SAAG, according on the SAAG value

A portal pressure gradient of more than 5-10 mm Hg is diagnostic of portal hypertension, a characteristic of cirrhosis. Varices develop in patients with portal hypertension when the portal circulation is relieved by portosystemic collaterals.
Methods: This prospective study comprised consecutive newly diagnosed liver disease patients with or without gastrointestinal bleeding from May 2021 to April 2022,at our tertiary referral facility General Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad. Before joining the trial, patients signed an informed consent.
Results: There were a total of 80 participants in the study. The median age of the population is 45, and its age distribution is between 18 and 74. The ratio of male to female patients was 2.11 to 1. There were 62 male patients. The typical duration of symptoms was 90 days (range, 10-230 days). Fifty patients had obvious ascites, and another 43 showed pedal edoema.
Conclusion: If proven effective, this would eliminate the need for expensive and intrusive examinations like gastrointestinal endoscopy and allow the use of beta-adrenergic antagonists as preventative treatments against primary variceal bleeding in patients with liver cirrhosis

Birth plans have received a positive response in most developed countries as a way to bridge gaps and enhance relationships between the subject and the care giver, but in some countries, they have been subjected to skepticism as it led to friction between the doctor and the subject. In India educational status is a great determinant of child birth planning. Most women lack formal education about process of delivery, its risks and complications, hence, in Indian scenario birth plans are still a neo entity. This study was conducted in order to assess awareness of birth plan in Indian women, awareness regarding the process of child birth, the mother’s preferences and choices regarding mode of delivery, and patient satisfaction post-delivery.
Methods: A questionnaire was developed that assessed parameters such as educational status, parity and awareness of birth plan in women in their third trimester attending the antenatal clinic and a post-partum questionnaire was administered within 2 weeks of birth or at post-partum visit. Patient satisfaction was then assessed based on the data collected.
Results: A total of 220 women completed the questionnaire, of which 1.4 per cent (n=3) were aware about a birth plan while the others (n=217) which included women from all strata of society and varying education levels, had no awareness of the concept of a birth plan. Although 98.6% of women were unaware of a birth plan most (77.3%) opted for a vaginal delivery and 22.7% opted for an elective cesarean section. While all the women (100%) requested for any form of pain relief intra and post-partum, only 87.7% (n=193) were satisfied with the pain relief they received. Women whose mode of delivery was as planned reported higher satisfaction rates. Overall 88.01% women (n=194) who were not aware of birth plan still had positive satisfactory childbirth experience while 11.98% (n=26) reported negative experience.
Conclusions: Though 50.50% of women in the study were educated up to higher secondary level only 1.4% were aware of the concept of a birth plan. Hence, education is not a sole determinant in the lack of awareness of planning for a birth. Other determinants that seemed to play a role in the mother’s satisfaction rates were mode of delivery, management of labour and post-partum analgesia and cultural beliefs such as sex of the child.

To evaluate early maternal warning triggers in the detection of maternal morbidity, by using two types of Early warning systems as a bedside screening tool and comparing their efficacy in routine use. To determine the effectiveness of maternal early warning scoring system as a screening tool for maternal morbidity. To compare the effectiveness of MEOWS chart over MEWT chart as screening tools for maternal morbidity in routine use.
Methods: From September 2019 to October 2021 (two years), a descriptive observational study was conducted at the department of obstetrics and gynecology, Kamineni Academy of Medical College and Research Centre, LB Nagar Hyderabad, India. Women who met the selection criteria for antenatal and postnatal care during the study period and gave their informed consent. 500 study participants were the sample size.
Results: Majority of study participants were in the age group of 21-25 years (45.2%). Mean age of study participants was 25.00 + 4.606 years ranging from 17 to 42 years.MEOWS colour coding and MEWT colour coding were matching in all the 500 cases in screening maternal morbidity (Kappa value of 1.00) and it was found to be statistically significant (P value <0.05).
Conclusion: We discovered that when screening for maternal morbidity, both the MEOWS and MEWT color coding matched in every instance. In order to identify early maternal warning signs by all healthcare professionals and thereby aid in the prevention of obstetric morbidity, we can use MEWT color coding, which is straightforward and simple to use with only 5 components as opposed to MEOWS color coding, which had 7 components.

Introduction: The Bicipital Groove (BG) lies below the anatomical neck of humerus, separating the greater and lesser tubercles. It lodges the tendon of Long Head of Biceps Brachii (LHBB) and ascending branch of the anterior circumflex humeral artery. The shoulder pain is frequently caused by biceps tendon pathologies, which are associated with variations in morphometry of the BG. Therefore, this study was conducted to determine morphometric features of BG in Gujarat region of India to provide additional information.
Materials & Methods: The data was collected from 100 dry adult humeral bones of unknown sex (50 right and 50 left) available in anatomy department of Pramukhswami Medical College, Karamsad, Gujarat, India. The digital Vernier caliper was used to precisely measure the BG’s length, breadth, depth, medial wall length, and lateral wall length.  The opening angle (OA) and medial wall angles (MWA) was measured by screen protractor software after capturing and transferring images of bones to the computer. Statistical analysis was done on the collected data.
Result: The length, width and depth of BG were 73.21 ± 9.08 mm, 10.15 ± 1.01 mm and 4.24 ± 0.69 mm on right side and 71.94 ± 8.45 mm, 10.11 ± 0.89 mm, 4.31 ± 0.83 mm on left sides respectively. The average opening angle on the right side was 76.11±13.79º, while on the left side was 76.11 ± 13.79º. The medial wall angle was 55.74 ± 11.92º on right side and 54.03 ± 8.94º on left side.
Conclusion: This study provides additional information on the morphometry of the BG in the Gujarat region, which can be useful for anatomists, anthropologists, orthopaedic surgeons and radiologists. The results of this study may also be used to determine prosthetic design, size, and position in humeral head replacement.

Covid 19 has been responsible for one of the deadliest pandemics in human history, resulting in widespread human suffering and loss of life. Minor alterations in the menstrual cycle have caused females to worry about the covid 19 vaccination because they are seen as a threat to the health and fertility that regular menstruation represents. Understanding the correlation between the covid-19 vaccine & changes in menstural cycle is crucial for sustaining community confidence in vaccination programmes.
Aim: To analyse menstrual cycle patterns in reproductive age group women who have received covid 19 vaccination.
Materials & methods: It was an observational cross-sectional study of 382 women wherein before & after getting the immunisation, women were surveyed through web-based questionnaire to assess changes in menstrual cycle parameters such as menstrual cycle length, its duration, flow volume. Menstrual cycle patterns were evaluated before vaccination, between first and second dose, between second and third dose and post booster dose.
Results: Out of 382 women, majority of women were between the age group of 26-35 years.. Seventy-five percent of women got the covishield vaccine, and seventy percent of those were Hindu. Only 16% of women saw transient, minor changes in menstrual cycle characteristics such as flow volume and frequency of cycles.
Conclusion: Immunisation against COVID-19 did not significantly alter the characteristics of the menstrual cycle. Therefore, more research is needed to assuage worries about the impact of covid immunisation on the menstrual phase.

The purpose of this study is to evaluate patients with a new diagnosis of Polycystic Ovarian Syndrome for hypothyroidism by measuring their serum thyroid stimulating hormone levels. The goal of this study is to evaluate the difference in hormone levels and other parameters between euthyroid and hypothyroid polycystic ovary syndrome patients.
Materials and Methodology: This study was designed as an observational cross-section. Women over the age of puberty who presented with menstrual abnormalities for at least three months and/or infertility were recruited from the department of physiology, kamineni institute of medical sciences, Narketpally, Nalgonda clinic for our study. We started the trial before we had ultrasound proof of polycystic ovaries. The Institutional Ethic Committee all-clears this study.
Results: Student t-test and Chi-square test were used to compare Age, BMI, WHR, FBS, PPBS, Ovarian volume, Testosterone, and HOMA-IR between the two PCOS groups. TSH, Total Testosterone, and WHR were correlated using Pearson co-efficient.
Conclusion: This hormonal discord disrupts ovarian homeostasis, which ultimately causes anovulation. The results of this study suggest that screening for hypothyroidism, along with reproductive hormone profile, should be investigated in polycystic ovary syndrome (PCOS)/infertile women to allow for early detection and treatment of the condition.

Epithelial Membrane Antigen may be used as a supplement marker to CKs for detection of epithelial differentiation, especially in sarcomatoid carcinoma or those undifferentiated carcinomas that are negative or only focally positive for CKs. Epithelial membrane antigen is not entirely specific for carcinomas. Every eligible specimen diagnosed as undifferentiated malignant tumors, poorly differentiated malignant tumours and small round cell tumours in histopathology received for immunohistochemistry in IHC LAB, Department of pathology, SMS Medical college and Hospital, Jaipur. Total out of 92 cases, most frequent diagnosis was mesenchymal followed by epithelial, hematopoietic and germ cell tumours.

Tuberculosis is a huge public health worry with high mortality rate. Usually presents with non- tender lumps in the neck region, malaise and weight loss. This study was undertaken to study the clinical and epidemiological profile of tubercular cervical adenitis.
Objective: To study the clinical and epidemiological profile of tubercular cervical adenitis and to determine and assess the outcome of anti- tuberculous treatment (ATT) in these patients.
Methods: A hospital based descriptive study was conducted among 35 subjects at a tertiary teaching hospital in Hyderabad for a period of one year. The collected data was analysed using SPSS version 21.
Results: The mean age was 31.1±12.8 years consisting of 13 males and 22 females. The swelling was tender in only one subject, hard in 74.3% and firm in 25.7%. FNAC was done in 94.3% and biopsy was done in 11.4%. All the 35 subjects were started on anti- tubercular treatment category I. Relapse was seen in 3 subjects. On association anti tubercular treatment of tubercular cervical adenitis increased the cure rate (p<0.04) and the chances of relapse was reduced (p<0.001).
Conclusion: High- cure rate and low relapse rate was observed with minimal adverse effects

To compare the functional outcome of biceps tenotomy vs biceps tenodesis as an operative treatment for Long head of biceps tendon lesions associated with rotator cuff injuries and study the associated complications.
Materials and Methods: 30 arthroscopic shoulder surgeries were performed at Sanjay Gandhi Institute of Trauma and Orthopedics from November 2020 to June 2022. 15 patients of Tenotomy and 15 patients of Tenodesis of biceps tendon associated with rotator cuff injuries. All patients were evaluated pre-operatively & post-operatively with VAS score, ASES score and CONSTANT score. Average pre-operative ASES score was 33.43 & CONSTANT score was 33.66. Follow up period ranged from 6 months to 12months.
Results: 15 (60.0%) of the participants had Group: Tenotomy. 10 (40.0%) of the participants had Group: Tenodesis. The mean Age (Years) was 49.36 ± 12.28. 8 (32.0%) of the participants had Age Group: <40 Years. 17 (68.0%) of the participants had Age Group: >40 Years. 17 (68.0%) of the participants had Gender: Male. 8 (32.0%) of the participants had Gender: Female. The mean Duration of Symptoms (Months) was 6.44 ± 6.48. The mean VAS (Pre-Operative) was 8.64 ± 0.49. The mean VAS (6 Weeks) was 7.24 ± 0.44. The mean VAS (12 Weeks) was 5.08 ± 0.57. The mean VAS (18 Weeks) was 3.84 ± 0.55. The mean VAS (24 Weeks) was 3.48 ± 0.59. The mean ASES Score was 81.52 ± 5.33. The mean CONSTANT Score was 79.36 ± 6.16. There was statistically significant improvement in the trend of VAS Score, ASES Score and CONSTANT Score over time in each group but it was favourable towards the Tenodesis group in younger patients.
Conclusion: In conclusion the ASES Scores and the CONSTANT Scores were higher in the Tenodesis group when compared to the tenotomy group respectively. Correspondingly, the improvement in the Visual Analogue Scale suggested an increased patient satisfaction in both the groups. Tenodesis can be a considered as a favourable option to treat young patients with long head of biceps tendon lesion with RCTs.

Peritrochanteric fractures consume major part of orthopaedic injuries with high morbidity and mortality affecting almost all age groups. These fractures are difficult to treat specially the unstable types and unstable fractures unite with difficulty of reduction of fracture and there are high chances of malunion and nonunion. For the last 15 to 20 years different modifications of both the extramedullary and intramedullary devises have been done.
Aim and Objective: The treatment goal is to achieve anatomic reduction with a stable fracture fixation to allow early functional rehabilitation. There are limited studies on proximal femur locking compression plates in peritrochantric fractures and the aim OF present study was to evaluate its outcomes.
Material and Method: The study was conducted on patients having peritrochanteric fractures fulfilling inclusion and exclusion criteria in SGRD Hospital attached to SGRDUHS Vallah, Amritsar from April 2021 to July 2022. Proximal femur locking compression plating was done and its clinical, functional and radiological outcomes were evaluated.
Results: The mean neck shaft angle in our study at 6 months was 124.37. The mean of HHS in our study at 1 month, 3 months and 6 months was 35.17, 64.10 and 81.83 respectively with 20% excellent, 46.7% good, 23.3% fair and 10% poor results and P value was found to be <0.001(significant). In our study Mean RUSH score at 1 month, 3 months and 6 months was 15.50, 21.23 and 23.87 respectively and p value was found to be <0.001(highly significant) In our study, 25 (83.3%) out of 30 cases showed union. Mean time for union in our study was 16.8 weeks.
Conclusion: Our study concluded that despite the advances in surgical techniques and fixation devices, certain groups of proximal femur fractures continue to be a treatment challenge. Few of the disadvantages associated with PF LCP are relatively difficult operative technique and mechanical hardware failure with varus collapse

Background: Clavicular fractures account for 4% of all adult fractures. However, simultaneous medial and lateral fractures occurring in the same clavicle (the so-called ‘bipolar clavicle fracture’) are rare. Treatment for this type of fracture is not well established. Herein, we report our experience of the operative management of bipolar clavicle fractures using two anatomical locking plates.
Methods: Patients who presented with bipolar clavicle fracture between Feb 2021 and December 2022 were prospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using pre-contoured clavicle plate/recon plate for medial fractures and hook plate for lateral end fracture. Functional and radiological outcome evaluated
Aim: To evaluate the functional and Radiological outcome in patients with bipolar clavicle fractures treated with dual anatomical locking plates
Results: In all the patients, bony union achieved at an average duration of 17.9±1.4weeks. The mean shoulder forward flexion was 166°±11.4°, and the mean DASH score was 3.3±2.3 with four cases assessed as excellent and one case assessed as good. The mean abduction was 168֯±9.8֯. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment.
Conclusion: Dual plating is an effective surgical procedure for treating bipolar clavicle fractures with very good functional results and early mobilization

The objective behind this study is to detect and study causes of seizure in patients with seizure disorder on MRI Brain and to age wise correlate most common causes found in different age groups, in a tertiary care hospital in Northern India.
Material and Methods
A total of 100 patients with clinical symptoms of seizures who were referred for MRI for diagnosis and evaluation, from the department of Neurology to the Department of Radio diagnosis, JAH Group of hospitals & G.R.M.C. Gwalior (M.P.) were included in the study. All MRI scans were performed on a 1.5 T Philips scanner with sequences of seizure protocol. Data was analyzed using SPSS version 16.0 and EPI INFO version 7.0.
Results
The mean age of presentation with seizure in our study was 20.5 years with male predominance seen. Age groups were divided into four categories ≤1year, 1-18 years, 18-40 years and >40 years for the purpose of our study with 17 patients found in ≤1year group, 37 patients in 1-18 year age group, 28 patients in 19-40 year and 18 patients in >40 year age group. Normal MRI was seen in 29 out of 100 patients (29%).
Infarct with gliosis was the most common finding in seizure patients (26% ) in our study followed by HIE (hypoxic ischemic encephalopathy) (17% with most common age group being ≤1year) & infection (15%). Other causes found were mesial temporal sclerosis in 10% patients, tumors in 6% patients , malformation of cortical development in 3% patients, neurocutaneous syndrome(SWS) identified in 1%, cavernoma in 2% cases, metabolic causes in 3% cases, demyelination in 3% cases and CVT was also found in 3% of cases.
Conclusion
Our prospective study suggests the importance of MRI in evaluation of underlying brain pathologies causing seizure disorder and age wise most common causes found on MRI brain study, which included cerebrovascular, HIE, infections, mesial temporal sclerosis, tumors, malformation of cortical development, neurocutaneous syndrome, metabolic, vacular malformation and demyelination. We hereby conclude that MRI plays a crucial role in diagnosis and management of patients with seizure disorder by detecting various underlying brain pathologies causing recurrent seizures in epilepsy patients

Background: Hansen's disease (leprosy) is a chronic infectious Granulomatous disease mainly affecting skin and peripheral nerves. There are varied clinical presentation & histopathological findings in leprosy which depends on the immunological status of the individual.
Aim: The aim of the present study is to determine the clinico-histopathological correlation of all suspected cases of leprosy using Ridly-Jopling system.
Materials & Methods: This is a hospital based cross sectional study done during the period of 1 year from July 2021 to June 2022.Skin biopsy samples received from clinically suspected leprosy patients were stained with H& E stain followed by fite-faraco stain for evaluation of lepra bacilli.
Results: Among the 58 clinically suspected cases of Hansen’s disease, 48 cases shows evidence of leprosy in histopathological examination with a clinico – histopathological correlation rate of 83%. On histopathological examination majority of cases were of Borderline tuberculoid (32%) followed by Lepromatous leprosy (14%). Borderline borderline (BB) gives maximum clinico-histopathological correlation (92%) and Borderline Lepromatous (BL) shows minimum clinico-histopathological correlation.
Conclusion: For accurate classification of disease, correlation between clinical, histopathological and microbiological findings is very crucial. Early clinical diagnosis is cornerstone for Leprosy eradication program. Therefore, all clinically suspicious cases must be followed by histopathological examination of the skin biopsy samples.

Introduction: Fine needle aspiration (FNA) cytology, which provides a very quick preliminary diagnosis with no harm to the patient and at a far cheaper cost than surgical biopsy, is commonly utilized in the analysis of lesions from diverse body sites. The ability to quickly and accurately diagnose with little invasiveness with FNAC is crucial. Materials & Methods: All patients with clinically enlarged peripheral swellings who presented to the pathology department are included. All FNAC samples of enlarged peripheral swellings were used to prepare air dried and alcohol fixed CSs to be stained with MGG stain or H&E stain respectively and to prepare CB by Plasma - Thromboplastin method and the sections were stained with H&E and specific stain as per diagnostic requirement. Results: A total of 51 patients were enrolled in this study between the Age of 10 to 90 yrs. The mean age of present study participants was 46.27± 18.43 year and cases within the age range of 46-60 years (31.4%) constituted the largest group. In the Conventional smear benign cases were 23.5% while in CB it was 21.6% observed. Malignancies were found in 37.3% while in CB it was reported 25.5%. This distribution was statistically significant (p value<0.05). Conclusion: The current study conclude that CS has a good correlation with malignant lesions, with adequate cellularity, clear visibility of nucleus and cytoplasm and wellpreserved architecture. However, blood obscuring and cellular degeneration is encountered more frequently. CB can hence be used as a supplement in arriving at an accurate diagnosis.

Introduction: Spinal anesthesia has been the choice of anesthesia for infraumblical surgeries. Aim: to evaluate the efficacy of adding clonidine (30µg) or dexmedetomidine (5µg) to 0.75% isobaric ropivacaine for administration of subarachnoid lumbar block in lower limb surgical procedures.
Methods: The Hospital based comparative, randomized, double blind, study was done on 120 patients (ASA grade 1-2) undergoing lower limb surgeries at S.M.S. Medical College and attached group of hospitals, Jaipur, after taking permission from the institutional ethical committee and review board. 120 patients were randomized into three groups of 40 each by sealed envelope method as follow: GROUP RS (0.75% Ropivacaine + 0.5 ml Isotonic saline), GROUP RC (0.75% Ropivacaine + 30µg Clonidine), GROUP RD (0.75% Ropivacaine + 5µg Dexmedetomidine).
Results: The mean time taken to achieve maximum sensory level was 18.40 minutes, 11.70mins and 18.80mins in groups RS, RC and RD, respectively (p<0.05). Mean time taken for sensory block to regress to L1 sensory level was 227.50minutes, 202.30minutes and 159.40minutes in groups RC, RD and RS, respectively(p<0.05). The time between the administration of subarachnoid block and request for rescue analgesic was 193.10 minutes, 347.60 minutes and 381.30 minutes in groups RS, RC and RD, respectively (p<0.05).
Conclusion: We conclude that both drugs, Clonidine and dexmedetomidine can be safely added as adjuvant to intrathecal Ropivacaine for lower limb surgeries, in view of similar sensory and motor block characteristics.

Background: Dengue was one of the top 10 probable health concerns to the world in 2019 according to the World Health Organization. Dengue fever has been associated with various types of renal manifestations such as proteinuria, hematuria, glomerulonephritis, and acute kidney injury (AKI). Hence, this prospective cross-sectional observational study was designed to analyze the frequency, characteristics, and clinical outcome of dengue fever in children with renal manifestations.
Materials & Methods: This was a cross sectional observational study done on 225 cases of children with dengue fever in the Department of pediatrics, SPMCHI hospital Sawai Man Singh Medical College, Jaipur. Data regarding the need for fluid resuscitation, colloid infusion, inotrope support, ventilatory requirement were collected. Creatinine values and urine output were noted and ‘Kidney Disease Improving Global Outcome 2012 (KDIGO)’ guideline was used to stage the acute kidney injury. Various renal manifestations of dengue will be studied and compared between the severity of dengue fever. Continuous variables were summarized as mean and standard deviation and were analyzed using independent sample t test for comparison between 2 groups and ANOVA test was used for comparison between multiple groups (>2 groups).
Results: Our study showed that Mean age of 225 children with dengue in present study was 7.98 ± 4.21 years. Male to female ratio was 1.06:1. Renal involvement was highest in patients with dengue shock syndrome (28.6%), followed by those with dengue hemorrhagic fever (18.4%) and was least in those with dengue fever (4.7%). This difference in incidence of renal involvement in relation to severity of dengue was found to best artistically significant (p<0.001). The duration of hospital stay was highest in patients with Failure p RIFLE criteria (11.5 ± 4.95 days), followed by injury category (7 ± 1.41 days) and was least in risk category (5± 0.89 days), and this difference was found to best artistically significant (p=0.019).
Conclusion: We concluded that renal involvement was more common in dengue shock syndrome. Transient proteinuria and hematuria have been detected in most patients with dengue fever. So a clinician who is dealing with dengue patients should have closed watched on renal functions so kidney injury can be avoid to some extent as well as the mortality in dengue.

ABSTRACT
Background: Pelvic injuries are a component of major Road traffic accidents. Erectile dysfunction together with stricture formation and urinary incontinence form a triad of deleterious consequences that affect patients sustaining a pelvic fracture urethral injury (PFUI). There is also a difficulty in differentiating erectile dysfunction due to PFUI and de novo erectile dysfunction due to urethral realignment or delayed urethroplasty, unless patients are assessed for erectile dysfunction at several times, ideally before and after injury as well as before and after repair. In this study, we try to find the incidence, probable cause and impact of surgery for urethral stricture on erectile dysfunction in patients with post traumatic urethral stricture due to pelvic fracture.
Materials & Methods: A randomized prospective observation study done on 33 patients of pelvic trauma (pelvic fracture) with urethral injury and pelvic fracture without urethral injury at NSCB medical college & hospital, Jabalpur, from January 2019 to august 2020. All patients with pelvic fracture were divided into two groups- Group A- Pelvic trauma (pelvic fracture) with posterior urethral Distraction injury and Group B- Pelvic fracture without urethral injury. Patients who were having erectile dysfunction were subjected to preoperative penile colour doppler. Colour doppler was done 3 months after the trauma, when the patient was admitted for urethroplasty.
Results: The total number of cases was 33. Of 23 patients had pelvic fracture with urethral injuries and 10 patients had only pelvic fracture. Majority of patients belonged to younger age group (42.42%) as they are more prone to road traffic injuries. The incidence of erectile dysfunction is 33.33%. The incidence is 39.13%. Out of which, 6 patients developed vasculogenic erectile dysfunction (incidence 26%) and 3 patients developed neurogenic/psychogenic erectile dysfunction (incidence 13%).
Conclusion: We concluded that pelvic fracture with urethral injuries is associated with higher incidence of erectile dysfunction (P-value 0.042). Pelvic fracture alone also has association with erectile dysfunction but not significant (P-value0.476). Vasculogenic erectile dysfunction is more common than neurogenic /psychogenic erectile dysfunction in patients with pelvic fracture. Surgery for urethral stricture (urethroplasty) is not associated with any improvement or deterioration in erectile function in these patients (P-value1).

Background: The broad spectrum of biliary tract disease includes the most often diagnosed gallstone disease (cholelithiasis), cholecystitis, or biliary dyskinesia. The present study was conducted to assess etiology and outcome of cholelithiasis.
Materials & Methods: This was a hospital based, “cohort” study to assess etiology and outcome of cholelithiasis. Data was collected. All the patients received UDCA treatment. A treatment response was considered complete dissolution of gallstones, as determined by USG. Chi square test, Student’s t test and Mann–Whitney U tests were conducted for comparisons of variables using SPSS 19.0. Statistical significance was set at 0.05 in all tests.
Results: A total of 100 patients were enrolled in the study in which 40% were males and 60% were females. Maximum participants were of age group 31-40 years (32%). Most common etiology was advanced age (72%). Gallstones disappeared within six months after treatment 22 32% cases, and in 10% more by the end of 1.5 years. No change was observed in 58% cases.
Conclusion: The present study concluded that advanced age was the most common etiological factor. Only 32% Gallstones disappeared within six months after treatment

Background: Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance that first occurs or is first diagnosed in pregnancy. GDM is long known to be associated with neonatal and maternal morbidity. Early screening and better diagnostic tools can help decrease chances of GDM. One of the most accessible and inexpensive inflammatory markers is platelet indices. Various studies show that indices like platelet count, mean platelet volume, plateletcrit, platelet to lymphocyte ratio have association with GDM occurrence but there is lack of such studies among the Indian population. This study aimed to investigate the association between mean platelet volume and the risk of GDM occurrence using maternal CBC sampling in the second trimester of pregnancy.
Materials and Methods: This cross-sectional study included 2 groups of 66 pregnant women with and without GDM. The women in each group were compared after the routine screening for GDM and CBC test at 24–28 weeks’ gestation after being matched according to the inclusion criteria. All the statistical analysis were done using Epi info version 7.2.1.0 statistical software.
Results: The two groups were compared with respect to various sociodemographic factors I. e., age, parity, religion, literacy status where the resulting difference was statistically significant in case of their socioeconomic status where majority (50%) of GDM pregnancies belonged to Lower class compared to 51.1% of healthy pregnancies from lower middle class. The difference in values of mean platelet volume among the two groups was found to be statistically significant (p<0.001). In the ROC, the area under the curve was 0.86 and with critical cut off value as 12.45fL, the sensitivity and specificity were 71.2% and 87.9% respectively.
Conclusion: Given the inflammatory nature of the disease, GDM and associated high levels of maternal and fetal morbidities, an adjunct to present screening techniques is needed. Our study infers that mean platelet volume is a highly specific indicator of GDM.  These values can further be studied in first trimester of pregnancy which may further be helpful in earlier diagnosis of GDM.

Background: The present study was conducted for evaluating Post-Natal Depression.
Materials & Methods: A total of 100 subjects were enrolled. Out of the total, 70 belonging to the first group of women in the immediate postnatal period, and 30 at 6-8 weeks post-delivery. Edinburgh Postnatal Depression Scale (EPDS) was taken under consideration. Mean EPDS scores were taken. Data was analyzed using SPSS software.
Results: Mean score for women in the immediate postnatal period was 11.20 and that for those at 6-8 weeks post-delivery was 11.73. There was no difference between these two means. 41.5% among women within one week of delivery and 43.4% among women within 6-8 weeks of delivery screened positive for postnatal depression.
Conclusion: It can be concluded that there was high prevalence of postnatal depression in women. However; further studies are recommended.

In the current study, a reverse phase high performance liquid chromatography (RP-HPLC) approach that was developed and validated for the simultaneous quantification of hydroquinone, allantoin, and tretenoin in a cream formulation is discussed. On a reversed-phase InertsilC₁₈ column (4.6 mm I.D. 250 mm, 5 m), the chromatographic separation was completed using a mobile phase made up of buffer (pH 3.5), 0.05 M potassium dihydrogen ortho phosphate-methanol (70:30% V/V), and UV detection at λmax 223nm. The technique demonstrated linearity, with Hydroquinone, Allantoin, and Tretenoin correlation coefficients of 0.999, 0.999, and 0.999 spanning ranges of 100-300 g/mL, 50 to 150 g/mL, and 0.625 to 1.875 g/mL, respectively. All of the components' mean recoveries ranged from 99.00 to 101.00%. The technique was approved in accordance with ICH standards. With no unwelcome interference, the established approach was extremely precise, repeatable, and detectable for hydroquinone, allantoin, and tretenoin together. The approach is effective in isolating the API from its degradants when judged on many criteria, including system suitability, precision, accuracy, linearity, robustness, and stability studies. It can be used to analyse samples of hydroquinone, allantoin, and tretenoin.

The aim of the present study was to assess the association between RDW and mortality in children admitted in pediatric intensive care unit (PICU).
Methods: The study was conducted in the department of Pediatric medicine, Sir Padampat mother and child health institute (SPMCHI) and advanced hematology laboratory, SMS medical College, Jaipur from October 2018 to April 2019. 170 patients were included in the study. All the patients who were admitted in PICU of SPMCHI hospital, SMS medical college consecutively in the above said time period were taken as subjects in this study, after screening for inclusion and exclusion criteria.
Results: Total 170 children admitted in ICU ranged from 1month to 17 years, Majority of subjects belonged to age group 1month-5 years (36.4%), followed by 5-10 year and rest was age group of 10-18 years (30.7%). Out of 170 children, total number of males was 109(64.2%) and number of females was 61(35.8%). Among age group 1m-5y total 49(79%) were having haemoglobin in range of 9-11g/dl, 11 (17.7%) were having haemoglobin in range of 11-13g/dl, 2(3.3%) were having haemoglobin more than 13g/dl. In age group 5-10y total 39(69.6%) were having haemoglobin in range of 9-11g/dl, 13 (23.2%) were having haemoglobin in range of 11-13g/dl, 4 (7.1%) were having haemoglobin more than 13g/dl. Among age group 10-18y total 36 (69.2%) were having haemoglobin in range of 9-11g/dl, 13 (25%) were having haemoglobin in range of 11- 13g/dl, 3 (5.8%) were having haemoglobin more than 13g/dl.
Conclusion: CRP in our study did not correlate with mortality, hence to conclude in resource poor setting where parameter for predicting mortality in critical care are not readily available, RDW which can be measured easily by coulter counter can be used as a predictor of mortality.

Asthma-COPD overlap (ACO) is known by many names in many countries and a universal consensus has not yet been reached on this subject regarding its definite clinical pattern and diagnosis. However, the GINA and GOLD committees have together established a guideline, by which a clinician can arrive at a diagnosis of Asthma-COPD overlap syndrome ^1,2.
Aim/Objectives: Assessment of patients diagnosed to have Asthma or Chronic Obstructive Pulmonary Disease (COPD) fulfilling current criteria for ACO.
Materials and Methods: The study was a Cross-sectional study done in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana. From November 2019 to May 2021 and 107 patients were included in the study.
Results: Of the 65 pre-study asthma patients, only 62 (96%) confirmed as asthmatics, 1 (1.7%) as COPD and 2(2.3%) were confirmed to be ACO. Likewise of the 35, pre-study diagnosis of COPD patients, only 20 (58%) confirmed as COPD, 9 (25%) confirmed as Asthma patients and 6 (17%) confirmed ACO patients. There were 7 ACO patients however only 1 of them was confirmed to be ACO, 5 confirmed as Asthma and 1 confirmed to be COPD.
Conclusion: The prevalence of ACO was established in the study population; 17.2% from COPD and 2.8% from Asthma. Overall, it was 5.4% of all obstructive airway diseases, obtained from our study population.

The objective of the study is to evaluate the effectiveness and tissue response of intralesional platelet‑rich plasma (PRP) injection with serial USG follow up among 40 patients in plantar fascitis.
Materials and Methods: A total number of 40 patients with plantar fascitis. Pre‑ and post‑intervention visual analogue scale (VAS) for the assessment of pain relief and assessment of plantar fasicia(PF) thickness using USG with 1 month, 3 month and 6 month follow up.
Results: The mean VAS scores for heel pain measured at 1st month of treatment was 3.025±0.831, at 3months was 2.225±0.5767, at 6months was 0.025±0.1581. The decrease in mean VAS score was statistically significant when compared with pre-treatment values (8.926±0.565).
The mean plantar fascial thickness measured at 1 month was 3.575±0.5006, at 3 months was 3.4±0.4961, at 6 months was 3.1±0.2819. The decrease in mean plantar fascial thickness was statistically significant when compared with pre-treatment values (6.5725±0.7161).
Conclusion: Intralesional injection of the PRP is effective and safe modalities of treatment for plantar fasciitis with significant reduction in PF thickness.
 

Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. The use of distal humerus locking compression plates is promoted for the management of these fractures.
Objectives: To evaluate the Functional and radiological outcome of extra-articular distal humerus fractures treated with distal humerus locking compression plate.
Materials and Methods: Our study consists of 29 cases of extra-articular distal humerus fracture operated at Mysore medical college and research institute from January 2021 to January 2023. Functional outcome was assessed through The Mayo Elbow Performance Score. All the cases in the study were post traumatic. Patients were following up regularly for a period of 1 year post operatively. And radiological parameters like Metaphyseal-Diaphyseal angle, humeral-ulnar angle, shaft-condylar angle, anterior line are calculated and were compared with normal values.
Results: There were 21 male (70.0%) patients and 8 (30%) female patients. Average age of the patients was 41.38 years with age ranging from 24 years to 65years. 16 cases were right humerus and 13 were left sided humerus involved. All cases were of AO type 13A fractures were operated using paratricipital approach, fracture stabilized with distal humerus locking compression plate. Most of the patients had excellent postoperative elbow flexion with average arc of elbow flexion of 117.33 degrees, average extension deficit of 8.67 degrees, average pronation of 70.83 degrees, average supination of 70.83 degrees. 2 patients in our study had superficial skin infection, 6 cases had Radial nerve neuropraxia.
Conclusion: Distal humerus locking compression plates offer a good fixation for the extra-articular distal humerus fractures with particular advantage in extra-articular type A3. The device helps in early mobilisation even in fractures with comminution due to its enhanced stability where as other fixation methods tend to delay mobilisation due to lack of stability of construct.

highest incidence of supracondylar fracture of humerus is in Pediatric age group and the most common being the extension type of supracondylar fracture. Precise diagnosis evaluation and planning is required for deciding the best modality of treatment for these fractures. They are most widely managed by utilizing two methods; lateral pinning and crossed pinning. So aim of study remains to determine the superiority of either of these techniques over the other.
Materials and Methods: A prospective, single blinded, randomized control trial with 53 cases, out of which 39 were boys and 14 were girls was conducted. Mean age group of study was 6.9 years. Acoording to Gartland classification Type III supracondylar fractures were included in this study. Detailed post-operative primary assessment for major loss of reduction and iatrogenic ulnar nerve injury was done. Clinical outcome, elbow range of motion, radiographic measurement, Flynn’s grading and complications were the secondary parameters which were assessed.
Results: Both groups exhibited no major loss of reduction. Change of Boumann angle was statistically insignificant. Metaphysial-Diaphysial angle, Flynn grade, carrying angle and total elbow range of motion between the two groups showed no statistically significant difference.
Conclusion: Lateral pin fixation offers parallel results in terms of functional and radiological outcomes and nearly equal mechanical stability compared to medial-lateral pinning without the added shortcoming of possibility of iatrogenic ulnar nerve injury.

Rhino-Orbital-Cerebral Mucormycosis (ROCM) was an emerging threat among patients with Covid-19 during the pandemic year of 2021. Diagnosis of the disease in its early phase was crucial. A study was carried out to evaluate the role of CT and MRI in diagnosing and monitoring the treatment of Rhino-Orbito-Cerebral Mucormycosis and assess the disease’s outcome.
 
The characteristic imaging findings helped in accurately diagnosing the disease.  Some key diagnostic findings were; the involvement of the periantral fat favoring angioinvasive disease;  and empty turbinate sign correlating pathologically with fungal hyphae. Tiny focal air lucencies within the permeative pattern of bone destruction were exclusively seen in fungal osteomyelitis. Another important feature of the disease seen in our study was the “pseudo empty sinus sign” from mild enlargement/widening of predominantly the ethmoid and sphenoid sinuses due to the filling of the sinuses with fungal hyphae. The affected sinuses exhibited signal void/hypointense signal on T2 subtle iso-intense signal on T1 with mild patchy enhancement in the post-contrast study.

Self-medication (SM) is the act of obtaining and using one or more drugs for treatment, diagnosis, or prescription without a doctor's prescription or recommendation. In percentage, SM is growing in rural areas. Since the prevalence and pattern of SM use are not well established, a cross-sectional survey was conducted, and 400 individuals were randomly chosen from district Baharaich's rural areas.
Method: Each participant underwent a face to face interview with the help of a structured questionnaire; data collected was analyzed using descriptive and inferential statics in Epi info version 7 software.
Result: Overall, out of 400 participants, 70 % of them reported that they have used SM in the past. The frequency of SM use varied among the subjects with a minimum of at least one time to maximum of 5 times and above. When the participants were asked about the reasons for SM use, the majority of them 33% stated lack of time to visit a doctor as the main reason followed by Ease and convenience (17%), Avoiding crowd in visiting doctor (14%) and Economical (14%).The major source through which the participants learned to use SM were as follows, directly from pharmacist (61%) followed by television/media/google (18%) , prescription of previous illness (12%), friends (12.5%). The main indications for SM use were headache (35%) followed by fever (32%), then cough/cold/sore throat (21%).The most commonly used drugs for self-medication were paracetamol (34%) followed by nonsteroidal anti-inflammatory drugs (NSAIDs) (30%) and cold remedies (21%).
Conclusion: Self-medication is an alarming sign for society. Self-medication can be prevented or minimized by increased awareness and education in society.

The information about imaging findings of COVID-19 disease on HRCT is evolving every day and is widely distributed across numerous publications Main objectives of our study were to identify important imaging manifestations, atypical manifestations and distribution of the lesions in the patients with COVID-19 to help the fellow radiologists and physicians globally so that it ensures proper clinical management. Our study is a multi-centric retrospective study done on a total of 81 COVID-19 affected symptomatic patients. HRCT was done on all the patients and detailed history of the patient’s symptoms and characteristics are recorded. The most common symptoms observed were fever, cough and dyspnoea. On HRCT the most common finding observed was ground glass opacities, seen in 28 cases which comprise 35% of the study population. Consolidation alone and combined consolidation & ground glass opacities were observed in 12(15%) and 17(21.1%) cases respectively. Among other ancillary findings air-bronchogram, sub-pleural lines and fibrotic opacities were most commonly observed. Most of the cases showed peripheral or sub-pleural involvement and both lower lobes are the most affected regions of the lungs. In our study we found that ground glass opacities are the most common findings in the lungs of COVID-19 patients. The sub-pleural or peripheral lung fields and the lower lobes are the most affected regions of the lungs. Most of the COVID-19 cases show region s of sub-pleural fibrosis as evidenced by presence of sub-pleural lines

Diagnostic accuracy of drain fluid amylase as a triage test for the detection of clinically significant pancreatic leaks, so that an informed decision can be made as to whether the patient with a suspected pancreatic leak needs further investigations, treatment and also a predictor for early drain removal and help in enhanced recovery after surgery. Aims And Objective: To analyze the drain fluid amylase (DFA) on the 3rd Post-operative day (POD) as a predictor for early drain removal and its associated complications. Methodology: Patients admitted to our hospital and after a detailed history and investigations those who were diagnosed with carcinoma head of the pancreas,  periampullary carcinoma, chronic pancreatitis, and underwent pancreatoduodenectomy and Lateral pancreaticojejunostomy patients were analyzed prospectively. Twenty cases were taken into the study. DFA analysis was done on Day 1 and Day 3. Those patients without drains or POD 1 DFA >5000 U/L were excluded. Patients with POD 1 DFA <5000 U/L were divided into groups based on POD 3 DFA: Group A (<350 U/L) and Group B (>350 U/L). Analysis of postoperative pancreatic fistula, bile leak, chyle leak, enteric leak, length of hospital stay, and readmission was done. Results: Among 20 patients in the database. Patients with POD 1 DFA <5000 U/L, Group A on POD 3 DFA <350 U/L (12 cases) & Group B with DFA >350 U/L (8 cases). Complications like Postoperative pancreatic fistula, bile leak, chyle leak, and length of hospital stay were more in Group B with a p-value <0.05. Conclusion: Patients with POD 1 < DFA 5000 U/L, and POD 3 DFA < 350 U/L had been good predictor’s early drain removal with minimal complications.

Art Therapy is a formof psychotherapy that involves usage of art making as a part of therapeutic process to facilitate expression and insight creation on part of the clients during the session. This formof psychotherapy encourages expression and projection of emotions on part of the client in the most non-intimidating and non-
invasive manner and hence yields to a safe space of interaction and sharing amongst both the therapist as well as the client. To understand the usage of Art Therapy as an Emerging Approach to Improve Mental, Emotional and
Physical Health Concerns, given research study has an objective to reflect upon and understand the potential that art
psychotherapy in positively influencing the management or improvement of mental, physical and emotional health concerns. The study is a non-quantitative systematic review comprising of analysis of fourteenstudies which were screened out of forty selected studies for review purpose. The studies were selected fromthe database available of the past ten years to ensure relevancy in results and conclusions derived. Results showed positive significant relationship existing between Art Therapy and Mental, Physical as well as Emotional health concerns such as improvement in mood, symptoms of depression, anxiety and physical pain, induced more relaxation, enhanced self- efficacy etc. The findings of the study supported that hypotheses and hence could be considered as a resource to further support and encourage introduction and implementation of art therapy in India as a standard approach to psychotherapy. Art Psychotherapy or Art Therapy can be referred to as an emerging psychotherapy holding potential to serve mental emotional and physical health concerns.

INTRODUCTION: When the intrathecal opioid drug was administered with the local anaesthetic in Spinal anaesthesia they develop the superior quality of analgesia. Fentanyl was found to provide safe potentiate of local anaesthetic effects by its increased lipophilic quality and decreased rostral spread. The present study was conducted to compare block characteristics of equal doses of isobaric levobupivacaine 0.5% (10 mg) with normal saline and isobaric levobupivacaine 0.5% (10 mg) plus fentanyl (25 μg), in infraumbilical surgeries under spinal anaesthesia.
MATERIALS AND METHODS: The present prospective observational study was conducted in tertiary health centre from January 2020 to June 2021 amongst 120 patients belong to ASA physical status I and II aged between 20 to 65years who underwent infraumbilical surgeries. Study population were divided into Group L: Group of 60 patients received 2 ml of 0.5% isobaric levobupivacaine (10 mg) plus 0.5 ml normal saline and Group LF: Group of 60 patients received 2 ml of 0.5% isobaric levobupivacaine (10mg) + 0.5 ml fentanyl (25 μg).
RESULTS: The mean time for onset of sensory blockade at T10 dermatome in group L (7.1±1.4 min) was late than in group LF (5±1.6 min). Higher dermatomal level of sensory blockade was achieved by addition of fentanyl. The mean time for maximum sensory blockade was earlier in group LF (8.1±1.7min) than in group L (15.6±2.1min.). Maximum motor blockade was achieved significantly earlier in group LF than group L. The total duration of sensory blockade was significantly prolonged in group LF than in group L.Total duration of analgesia in group L was 199.2 ± 10.7 min and in group LF was 263.2 ± 14.7 min.
CONCLUSION: It was concluded that addition of fentanyl to levobupivacaine leads to early onset of sensory blockade and prolonged duration of sensory blockade, motor blockade, stable hemodynamics and prolonged postoperative analgesia thus decreasing the doses of rescue analgesics.

Background: To ensure long-term implant success, the atrophic maxilla frequently needs bone augmentation before to implant implantation. The application of platelet-rich plasma (PRP) during maxillary augmentation was studied in a prior prospective clinical research. The immediate results revealed no benefit from PRP. The purpose of this study was to assess the long-term effects of PRP on the survival and success of dental implants in the same patient group as the previous study.
Materials and methods: In this investigation, 50 patients from the previous study who had been treated for maxillary atrophy with dental implants and autologous bone grafts from the iliac crest were taken into account. 30 patients had treatment using a split-mouth design, where one randomly selected side received additional PRP treatment while the other served as the control side. 20 patients received one-sided treatment and were randomized to either the PRP or the control group. The patients from the prior study had their implants followed up with on average 5 years later. Two distinct success metrics were used to assess the success of the implants.
Results: In this study, 30 patients (20 women and 10 males) were examined. The PRP group consisted of 15 patients (10 female, 5 male), whereas the control group consisted of 15 patients (10 female, 5 male). There were 240 implants installed altogether. The PRP group received 100 implants while the control group received 100 implants. The survival rate: 95, while in the control group had a survival rate of 98%. The cumulative likelihood of survival after 5 years was 94% in the PRP group and 98% in the control group, with no discernible difference between the two groups. Albrektson criteria were used to calculate the cumulative success probability, and a higher significant difference was obtained for the control group (p = 0.05).
Conclusion: PRP did not have a positive effect on the success and longevity of implants.

Introduction: This study compares two of the widely used procedures for olecranon fracture fixation in attempt to find a conclusive data and form a treatment protocol.
Material and Method: It is a single-blinded, prospective randomized study performed at single centre, aims to compare the outcomes of tension band wiring and plating for the isolated two part olecranon fracture fixation. 40 patients with mean age of 32y ( range 22 to 45) were included in the study and randomized to either TBW (n=20) or plate fixation (n=20) group  and were evaluated at 4 weeks, 12 weeks, 6 months and 12 months, post-operatively.
Results: Patients were assessed using DASH (Disabilities of Arm, Shoulder and Hand) score and Visual Analogue Score (VAS) at final follow-up at one year. DASH scores were comparable among two groups, Range of movement were satisfactory in both groups, four patients in TBW group complained of implant protrusion through skin and irritation during elbow movement, those patients were re-operated for loosening of implant and implant irritation. One patient in Plate group complained of painful range of movement and joint stiffness. Mean Union time was comparable in both groups. (6-8 weeks). Overall complication rates were higher in TBW group.
Conclusion:  Although fracture union time and range of movement was almost similar in both groups, TBW group patients reported complications more often, mostly because of implant irritation and impingement.

Most clavicle fractures are treated conservatively. Treatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures.
Methods: Patients who presented with a displaced fracture of the medial clavicle between March 2021 and December 2022 were prospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle. Functional outcome was recorded using the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant–Murley score; visual analog scale (VAS) score; and complications.
Results: The patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1±2.0 months, each fracture had solid bone union. The mean shoulder forward fexion was 159.3°±7.9°, and the mean DASH score was 8.8±5.1. The mean Constant–Murley score was 88.9±7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0±1.5, and the mean patient satisfaction score was 9.3±0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfed with their treatment.
Conclusion: Surgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results

Aim: We investigated whether FAR had a potential value in evaluating the prognosis of patients with non-metastatic kidney cancer or not.
Methods: The present study was conducted in the department of Urology, Rajendra Institute of medical sciences (RIMS), Ranchi, Jharkhand, India and 50 patients with renal cancer who underwent radical nephrectomy were included in the study.
Results: Of the 50 patients included in the study, 36 (72%) were male and 14 (28%) were female. Of the 50 individuals in our control group, 44 (88%) were male and 6 (12%) were female. The mean age in the patient group was 58.86 (min 34-max 82) and the mean age in the control group was 59.05 (min 32-max 81). There were 43 (86%) patients with grade 1–2 and 7 (14%) patients with grade 3–4 according to Furhman Grade (FG). The distribution by tumor size was similar to the distribution set by FG. According to TNM staging, the number of patients with T1-2 was 43 (86%) and the number of patients with T3-4 was 7 (14%). Median score (min–max) NLR, PLR, HRR, LMR, SLL and FAR in all patient groups were 6.10 (1.17–25.37), 165.0650 (41.30–708.33), 0.9450 (0.44–1.38), 2.4100(0.42–32.87), 1,271,030(102,030–7,203,240) and 0.08000(0.007/0.286) respectively. In the control group, the Median score (min–max) of NLR, PLR, HRR, LMR, SLL and FAR were 1.4500 (0.34–4.69), 93.6250 (67.00–270.23), 1.0250 (0.57–1.35), 2.3000 (1.00–8.09), 505,975.00 (234,546– 1,428,000) and 0.05450 (0.010– 0.117) respectively.
Conclusion: Recently, the prognostic significance of FAR in various cancers has been investigated. In non-metastatic RCC patients, there is a need for indices which have prognostic importance to determine a cut-off during follow-up; to better categorize patients according to grade and tumor size; to reach early treatment and not to impair patients’ quality of life.

Background and Objectives: Hyperlipidaemia refers to elevated levels of lipids in the blood. Lipids such as cholesterol and triglycerides are insoluble in plasma. Circulating lipid is carried in lipoproteins that transport the lipid to various tissues for energy use, lipid deposition, steroid hormone production, and bile acid formation. To compare the efficacy of Atorvastatin alone with Atorvastatin plus Omega- 3 fatty acids combination in management of hyperlipidaemia. Methods: The study was a comparative, prospective, randomized and open label study. Patients with history of recent MI or post MI, attending the out patients / in patients, Department of General Medicine, DMCH, Darbhanga. Study duration of Two years. Conclusion: The efficacy of combination therapy i.e., Atorvastatin plus Omega-3 fatty acids showed statistically significant rise in HDL cholesterol with mean percentage difference of 3.7% when compared to monotherapy with Atorvastatin.

Background andObjectives: - This study was conducted to determine the relationship of LF thickness with spinal canal diameter with LF thickening identification at a specific lumbar level. The relationship of lumbar spinal LF thickening with age and sex using magnetic resonance imaging (MRI) was also assessed. 
Materials and Methods:-This was a prospective study done on 60 cases at  IGIMS, Patna. Patients were referred from different department specially neuromedicine and neurosurgery department. Measurements of spinal canal diameter and LF thickness were taken from T1- and T2-weighted axial MRI scans using optima MR360/ 1.5T MRI.
Results: A total of 300 spinal canal diameters, along with 300 intervertebral disc heights and 600 ligamentum flavum thicknesses with mean value of bilateral LF thickness were assessed from MRI scans. The most common involved level with maximum stenosis was L4-5 (53.33 %) which needed surgery with more non-DSS involvement. Maximum thickness of LF with mean value of 9.4 mm was noted at L4-5 level (53.33 %) which was associated with maximum spinal canal stenosis.
Conclusion: This study shows significant difference in the relationships of spinal canal diameter, LF hypertrophy in DSS and non-DSS group.  Thickness of the ligamentum flavum increased with age and this increase is most pronounced at the lower lumbar levels which lead to lumbar spinal stenosis of variable degrees, specifically in Non-DSS group.

Background and Objectives: The purpose of this study is to evaluate the role of MRI as an investigative modality in white matter diseases and to document clinic-radiological value in early diagnosis and management. This was done by studying the MR findings of different white matter diseases at our hospital with clinical presentation correlation along with most prevalent diseases and their location identification.
Materials and Methods: Forty patients with a strong clinical suspicion of demyelinating disorder were evaluated by MRI using 1.5 Tesla (GE Optima MR360) scanners in a prospective study period of 1 year after ethical approval at GIMS, Patna, Dept. of Radiology. Patients were referred from neuromedicine department.
Results: PRES (MS) was the most common white matter disease encountered in our one year study after ethical approval. Out of 40 cases, 16(40%) cases presented with altered sensorium, seizure and visual disturbances among which most of cases were of nephrotic syndrome and few hypertensive post delivery female patients. Among 16 cases of PRES,all 16(100%) cases showed posterior parieto-occipital periventricular and deep white matter involvement on MRI as T2/FLAIR axial images hyperintensity and T1 hypointensity.
Conclusion: MRI is the modality of choice for early lesion detection, disease progression and in follow up cases in both subclinical and clinical settings due to its multiplanar images and better resolution. Therefore, early management  for  better patient cure is possible.

Background and objective: The intensive care unit (ICU) often called as the epicentre of infections, due to its vulnerable population. It has been reported that the incidence of nosocomial infections in the intensive care unit (ICU) is about 2 to 5 times higher than in the general inpatient hospital population. The present study aims to know the causative organisms and antibiotic susceptibility of infections in intensive care units.
Methods: It is a prospective study with 300 patients with suspected infections included were included. Samples were processed as per standard guidelines and the colonies were identified according to standard biochemical tests. Antibiotic susceptibility testing was done on DMC Darbhanga, disc diffusion test. ESBL production was tested by disc diffusion method as in CLSI phenotypic method.
Conclusion: There is increase in number of infections in ICUs due to multidrug resistance organism ,which is the big public health threat and challenge for both prevention and treatment of infections. Thus the incidence rates, the causative agents and their susceptibility play a vital role in the management of infections in ICU.

Aim: The aim of the present study was to determine the HSG findings of genital TB in infertile women.
Methods: The present study was conducted in the Department of obstetrics and Gynecology, Advanced Maternity Fertility Centre Janm IVF, Bhagalpur, Bihar, India of 100 women who had a proven genital TB.
Results: The mean age was 26.6 ± 4.4 years, mean body mass index was 24.8 kg/m2, and mean duration of infertility was 6.08 years. Primary infertility was seen in 33 (66%) women, while secondary infertility was seen in 17 (34%) women. Normal cycles were seen in 50 women, menorrhagia in 10, hypomenorrhea in 30, oligomenorrhea in 5, primary amenorrhea in 3 and secondary amenorrhea in 2 women. There was no difference in the serum FSH concentration levels. However AMH and AFC were significantly lower.
Conclusion: Both laparoscopy and molecular tests are complementary tests and together can effectively confirm the diagnosis of Genital TB. Very often, it is the HSG finding that alerts the clinician as to the presence of GTB. Though imaging findings may be highly suggestive of TB, some of the features such as tubal block and hydrosalpinx are not specific for TB and may be seen in other infective causes of tubal damage also.

Aim: To assess the safety and feasibility of transrectal ultrasound (TRUS) guided free‑hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer.
Methods: The present study was conducted in the Department of urology, Rajendra Institute of medical sciences (RIMS), Ranchi, Jharkhand, India for a period of 18 months. Total 40 patients were included in the study. Institutional Ethics Committee approval was obtained before initiation of this study. Informed consent and patient information sheet were explained in detail to the study subjects prior to their enrolment.
Results: Out of 30 cases of malignancy, 28 (93.33%) cases showed clinically significant cancer (International Society of Urological Pathology class ≥2), and remaining 2 cases were clinically insignificant cancer (ISUP class <2). Over 91% of patients with PIRADS score 4 or 5 and 66.7% of patients with PIRADS score 3 showed malignancy. The odds of having malignancy in PIRADS 4 or 5 lesions was five times more than in PIRADS 3 lesions (OR 5.5, P = 0.033, 95% confidence interval 1.02–29.6). Around 84% of patients had abnormal DRE and all of them had malignancy. Of all patients, only 5 developed complications after procedure (four had hematuria, one had acute urinary retention and none presented with either hematospermia or hematochezia).
Conclusion: Freehand TRUS‑guided transperineal prostate biopsy vvith coaxial needle technique under LA is a safe procedure with good tolerability, good CDR, and five complications, especialy no sepsis. In our population group, this approach is cheaper vvith less hospital stay and good patient tolerance .

Background & Objective: Mechanical ventilation is the standard treatment for hyaline membrane disease (HMD) and has increased neonatal surval. However this increased survive has come at the expense of incrected morbindity in the form of chronic lug disease, langer duration of hospitals stay and at the cost of expensive technology. Alternate form of respiratory support is early nasal CPAP. Hence present study aims at managing increasing number of preterm babies with HMD with a non-invasive approach in the form of early nasal CPAP.
Methods: 50 babies of 28-34 weeks gestational age admitted in neonatal ICU of pediatrics Department at Patna Medical collage & hospital, Patna with clinical diagnosis of HMD, requiring respiratory support were  treated with early nasal CPAP and studied prospectively from 01.12.2019 to 30.11.2020.
Statistical analysis: Chi-square and other appropriate tests.
Results: We found a success rate of 80% in babies with HMD, who were managed with early nasal CPAP alone. Remaining 20% needed intubation and higher mode of ventilation. Mild and moderate grade HMD were effectively managed with early nasal CPAP (P<0.05). It was also found to be effective in babies of mothers who have received antenatal steroids (P<0.05).
Conclusion: Prematurity is the commonest predisposing cause for HMD. Early nasal CPAP is safe, inexpensive and effective means of respiratory support in HMD. it is useful in mild and moderate grade disease. It may not be a replacement for assisted ventilation in severe disease. It is also found to be effective in abies of mothers who have received antenatal steroids.

Aim: The objective of the present study was to assess the effect of moderate intensity exercises on P-300 component of event related potential during different menstrual phases in young obese and non-obese women of Bihar.
Methods: It was a cross-sectional observational study conducted at Patna Medical College, Patna, Bihar, India, on young normally menstruating women with normal auditory capability of age group 18–35 years, BMI (Normal =18-24.9 kg/m² and Obese>25 kg/m²)according to the WHO criteria and without any major chronic illness and neurocognitive deficit. The ethical approval for this study was obtained from Institutional Ethical Committee.
Results: It is evident from the study that the participants were mostly in the age group of 19–21 years. BMI of the normal subjects was mostly in between 19.4 and 22.13. BMI of the obese subjects was mostly in between 25.4 and 30.13. Waist–hip ratio (WHR) of the subjects was mostly little above normal range (normal being <0.8). Observation showed that most of the subjects perceived physical activity as light to extremely light except for a few subjects. The amplitude and latencies of P300 ERP in obese and non-obese showed no significant difference at resting state (pre-exercise) during early follicular and mid-luteal phases. The amplitude of P300 ERP displayed no significant change in post-exercise session in comparison to pre-exercise session in both phases among obese and non-obese subjects. However, P300 latency showed significant decrease in post-exercise session when recorded at Cz (P = 0.024, P = 0.05) as well as Pz position (P = 0.03, P = 0.003) in both phases of menstrual cycle among both groups. However, P300 latency recorded at Fz position displayed no significant change in post-exercise session in comparison to pre-exercise session in nonobese and obese persons during both phases of menstrual cycle.

Introduction: The aim of the study is to compare the outcomes of arthroplasty performed through medial parapatellar approach versus subvastus with oblique cut approach.
Materials and Methodology: After obtaining the permission from the institutional ethical committee, the study was carried out in those patients with osteoarthritis. This study was conducted as a prospective comparative study in assessing the factors influencing the total knee replacement surgeries through medial parapatellar and subvastus oblique approach. A total of 150 patients were included in the study and the proposed study period was about 12 months.
Results: A total of 150 patients were included in the study who are all underwent total knee replacement in our study centre and 109 patients were included in group – I that is MP approach (24 males and 85 females) group – II included 41 patients (7 males and 34 females) with the mean age observed at 71.6 ± 6.3 years and 73.3 ± 5.1 years. The pre-operative levels of haemoglobin level was observed to be potent significant risk factor as observed in this study which indicated that for every 1 unit rise in Hb, the probability of deferring the transfusion increases by 2.6 times. This result was in concordance with the results obtained from the earlier studies.
Conclusion: when comparing the subvastus approach with the medial parapatellar surgical approach in managing the total knee arthroplasty patients, early active straight leg raising for up to over 10 days after the surgical procedure had been reported.

Spontaneous rupture of gangrenous uterus with generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract which makes preoperative diagnosis difficult. A correct and definite diagnosis can be made with laparotomy or laparoscopy.  We report a case of a 55-year-old lady who presented with generalized peritonitis with pneumoperitoneum. This report aims to alert surgeons to the possibility that perforation of uterus due to gangrene with anaerobic infection also shows air under diaphragm apart from hollow viscus perforation

Pregnancy complications, including anaemia, eclampsia and other hypertensive disorders, antepartum and intrapartum haemorrhage, abnormal fetal position, breech presentation and obstructed labour significantly increase the odds of stillbirth. Present study was aimed to study prevalence & causes of stillbirths at a tertiary hospital. Material and Methods: Present study was retrospective, case record-based study, conducted in cases of intrauterine death which were diagnosed during the antenatal period as well as intrapartum deaths. Results: During study period, among total 4279 birth, 98 stillbirths were observed, prevalence of stillbirth was 22.9 per 1000 total births. In majority of cases, 21-30 years age group (91.08 %), gravida ≤ 2 (71.43 %) & preterm (80.61 %). Majority required induction of labour (67.35 %), delivered vaginally (88.78 %). Majority of stillbirth neonates were male (56.57 %), had birth weight less than 2.5 kg (81.82 %). Common risk factors noted were hemoglobin less than 9 gm % (50 %), hypertensive disorders of pregnancy (41.84 %) (pre- eclampsia - 31.63 %, gestational HTN 7.14 % & eclampsia 3.06 %), hypothyroidism (15.31 %), antepartum hemorrhage (11.22 %), history of infertility (10.2 %), history of febrile illness in last 7 days (5.1 %), overt diabetes mellites (4.08 %), GDM (3.06 %), jaundice (3.06 %), Rh incompatibility (1.02 %) & multiple pregnancy (1.02 %). Common noticeable causes of stillbirth were hypertensive disorders of pregnancy (23.47 %), antepartum hemorrhage (11.22 %), multifactorial genetic cause (11.22 %), overt diabetes mellites (3.06 %), infections (3.06 %), GDM (2.04 %) & jaundice (2.04 %). Among majority of cases, causes of stillbirth were unknown (43.88 %). Conclusion: Common causes of stillbirth were hypertensive disorders of pregnancy, antepartum hemorrhage, multifactorial genetic cause, overt diabetes mellites & infections

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, the pathogenesis of which remains elusive. Recently, many studies have indicated that the prevalence of thyroid dysfunction is higher in SLE patients than in the general population. Present study was aimed to study prevalence of thyroid dysfunction in patients with systemic lupus erythematosus. Material and Methods: Present study was descriptive, cross‑sectional observational study, conducted in patients attending OPD / IPD, diagnosed cases of SLE by Systemic Lupus International Collaborating Clinics 2012 lupus classification criteria. Results: In present study, 63 SLE patients were studied. Among 63 patients, only 3 were male (4.76 %), rest were female (95.24 %) & mean age was 34.56 ± 11.95 years. Prevalence of autoantibodies was noted as ANA (77.78 %), dsDNA (57.14 %), %), Anti-TPO (34.92 %) & Anti-Tg (30.16 %), In present study, normal TSH levels was 0.35-5.5 µIU/ml, normal fT3 levels was 2.1-4.4 pg/ml & normal fT4 levels was 0.7-1.8 ng/dl. In present study, abnormal TSH levels noted in 16 cases (high – 22.22 % & low- 3.17 %), abnormal fT3 levels noted in 14 cases (low – 20.63 % & high- 1.59 %) & abnormal fT4 levels noted in 18 cases (high – 1.59 % & low- 26.98 %). Thyroid dysfunction was noted in 27 cases (42.86 %), majority had subclinical hypothyroidism (17.46 %), clinical hypothyroidism (11.11 %) & subclinical hyperthyroidism (1.59 %), while anti‑TPO alone elevated noted in 8 cases (12.7 %). Conclusion: There is a greater possibility of missing the diagnosis of thyroid dysfunctions in SLE patients, as both the diseases have similar clinical manifestations. We noted higher incidence of thyroid dysfunctions in SLE patients

Pregnancy complications, including anaemia, eclampsia and other hypertensive disorders, antepartum and intrapartum haemorrhage, abnormal fetal position, breech presentation and obstructed labour significantly increase the odds of stillbirth. Present study was aimed to study prevalence & causes of stillbirths at a tertiary hospital. Material and Methods: Present study was retrospective, case record-based study, conducted in cases of intrauterine death which were diagnosed during the antenatal period as well as intrapartum deaths. Results: During study period, among total 4279 birth, 98 stillbirths were observed, prevalence of stillbirth was 22.9 per 1000 total births. In majority of cases, 21-30 years age group (91.08 %), gravida ≤ 2 (71.43 %) & preterm (80.61 %). Majority required induction of labour (67.35 %), delivered vaginally (88.78 %). Majority of stillbirth neonates were male (56.57 %), had birth weight less than 2.5 kg (81.82 %). Common risk factors noted were hemoglobin less than 9 gm % (50 %), hypertensive disorders of pregnancy (41.84 %) (pre- eclampsia - 31.63 %, gestational HTN 7.14 % & eclampsia 3.06 %), hypothyroidism (15.31 %), antepartum hemorrhage (11.22 %), history of infertility (10.2 %), history of febrile illness in last 7 days (5.1 %), overt diabetes mellites (4.08 %), GDM (3.06 %), jaundice (3.06 %), Rh incompatibility (1.02 %) & multiple pregnancy (1.02 %). Common noticeable causes of stillbirth were hypertensive disorders of pregnancy (23.47 %), antepartum hemorrhage (11.22 %), multifactorial genetic cause (11.22 %), overt diabetes mellites (3.06 %), infections (3.06 %), GDM (2.04 %) & jaundice (2.04 %). Among majority of cases, causes of stillbirth were unknown (43.88 %). Conclusion: Common causes of stillbirth were hypertensive disorders of pregnancy, antepartum hemorrhage, multifactorial genetic cause, overt diabetes mellites & infections.

The impact of oral diseases on the quality of life is well documented in literature. Oral Health Related Quality of Life (OHRQoL) is a multidimensional idea which can be defined as a person’s assessment of how oral health affects quality of life related to oral functioning, psychological well-being, social well-being as well as pain / discomfort. Auto-rickshaw drivers are a ubiquitous and unique community of people with long and often irregular work hours. Even though there are lot of studies evaluating the oral health status, oral hygiene practices, oral habits etc of auto-rickshaw drivers in India, studies on OHRQoL are rare
Objectives
To evaluate the Oral Health Quality of Life of auto-rickshaw drivers in Kanchipuram, India and thereby assess the treatment needs and form a baseline value for further evaluations.
Materials and Methods
Descriptive cross sectional study was done using the short form of Oral Health Impact Profile (OHIP-14). The Oral Health Impact Profile (OHIP-14) questionnaire comprising of 14 closed ended questions and the 3 basic demographic data were administered to the auto-rickshaw drivers
Results
The mean age of the participants was 40.86 years. The mean OHIP-14 score in this study was 18.5 out of a maximum possible score of 56. OHIP-14 score increases with age.
Conclusion
Within the limitations of the study, it can be concluded that the auto rickshaw drivers have oral health issues that increase with age affecting their quality of life that need comprehensive oral and general examination to assess the full extent of the oral health status and treatment needs

Tumors of the abdominal wall are divided into benign and malignant lesions which are composed of primary tumors and by the parietal invasion of intraabdominal tumors and metastatic parietal implants. Metastatic tumor of abdominal wall has an incidence of approximately 0.7–9%. Most common causes are secondary to neoplasms of colonic or gastric origin and implants of trocar holes, metastasis of lung origin is very rare. This case is presented to highlight the rare presentation of bronchogenic carcinoma as a metastatic abdominal wall tumor.

The aim of the study was to understand the factors causing meconium aspiration syndrome (MAS) in relation to gestational age and birth weight and their immediate outcome.
Methods: This study was carried out in Neonatal Intensive Care Unit of Surabhi institute of medical sciences Siddipet, Telangana. The study included the clinical profile of consecutive 50 cases of meconium aspiration syndrome admitted to the above center during the period of July 2021 to January 2023.
Results: The mean birth weight of babies with MAS was 2.68 kg (1.7- 4 kgs). In these study, maximum number of cases of MAS were seen in babies with birth weight between 2- 2.4kgs (n=19, 38%), followed by babies with birth weight between 2.5-2.9 kg (n=16, 32%). Babies with birth weight between 3-3.4 formed 22% (n=11) of cases. MAS were also seen in preterm babies. 4 (8%) cases were of 34-36 weeks of gestation and 4 cases (8%) belonged to 36-38 weeks of gestation. None of the cases were below 34 weeks of gestation. In this study of babies with MAS, the most common complication was birth asphyxia in (38%, n=19) of cases, followed by ARF in (n=10, 20%) cases. Septicemia was seen in 18% (n=9) cases, pneumothorax in 8% (n=4), pulmonary hemorrhage in 4% (n=2) and pneumonia in 4%. (n=2) of cases.
Conclusion: MAS is an entity which is commonly seen in term and post term babies with birth weight >2.5 kg. There is a significant correlation between the birth weight and outcome in MAS. When thick meconium stained liquor is noted prior to birth, anticipation is necessary and non vigorous babies need aggressive management and possibly early ventilation. Asphyxiated babies should be followed up astutely. Continuous monitoring and early intervention, followed by due resuscitation as per guidelines can reduce the morbidity, complications and the mortality in MAS

Background: To assess the incidence of QT prolongation among patients with cirrhosis of the liver.
Materials & methods: A total of 100 patients with cirrhosis of the liver were enrolled. Complete demographic details of all the patients were obtained. Blood samples were obtained, and the serum renal profile was evaluated. The categorization of patients with the cirrhosis of liver was done according to the Child-Pugh score (CPS) into Grade A, Grade B and Grade C. ECHO and ECG were done on all the patients. Relevant findings were recorded. Incidence of QT prolongation was recorded and correlated with the severity of the cirrhosis of the liver.
Results: The mean age of the patients was 45.3 years. QT prolongation was seen in 43 percent of the patients. Significant findings were obtained when examining the relationship between QT prolongation and the severity grading of liver cirrhosis.
Conclusion: The cardiac profile significantly deteriorates in patients with cirrhosis of the liver.

Introduction:  Cerebrovascular accident (CVA) or stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Cerebrovascular accidents (CVA) can be classified into two major categories: about 87% of strokes are ischemic, the rest being haemorrhagic.Studies have demonstrated the fact that primary neurologic abnormalities may produce ECG changes without any myocardial lesion.
Aim: To study the various types of ECG changes in patients of cerebrovascular accidents. To compare the ECG changes in patients of haemorrhagic and ischemic cerebrovascular accidents.
Material and methods: This present study was carried out in 50 cases diagnosed as CVA admitted in the Department of Medicine in a tertiary care hospital of Punjab(North India) after obtaining their informed consent.All patients with CVA of less than 10 days duration admitted in the Department of Medicine were included in this study. A detailed history was taken and patients were selected as per inclusion and exclusion criteria. Along with other investigations 12 lead ECG tracing on admission and after 72 hours of stroke onset was performed. The ECGs were analysed for the occurrence of arrhythmias, ST-T segment changes, changes in various intervals and ectopic beats.
Results: In our study population of 50 patients, 38 (76%) patients were having ischemic stroke and 12 (24%) patients were having haemorrhagic stroke. In our study, prolonged QTc was the most common ECG abnormality.In our study, ST segment changes were most commonly noted in ischemic stroke.12% of patients with ischemic stroke had ST depression and 2% had ST elevation. In our study, sinus tachycardia was the most common rhythm change observed in both ischemic CVA(26%) and haemorrhagic CVA(36%) followed by sinus bradycardia.
Conclusion: This study showed male predominance in stroke cases. Cerebral infarction was more than haemorrhage.ECG changes were more commonly associated with ischemic stroke as compared to haemorrhagic stroke.Cardiac disturbances are diverse and frequent in the setting of acute neurological injury.Understanding of these ECG changes occurring in patients with CVA is important because it may lead to erroneous judgment of assigning these patients as CAD.These patient should be evaluated for cardiac injury and treated only if necessary.

Background: Cholelithiasis remains a common cause of surgical intervention, contributing substantially to health care costs. The present study was conducted to assess clinical presentation and management and outcomes of the cholelithiasis.
Materials & Methods: 84 adult patients of cholelithiasis of both genders were included. Parameters such as nature of the symptoms, hemogram, electrocardiogram, liver function test, blood sugar, blood urea, serum creatinine, urine analysis, blood group, chest X-ray, and ultrasound scan of the abdomen. All patients underwent open cholecystectomy
Results: Out of 84 patients, males were 32 and females were 52. Common clinical features were pain abdomen seen in 84, dyspepsia was present in 56 patients and nausea in 32. The difference was significant (P< 0.05). Number of stones was single in 14, double in 26 and multiple in 44. Type was cholesterol in 28, pigmented in 24 and mixed in 32. Shape was round in 24, irregular in 34 and facet shaped in 26. The difference was significant (P< 0.05).
Conclusion: Most common shape of stones was irregular and type was mixed. Common clinical features were pain abdomen, dyspepsia and nausea.

Background: Autopsy (necropsy, post mortem examination, thanatopsy) is the meticulous and thorough examination of a person’s body after death. An autopsy can be of different types. To the forensic pathologist, Medicolegal autopsy is the most important concern. Study of weight of human body organs plays a significant role in almost all the branches of medical sciences as any deviation in weight from the normal range may suggest some pathological change in the organ. Recording of organ weights is one of regular criteria by the forensic experts during an autopsy. The findings were compared to what is standard or average of a specific organ for a specific age range and particular sex. The determination of weights of brain in particular has significant clinical value.
Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 570 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria.
Results: Total 570 cases had been selected after following the inclusion and exclusion criteria out of which 362 were males and 208 were females. Among the studied 570 cases, 362 (63.5 %) were male and rest (36.5 %) were female. In this study the discussion was mainly on relation of age, sex, body weight, and body length upon the weight of brain.

Conclusion: A database may be deduced from this study regarding normal range of the weight of various organs and their relation with external parameters of the subjects which can be applicable on the population of this region for future reference. In severely mutilated bodies found in mass disasters or in homicidal killing, weights of isolated organs may give an idea about the stature, built and age of the victims helping in identification

Many of the factors that contribute to health risks among adolescents are preventable if identified and changed as early as possible. Early intervention can alter patterns of behaviors that would have placed young people at risk in later life. Preventing risky behavior and promoting healthy choices among adolescents can yield positive health outcomes not just during adolescence but also during adulthood.
Objectives: To assess the awareness of Non-communicable diseases and their risk factors among school going adolescents of Jamnagar city.
Methodology: A school based cross sectional study was conducted among 960 school going adolescents from the private and government schools of Jamnagar city. Socio-demographic data was collected and awareness of risk factors of non-communicable diseases was assessed with the help of a predesigned, pre-tested, self-administered questionnaire.
Results: In the study 59.6% adolescents were boys and 53.3% were studying in private schools. More than 80% knew the types, symptoms and presentation of Cancer and Diabetes while 75.5% and 74.3% respectively knew about heart disease and hypertension. For heart diseases main risk factors reported were fatty diet (35.7%), lack of physical activity and excessive anxiety (31.4%), fast food consumption (30.9%) and alcohol consumption (29.9%). For diabetes fatty diet (34.8%), soft drinks (32.2%) and fast food (27.4%) were the main risk factors. Tobacco chewing (87.4%), alcohol consumption (73.3%) and smoking (73.0%) were the risk factors for various type of cancer. Excessive salt intake (57.2%), excessive anxiety and stress (53.7%) and lack of physical activity (29.8%) were the risk factors for hypertension. Only 20.1% had reasonable knowledge about types, symptoms and nature of non-communicable diseases.

Scaphoid fractures are among the most common injuries which are usually resulting from RTA, Accidental fall, Sports injury. The greatest problems for the
orthopaedic surgeon to treating the unstable scaphoid fracture and the complications (persistent pain at wrist, non-union, hypertrophic scar) occur from Herbert screw
fixation that results in wrist strength. 
Material And Methods: 25patients were included in our study from OCTOBER 2021 to APRIL 2022, with subsequent period of follow up of 6 months (OCTOBER 2022). 25 patients with scaphoid fracture treated by operative fixation by Herbert screw.
Results: Regarding functional results, 24 cases (96%) had no difficulty doing day to day activity, in last follow up according to Modified Mayo Wrist Score. Regarding post-operative complications, Scar tenderness (2 cases, 8%) was seen and treated with local infiltration of corticosteroids. One patient had developed cast failure and one patient had developed persistent pain.
Conclusion: We have concluded that fractures of scaphoid when fixed with headless compression screw shows excellent functional outcome.  

To investigate the effect of therapeutic suggestions played to patients through earphones during surgery on postoperative pain and opioid use.
Design
Blinded randomised controlled study.
Setting
Tertiary care medical college hospital.
Participants
385 of 400 patients consecutively recruited from January to December 2022 who were to undergo surgery for 1-3 hours under general anaesthesia. In the per protocol analysis 191 patients were included in the intervention group and 194 patients in the control group.
Intervention
The intervention comprised an audiotape of background music and positive suggestions based on hypnotherapeutic principles, which was played repeatedly for 20 minutes followed by 10 minutes of silence to patients through earphones during general anaesthesia. Patients in the control group were assigned to a blank tape.
Main outcome measures
The main outcome was dose of opioid administered by patient controlled analgesia or nurse controlled analgesia within the first postoperative 24 hours, based on regular evaluation of pain intensity on a numerical rating scale (range 0-10, with higher scores representing more severe pain).

The objectives of this study was to assess the instrument design in comparison to the implant design, compare the initial implant stability obtained using four different osteotomy techniques in low-density synthetic bone, and determine a potential correlation between the insertion torque and initial stability quotient (ISQ).

To compare  the efficacy of derma roller versus TCA CROSS  technique for the treatment of acne scars in tertiary care hospital.
Methods – This was a hospital – based, non interventional, cross- sectional study carried out over a period of 3 months on 60 patients with post acne scarring. Group 1 patients underwent four sessions of dermaroller therapy four weeks apart. Group 2 were treated with four sessions of TCA CROSS technique four week apart.
Results –  Out of 60 patients in the study, 32 were male and 25 were females. Male patients had more severe acne vulgaris as compared to female (p=0.0001). Morphologically, majority of post acne scars were rolling in both the groups 75.86% in dermaroller group and 67.85% in TCA CROSS group. After four sessions of Dermaroller and TCA CROSS each, very good improvement was seen in 41.32 % patients in the dermaroller group and in 14.28% patients in tca group. Good improvement was seen in 51.72% in dermaroller group and 67.85% in tca group and no improvement was seen in 6.89 % in dermaroller group and 17.85 % in tca group. Side effects were mild and infrequent in both groups.
Conclusion – Both treatments are equally effective and safe for the treatment of acne scars.

With the emergence of second wave of Covid 19, the number of COVID positive cases started to rise drastically. Government imposed the second lockdown from 11th May, 2021 in Tamil Nadu & Pondicherry. In an attempt to control the spread of infection, there was restricted movement throughout the country and most of the businesses were shut down. Only the essential services staffs were allowed to leave home and the rest were allowed only to access health care or buy essential items. Alcohol and tobacco products were not in the list of essentials during the lockdown. This meant non-availability of these substances through authorized vendors. An unintended consequence of this dry period could be an increase in the incidence of severe alcohol withdrawal syndrome.

Introduction: Due to the destructive nature of pancreatic enzymes, a pseudocyst can extend into abdomen, mediastinum more commonly and intrahepatic parts, intercostal space, lumbar region rarely. In literature, only 5-6 case reports of this rare presentation, Pancreatic psudocysts presenting as lumbar mass have been reported.
Case: A forty-five years old gentleman, known chronic alcoholic, presented with a painful swelling over left flank region for 8 days.  On examination, A cystic swelling of approximately size 10x8 cm was present over left lumbar region, having no local rise of temperature, cystic in consistency, fluctuant and non-tender. USG (A+P) was suggestive of cystic swelling with purulent collection differential diagnosis being? Infected pancreatic pseudocyst or? infected urinoma. CECT A +P was s/o subacute focal pancreatitis involving tail region with infected multiloculated pseudocyst involving left anterior pararenal, posterior pararenal, perinephric spaces, posterior paraspinal muscles and left kidney. This case was managed by external drainage using USG guided percutaneous Pigtail catheter insertion
Discussion: Pancreatic pseudocyst must be differentiated from other cystic retroperitoneal swellings. Ultrasound (USG) is initial diagnostic tool with sensitivity rates for USG in the detection of pancreatic pseudocysts are from 75% to 90%. But, Computerized tomography (CT) is often the imaging method of choice, with 82% to 100% sensitivity and 98% specificity.
Conclusion: A differential diagnosis of pancreatic pseudocyst should be considered especially in known chronic alcoholic patients and known patients with previous history of pancreatitis. Percutaneous drainage procedures with pigtail catheter insertion, less invasive than internal drainage with laparotomy or other interventional procedures, hence reduces morbidity due to easy accessibility.

Background: Magnesium deficiency at cellular level alters the membrane-bound Na+ K+ AT Pase activity, which is essential for maintenance of sodium and potassium gradients in the transport of glucose. Hypomagnesemia has been linked with defective activity of tyrosine kinase which leads to impaired sensitivity of insulin receptors and exacerbates the insulin resistance among type 2 diabetics. This study was conducted to study serum magnesium levels and HbA1C levels in Type 2 DM patients and to study correlation between serum magnesium levels and HbA1C levels in Type 2 DM patients.
Methodology: This study was conducted as cross sectional study on diabetic patient reporting to medicine department during the study period of 18 months. Detailed history was obtained and clinical examination was done. CBC, FBS, PPBS and serum magnesium assessment was done in each patient.
Results: The present study was conducted on a total of 125 cases of type 2 diabetes mellitus with mean age of 57.82±10.14 years. Mean HbA1c in diabetic patients was 8.2±1.5% and majority of cases had serum magnesium levels above 1.6 mg/dl. Hypomagnesemia was significantly associated with increase fasting as well as post prandial blood glucose level (p<0.05). We observed a statistically significant very strong negative correlation of serum magnesium levels with serum HbA1c (r=-0.808, p<0.05) i.e. as the HbA1c increased, serum magnesium levels decreased significantly (p<0.05).
Conclusions: Hypomagnesemia is one of the common findings in patients with type 2 diabetes mellitus. Poor glycemic control as evidenced from increased FBS, PPBS and HbA1c have been associated with lower serum magnesium levels. As hypomagnesemia is linked with poor glycemic status, it may predict the complications among diabetic patients. It is recommended that serum magnesium levels must be monitored routinely in patients with diabetes as magnesium supplement may help in providing better glycemic control and preventing or delaying the progression of complications

Background: There are various methods to diagnose different kinds of anaemia, but in developing countries many of the available investigation are also not feasible citing financial constraints. The present study was therefore conducted at tertiary care centre to assess RDW in different types of anemia; to investigate patients for peripheral smear picture, Iron Deficiency, Vitamin B12 Deficiency & Hemoglobinopathies wherever necessary; to determine efficacy of RDW in differentiating between Types of Anemia.
Methodology: The study was conducted as cross sectional study at Department of Medicine, PCMS and RC Bhopal during the study period of 18 months. A detailed history was obtained and examination was done. The study participates were then subjected to complete blood examination using hematology auto analyzer and RDW CV and RDW SD were recorded.
Results: This study included a total of 115 cases with anemia with mean age of 38.3±17.7 years. Mean RDW CV was lowest in hemolytic anemia, followed by anemia of chronic blood loss, dimorphic anemia and was highest in iron deficiency anemia (p<0.05). RDW SD was lowest in megaloblastic anemia, followed by anemia of chronic blood loss and hemolytic anemia (p<0.05). RDW CV as well as SD levels were significantly higher in severe anemia (p<0.05).
Conclusions: RDW is a simple and easily available screening tool helpful in screening of anemia as well as determining its severity. Red cell distribution width is increased in iron deficiency anemia and can be used routinely to differentiate iron deficiency anemia from other types of anemias with high accuracy. It can also be used in screening severe anemia irrespective of the type of anemia. RDW can be a cost effective tool for diagnosis of iron deficiency anemia as well as determining the severity of anemia

Background: Numerous pharmacological agents effectively lower the systemic blood pressure for hypotensive anaesthesia techniques. The present study was conducted to assess dexmedetomidine infusion during middle ear surgery under general anaesthesia.
Materials & Methods: 50 adults scheduled for elective middle ear surgery of both genders were divided into two groups of 25 each. Group I received infusion of dexmedetomidine 0.5 μg/kg/h and group II received placebo infusion of normal saline during middle ear surgery. Intra-operatively, the heart rate, arterial blood pressure, ECG, EtCO2 and peripheral pulse oximetry (SpO2) were monitored and recorded at 5 min intervals till end of surgery. The mean surgery time and isoflurane requirement was recorded.
Results: Group I had 12 males and 13 females and group II had 11 males and 14 females.ASA grade I was seen in 20 in group I and 19 in group II and II in 5 in group I and 6 in group II. The mean heart rate at baseline was 94.5 in group I and 92.1 in group II, after induction was 74.2 in group I and 70.6 in group II, after intubation was 76.4 in group I and 75.2 in group II and after extubation was 82.6 in group I and 96.4 in group II. Percentage of isoflurane requirement was 0.9 in group I and 1.5 in group II and the mean surgery time was 95.4 minutes in group I and 104.2 minutes in group II. The difference was significant (P< 0.05).
Conclusion: Dexmedetomidine infusion provided sufficient oligaemic surgical field for better visualisation under operating microscope for middle ear surgery.

Undernutrition is a condition in which nutrients are insufficiently consumed, poorly absorbed, or lost excessively. Overindulgence or excessive intake of particular nutrients are the main causes of overnutrition. Protein-calorie malnutrition (PCM), which is caused by a lack of macronutrients like protein, carbs, and fat, is one of the most significant nutritional issues, affecting hundreds of millions of pregnant women, the elderly, and small children in particular.
Methodology: Children with protein energy deficiency between the ages of 6 months and 5 years old participated in this study at the department of paediatrics. A thorough comprehensive examination and history were performed.
Results: The most frequent symptoms in our study were fever 85.34%, vomiting 49.50%, and cough 42.50%. In children decreased feeding was present in 35.29 percent of cases, loose stools were present in 36.28 percent of cases, oedema was present in 28.04 percent of cases, weight loss was present in 17.96% of cases, dyspnea was present in 17.84 percent of cases, abdominal pain was present in 20.16 percent of cases, and convulsions were present in 7.24% of cases. Prevalence of malnutrition in maximum in Grade II.

Facial nerve conservation during parotid and some submandibular surgeries determines post-operative outcomes. High attention is to be paid to the branching pattern of facial nerve. Variations in trunks and branches of facial nerve are not uncommon. Davis et al, Kwak, kantz and others have tried classifying branching pattern of facial nerve into different categories. This case report highlights one unique variant bilateral pattern with multiple complex anastomoses among the branches of temporofacial and cervicofacial trunk of facial nerve. Presence various communicating branches and formation of new branches by union of rami of main branches are observed. Knowledge of such variant patterns is essential not only for parotid surgeries but also for procedures like facial rhytidectomies, nerve transfer procedures and ligament release in various cosmetic surgeries

Metabolic Syndrome (MetS) is a set of interrelated clinical disorders, including dyslipidemia, central obesity, glucose intolerance, and high blood pressure. Hyperuricemia is known to cause various inflammatory diseases via uric acid deposition in the joints. Present study was aimed to study serum uric acid in patients with metabolic syndrome at a tertiary care hospital in rural Tamilnadu. Material and Methods: Present study was comparative, observational study, conducted in patients of age > 18 years, either gender, case of metabolic syndrome (cases) & healthy, age & gender matched subjects (controls). Results: In present study 400 cases & age, gender matched 400 controls were participated. We noticed that systolic blood pressure, diastolic blood pressure, fasting blood sugar & triglycerides were significantly higher among patients with metabolic syndrome as compared to controls & difference was statistically significant (p<0.001). While, high-density lipoprotein, total cholesterol & low-density lipoprotein (mg/dL) were comparable in both groups & difference was not significant statistically (p>0.05). In patients with metabolic syndrome higher levels of uric acid (6.78 ± 1.05) were noted as compared to controls (5.16 ± 0.95), difference was statistically significant (p<0.001).In patients of metabolic syndrome higher levels of uric acid were noted in patients with BMI > 30 kg/m² (6.17 ± 1.02 vs 4.81 ± 0.92), Fasting Blood Sugar ≥100 (6.29 ± 1.09 vs 4.92 ± 0.99), blood Pressure ≥130/85 (6.27 ± 1.13 vs 5.29 ± 1.01) & triglycerides > 150 mg/dL (6.05 ± 0.99 vs 5.53 ± 1.21), difference was statistically significant (p<0.001). Conclusion: Elevated levels of uric acid were seen in patients with metabolic syndrome and also in components of metabolic syndrome such as body mass index, fasting blood sugar, blood pressure & triglycerides

Cerebrovascular accident or stroke is one among the three leading causes of death, surpassed only by ischemic heart disease and malignancy. Stroke is also a common cause of physical disability, which imposes a substantial burden to the community in the foreseeable future. It is estimated that the incidence of stroke is likely to increase by about 20% in the next 20 years. Aim & Objective: 1. To study clinical profile and risk factors in cerebrovascular accident.2. study CT scan finding among cerebrovascular accident patients. Methods: Study design: Prospective Observational Study. Study setting: Medicine ward of tertiary care center. Study duration: 2017 to 2019
Study population: The study population included all the cases with stroke admitted at a tertiary care center. Sample size: 91. Results: The maximum incidence of stroke in this study was observed in the age group of above 60 yrs total -36, that is [18(19.78%)] each for 61-70 and >70 years of age. the male to female ratio in this study was 1.68:1. Most common risk factor was HTN 57.14%, DM 26.37, smoking 45.05%, Alcohol consumption 32.97%, Heart disease 20.88% and Hypercholesterolemia 10.99%. coronary artery disease was present in 12 patients (63.17%), rheumatic heart disease in 7 patients (36.83 %). CT Scan showed ischemic stroke in 86.81% and haemorrhage in 13.19%. 13 out of the 79 ischemic stroke patients and 09 out of the 12 haemorrhagic stroke patients were expired. Conclusion: Cerebrovascular accident cases were having male predominance with most common presentation among age group of 61-70years & more than 70 years. Hypertension was the commonest risk factor and other common factors were diabetes mellitus, cardiac disease, smoking. Ischaemic stroke constituted larger percentage of stroke and mortality was highest in haemorrhagic stroke. MCA territory was most commonly involved. CT scan was important for diagnosis of stroke as rational management depends on accurate diagnosis.

To study the efficacy and safety of intravenous administration of tranexamic acid in reducing blood loss in caesarean sections. Objectives: To compare the volume of blood loss (intraoperative and postoperative) in both study and control group. To assess the difference between preoperative and postoperative hemoglobin and hematocrit levels in both study and control group. To assess the need for additional uterotonics in both groups and to assess the side effects of this drug in study group. Materials And Methods: Material: Pregnant women aged 19years and above, primiparous or multiparous with gestational age between 34 to 40weeks who were to undergo elective or emergency caesarean sections at Bharati Vidyapeeth Medical College and Hospital , Sangli were selected for this study. Informed written consent was taken from all consenting patients.
Patient with history of thromboembolic disorders, any medical disorders ( renal, liver or cardiovascular diseases), severe hemorrhagic disease, anemia ( Hb< 9g/dl), anticoagulant therapy, allergy to tranexamic acid, morbid adherent placenta were excluded from this study. Method:  A retrospective observational study was conducted for a duration of 6 months in 50 ANC patients who fulfilled the inclusion criteria.  After taking informed consent, they were divided into two equal groups as study and control group. In study group, a bolus injection of 1 gram tranexamic acid diluted in 100ml normal saline was administered slowly 5-10mins before skin incision. No drug was given to control group. After delivery of neonate, routine care was given to both groups, that is 10 units oxytocin was added to ringer lactate and allowed to flow at rate of 75 to 100ml /hr for 3hours after surgery. Blood loss was measured in both the groups by gravimetric method. Hemoglobin and hematocrit values before and after the surgery was estimated and the percentage of difference was compared. Results: Hemoglobin and hematocrit values decreased significantly in control group than in study group. There was significant reduction of blood loss calculated from placental delivery till the end of surgery in study group as compared to control group. Similarly blood loss measured 24hrs after caesarean section was less in tranexamic acid group compared to control group. Tranexamic acid group has lesser requirement of uterotonic agents. There were no immediate postoperative complications or side effects to mother and neonate. Conclusion: Injection tranexamic acid is the antifibrinolytic agent when given with safe dose plays an effective role in decreasing blood loss during caesarean section.  The use of this antifibrinolytic agent was not associated with any side effects or complications in the immediate postpartum period. Hence it can be used safely and effectively in subjects undergoing caesarean section.

Inguinal hernia is one of the most prevalent surgical disease in clinical practice. Laparoscopic inguinal hernia repair has been shown to be slightly superior to open approaches and is performed with placement of mesh into the pre peritoneal space. Mesh fixation is thought to increase postoperative pain and risk of nerve injury (femoral branch of genitofemoral nerve and the lateral cutaneous nerve of thigh). Non-fixation of the mesh can reduce pain; however it is theoretically a predisposing risk factor for hernia recurrence due to the risk of mesh displacement. The purpose of this study is to compare mesh fixation with non-fixation in terms of postoperative pain, incidence of nerve injury, incidence of recurrence of hernia during laparoscopic Trans Abdominal Pre-Peritoneal hernia repair Methodology: Patients visiting OPD or admitted in ward will be explained about the study and on willingness will be enrolled up after written informed consent is obtained. Will be divided alternately into the 2 groups. One group will undergo TAPP with fixation of the mesh and the other without. Results: 10 patients with direct inguinal hernia and 15  indirect hernia in mesh fixation group. 14 patients with direct inguinal hernia and 11 patients with indirect inguinal hernia were in non-fixation group. All patients were operated under general anesthesia. Laparoscopic converted open hernioplasty cases were excluded. There were 24 patients in tack fixation group and  11 patients in non-fixation  group required rescue analgesia at 8th hour of postoperative period. The difference of both groups were statically significant. The hospital stay in our study was 1 day and discharged on 2nd postoperative day. No recurrence in this study. Conclusion: non-fixation of mesh can significantly reduces the post operative pain in LAP TAPP.

Downs Syndrome(DS) is also known as trisomy 21. It is a genetic disorder which results in delayed physical and mental growth, along with some typical physical features like flat and wide face, protruding tongue, short neck, small chin etc. If supported with proper love and care, people with DS can live happy and healthy life. According to some research, having a brother or sister with DS has many benefits. Brothers or sisters of the DS children experience many emotions, but mostly the positive ones. Siblings of brothers/sisters with Down syndrome showed closer, warmer sibling relationships, along with slightly better health, lower levels of depressive symptoms as compared to siblings of the children with autism. Research on coping strategies amongst the siblings of DS are very few in the Indian population. Hence, in this research, we wish to study the coping strategies amongst the siblings of the Downs Syndrome. Methodology: Ethical clearance from the Institutional ethics committee was taken before beginning of the study. The study was conducted on siblings of children with DS and the duration of the study was from September 2015 to August 2016. All parents and children have been explained about the nature of study and its application. Siblings of consecutive children attending the Paediatric research lab and satisfying the inclusion and exclusion criteria were enrolled for study. 40 participants were included for the study. The Coping mechanisms used by siblings  were assessed by using the ‘CHILDREN’S COPING STRATEGIES CHECKLIST REVISION 1 SCALE’. Each sibling had to go through interview. Result: In our study, it is found that majority of siblings (87.5%) used active and support seeking’ coping strategies while minority of them (27.5%) used distraction and avoidant coping strategies. Conclusion: Although most siblings were found to switch between styles, they were each found to have a predominant style of coping. Some of Siblings were found to engage in both problem-focused as well as avoidant/distraction coping strategies

To predict the risk factor for intra uterine growth retardation and preeclampsia in pregnant women with the help of uterine artery Doppler screening and associated indices (pulsatility index and diastolic notching) of sensitivity and specificity
Method: Prospective, Descriptive study uterine artery Doppler assessment was carried out at 12 to 14 weeks and 20 to 26 weeks gestation in unselected women with singleton as well as multiple pregnancies, attending for routine antenatal care in a primary care center. The Diastolic notching, pulsatility index (PI) and its relationship to preeclampsia as well as IUGR were evaluated at first and second trimester.
Results: Uterine artery diastolic notch detection had a sensitivity (preeclampsia=52% ; IUGR=18.92%) and a specificity (preeclampsia= 76.8 %; IUGR=66.27%) of in the first trimester whereas a sensitivity (preeclampsia=68% ; IUGR=27.03%) and a specificity (preeclampsia= 89.5%; IUGR=79.52%) in the mid trimester. The pulsatile index detection had a sensitivity of (preeclampsia= 48%; IUGR=35.14%)  and a specificity (preeclampsia=49.5% ; IUGR=43.37) of in the first trimester whereas a sensitivity (preeclampsia=40% ; IUGR=29.73%) of 40% and a specificity(preeclampsia= 55.59%; IUGR=50.60%)  of in the mid trimester.
Conclusion: Uterine artery Doppler sonography fulfill all the requirements for screening in prediction of pre-eclampsia and IUGR. Our results are comparable to the results of other studies.

Background and Aim: Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia. Dexmedetomidine, a highly selective alpha-2adrenergic agonist, has emerged as a valuable adjunct to regional anesthesia and analgesia. The study was aimed to compare the onset, duration of sensory and motor block, hemodynamic effects, post-operative analgesia, and adverse effects of dexmedetomidine and clonidine with bupivacaine for spinal anesthesia.
Material and Methods: Present study was conducted at GMERS Medical College and Hospital, Vadnagar, Gujarat for the duration of 2 years and 1 month. A total of 80 numbers of patients belonging to American Society of Anesthesiology (ASA) Grades 1 and 2 scheduled for gynecological surgery under subarachnoid block were enrolled after obtaining approval from the Hospital Ethics Committee. The patients were allocated in two groups (40 each). Group I bupivacaine + clonidine (B+C) received 17.5 mg of bupivacaine supplemented 45 mcg clonidine and Group II bupivacaine + dexmedetomidine (B+D) received 17.5 mg bupivacaine supplemented 5 mcg dexmedetomidine. The onset time of sensory and motor level, time to reach peak sensory and motor level, hemodynamic changes and side effects were recorded.
Results: Mean time of onset of sensory block in Group I and Group II were found to be 3.69±0.12 mins and 2.14±0.01 mins respectively (p>0.05). The onset of motor block in Group I was slightly less (3.99±0.44 mins) than Group II (4.24±0.80 mins), however, the difference was insignificant. Duration of sensory and motor block was significantly prolonged in group I as compared to group II (p<0.05) The duration of spinal anesthesia was shorter in group I as compared to group II (p<0.05)
Conclusion: The use of intrathecal dexmedetomidine as an adjuvant to bupivacaine seems to be an attractive alternative to clonidine for long duration gynecological surgical procedures due to its profound intrathecal anesthetic and analgesic properties combined with minimal side effects.

Mosquito borne diseases accounts for about 17% of all infections globally and is a major public health concern in India. The vector-borne diseases reduced the fighting capacity of armies. Vector control and personal protection measures therefore continue to ensure the operational readiness of Armed Forces. The Behavioural Change Communication strategy is part of the control and prevention measures.
Methods: A community based cross-sectional study was conducted in a large Naval station in Mumbai during pre and post monsoon period in 2017. Data was collected using a pretested semi-structured questionnaire by directly administering the questionnaire to the sample population. Details on socio-demographic parameters, knowledge about mosquito breeding sites, awareness on mosquito borne diseases, expenses on mosquito control measures and PPM were recorded during the interview.
Results: A total of 750 individuals were interviewed in this study. The mean age of the respondents were 32.79 years (95%CI 32.2-33.4). Majority of the respondents were males (75.69%) and most of the families belonged to nuclear (75.4%) type. About 78% of the participants were exposed to mosquito bite at some point in the recent past. However, after BCC intervention about 28% reduction in exposure to mosquito bite was reported. There was significant change in knowledge, attitude and practice towards mosquito borne diseases after Behavioural Change Communication activities.
Conclusion: There was a fair level of knowledge, attitude and practice in the community. Imparting education on methods of prevention of mosquito bites and it showed improvement in choices of preventive behaviours in the study population

Background: Tuberculosis is most common infectious disease in developing countries. New rapid molecular diagnostics could dramatically increase TB detection and linkage-to-care, which are key components of both the World Health Organization’s (WHO) End TB Strategy and India’s National Strategic Plan for Tuberculosis Elimination 2017–2025.
Aim: To compare the Truenat with sputum smear microscopy.
Material and Methods: The study was conducted in a tertiary care hospital, Gujarat. 150 patients having symptoms related to tuberculosis were tested for sputum smear microscopy as well as by Truenat for molecular diagnosis of tuberculosis and rifampicin resistance at Microbiology laboratory.
Results: Out of 150 samples 54 samples shows positive results for Mycobacterium tuberculosis by smear microscopy and 69 samples shows positive results by truenat for detection of Mycobacterium tuberculosis. Amongst 69 samples 7 samples shows rifampicin resistance while rest 62 shows rifampicin sensitive.
Conclusion: As truenat MTB is portable, TrueNAT could increase treatment initiation by reducing turnaround time for test results and decreasing the need for laboratory referrals at developing countries

A reliable predictive indicator for the course of critically ill patients' conditions is lactate. Metformin users have increased lactate levels at ICU admission without a concurrent rise in mortality, according to a number of small studies. In a wide range of patient populations, elevated lactate has been linked to greater mortality. The purpose of this study was to evaluate lactate levels and compare 30 days mortality in intensive caredunit patients who had and had not previously received metformin medication. Material and Method: This study included patients admitted in intensive care units of Assam medical college between June 2021 to May 2022 with at least one blood lactate level between 12 hr. before until 6 hr after ICU admission. The statistical analysis of the data was done with Microsoft Excel 2010 and the statistical package for social sciences, SPSS for Windows, version 20.0. Chicago: SPSS Inc. Results: The mean lactate in survivors was 3.05 mmol/L with a standard deviation of 2.41 and was lower than that in non-survivors, where it was 4.01 mmol/L with a standard deviation of 2.39.  Non-survivors had a higher distribution of lactate levels than do survivors. Since the p-value was 0.001, which was highly significant, it may be concluded that lactate levels and survival were related. Metformin was used by both 64% of survivors and 30% of non-survivors. 36% of those who did not take metformin lived, compared to 70% of users. The use of metformin and survival were significantly correlated, as shown by the p-value of 0.001, which was highly significant. Conclusion: Lactate concentrations were significantly correlated with mortality in this observational study. Early lactate levels were an important predictor of mortality in critically ill patients admitted to the intensive care unit, and higher preadmission metformin use in survivors demonstrated metformin's important contribution to higher survival rates.

The outcome of neonates with neonatal seizures has changed in recent years due to improved prenatal care, better obstetrical care and intensive neonatal care. Neonates with seizures are at an increased risk of mortality, and the survivors are at risk of neurological sequelae as developmental delay, epilepsy and cognitive impairment.Present study was aimed to study etiology, clinical type and short outcome of neonatal seizures in term babies at tertiary care hospital. Material and Methods: Present study was retrospective observational study, conducted in neonates admitted with diagnosis of neonatal seizure (Clinically apparent convulsions, history of convulsions or who developed convulsions during hospitalization), admitted in NICU. Results: Among 74 cases, majority of neonates were born to mothers of 21-25 years age (37.84 %) & 26-30 years age (32.43 %), were male neonates (56.76 %), had gestational age 37-40 weeks (55.41 %), had birthweight of 2.5-4 kg (51.35 %) & were delivered vaginally (71.62 %). Among majority of neonates common type of seizure was subtle seizures (47.3 %) followed by focal clonic type (24.32 %), generalised tonic (13.51 %), multifocal clonic (8.11 %), myoclonic (4.05 %) & focal tonic (2.7 %).  Among neonates with seizures, common etiology noted was birth asphyxia/hypoxic ischemic encephalopathy (29.73 %) followed by hypoglycemia (17.57 %), septicemia (17.57 %), hypocalcemia (10.81 %) & 11 neonatal seizures were of idiopathic etiology (14.86 %). Majority neonates were discharged uneventfully (82.43 %) while 4 neonates (5.41 %) took discharge against medical advice. Mortality was noted in 12.16 % (majority had septicemia/ intraventricular hemorrhage, with low birth weight). Conclusion: Birth asphyxia/hypoxic ischemic encephalopathy, hypoglycemia, septicemia & hypocalcemia were major causes of neonatal seizures. Common clinical type was subtle seizure and short outcome was good of neonatal seizures

Hypertension is an important public health problem and it has no obvious
signs or symptoms making the persons unaware of condition. World Health
Organization (WHO) has stated that around 1.3 billion people around the world suffers
from hypertension and less than one in five have their blood pressure under control
Methods: A cross sectional study, Study setting: Community medicine department of
Tertiary care center. Study population: The study population included all the sanitary
workers in tertiary care center. Study duration 2 months. Sample size: 311 Results:
Only 10.7% of the workers were current tobacco users, while almost 15% were current
alcohol users. More than three fourth of the study participants were physically active.
More than 50% of the participants were obese (≥ 25.00 kg/m2). Abdominal obesity was
present in about 35% of the participants. Prevalence of hypertension among the
sanitary workers was 36.6% (95% CI: 31.3-41.3%). Only 34 (10.9%) participants were
aware of their hypertension status and 80 (25.7%) of the participants were newly
diagnosed to have hypertension. Prehypertension was present in 114 out of 277
participants (41.1%; 95% CI: 35.3-47.2%) without any known history of hypertension.
Among the 34 patients with known history of hypertension, only 12 (35.3%) belonged to
controlled status category. Current tobacco users had 1.61 times higher prevalence of
hypertension when compared to those who are not current users and this was
statistically significant (P = 0.003). Current alcohol users had significant association
with hypertension (aPR-1.25; P = 0.02). Conclusions: The current study found that
more than one-third of the sanitary workers had hypertension. However, almost threefourth
of the hypertensives were not aware about their status.

The aim of this study is toobserve the effect of oral melatonin premedication on induction doses of propofol and pentothal sodium. The patients was examined clinically a day before the surgery to note demographic data, baseline heart rate, blood pressure, respiratory rate, oxygen saturation of Hb. Biochemical tests were done to rule out co-morbid condition associated. ECG and X –Ray chest was done ASA grade 1 and 2 patients of either gender, 18 - 60 years old, scheduled to undergo elective surgical procedures under general anesthesia will be assigned into equal groups- group (P+M), group (P), group (PS+M) and group (PS).
Result:
In P Group, the mean Pulse 120 minutes after drugs (mean± s.d.) of patients was 91.6774± 11.5741. In P + M Group, the mean Pulse 120 minutes after drugs (mean± s.d.) of patients was 82.0968± 7.4938. In PS Group, the mean Pulse 120 minutes after drugs (mean± s.d.) of patients was 90.1613± 10.2538. In PS + M Group, the mean Pulse 120 minutes after drugs (mean± s.d.) of patients was 80.4516± 7.9282. Distribution of mean Pulse 120 minutes after drugs with Group was statistically significant (p=<0.0001).
In P Group, the mean MAP 120 minutes after drugs (mean± s.d.) of patients was 99.9677± 6.4626. In P + M Group, the mean MAP 120 minutes after drugs (mean± s.d.) of patients was 89.1290± 7.4420.  In PS Group, the mean MAP 120 minutes after drugs (mean± s.d.) of patients was 100.0000± 7.0475.  In PS + M Group, the mean MAP 120 minutes after drugs (mean± s.d.) of patients was 86.0968± 8.0056.  Distribution of mean MAP 120 minutes after drugs with Group was statistically significant (p=<0.0001).
In P Group, the mean Dose calculated as mg/kg (mean± s.d.) of patients was 1.9529± .1710.  In P + M Group, the mean Dose calculated as mg/kg (mean± s.d.) of patients was 1.0932± .0754.  In PS Group, the mean Dose calculated as mg/kg (mean± s.d.) of patients was 4.6161± .3666.  In PS + M Group, the mean Dose calculated as mg/kg (mean± s.d.) of patients was 2.6835± .3678.  Distribution of mean Dose calculated as mg/kg with Group was statistically significant (p=<0.0001).
In P Group, the mean Dose required (mg) (mean± s.d.) of patients was 107.7419± 19.0979.  In P + M Group, the mean Dose required (mg)(mean± s.d.) of patients was 72.2581± 14.3084.  In PS Group, the mean Dose required (mg) (mean± s.d.) of patients was 295.1613± 40.5274.  In PS + M Group, the mean Dose required (mg) (mean± s.d.) of patients was 186.2903± 42.7389.  Distribution of mean Dose required (mg) with Group was statistically significant (p=<0.0001).
Conclusion: We concluded that the significant effect was found in oral melatonin on induction doses of propofol and Pentothal sodium and changes in vital parameters before and after 90-120 minutes of oral administration of study drug.
Melatonin premedication significantly decreased the doses of both propofol and pentothal sodium required to induce anesthesia.

Lumbar prolapse of intervertebral disc (PIVD) is seen in over 1% of adults with the most incidence between the 3rd to 5th decades of life. It appears to be more prevalent in the male population and predominantly affects the L4-L5 and L5-S1 levels. Over the years several surgical techniques have been developed for its management but the best technique is still debatable.
Aims: This study aims to compare both immediate and long-term functional outcome following minimally invasive spine surgery (MISS) and open discectomies for Lumbar prolapse.
Settings and Design: It is a non-randomised controlled study.
Methods and Material: The patients, diagnosed with lumbar disc prolapse, were taken for the surgery of choice following an initial assessment. The outcome is assessed in the immediate post-operative period using VAS and ODI and long-term functional outcome using Modified macnab criteria between 12 and 18 months post-surgery.
Statistical analysis used: The IBM SPSS software was used to study the correlation. One-tailed ANOVA with CI of 95% was conducted for VAS score and ODI score while Mann-Whitney U test was done on the Modified Macnab Criteria.
Results: This study was conducted on 103 subjects with 56.3% undergoing open discectomies while 43.7% underwent minimally invasive discectomies. 73 subjects were operated on the L4-L5 level and 30 on the L5-S1 level. The study revealed that the operative duration of MISS is significantly more than that of open procedure. The VAS score for the MISS procedure had a mean change of 3.067 in the immediate postoperative period versus the mean reduction of 2.603 for open procedure. The ODI of MISS has decreased from 44.27 to 13.73 and that of Open procedure has decreased from 43.19 to 17.48. The long-term outcome at 12-18 months after surgery was excellent for 75.5% of MISS patients but only 25.9% open discectomy cases
Conclusions: The MISS procedure did not produce a strongly clinical outcome compared to open discectomies in the immediate after surgery but the functional outcome of MISS procedure on the long-term was greater than that of the conventional method

To compare the efficacy of epidural FENTANYL and TRAMADOL for post-operative analgesia in lower limb surgeries in terms of onset of analgesia, duration of analgesia, quality of analgesia and undesirable effect.
Material Method: This prospective randomized study was conducted to compare the analgesic efficacy and side effects of epidural fentanyl and that of epidural tramadol and included sixty (60) patients of either sex in the age range of 18-65 years, undergoing lower limb surgeries under Combined Spinal Epidural anaesthesia (CSE) with ASA physical status I & II. These were divided into two groups of 30 patients each. Group F- Fentanyl group and Group T- Tramadol group. Patients of Group F received 50 mcg of Fentanyl + 8ml of 0.125% Bupivacaine (9 ml) and that of Group T received 50 mg of Tramadol and 8ml of 0.125% Bupivacaine(9 ml).The patients were randomly given epidural fentanyl or epidural tramadol when patient complained of pain post operatively with Visual analog score 3 or above. Patients were closely monitored in the post-operative period till they had pain relief. Quality of pain relief was measured using visual analogue scale and occurrence of side effects like nausea and vomiting, pruritis, respiratory depression were noted.A detailed clinical history and physical examination of the patients was done and all vital parameters were recorded well in advance. An informed and written consent was taken from the patient for the study.
Result: Mean Time of onset of analgesia after epidural injection was 5.42 ± 1.18 minutes in Group F and 12.80 ± 1.62 minutes in Group T and the difference was found to be statistically significant. Mean Duration of analgesia was 240.22 ± 36.53 in Fentanyl group and 360.52 ± 24.83 in Tramadol groups respectively which was also statistically significant. Pruritis was significantly higher in Fentanyl group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia was better following administration of epidural Fentanyl.
Conclusion: Both epidural Fentanyl and Tramadol are effective in relieving post-operative pain; however Fentanyl produced better patient satisfaction compared to tramadol but the duration of action was short.

A very frequent emergency that is encountered in the Emergency/Surgical Department is Blunt abdominal trauma (BAT). In spite of the improved modes of prevention, recognition, diagnosis and treatment, BAT continues to be associated with significant morbidity and mortality.
Aim: To study the causes and factors affecting the outcome of the patients with blunt abdominal trauma and evaluate the impact of blunt abdominal trauma on intra peritoneal organs like liver, spleen and hollow viscera like stomach, small intestine and large intestine, treated at our hospital.
Methods: The study was conducted in IMCHRC among the patients who were admitted in the department of general surgery with blunt abdominal trauma.
Conclusion: Males were predominantly affected. It is mostly seen in the age group of 31 to 45 years which form the productive age group. Road traffic accidents form the most common mode of injury followed by blow with blunt object. Liver was the most common organ injured followed by spleen. Spleen and liver together were most commonly injured organ followed by spleen, liver and mesentery. Majority of patients were managed conservatively and improved over the course of time while only four patients amongst 120 could not survive and died during the course of their stay in hospital.

Background: To study the clinical features of nasal polyp.
Materials & methods: A total of 20 subjects were enrolled. Patients presenting with clinical features of nasal polyp, of all age groups and both sexes, and also recurrence cases were included. The two types of polyps were included as ethmoidal and antrochoanal polyps. They were further divided as unilateral or bilateral. Data was collected and results were evaluated using SPSS software.
Results: A total of 20 subjects were enrolled. The most common symptom was nasal obstruction seen in 18 subjects (90%), followed by sneezing present in 11 subjects (55%) followed by headache in 10 subjects (50%) and nasal discharge in 8 (40%). Epistaxis was the least seen in 1 patient (5%).
Conclusion: Antrochoanal polyps had 100% unilateral presentation with predominance of right side (60%).

 
Background: Menstrual hygiene management is an important issue for adolescent girls. Lack of education and communication regarding reproductive system further adds to the problem. Good menstrual hygienic practices such as the use of sanitary pads and adequate washing of genital area are essential during menstruation.
Aims and objectives: To assess the knowledge, attitude and practice of menstrual hygiene among adolescent girls in Sothern Rajasthan India.
Materials and Method: A cross sectional study was conducted among 185 school going adolescent girls of southern Rajasthan. A pre formed pre-tested questionnaire was used. Data were analyzed statistically by simple proportions.
Result: Most of the girls (84.3%) attaining menarche in the age group of 12-13 years. 74.6% girls residing at rural area, 56.2% belonged to joint family and 58.4% was lower socio-economic class. Knowledge of menstruation before menarche was found in 39.5% of girls. 84.3% menstrual habits were inculcated by their mothers.76.7% girls were using sanitary napkins as absorbent material during their menstrual cycle. 82.7% were doing vaginal wash daily. 64.6% of girls were having good menstrual practice.

Background: Birth weight is an important determinant of child survival and development. Low birth weight (LBW) is an index of our status of public health, maternal health and nutrition. The major challenge in the field of public health is to identify the factors influencing low birth weight and to institute remedial measures.
Aim: The aim of this study was attempted to assess incidence of low birth weight and its risk factors affecting low birth weight.
Materials and methods: A cross sectional study design was carried out in a tertiary care government hospital.A total of 1120 postnatal mothers who delivered in the hospital during study period were included in the study except still births. All babies were weighted on standard beam balance within 24 hours of delivery and mother’s height was measured by height measuring stand. The collected data was analyzed using statistical package for the social sciences (SPSS) version 22.
Results and analysis:incidence of LBW neo-born babies was 240/1120 (21.4%)where 104 (43.3%) were males and 136 (56.7%) were female babies. Mean age of the mothers was 23.52±3.16 years; mean weight noted was 58.94±10.09 kg and mean height was 159.1±7.15 cm. The study showed associations between birth weight and mother’s age, weight, height, hemoglobin (Hb) %, birth interval, income, bad obstetric history and complications
Discussion and conclusion: The incidence of low birth weight was found to be very high and it was associated with many risk factors related to maternal health and services. Hence it is recommended to improve maternal health through strengthening the existing maternal services at the basic level of community.

The incidence of chronic disabling conditions of the hip including osteoarthritis, inflammatory arthritis and osteonecrosis is on the rise. Total hip arthroplasty (THA) is one of the most common surgical procedures performed in these conditions. The increasing number of young and active patients is requiring long lasting and reliable primary hip arthroplasty (THA). Ceramic on ceramic (COC) hip articulations made from alumina have become an attractive option for young and active patients who require THA. The reports suggesting the study of clinical and functional outcome of ceramic on ceramic bearing surfaces are scant in this part of the country. Hence it was decided to take up this study with the aim of studying the clinical and functional outcome of ceramic on ceramic bearing surfaces.
Objectives: To study and compare the clinical and functional outcome of ceramic on ceramic bearing surfaces total hip arthropalsty in a group of patients.
Methodology: A prospective comparative study was undertaken in the Department of orthopaedics of GS Kulkarni Hospital, Miraj. A total of 30 patients undergoing THA with ceramic on ceramic bearing surface were included as study sample and same number of patients with other bearing surface implants was included as controls. The clinical and functional outcomes were evaluated by Modified Harris Hip Score. The radiological assessment included positioning and alignment of the acetabular and femoral components and complications such as periprosthetic fractures, loosening, osteolysis, dislocation, subsidence and heterotrophic ossification.
Results: In our study, both study groups COC and other implants group were statistically comparable for demographical parameters. The stem size, head size, offset, shell size and the liner size were comparable in both study groups. The difference between mean pre operative score and mean post operative was statistically significant in both study groups in various categories such as pain, gait, functional activity, absence of deformity and ROM scores. The acetabular angle and the coverage were not statistically significant between study groups. However the femoral varus deformity was present in 13.3% of the patents in ceramic on ceramic surface group of patients and 36.7% of the other implant cases which was statistically significant between the two groups. Superficial infection was the common complication in both the groups. One patient in ceramic on ceramic surface group had Anterior thigh pain (ATP). About 6.7% of the patients in other type of implant group had ATP and osteolysis. one patient had nerve injury in other implants group.
Conclusion: This study was mainly undertaken to compare the efficacy of the ceramic on ceramic surface with the other type of implants. This study had reported that, majority of the patients with COC were between 41 – 50 years, majority of male gender and AVN was the main indication for the surgery. In both study groups the pain scores, functional gait score, function activity scores, absence of deformity scores, ROM scores, total scores and acetabular angle were significantly different before and after surgery. But there was no statistically significant difference after surgery between the ceramic on ceramic and other type of implant groups except for femoral varus deformity. But this study is not without limitations. The sample size is not large enough to generalize the study results. But this study was able to bring out many facts about the use of ceramic on ceramic implants. Further research with elegant methodology can bring out many facts about the disease.

Corticosteroids are used to suppress the immune system and reduce inflammation in different conditions, ranging from skin diseases to brain tumors. Corticosteroids are administered by parenteral, oral and topical route. Topical corticosteroids are considered to have safer than oral corticosteroids. There are different topical corticosteroids preparations used in skin diseases. E.g. mometasone clobetasol, betamethasone, beclomethasone, fludrocortisone and desonide. Use of these steroids depends on anatomic location and strength of corticosteroids.
Clinical effectiveness of topically applied medications depends on the ability of the active ingredient to leave its vehicle and penetrate into the epidermis. Adverse effects of corticosteroids depend on duration of treatment, potency of corticosteroids and area of involvement. We have investigated effect of topical Clobetasole propionate on blood pressure, blood sugar level and blood calcium level after seven day application in patients requiring topical clobetasol therapy. Area of application measured by “Palmar method”, blood pressure by sphygmomanometer, blood sugar by glucometer, calcium investigation by O – cresolphthalein complexone method, concentration of clobetasol propionate by HPLC method. After seven day application, clobetasol propionate had raised systolic blood pressure. The systolic blood pressure was raised more than the diastolic blood pressure. Blood sugar level was raised by clobetasol propionate. Clobetasol propionate after once daily application for seven days did not change blood calcium levels. As area of application of topical steroids increase there were increases in blood concentration of corticosteroids.

In women of reproductive age, polycystic ovarian syndrome (PCOS) is a frequent endocrinopathy and a heterogeneous, enigmatic condition that is still not fully understood. It begins to manifest between the ages of 18 and 45, and it may take years for its clinical manifestation to manifest. Vitamin D affects progesterone production in human granulosa cells, anti-müllerian hormone (AMH) signalling, follicle-stimulating hormone sensitivity, and ovarian follicular growth and luteinization as part of its physiological role in reproduction. Increased LH/FSH ratios can occur in ovulatory women with the polycystic morphology, but they may not be seen in a single blood sample. With this context in mind, the current study was conducted to determine and evaluate the biochemical tests in individuals with clinical symptoms of polycystic ovarian syndrome, such as Vitamin D, LH/FSH ratio, and serum insulin levels

Diabetes puts people at a higher risk for a wide range of microvascular and macrovascular problems.
Aim: The aim of the present was to study the effect of hyperglycemia, HbA1c on total cholesterol (TC) and High-Density Lipoprotein (HDLc) in Type 2 Diabetes mellitus (T2DM) subjects.
Materials &methods: In this case-control study, we compared a group of people with type 2 diabetes (T2DM) with a group of people without T2DM, totaling 200 people. All participants were evaluated at Index Medical College & Research Centre in Indore, India, using the center's outpatient services. The authors of the study have begun their work after receiving approval from the relevant ethics board. Each individual in this study has given their consent before the study began.
Results: Age, BMI, FBS, and HbA1c, were measured. BMI, FBS (t=6.955, d=198), HbA1c (t=10.931, d=198), shown to be significantly higher in T2DM patients compared with healthy controls. This shows that increased glucose levels may hamper the sensitivity of the insulin and as well as glycation of the proteins. On the contrary, the present study did not observe significant difference in case with the age of the subjects present in the study. TC, and HDLc, levels were shown above. TC (t=5.043, d=198) level was significantly higher in T2DM patients compared with healthy controls.
Conclusion: Reducing ROS generation may lower hyperglycemia, dyslipidemia, and oxidative stress. These advancements may result from: However, lowering oxidative stress, which causes hyperglycemia and dyslipidemia, may increase serum insulin levels, according to the study's authors.

Various modifications in tympanomeatal flap elevation in tympanoplasty were described by otolaryngologist all over the world to achieve best surgical outcome. In this study the surgical and audiological outcomes of anterior tucking tympanomeatal flap elevation and over-under technique of flap elevation were compared in type 1 tympanoplasty.
Objective: The aim of this study is to compare surgical outcomes of two techniques of tympanomeatal flap elevation in tympanoplasty.
Material and methods: This prospective randomised study included 200 patients. Patients were randomly allocated in 2 groups. Patients were followed for 3 months and compared surgical and audiological outcomes in 2 groups.
Result:  In anterior tucking (group A) techniques overall success (97.3%) and anterior blunting (9.1%) were more whereas residual perforation (2.7%), granulation formation (2.7%) and lateralisation (0.0%) were less common as compared to over-underlay technique (group B). In over-underlay technique (group B) success, residual perforation, lateralisation and anterior blunting were seen in 82.2%, 17.8%, 4.4%, 2.2% respectively.
Conclusion: Both anteriortucking underlay and over-underlay techniques of tympanoplasty are effective surgical technique with satisfactory outcome.

School-going age is full of challenges when it comes to growth and puberty. Anthropometric measurements including body mass index (BMI) remain the most popular methods to assess the nutritional status of children. On the other hand, body image is a complex term and includes how we perceive, think, and act toward our bodies. This study was undertaken to determine the association between body image perception and nutritional status in students of independent schools. 
Materials and methods: A cross-sectional study was carried out on 402 students of the middle and secondary stage (class 6-12) attending independent schools in Dehradun, India. An interview method was used to collect the data on their body image followed by a physical examination and nutritional assessment.
Results: 63.18% of students (n=254) were having normal BMI, 2.24% (n=9) were underweight, 26.62% (n=107) were overweight and 7.96% (n=32) were found to be obese. 25.62% (n=103) of students had an accurate perception of their body image when compared to their BMI. On the contrary, 74.38% (n=299) of students were observed with inaccurate perceptions of their current height and body weight. 
Conclusion:In this present study, we could conclude that the majority of the students were not aware of their current weight and height. Also, the majority had a false perception of their body image as compared to their weight/ BMI. 

The aim of present study is to study Role of cervical length in assessment of Preterm birth. Prematurity causes 70% of fetal/neonatal deaths, with 11.4% of births occurring at < 37 weeks gestation. The rate of prematurity increases with the number of fetuses - singletons 10%; twins 54.9%; and triplets 93.6%. The expansion of the bladder that is required with the transabdominal approach results in cervical lengthening and the translabial or transperineal technique do not give accurate measurement of cervical length. Therefore, the transvaginal approach is the most accurate method to assess the cervical length.
Result: The incidence was 14% low birth weight; while in group B it was 17% and in group C it was 83%. Group A all delivered at term and no baby required NICU admission.Reduction in cervical length between 11-14 weeks to 20-22 weeks of gestation in prediction of preterm delivery. At the cut-off value of reduction in cervical length between 11-14 weeks and 20- 22 weeks of gestation of >0.6 cm, sensitivity was 66.67%, specificity was 87.5%, PPV was 42.11%, NPV was 95.06%, and p value was < 0.00001.
Conclusion: Considering the magnitude of preterm labor, cost of management of preterm babies and morbidity-mortality associated with it, transvaginal ultrasonography of the cervix during routine NT scan and anomaly scan has emerged as a safe, acceptable and a cost-effective test to assess risk of preterm delivery.

Our aim of the study was to determine the role of foetal kidney length to predict gestational age at third trimester.
Material and Methods: We were conducted a prospective, observational study between the duration of January 2021 to June 2022. In our study, we were enrolled 140 pregnant women who having third trimester of pregnancy. We were observed kidney length, femur length, HC, AC and BPD during our study.
Result: Among 140 patients, Multigravida patients were highly observed compared to primigravidae. We observed that gestational age with last menstrual period was highly significantly positively correlated with mean kidney length (r=0.958) compared to right kidney length, left kidney length, MKL, femur length  , BPD , AC  ,HC and weight. Based on mean kidney length, we were predicted (r2=91%) equation to determine gestational age at third trimester.
Conclusion: Foetal kidney length can be utilised as an additional criterion for estimating gestational age in the third trimester since the results of the current study have demonstrated a substantial link between renal length and gestational age, particularly in the third trimester.

Scrotal swellings are a common problem occurring in almost all age groups encountered in day-to-day surgical practice. Most of the patients present late and are reluctant to seek medical attention due to the social stigma and embarrassment associated with the disease. The aim of this study is to identify the age distribution of the disease in adults, its etiology, modes of presentation, modalities of treatment, and the post-operative complications. This is a prospective hospital-based study conducted in the Department of Surgery, Jorhat Medical College and Hospital, Assam, India. A total of 40 cases with scrotal swelling and fulfilling the study criteria were selected for the study. Detailed history and clinical examination along with ultrasonography of bilateral scrotum with color doppler was done in all the cases. Treatment options were selected based on the disease condition and were either surgical or conservative. Intra-operative findings were noted and post-operative complications were recorded. The data collected was then analyzed using tables and figures. Most of the patients were in the age group of (29-38) years. Majority of the patients presented with painless scrotal swelling. Primary vaginal hydrocele was the most common cause of scrotal swelling, followed by epididymo-orchitis and they were common in the age group of (29-38) years. 62% of the patients were treated surgically, whereas the rest underwent conservative management. Pain was the most common post-operative complaint.

Rectal bleeding in patients with hemorrhoids requires exact diagnosis because it may be not simply a hemorrhoidal bleeding and can be an early sign of severe bowel diseases, such as colon carcinoma, or inflammatory bowel diseases that could be discovered by colonoscopy.The present study was thus conducted to assess the role of preoperative colonoscopy in patients with haemorrhoids. Material and Methods: Present study was prospective, observational study, conducted in patients of age > 18 years, either gender, clinically diagnosed with haemorrhoids, underwent colonoscopic evaluation. Results: In present study, out of 50 cases of hemorrhoids, most common age group affected was between 41-60 years of age (64 %) with mean age of 48.32 ± 10.16 years. Male predominance was seen in present study with 64% males to 34% females. Male to female ratio being 1.78:1. Most common presenting complaint was bleeding (86%) followed by constipation (72%) and pain (18%). On colonoscopy examination, grade I and II haemorrhoids were seen in 28% cases while grade III and IV were observed in 48% and 24% cases respectively. Associated pathologies were reported in 30% cases with benign conditions in 22% and malignant condition in remaining 8% cases. Benign pathologies include: ulcerative colitis (10%), polyp (10%) and rectal ulcer (2%) while colorectal carcinoma was seen in 8% cases. Only 1 patient complained of pain after the procedure while bleeding was not reported in any case. Conclusion: Rectal bleeding warrants a complete colonic investigation, preferably by total colonoscopy. Avoiding colonoscopy in these patients can lead to missed-diagnosis or delay in diagnosis.

Recently, homeopathy, the most popular system of therapy, is recognized as one of the components of complementary and alternative medicine (CAM) across the world. It is widely used as palliative and as supportive therapy in cancer patients. Limited studies were reported on patients using homeopathy after surgery, radiotherapy, and chemotherapy, generally for overcoming side effects. Therefore, homeopathic treatment is considered as an add-on to conventional therapy, with almost no interaction with the conventional drugs due to the small dose, and improves lives by providing symptomatic relief, increasing survival time and boosting patient immunity. The present review was conducted to highlight the homeopathic studies conducted on Palliative Care and Comprehensive Therapy in Terminally Ill Cancer Patients

The aim of this study is toMesh needs fixation in Laparoscopic Groin Hernia Repair.  40 cases were operated with Laparoscopic groin hernia repair. The cases were evaluated through proper history taking, clinical examination, operative procedure and post-operative follow ups.
Result: Post-operative complications in laparoscopic repair was port site infection-2.5%,seroma collection-2.5%, The duration of stay in hospital was 4 days for Laparoscopic repair. The recurrence rate nil recurrence with Laparoscopic repair. The return to daily activities was 7 days in Laparoscopic repair, The patient’s feedback was good with Laparoscopic repair.
Conclusion: Less complication and 0 recurrences in Laparoscopic repair.  Cost was reduced as we used a single fixation device and closure was done using barb sutures / vicryl. The short term results clearly favour laparoscopic repair regarding post-operative pain, sick leave and resumption of normal physical activities.

Hyperhomocysteinemia has been known to cause many vascular diseases. But the exact pathogenesis of Hyperhomocysteinemia induced vascular damage is not clearly known. Several factors such as oxidative stress, endothelial dysfunction, smooth muscle cell proliferation and coagulation abnormalities have been attributed to Hyperhomocysteinemia. Serum homocysteine was estimated on 5 ml of serum by competitive chemiluminescent enzyme immunoassay method and the specimen was transported to the laboratory within 30 minutes of collection. Results were assured as per standard quality control regime. The normal values of serum homocysteine in pregnancy during second trimester is 2-26.9 μmol/L, while it is 3.2-21.4 μmol/L in third trimester. Proportion of cases with normal level of serum homocysteine were observed in 37.5% and that controls were 87.5%. Proportion of cases with mild elevated levels of serum homocysteine were observed in 37.5% and that controls were 12.5%. Proportion of cases with moderate and marked elevated levels of serum homocysteine were observed in 17.5% and 7.5% respectively as compared to zero controls. This difference in the proportion of serum homocysteine levels amongst cases and controls was found statistically significant i.e. (p<0.05). It means serum homocysteine levels were significantly elevated in preeclampsia cases in our study.

The three major causes of bleeding in first trimester are Abortions, Ectopic pregnancy and Gestational trophoblastic disease. Ultrasound helps in assessing the type of abortion. Life threatening emergency like ectopic pregnancy, when evaluated by ultrasound gives scope for conservative approach without affecting the fertility status. It was a cross sectional study of patients presenting with bleeding per vagina in the first trimester of pregnancy during the study period. Informed consent and ethical committee clearance was taken. In the present study, follow up of clinically diagnosed cases out of 57 cases of suspected threatened abortion, 36 cases continued to term gestation. Only 21 cases were confirmed on sonography. 9 cases of incomplete abortion were misdiagnosed as threatened abortion, l case of missed abortion, l0 cases of anembryonic gestation, and l case of molar pregnancy were misdiagnosed as threatened abortion.

Organophosphorus compound poisoning is one of the most common poisonings often requiring ICU care and ventilatory support. Hence, this study has been undertaken to identify the factors, which predict the need for ventilation in these patients. All the patients who were diagnosed to have consumed organophosphorus compound poison who presented within 24 hours of consumption were included in the study. Patients with concomitant respiratory illness double poisonings were excluded from the study. Of the 12 patients who has oxygen saturation levels < 89%, 8(33.33%) required ventilation. Ventilation was required by 46% of patients who had a GCS score of <10. 38% of patients with a fasciculation score of > 4 required ventilations. Of the patients admitted to the hospital > 4 hours after consumption of poison, 70% required ventilation. 5% of patients with mild and 20% with moderate poisoning required ventilation. In contrast 75% of patients with severe poisoning required ventilation. Patients who were ventilated required a higher dose of atropine within 48 hours of admission as compared to those who were not ventilated. Patients who presented with higher respiratory rate, accessory muscles of respiration in action, higher fasciculation score, GCS-score of <10, greater time lag between consumption of poison and admission to hospital (>4 hours), Pinpoint (<2) pupil, severe grade of poisoning, low values of Pseudocholinesterase and O2 saturation <89% were more likely to require ventilation.

THA is a successful orthopaedic intervention & the procedure has relieved pain of many patients, yet some of them remain unsatisfied & has some complications which has least mortality but could have quite reasonable discomfort, especially in initial rehabilitation periods. Difference in the limb length is one among them & this LLD (limb length discrepancy) can persist permanently in these few. Understanding this effect on patients satisfaction is an important aspect.
Thus, in this research we aimed at understanding the outcome of THA patients assessed by using PROM-Patient reported outcome measurement tools like Harris Hip score (HHS) & X- Ray based measurements of change in LLD before & after surgery.
In this prospective study of 6 months follow up of each individual patients of uninfected aetiology & patients above 18 years of age irrespective of gender, we studied 45 hips in total 42 patients. All of them underwent Total Hip Replacement for various reasons of painful end stage arthritis or fractures of hips, with one third young patients having age less than 40 years.
In terms of negative results, only one THA was restored to same LLD from preop to post op (i:e 0 mm to 0 mm-zero to zero) as compared to other 44 Total hips, where change in LLD was observed as inevitable event in a range from 0 to 40 mm LLD in preoperative restored to range of 0 to 20 mm of LLD in the post operative period

A common metabolic issue in new born is neonatal hypoglycemia, which is more prevalent in conditions including preterm, sepsis, and for small gestational age. New born without obvious risk factors may experience episodes of asymptomatic hypoglycemia.
Material and Methods: In a tertiary care facility, a hospital-based prospective study was carried out for a period of six months from August 2022 to January 2023. In the study, 104 new-borns who had successive deliveries were taken into account. At 3 hours, 12 hours, and 36 hours after birth, their babies have tested for plasma glucose levels. Using the SPSS (version 21) statistical program, the plasma glucose values were analysed statistically using descriptive and inferential statistics.
Results: The incidence of asymptomatic hypoglycemia among new-borns weighing more than two kgs was 18.3%. The risk factors such as male gender, Low birth weight babies, caesarean delivery small for gestational age was significantly associated with asymptomatic hypoglycaemia. Blood glucose levels was significantly lower in SGA babies and caesarean birth babies.
Conclusion: In neonates, asymptomatic hypoglycemia occurs quite frequently. In order to recognise asymptomatic hypoglycemia and implement preventative interventions to stop the transition to symptomatic hypoglycemia and its consequences later in life, strict monitoring and close attention are required

The COVID-19 pandemic caused relatively high mortality in patients, especially in those with concomitant diseases (i.e., diabetes, hypertension, and chronic obstructive pulmonary disease (COPD)). In most of aforementioned comorbidities, the oxidative stress appears to be an important player in their pathogenesis. The direct cause of death in critically ill patients with COVID-19 is still far from being elucidated. In this regard oxidative stress is one of the topics that need to be investigated. Therefore, the present research study was carried out to explore the relationship between the oxidant/antioxidant system and COVID‐19 exacerbation.
Materials and Methods: A total number of 60 children were involved in this study; they further equally divided into patient and control group. Blood Samples were collected from 30children confirmed diagnosed with COVID-19 infection and 30 healthy children volunteers as the control group. The patient group consisted of 22children with mild disease and 8 children severely ill patients.
Results: COVID-19 patients with mild and severe disease have shown the signs ofanaemia, leucocytosis and thrombocytopenia than control group. Serum levels of total antioxidant capacity (TAC) and nitric oxide (NO) were measured. TAC levels were considerably lower in patients compared with healthy individuals (control group). An increasing trend was found in NO concentration as well as MDA levels in patient group.
Conclusion: These findings suggest that COVID-19 patients may be susceptible to depleted total antioxidant capacity. Moreover, showing such variations in blood samples of infected individuals could be considered as a predictive marker of COVID-19 severity.

To compare the treatment efficacy of intravitreal bevacizumab (1.25 mg) and laser monotherapy in diabetic macular edema in patients of type 2 diabetes mellitus.
Settings and Design: Randomised, non-blinded prospective interventional study conducted in a tertiary care hospital on 66 eyes of type 2 diabetes patients.
Methods and Material: After obtaining informed consent, patients diagnosed with non-proliferative diabetic retinopathy (NPDR) and DME defined as clinically significant macular edema (CSME) were recruited in the study. The selected patients were randomized into two groups – group A (n=33) - macular laser photocoagulation and group B (n=33) - three monthly intravitreal bevacizumab injections (1.25 mg). At 3 months follow up, comparison of change in central macular thickness (CMT), macular volume (MV) and best corrected visual acuity (BCVA) was done.
Statistical analysis used: SPSS 21, IBM, USA, Pearson’s chi-squared test and two sample t-test.
Results: CSME resolved in 11 (33.33%) patients in laser group and 21 (63.64%) patients in the intravitreal bevacizumab group. Mean CMT decreased from 496.03µm to 339.24µm in laser group and from 516.48µm to 283.27µm in the bevacizumab group (p<0.05). Bevacizumab group showed greater reduction in mean MV laser group (p<0.05). Mean BCVA (logMAR) improved from 0.83 to 0.49 in the bevacizumab group while in the laser group, marginal improvement was seen from 0.81 to 0.76 (p<0.001).
Conclusions: Intravitreal bevacizumab is superior to macular laser photocoagulation in structural and functional improvement in NPDR with CSME.

To evaluate the effect of uncomplicated phacoemulsification on central macular thickness (CMT) and best corrected visual acuity (BCVA) in diabetic patients without diabetic retinopathy (DR) and diabetic patients with mild to moderate non proliferative diabetic retinopathy (NPDR).
Materials & methods: A total of 200 diabetic patients (200 eyes) who underwent phacoemulsification were divided into 2 groups as Group A:100 patients withoutDR and Group B:100 patients with mild to moderate NPDR. All patients entered into the study were followed up preoperatively and at 1 month, 6 months and 1 year after phacoemulsification and CMT and BCVA were evaluated at each follow up and tabulated and analyzed by suitable statistical tests.
Results: CMT of group A at postoperative 1 month and 6 months was 259.20±20.57µm and 243.48±11.11µm respectively and of group B was 280.03±34.52µm and 254.28±16.46µm respectively. There was significant difference between 2 groups at both postoperative 1 month and 6 months after uncomplicated phacoemulsification. There was no significant difference in the postoperative mean CMT at 1 year between group A (234.03±9.38µm) and group B (240.21±34.00 µm). Mean BCVA Log MAR was 0.15±0.22 in group A as compared to 0.30±0.34 in group B at postoperative 1 month, mean BCVA Log MAR was 0.13±0.12 in group A as compared to 0.20±0.20 in group B at postoperative 6 months, mean BCVA Log MAR was 0.11±0.11 in group A as compared to 0.17±0.15 in group B at postoperative 1 year. ‘p’-value was highly significant in the mean BCVA Log MAR at postoperative at 1 month,6 months and 1 year between the two groups.
Conclusion: There was significant increase in mean CMT and mean BCVA Log MAR at postoperative 1 month,6 months and 1 year in both the groups. At postoperative 1 and 6 months there was significant difference in CMT between both groups whereas there was no significant difference in CMT at 1 year between the 2 groups. At postoperative 1 month, 6 months and 1 year, there was significant difference in BCVA Log MAR between both groups.

This clinical study was conducted to assess the effect of intracameral 0.02% tropicamide, 0.31% phenylephrine, 1% lidocaine in initiation and maintenance of pupillary mydriasis during phacoemulsification under topical anaesthesia.
Materials & methods: This study was conducted on randomly selected 100 patients with immature or mature senile cataract, who were planned for phacoemulsification followed by intraocular lens implantation. All patients selected for intracameral injection were instilled with single drop of topical anaesthetic proparacaine 0.5% three times, five minutes before surgery. Pre prepared 0.2 ml combination of mydriatic and anaesthetic agents was given intracameral to all patients undergoing surgery after initial clear corneal incision. All data was analysed by using statistics software SPSS 26, IBM, USA. Pearson Chi-square test, Pearson correlation 2-tailed tests were used for statistical analysis. p-values of <0.05 were considered significant.
Results: It was observed that a maximum of 7.54±0.44 mm mean mydriasis was achieved with ICM combination of mydriatics and anaesthetic in all patients. Mean time taken to achieve maximum mydriasis was 8.92±1.64 seconds. Sustained mydriasis was observed in 99% of cases throughout the surgery. A statistically significant positive correlation was observed in patient’s comfort and surgeon’s comfort. Highly significant difference in preoperative and postoperative BCVA was observed statistically.
Conclusion: Intracameral injection of 0.02% of tropicamide + 0.31% phenylephrine + 1% lidocaine, along with topical anaesthesia, is rapid, effective and safe in inducing and maintaining intra-operative mydriasis in phacoemulsification, as demonstrated by pupillary diameter measurements during surgery, patient's feedback and surgeon’s feedback.

Red cell distribution width (RDW) have been found to be altered in uncontrolled diabetic patients because of consistent increase in HbA1c values that are known to induce functional and structural changes in Hb and an alteration in its cytoplasmic environment. Alteration in RDW may have a role in the diagnosis and monitoring of glycemic status along with its complications.
Objective: Present study aims towards analysis of correlation of red cell distribution width with HbA1c in T2DM patients.
Methodology: Present study was a case control study in which total 50 cases and 50 controls were recruited. Controls were the healthy non-diabetic patients and cases involved patients with diabetes. Patients were categorized as diabetic and non-diabetic as per American Diabetes Association Diagnostic Criteria. 3ml blood sample was obtained to analyze the RDW and HbA1c.
Results: The mean age of patients was 59.54±10.78 in the cases and was 55.40±15.63 in control group. The mean HbA1c was 10.79±2.45 was significantly high in cases compared to 5.59±0.31 in controls. The mean RDW was 13.69±1.31 in cases and 13.40±1.17 in controls which do not differ significantly. In diabetes patients, a non-significant positive correlation was observed between the HbA1c and RDW with the correlation coeffect of 0.027.
Conclusion: In present study, a non- significant correlation was observed between the RDW and HbA1c in diabetes patients. A multicentric study with a large sample size is required to establish diagnostic significance of RDW in diabetes patients.

Placenta Previa is the complete or partial covering of the internal os of the cervix with placenta. It is the major risk factor for postpartum haemorrhage and lead to morbidity and mortality of the mother and new born. Uncontrolled postpartum hemorrhage from placenta previa and PAS (placenta accreta spectrum may necessitate need for blood transfusion, hysterectomy, ICU admissions and even death.
Aim: To compare the maternal and fetal outcome between primigravida and multigravida women with placenta previa admitted in Government Vellore Medical College, Tamil Nadu.
Results: The incidence of placenta previa was highest among the following age groups
20-29yrs i.e.67.32%, most common risk factors are caesarean section 45.5%(1 LSCS-30%, 2LSCS-16%), 1 bleeding episode cases-78% followed by 15% of cases has 2 episodes of bleeding,79% of cases in our study participants had cephalic presentation followed by breech 16% followed by transverse lie 5%,Type 2A Placenta previa had 46%, Type 2B placenta previa had 18%,Type 3 Placenta previa 16%,Type 4-11% Lowest incidence.
Type 1 placenta previa 9%, 82% of cases underwent emergency LSCS, 50% of cases underwent prophylactic uterine artery ligation, 32% of cases had PPH managed medically and surgically, 9% of cases underwent elective LSCS, for all 9 cases prophylactic uterine artery ligation done, no postpartum hemorrhage.
Type 2A placenta previa - 46 cases (6 cases elective LSCS, 40 cases emergency LSCS) 15 cases had foley tamponade with uterine artery ligation, 12% cases had foley tamponade, 1 cases underwent subtotal hysterectomy).
Type 2B placenta previa -18 cases (2 cases elective lscs, 16 cases emergency lscs) 9 cases had foley tamponade with uterine artery ligation, 4 cases had uterine artery ligation, 2cases had uterine artery ligation with B lynch).
Type 4 placenta Previa, 11 cases (emergency lscs), 5 cases – Foley with uterine artery ligation, 3 cases total hysterectomy, 1 case subtotal hysterectomy1 bladder repair.
Out of 9 perinatal deaths, Asphyxia and prematurity were major contributions 4.3% and 2.6% respectively followed by RDS1.6%) Neonatal mortality was 8-9% with placenta previa. Perinatal death were higher in gestational age between 30-33 weeks.

Epiphora is the overflowing of tears in the presence of normal tear production that could be due to obstruction in the lacrimal drainage apparatus. Immediate resolution might occur in most of the cases within one year of life. The objective of this study is to assess the clinical profile and treatment outcome of various children with epiphora.
Materials and Methodology: A total of 215 eyes of 175 patients (50 bilateral cases) aged less than 11 years. Demographic data such as age, gender, laterality and clinical history of the patients were recorder after getting details from the parents or attendants. Chi‑square and Fisher’s exact test were used to test the difference in the two proportions was done using SPSS (version 11) (SPSS Inc., Chicago, USA) P < 0.05 was denoted a statistically significant difference.
Results: A total of 175 patients were studied. The mean age of onset of symptoms was 1.6 ± 2 years (range, 1 month–8 years) and the mean age of presentation was 2.8 ± 2.5 years (range, 2 months–9 years). Ninety‑six patients (55%) had an early onset (<3 years) and 79 patients (45%) had a late‑onset epiphora (≥3 years). The male: female ratio in the early‑onset group was 1.5:1, and in the late‑onset group, it was 3.3:1, with an overall ratio of 1.9:1. Overall, 131 cases (75%) were unilateral (64% in early‑onset group and 88% in late‑onset group).
Conclusion: Increasing age invariably decreases the success rate of sac massage and probing. The factors that are predictive of treatment failure other than age are laterality, increasing symptom severity, presence of infection, and previous history of treatment.

The objective of this study is to compare the outcomes of femtosecond laser assisted DALK with stromal dissection and femtosecond laser-assisted DALK without stromal dissection in the management of keratoconus.
Materials and Methodology: A total of 24 keratoconus affected eyes of 20 patients who had undergone femtosecond laser-assisted keratoplasty in the Department. Predescemetric group comprised of 13 eyes from 9 patients (8 males, 2 females) with the mean age of 29.6±8.9 years whereas in the descemetric group 11 eyes from 11 patients (8 males, 3 females). All those treated patients were clearly examined pre and postoperatively with respect to uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA).
Results: The differences of BCVA, corneal astigmatism, corneal curvature between the two groups were not statistically significant (p>0.05). Loss of endothelial cell density (ECD) was slightly higher in the descemetric group (6.6%) than the predescemetric group (4.8%). But the mean postoperative myopia was -9.45±7.47 D in the predescemetric group when compared with -1.05±1.15D in descemetric group which was seemed to be statistically significant.
Conclusion: Femtosecond laser-assisted descemetric lamellar keratoplasty with big bubble technique has proved to be the alternative procedure to manage the patients with keratoconus when compared with femtosecond laser-assisted predescemetric lamellar keratoplasty.

The gallbladder is stimulated to contract and expel the bile in to
duodenum by the hormone cholecystokinin pancreozymin (CCK) produced by the
endocrine cells of the duodenal mucosa in response to food (Norman S. Williums, Bailey
and Loves, 25th edition). Aims and Objectives: Study of Clinical profile and factors
associated with Gall Stones at tertiary health care center. Methodology: This was a
cross-sectional study in the patients of Gall bladder disease in the department of
Surgery of a tertiary health care center during the year January 2016 to January 2017
so during one-year period there were 106 patients after written consent were included
into study. The data was presented in the Tabular form and expressed in the
percentages. Result: In our study we have seen that The majority of the patients were in
the age group of 40-50 were 30.19%, followed by 50-60 -26.42%, >60 were 19.81%, 30-
40 were 14.15%, 20-30 were 6.60%, <20 were 2.83%. The majority of the patients were
Female i.e. 55.66 %, followed by Male- 44.34 %. The most common clinical features
were Belching in 90%, followed by Heartburn in 85%, Nausea -80%, Vomiting in 78%,
Bloated feeling after meals in 74%, Intolerance to fatty or fried foods in 70%. Bitter
taste in the morning in 65%, Epigastric discomfort in 59%, Pain in right shoulder in
49%, Back pain in 43%. The most common associated factors were Age >40 in 76.41%,
Obese (BMI > 30) in 60%, Female -55.66 %, Family history in 50%, H/o Diabetes -49%,
H/o Liver disease -43%, Non- Veg diet-40%, Diet low in fiber -39% Conclusion: It can
be concluded from our study that The most common clinical features were Belching,
followed by Heartburn, Nausea etc. and the most common associated factors were Age
>40, Obese (BMI > 30), Female sex, Family history, H/o Diabetes, H/o Liver disease,
Non- Veg dietDiet low in fiber etc.

Breast cancer is a leading cause of cancer mortality among women second only to lung carcinoma. There has been substantial progress over the years and decline in mortality is due to early diagnosis and intervention. Growing knowledge regarding breast carcinoma biology has had a greater impact on its management. SARS CoV-2 COVID-19 outbreak had a significant effect on the existing health care services. This pandemic posed multiple challenges in care and management of non-COVID diseases including breast cancer management. Methods: The present study is retrospective data analysis of patients suffering from carcinoma breast reporting to the Government Medical College and Hospital, Jammu from March 2020 to August 2022 and type of management offered to them. This was compared with data from January 2018 to December 2019. 372 patients in the age group of 20-80 years of either sex reported in 2020-2022 and 710 patients in the age group of 20-80 years of either sex reported during 2018-2019. Result: During 2020-2022, most of the patients (n= 346) presented with advanced breast cancer and underwent neo-adjuvant therapy. 26 patients underwent modified radical mastectomy followed by adjuvant chemotherapy. 157 patients were lost to follow up. As against the previous years where the number of patients who underwent modified radical mastectomy were n= 67(2018), n= 73(2019) and number of patients who underwent neoadjuvant therapy were n= 253 (2018) and n= 317 (2019). Conclusion: Due to COVID – 19 pandemic, there was drastic decrease in carcinoma breast patients reporting to tertiary health care centre. Whosoever reported were in advanced stage of the disease leading to poor prognosis. Furthermore, large number of patients were lost to follow up. Healthcare policy needs to be redefined for non-COVID surgical diseases management including cancer patients

Fracture shaft humerus make up to approximately 1% of all fractures. Surgeons are now trying to balance the disadvantages of conservative and operative management by minimal surgical intervention (biological fixation by closed intramedullary nailing). The present study was aimed to study antegrade interlocking intramedullary nailing of the humerus in adults. Material and Methods: Present study was hospital based, prospective & observational study, conducted in patients > 18years, either gender, with fresh fracture shaft of humerus underwent antegrade interlocking intramedullary nailing of the humerus. Results: Out of 30 patients, commonest age group affected was between 31 to 40 years (30%). Majority of patients 12(40%) had simple transverse type of fracture followed by bending wedge fracture in 7(23.33%) patients. Majority of patients 15 (50.00%) were operated on due to associated multiple injuries of the axial or appendicle skeleton, 23(76.67%) Acute fracture, 1(3.33%) delayed unions, 4 non-union and 2 pathological fractures were treated. There were 25(83.33%) closed fractures and 5(16.67%) open fractures at admission. The commonest associated injury was trauma to the contralateral Colle’s fracture 4 (2 1%) femoral shaft fracture 4 (13.2) followed by associated juries to the appendicular or axial skeleton. Excellent to good results were seen in 93.33% patients. Out of the 30 cases followed up, one patient had pain in the shoulder in abduction and forward flexion, symptoms of the impingement syndrome which were relieved after removal of implant. All 4 cases of radial nerve palsy had excellent function return at the end of 6 months. Conclusion: Management of fracture shaft humerus by the antegrade interlocking nail in adults had advantages of a closed over an open procedure are, short operative time, immediate postoperative mobilization of patient, the biomechanical advantages and low complication rate.

Snake bite is a major health problem throughout the world, more so in tropical and sub-tropical countries. One of the most important effects of snake envenomation is hematologic abnormalities including coagulopathy, most commonly a venom-induced consumption coagulopathy (VICC).Present study was aimed to study international normalized ratio and whole blood clotting time in patients with vasculotoxic snake bite at a tertiary hospital. Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of age > 18 years, either gender, with history of snake bite, features suggestive of hemotoxic envenomation - Rapid extension of local swelling from site of bite or early spontaneous systemic bleeding or early systemic symptoms of collapse (hypotension and shock) or passage of cola coloured urine OR Whole blood clotting time more than 20 minutes OR INR > 1.5. Results: In present study, out of 91 snake bite cases, 51 cases were vasculotoxic (56.04 %). Mean age of study patients was 35.23 ± 11.34 years, majority were male (60.78 %). Among 51 cases, 20-minute WBCT was positive in 23 cases (45.1 %) & negative in 28 cases (54.9 %). Based on INR, Coagulopathy (INR >1.5) was noted in 30 cases (58.82 %) & Non-coagulopathy (INR ≤1.5) was noted in 21 cases (41.18 %). Sensitivity and specificity of 20-minute WBCT (by considering INR as standard) was 60 % & 76.19 % respectively. Positive predictive value & negative predictive value of 20-minute WBCT (by considering INR as standard) was 78.2 % & 57.14 % respectively. Conclusion: Sensitivity, specificity, positive predictive value & negative predictive value of 20-minute WBCT (by considering INR as standard) was 60 %, 76.19 %, 78.2 % & 57.14 % respectively.

The purpose of this study was to determine the GA by using sonographic measurement of the (HL) and to confirm that if it is reliable in estimation of GA and comparing with that (FL) in second and third trimesters in normal fetuses.
Methods: This was a descriptive cross-sectional study, consisted of normal pregnant women with singleton fetus during the second trimester and aim to evaluate the reliability of HL and FL in assessing the gestational age. This study included 175 normal pregnant women with singleton fetus, in their second trimester, with known LMP and healthy fetus. This study was conducted at the Ultrasound Department in Rajarajeswari medical college and hospital, in the period from January 2022- January 2023.
Results: In the present study, there were 45 cases in 20 gestational week followed by 29 cases in 21 gestational week. There were 37 cases with age of 21 years followed by 28 cases with age of 20 years. 3 cases were with the age of 29 years. The minimum humerus length was 11 mm at 13 weeks and maximum was 38 mm at 24 weeks. The mean sonographic humerus length at 13 weeks was 7.1 – 10.3mm and at 24 weeks of gestation is 38.6 – 40.5mm. The minimum humerus length was 10 mm at 13 weeks and maximum was 38 mm at 24 weeks. The mean sonographic humerus length at 13 weeks was 7.6 - 10.3 mm and at 24 weeks of gestation is 41.4 – 43.5 mm. There was two-fold increase in humerus length from 13 weeks to 24 weeks. It demonstrates a linear relationship between foetal humerus length and gestational age. There were 37 cases with age of 21 years followed by 28 cases with age of 20 years. 3 cases were with the age of 29 years.
Conclusion: The present study concluded that both femoral and humeral lengths were similar and reliable to estimate the GA. There was strong positive correlation between HL and gestational age done by (LMP). The HL is a basic of fetal biometry in determination of the GA and could be used in combines with FL to detect fetal bone abnormalities.

Many total knee arthroplasties in osteoarthritis Knees are being performed nowadays. The clinic-radiological profile of these cases is varied. The study is to assess the clinical and radiological outcome in cases of osteoarthritis knee that have undergone total knee arthroplasty (TKA).
Materials & methods: The randomly selected 64 patients, who had undergone TKR for osteoarthritis knee during the preceding 36 months were studied, retrospectively. Their records were evaluated in depth after getting ethical clearance. The preoperative routine and clinical assessment data were noted from the records. Wherever needed, the patients were also examined and interviewed physically during their follow-up at their convenience and after taking the individual’s due consent. It was to fill the gaps wherever felt. The data and results thus collected were recorded in a Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Student t-test and Pearson’s correlation were used for evaluation of the level of significance.
Results: According to KL grading, 28.13 per cent and 26.56 per cent of the patients were of Grades 3 and 4, respectively while 25 per cent and 20.31 per cent of the patients were of Grades 2 and 1, respectively.
Conclusion: It seems possible that the relationship between clinical and radiographic osteoarthritis severity and postoperative outcomes might be relatively unrelated to the relationship seen between preoperative KSS and postoperative outcomes. To understand and establish this relationship, further work is needed

Supplementation of vitamin D with Oral hypoglycaemics is known to reduce the levels of blood glucose. This study evaluated the role of vitamin D and its combination with metformin on blood glucose level, body weight and assess the effect on serum IL-6.
Material and Methods: An experimental study was conducted in Department of Pharmacology and Therapeutics, King George’s Medical University, Lucknow. Total of 30 wistar rats divided into 5 groups with 6 rats in each group. All rats were induced type 2 diabetes after administration of high-fat diet (HFD) for 2 weeks followed by an intraperitoneal (i.p.) injection of single low dose of streptozotocin (STZ) (35mg/Kg) dissolved in cold sodium citrate buffer (pH 4.5, 0.1 M)  in a dose volume of 1ml kg−1 except the first group that served as control untreated group. A total of 6 diabetic rats treated with an oral dose of vitamin D₃ (500IU/day) with metformin (200 mg/day) for 7 weeks along with HFD comprised the Group 3 of the study while another 6 diabetic rats treated with an oral dose of vitamin D3 (100IU/day) with metformin (200mg/day) for 7 weeks along with HFD comprised Group 4 and 6 diabetic rats treated with metformin (200mg/kg) for 7 weeks along HFD who comprised Group 5 of the study.
Results: A total 6 rats were fed on normal pellet diet throughout the experiment. There was a statistically a significant difference in the blood glucose levels in this study (p<0.05). The intergroup comparison also shown the same. The intergroup comparison of IL-6 had also shown a significant difference (p<0.05). The post hoc analysis had also shown a significant difference between the groups.
Conclusion: The authors conclude that there is a significant reduction of serum glucose and IL-6 levels in rats treated with the combination of Vitamin D and Metformin than the controls.

The Sequential Organ Failure Assessment (SOFA) Score has been developed, to describe the degree of organ dysfunction/failure over time in groups of patients. Present study was aimed to evaluate the SOFA score at 0 and 72 hrs and predict the outcome in patients admitted in sepsis through emergency department. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients age more than 18 years, both gender, with suspected infection, had any 2 of the q SOFA criteria(Altered mental status OR Respiratory rate >22 OR Systolic BP <= 100mmhg) & SOFA scoring more than 2, relatives willing to participate in present study.Results: In present study, 50 patients were studied. Mean age was 53.26 ± 11.619. Of the 50 subjects who were enrolled in our study 32 (64%) were male and 18(36%) were female. Final outcome of the study was 46% dead and 54% alive. Mean length of stay in hospital was 7.26 ± 3.82 days. SOFA score at admission, scores 4-5 have highest frequency and 2-3 has the lowest frequency of occurrence. As the SOFA score increases the mortality increases and as the SOFA score decreases mortality decreases. SOFA score at 72 hrs, when SOFA score is >11 it has a 78% mortality. Initial score from 2-7 had a mortality rate of 12.5%,8-11 had a mortality rate of 60% and above 11 had a mortality rate >91%.Delta SOFA with mortality when the score is > 2 there is a mortality of 20 persons and when the score is <-2 there is less mortality.Conclusion: The SOFA score demonstrated fair to good accuracy for predicting in-hospital mortality when applied to patients with severe sepsis with evidence of hypo-perfusionat the time of ED presentation.

There are limited data available on comparing dexmedetomidine and fentanyl as adjuvant to Bupivacaine in brachial plexus block. Considering the low side effect and excellent postoperative analgesic efficacy of two drugs, it is essential to carry out a comparative evaluation of two drugs for their use with bupivacaine as adjuvant in patients undergoing upper limb surgeries which require supraclavicular brachial plexus block. Thus, the present work has been undertaken to study and compare the effect provided by dexmedetomidine and fentanyl as adjuvants to bupivacaine in supraclavicular block.
Material and Methods:  90 patients were divided into three groups; Group C (n=30): 0.5% bupivacaine hydrochloride 30ml, Group D (n=30): 0.5% bupivacaine hydrochloride 30ml and 1mcg/kg dexmedetomidine and Group F (n=30): 0.5% bupivacaine hydrochloride 30ml and 1mcg/kg fentanyl. After completion of injection; parameters (HR, RR, SBP, DBP, MAP, SpO2) were noted. Statistical analysis was performed using SPSS version 22.0 IBM. Parametric data was analysed using student t-test.
Results: Heart rates were similarly maintained in all the three groups across the time points as revealed by the insignificant p value at all the time points (p>0.05). Mean arterial pressure (MAP) was similarly maintained in all the three groups across the time points as revealed by the insignificant p value at all the time points (p>0.05). One incident of bradycardia was noted in Group F which was managed by giving Inj. Atropine 0.6mg; One patient complained of Dry mouth in Group D; One incidence of nausea was seen in Control group and Group F. Other side effects like hypotension, sedation, or itching were not noted in any of the groups in the present study.
Conclusion: The study showed no significant difference in heart rate and mean arterial pressure or any incidence of significant side effects seen with Fentanyl and Dexmeditomidine groups. Thus, we conclude that Dexmedetomidine is better than Fentanyl when added to Bupivacaine or Bupivacaine alone for use in nerve stimulator guided supraclavicular brachial plexus block without any significant complications

Zinc is one of the most important trace elements for the body. It plays a major role in various aspects of physiology, immunity and skeletal growth. Zinc deficiency may be particularly relevant to early development, growth and function of many organ systems, including the neurologic system. Typical clinical manifestations are commonly observed only for conditions of severe zinc deficiency. Increasing data suggest significant subclinical effects of a moderate zinc deficiency in preterm neonate. Thus, this study was done to see the effect of zinc for growth and neurodevelopment in premature babies.
Materials& Methods: The prospective cohort study was conducted in preterm neonate from December 2019 to December 2020 at Department of pediatrics J.L.N. Hospital & attached group of hospital Ajmer, Rajasthan, India. A total of initial 100 premature babies who fulfilled the inclusion criteria, were included in the study. We included infant born preterm (gestational age 30 to < 37 weeks) and low birth weight (birth weight 1000 to <2500 grams) who were admitted to the neonatal intensive care unit of pediatrics department. Zinc was given once daily till 3 months of age in the study group and follow up for 6 months. All 50 preterm neonates receiving Zinc supplementation included in group I.  All 50 preterm neonates not receiving Zinc supplementation included in group II.
Results: A total of 100 premature babies were enrolled for study out of which 50 (50%) in group I (zinc) and 50 (50%) in group II (non-zinc). Our study presents the successive p-values for Weight, Length and Head Circumference at Baseline, 1Month, 3 Month and 6Month intervals. Weight was not significant at the enrolment phase but in the first month, three month and six month was significant (P value <0.05) the difference in the means of group I and group II. In the case of Length, at baseline phase, the difference in means was not significant but in length at 1^st month age (p-value 0.001), at 3^rd month (p-value 0.000), and at 6^th month (p-value 0.001) were significantly in group I as compared to group II. The Mean of head circumference at different levels at enrolment (P-value 0.11), at 1^st month of age (P-value 0.36), 3^rd month (P-value 0.13) and 6^th month (P-value 0.0.22) were not significant. However, there was no significant difference between zinc and control group in head circumference and neurodevelopmental score at age of 6-month.
Conclusion: We concluded that enteral zinc supplementation in preterm infants at the dose of 2mg/kg/day for 3 months resulted in improved weight gain and linear growth till 6 months follow up. However, there was no significant difference between zinc and control group in head circumference and neurodevelopmental score at age of 6-month.

Prostatic specimens have a wide histological spectrum of benign and malignant lesions. With benign mimickers of prostatic adenocarcinoma, it can be diagnostically challenging in some cases. The present study was conducted to observe the histomorphological spectrum of prostatic lesions, and to evaluate the usefulness of basal cell specific anti-cytokeratin antibody for HMWCK (34ßE12) immunostaining in differentiating benign mimickers from prostatic adenocarcinoma.
Materials and Methods: Histomorphology of 229 consecutive prostatic specimens received over a period of six months was studied in this retrospective study. Immunohistochemical staining using basal cell specific antibody high molecular weight cytokeratin HMWCK (34ßE12) was done on 33 cases. Prostatic adenocarcinoma cases were graded according to ISUP 2014 Modified Gleason grading system.
Results: Both benign and malignant lesions had a peak incidence in seventh decade of life. Benign lesions accounted for majority of cases (88.21%), of which benign prostatic hyperplasia was the commonest lesion (84.71%). The incidence of prostatic adenocarcinoma was 11.79%. In cases of adenocarcinoma, maximum number of cases were of grade group 5 (40.8%). IHC using HMWCK was useful in 90.9% cases where it either confirmed (81.8%) or changed (9.1%) the diagnosis, thereby improving overall diagnostic efficacy.
Conclusion: Morphological spectrum of prostatic lesions is wide. Histopathology remains the cornerstone of diagnosis in most cases. Immunohistochemistry with basal cell specific marker HMWCK is valuable as an adjuvant to histopathology in diagnostically challenging cases.

Yoga asanas and pranayama can control the blood sugar in a cost-effective manner, as there is no requirement of any sophisticated equipment with maximum space or fitness classes. The aim of this study to evaluate the effect of Yoga on blood sugar and body mass index (BMI) values for different time durations of Yoga training at tertiary care center.
Materials & Methods: A cross sectional observational study done on 200 subjects of both the genders in the age group 20-50 years were performed in the Department of physiology and Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, U.P., India during one year period. Subjects performed asanas supervised by primary investigator, in sitting, standing and lying position for 45 minutes daily, five days a week. Each asana was performed for 3 repetitions and the end position of each repetition was hold for 30 seconds. Purak and Rechak (deep breathing) was coordinated with the different posture of every asana. Thirty seconds rest period was given between each asana. Cool down was done with Shavasana for 5 minutes.Appropriate descriptive and implemented statistics were carried out using SPSS (Statistical Package for Social Sciences) version 22.0 software.
Results: Our study showed that 62% of participants were between 41-50 years among males and 92% of participants between 31-50 year’s  in females. Both male and female participants showed a negative correlation between the blood sugar level and yoga performance. Also, a negative correlation existed between the BMI and their yoga performance. Positive correlation is seen between the blood sugar levels and BMI values in both genders.
Conclusion: Yoga cannot cure diabetes but keeps a beneficial check on blood sugar values. Hence yoga is more of cost effective, does not need any equipment as in exercise, it can be done within four walls   with adequate ventilation and long term effect of this yoga can explore the beneficial effects on glucose and other hormonal homeostasis, insulin sensitivity, it can improve cognition, and keep the body in shape with a sense of well-being.

Preterm prelabour rupture of membranes (pPROM) occurs in 2–3% of all pregnancies leading to 30–40% of preterm births. The latent period from membrane rupture to delivery is typically brief after pPROM. The present study undertaken is to identify the risk factors causing pPROM and to study fetal and maternal outcome associated with pPROM.
Materials & Methods: A hospital based prospective study done on 60 patients admitted with pPROM under the Obstetrics and Gynaecology department, at district Hospital during one year period. The onset of complications like fetal distress, fetal heart rate variations, chorioamnionitis were looked for. In cases of fetal jeopardy or any other obstetric complications, labour was cut short by the caesarean section. The babies were followed up in the postnatal period. Neonatal mortality and morbidity were noted. Neonates were monitored for the complications of birth injuries, signs of asphyxia, meconium aspiration and sepsis. Both mother and baby were followed up till their stay in the hospital. Statistical analysis was performed with SPSS statistical software with all the relevant data compiled and entered.
Results: Among the selected cases, pPROM was noted in 6 (10%) mothers in the age group of <20 years, 33 (55%) mothers in the age group of 21-25 years, 14 (23.33%) mothers were in the age group of 26-30 years, and 7 (11.66%) mothers above 30 years of age. Majority of cases belong to socioeconomic status V with a total of 39 cases (65%). Number of multigravida in the study was 22 (36.66%) and primigravida were 38 (63.33%). Out of 60 patients studied, 49 cases (81.66%) were booked and 11 cases (18.33%) were unbooked. Out of 20.58% of neonatal morbidity, complications were maximum in 35-36 weeks group. NICU admissions were more common in 28-31 weeks group. Risk factors were commonly found among 32-34 weeks group with 45%. Out of 13.33% who had latent phase of >3 days, 10% of them were of <34 weeks of gestational age.
Conclusion: We concluded that the most common age group to suffer from pPROM was 21-25 years. There were no risk factors in most of the mothers, but the risk of breech presentation can be avoided by coitus in the later weeks of pregnancy reduces the risk of pPROM. Neonatal care facilities can be improved to manage neonatal emergencies so as to reduce neonatal deaths.

Childhood poisoning is one of the emergencies commonly encountered in paediatric practice.Young children aged 1 to 5 years were found to be more prone to innocently ingesting small amounts of a single substance. New research indicates that various social and demographic factors like family size, socioeconomic condition, child rearing and care, exposure and accessibility of poison as well as availability and efficiency of medical facilities are important factors which significantly influence the occurrence and outcome of acute household poisoning cases in children.So, the present study was intended to know various epidemiological factors and clinical profile of children presenting with poisoning.
Materials & Methods: A cross sectional prospective descriptive study done on 100children admitted to Pediatric ward were strongly suspected or proven to suffer with acute poisoning at department of Pediatrics J.L.N. Hospital, a tertiary care medical centre attached to J.L.N Medical College Ajmer, Rajasthan during one year period. Socio economic status was classified according to Modified Kuppuswamy SE scale. Patient’s bio data, detailed history, type and nature of poisoning, associated psychological factors and clinical features, course and outcome of acute poisoning in the children. Data entry and Statistical Analysis was performed with the help of Microsoft Excel and SPSS version 22.0v.
Results: The mean age of subjects in this study was 10.99 years. 53% of the children were in the 12-18 years group. 53% of the subjects were females. More than 80% of the study population belonged to the lower and lower middle class. The mean duration in hospital was 1.92 days. Insecticides formed 53% of the poisoning agent followed by household poisons like rat poison and ant killer chalk 20%.57% of children had consumed poison with an attempt to commit suicide and 43% had it accidentally.
Conclusion: We concluded that low socioeconomic status and low percentage of literacy among the parents of the study subjects resulted in poor awareness about the danger of inadvertent or intentional poisoning of their children

Pleural effusion is a collection of fluid in the Pleural space. Determining the cause of a pleural effusion is greatly facilitated by analysis of the pleural fluid. Etiological diagnosis in of those cases is a diagnostic challenge to the clinician because even after all cumbersome work-ups some cases remain undiagnosed. Pleural effusion remains undiagnosed after routine tests in pleural fluid in many patients. so, we need a simple and safe investigative tool to evaluate undiagnosed effusion. This study is designed to diagnose the cases of undiagnosed effusions by a simple and safe investigative tool.
Materials & Methods: A hospital based prospective study done in 30 patients with exudative pleural effusion remain undiagnosed after pleural fluid analysis in department of respiratory medicine at government medical college, Bhilwara, Rajasthan during one-year period. Pleural fluid sent for basic biochemical and microbiological investigations. Pleural biopsy was performed using ABRAM’S pleural biopsy needle under strict aseptic precaution under local anesthesia and the specimen was sent for the following investigations such as histopathological examination, rt-PCR and culture for Tuberculosis by BACTEC.
Results: Histopathological examination diagnosed 46.66% of biopsy specimens as tuberculosis and 23.33% as malignancy. The rest 30% of case were left undiagnosed after histopathological examination of Pleural biopsy. Reverse Transcriptase Polymerase Chain reaction was positive in16.66% of the cases and was negative in 83.33% of the cases. Our study shows that tuberculous pleural effusion is more common in the younger age group and malignant pleural effusion more common in the elder age in both males and females. There were no false positive results with histopathological examination, BACTEC & rt PCR making the specificity and positive predictive value as 100%. The sensitivity was 70%, 10% & 25% respectively and negative predictive value was60%, 35% & 40% respectively in tuberculosis patients

Magnesium deficiency leads to the progression of atheromatous plaques which occurs as a result of hyperlipidemia. Myocardial infarction is one of the most common causes of mortality where its prognosis depends upon various factors.This study is designed to know the contribution of magnesium levels in the serum of acute MI patients to the occurrence of arrhythmias.
Materials & Methods: This observational cross-sectional study was conducted in the Medicine Department, Govt. Medical College, Barmer, Rajasthan, India during one year period. A total of 30 patients of AMI were enrolled in this study. They were diagnosed with AMI on the basis of clinical symptoms, cardiac biomarker levels and/or Electrocardiography (ECG) findings. For all the patients, serum magnesium levels on day 1 and day 5 were measured and its association was observed with the clinical consequences.
Results: In this study group of 30 cases, 25 were males and 5 were female patients with a male-female ratio of 5:1. The mean value of serum magnesium on day-1 those with arrhythmias is 1.62±0.23 those without arrhythmias is 2.03±0.49 (p<0.001). There is a significant difference in the magnesium level in patients with arrhythmias and without arrhythmias. The serum magnesium level in patients with arrhythmia on Day-5 is 1.93±0.26 and in those without arrhythmia is 2.52±0.61. The difference between these two is found to be statistically significant with p- value (p<0.001).
Conclusion: We concluded that patients with acute myocardial infarction with low magnesium levels are more prone to develop ventricular arrhythmias compared to those who are having normal magnesium levels.

The surgical site infection is defined as the occurrence of infection to the surgical site within 30 days of surgery if no prosthesis is placed and up to 12months if a prosthetic is implanted in the patients. The commonest risk factors of surgical site infection are, degree of contamination, patient’s own normal flora, organisms present in the hospital environment, preoperative preparation of surgical site, comorbidities etc. The present study was undertaken to evaluate the role of subcutaneous suction drain in reducing surgical site infections in emergency laparotomies.
Material and Methods: This prospective comparative study was conductedin Department of Surgery, GMC, Jammu over the period of 6 months and categorized a total of 100 patients in two groups, i.e. Group -A and Group- B. Group – A consist of 50 patients who had subcutaneous suction drain and Group-B consist of 50 patients, who didn’t receive subcutaneous suction drain.A detailed history was collected, physical examination and routine investigations were done and all the patients were followed up in post-operative phase. Data was tabulated, organized, analysed and interpreted in both descriptive and inferential statistics i.e., frequency and percentage distribution, by using statistical package for social science software (SPSS), version 22.0.
Results: In the present study, 16% patients in the drain group and 42% in the non-drain group developed infections. The hospital stay in the drain group was also relatively lower (5.23 ± 3.2 days) as compared to non-drain group i.e. 8.98±4.56 days. Further, the most common organism found was E. coli (78%) in Group-A and (80%) in Group-B respectively.
Conclusion: The findings of the present study revealed that the rate of surgical site infection (SSIs) was more in Group-B as compared to Group-A and the presence of SSIs increases the duration of hospital stay. It was concluded that the subcutaneous suction drains in emergency setting play significant role in reducing the incidence of surgical site infection.

The development of laparoscopic surgery has widened up the horizon as approach to abdominal surgery conforms and today provides an option to consider even in abdominal surgical emergencies. In this paper, we would like to highlight our experience of laparoscopic approach to treat early duodenal ulcer perforation emergencies.
Aims and objectives: To highlight the results of laparoscopic primary repair of 12 cases of duodenal ulcer perforation.
Methods: A hospital-based prospective observational study carried out on 12 patients presenting with duodenal ulcer perforation in the emergency department. The decision to choose between laparoscopic and open approach was based on the discretion of the supervising surgeon, and 12 cases were randomly selected from a spectrum of patients presenting with clinically and radiologically established hollow viscus perforation.
Conclusion: . As most of the laparoscopic surgeons are well-acquainted with laparoscopic cholecystectomy, duodenal ulcer perforation repair by laparoscopy can be feasible with intracorporeal suturing skills.

Adverse events during surgery have major consequences not only on the patients but also on the healthcare system. With around 310 million surgeries happening globally and increasing complexities in surgery, mishaps during surgery have contributed to a major proportion of preventable errors. The World Health Organization (WHO) introduced the WHO Surgical Safety Checklist (WHO SSC), as a tool to reduce harm in surgical patients, in 2008. The checklist has had global acceptance, evidenced by mandatory implementation across the globe by regulatory authorities. This literature review is intended to understand the evolution of the WHO SSC, the pattern of implementation, impact of the WHO SSC on global healthcare and the improvisation of existing checklist strategy. The use of the WHO SSC across the global healthcare facilities is widespread and the operating room staff perceive the checklist as having a huge positive impact on patient safety and work efficiency

There is insufficient support for a permanent restoration in endodontically treated teeth with significant tooth structural loss. It's critical to preserve the apical seal when repairing them with post and core.
Aim: Apical leakage assessment following both delayed and instant postspace preparation utilizing different root canal sealers.
Materials and Methods: The roots of forty single-rooted teeth were biomechanically shaped, while using gutta percha for obturation, and sealed with AH Plus (Group A, n = 20) and Sure-Seal root canal sealer (Group B, n = 20) after being decoronated. A and B Groups were further separated as A1 and A2 and B1 and B2, respectively. Postspace was created straightaway for A1 and B1. After one week of preservation in physiologic saline, the post space for A2 and B2 was created. Rhodamine B dye was applied to the samples for 48 hours, after which they were cut lengthwise to examine dye penetration along the radicular dentinal wall via a stereomicroscope. The penetration of dye was linearly calculated, and then subjected values were analyzed with t-test statistical analysis and one-way analysis of variance
Results: The comparative variance between Group A (0.9 mm) and B (3 mm) proved to be statistically significant (P 0.001). Though, no statistically relevant difference between the subgroups for delayed and immediate post space preparation (B1 = 2 and B2 = 3 ; A1 = 0.9; A2 = 1, P 0.001).
Conclusion: As compared to Sure-Seal root canal sealing material, AH Plus sealing material shown less leakage. Timing for making postspace has no effect on apical leakage, since the difference in leakage values between the delayed and immediate post space preparation groups was not statistically relevant

Candidiasis is the commonest fungal infection affecting mucosa, skin, nails, and internal organs in the human host. Resistance to antifungal drugs is a growing problem, thus it important to study the burden of fungal infections and best therapeutic options available to treat them in a geographical location.
Objectives:  The purpose of this study was to determine the prevalence of infections caused by Candida species and its antifungal susceptibility profile in a tertiary care teaching hospital of rural Gujarat, India.
Materials and Methods: This is an observational retrospective study. Data was collected for a period of five years (from January 2016 to December 2020) using Laboratory Information System (LIS) of Central Diagnostic laboratory of a tertiary care teaching hospital in rural Gujarat. The antifungal tested were Amphotericin B, Clo-trimazole, Fluconazole, Flucytosine, Voriconazole, Caspeofungin and Micafungin with isolated fungal species in our study.
Results: A total of 53,195 culture samples were received during the study period with culture positivity rate of 37.27% (n=19,829) including bacterial and fungal isolates. Out of 19,829 isolates, 544 (2.74%) belonged to Candida species. Majority of candida isolates i.e., 70.8% were from critical care units. The most common species isolated was Candida tropicalis (44.30%) followed by Candida albicans (36.02%), Candida glabrata (8.08%) and Candida parapsilosis (4.59 %). The drug susceptibility of Candida tropicalis to Amphotericin B, Fluconazole, Flucytosine, Voriconazole, Caspeofungin and Micafungin were 96.4%, 91%, 95.4%,95.3%, 97.4% and 98.2% respectively. Percentage susceptibility of Candida albicans, ranged from 85.7% to 99.4% for various antifungal agents. The susceptibility rates for Candida glabrata ranged from 34.7% to 100% for all antifungal agents tested. The susceptibility rates for Candida parapsilosis were 42.8% to 100% for various antifungal agents tested. Conclusion: Majority of the infections were found in ICUs. Candida tropicalis was the most frequent isolate in our study and was highly susceptible to Micafungin i.e., 98.2%. Maximum resistance was found in Candida glabrata with Caspeofungin drug i.e., 30%.

The term "diabetic nephropathy" refers to a clinical syndrome that includes persistent albuminuria, a consistent decrease in glomerular filtration rate (GFR) that eventually leads to end-stage renal disease, elevated arterial blood pressure, and increased cardiovascular morbidity and mortality. The apparent diffusion coefficient (ADC) has shown potential as a marker of renal function in several investigations, with decreased renal ADC in kidney disease. The aim of this study was to assess the difference in apparent diffusion coefficient (ADC) value in normal and diabetic kidney.
Methods: This was a cross sectional analytical study conducted from January 2021 to October 2022 in in Department of Radio diagnosis with the help of Department of Medicine. The cases coming to the Department of Medicine for routine follow up fulfilling the inclusion (age >18 years of diabetes mellitus with history of diabetic nephropathy). The MRI examination was performed using a 3 Tesla system.Binary logistic regression analysis was used for estimating the parameters of a logistic model (the coefficients in the linear combination). The p-value was taken significant when less than 0.05 and confidence interval of 95% was taken.
Results: In the study 26 (52%) cases were of diabetes mellitus while 24 (48%) cases were taken as control who were non diabetic. Out of 26 cases, majority belong to the stage 3 (46.2%) followed by the stage 4 and stage 5 with 6 (23.1%) cases each. The study included 1 case each of Stage 1 and stage 2. The ROC Analysis to find Accuracy of ADC Parameters for Detecting DM revealed that Lt, Rt and overall ADC values are highly accurate for detecting DM cases as their AUROC values comes out to be 0.999, 0.960 and 1.000 respectively, the very close/equal to perfect standard 1.000.
Conclusion: The magnetic resonance imaging- Apparent diffusion Coefficient (ADC) value is an appropriate method for assessment and evaluation of diabetic nephropathy. Renal ADC values show a significant correlation with clinical stages of diabetic nephropathy, it is a reliable diagnostic tool for differentiation between diabetic nephropathy patients from diabetic patients without nephropathy

To study hypertension induced by pregnancy and neonatal outcomes.
Materials & methods: A total of 200 premature newborns of gestational age (GA) between 20 and 35 weeks and 5 days, born alive were included. In total, 90 infants were born to hypertensive mothers (G1) and 110 to normotensive mothers (G2). The data was recorded. The results were analysed using SPSS software.
Results: The anthropometric measurements of birth weight were significantly lower in G1. Resuscitation in the delivery room and the need to use surfactant and oxygen dependence at 36 weeks of gestational age did not differ between groups.
Conclusion: There was no difference in weight and survival at 18 months of chronological age.

Constipation is defined as FC if there is no underlying organic cause, what is the case in up to 95% of children. The present study was conducted to find out the bowel function, dietary habits and their association with physical and behavioral problems in children suffering from functional constipation.
Material & methods:The present cross Sectional, descriptive study was conducted among 290 Children with functional constipation. In order to determine the kind of stool passed, a Bristol chart was employed. The proforma had been filled by principal investigator. SPSS statistical software was used for all statistical analyses (version 25.0). Statistical significance was defined as two-sided values of <0.05.
Results:About 41.8% children were less than 5year of age group and 48.9% children were between age group 6-10 years and 9.3% children belong to age group 11-14year. About 45.8% children were males and 54.2% children were females. About 37.2% children were from rural area and 62.8% children were from urban area. Maximum children (66.2%)   had  milk based diet. The p-value was 0.041366.  About 55.8% children had inadequate water intake. The p-value was .001933. About 66.5% children played indoor games. The p-value was < .00001. About 31.7% children had bowel >2/week and 68.2% children had bowel <2/week. About 28.9% children had retentive posture.  About 33.1% children had fecal incontinence and 85.5% children passed hard stool. The p-value was .046081. About 27.9% children passed Type 1 stool, 45.8% children passed Type 2 stool, 12.4% children passed Type 3 stool, 6.2% children  passed Type 4 stool, 2.7% children passed Type 5 stool, 4.1% children pass type  6 stool and no children passed Type 7 stool. The p-value was < 0.00001. About (78.6%)  children had recurrent abdominal pain.The p-value was .031733,and (49.6%) children had temper tantrum. The p-value was .044881.

Evaluation of OCT 4 expression in oral squamous cell carcinoma is the goal.
Materials and methods: The study contained 30 samples of archival tissue blocks, which were then divided into 10 each for the Well-differentiated & Moderately differentiated squamous cell carcinoma in the Cases (Oral squamous cell cancer) groups and 10 blocks for the control normal mucosa. Anti-Oct-4 antibody was used for immunohistochemical staining on the sections of Group I and Group II. The cells were counted, and the data were compared for significance with a p-value of 0.05 being considered significant.
Results: When the mean number of positive cells is compared between the control and study groups, statistical significance is seen on the correlation of OCT 4 expressions. When the average number of positive cells in normal mucosa and moderately differentiated Squamous cell carcinoma are compared, a strong statistical significance is seen on the association of OCT 4 expressions.
Conclusion: It appears that OCT 4 is involved in determining the prognosis of oral squamous cell carcinoma patients since its quantitative expression rose from normal mucosa to the well-differentiated variation of the disease, and then to the moderately differentiated variant.

Background and Objectives - The advancement in genetics has shown that recurrent pregnancy loss is associated with chromosomal abnormalities. The main objective of this study is to find out the percentage of underlying chromosomal abnormalities in cases of recurrent pregnancy loss.
Result - Out of 50 patients (16 males and 34 females) studied for karyotyping, 7 (14%) were found positive for chromosomal abnormality leading to RPL. The 4 females and 3 males with abnormalities had structural chromosomal variations; 4 heteromorphism and 3 inversion types. Chromosomes 9, 21, and Y were associated with the abnormalities, with chromosome 9 being the most frequent. The age group 26-35 years and patients with more than 4 previous abortions had a higher prevalence of chromosomal abnormalities leading to RPL. Hypertension, consanguinity, and asthma may also have some associations with RPL.
Conclusion- Chromosome 9 was the most commonly affected chromosome in both male and female patients with RPL, showing heteromorphisms and pericentric inversions. Of the 7 patients with chromosomal abnormalities, 4 were female and 3 were male, highlighting the importance of cytogenetic testing for both parents and offering alternative options for future offspring.

The study aimed to know the efficiency of cytological examination with histopathological correlation and to test the utility of F.N.A.C.in clinically suspected breast lesions.
Methods: The present cross-sectional study was done in a tertiary care teaching hospital on 122 cases. All clinically suspected cases of lump in the breast attending the cytology OPD followed with histopathological examination referred from the surgery OPD.
Results: Out of 122 study subjects it was found that 64.75% of the lesions were benign neoplastic in nature,9.84%were atypical /intermediate,2.84%lesions had suspicious for malignancy,22.95%were malignant.
Conclusion: The sensitivity specificity, PPV, NPV of FNAC in our study was found to be 96.66%,100%,100%,98.92%respectively.

Fetal biometry is a methodology devoted to measuring several parts of fetal anatomy and their growth.The present study was carried out to assess gestational age in the second and third trimesters with the help of ultrasonographic measurements of four fetal biometric parameters (i.e., biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL]) in the local population Hyderabad, and also to evaluate efficacy and significance of these four fetal biometric parameters in the prediction of gestational age by ultrasound.
Materials and Methods: The present study was carried out in 100 normal pregnant women with singleton uncomplicated pregnancy, with the known last menstrual period (LMP).
Results: FL was found to be more reliable parameter as compared to HL in both second trimester of pregnancy.
Conclusions: Variation in predicted gestational age by ultrasonography (USG) is attributed to the anthropometric difference between the two populations due to racial, genetic, nutritional, and socioeconomic factors. Therefore, population-specific measurements should be made to generate tables and regression equations for more precise reporting of gestational age and EDD by USG

Ambulatory surgery is upcoming in all parts of the world as life becomes more fast pace and time is a limited commodity. In this setting general anaesthesia using the Laryngeal Mask Airway is widely used. Laryngeal Mask Airway insertion is accomplished using Propofol as it helps blunt the laryngeal reflexes well, when compared to other induction agents.
Materials and Methods: The study was        predominantly done in the day care theatre, as this is where most number of Laryngeal Mask  Airways are used in a day. The required sample size to show a difference in the insertion conditions
Results: The following results were obtained from the study. Group I refers to placebo which was saline, Group II refers to 0.1mg/kg of Succinylcholine and Group III refers to 0.25mg/kg of Succinylcholine. Adequate sample sizewas attained with a total of 283 patients. Informed consent was taken from all patients. Group I and II had 95 patients each, and Group III 93 patients. All patients were ASA I or II. None of the patients had a difficult airway.
Conclusion: This study concludes that a low dose of Succinylcholine does facilitate insertion of the Laryngeal Mask Airway. The ideal dose is 0.25mg/kg of Succinylcholine. 0.1mg/kg is not sufficient and is associated inadequate jaw relaxation and does not always provide smooth insertion conditions.

Hearing impairment have an important consequence for language acquisition, communication, cognitive, social& emotional development; Perceived maternal stress is a risk factor for hearing impairment in infants upto 12 months of age. BERA being a noninvasive, objective test when used and interpreted properly provide a useful method of obtaining reliable estimate of hearing sensitivity among the infants.
 Aims: 1) Screening for Auditory Impairment in infants upto 12 months of age who are at risk.2) Assessment of perceived stress on mother.
Materials and method: The present study was an Analytical, Observational study. This study was conducted for a period of 12 months at R. G. Kar Medical College and Hospital, Kolkata. Total 85 subjects were included in this study.
Result: Our study showed that, more number of patients had A+ blood group [37 (43.5%)] but this was not statistically significant (p.1556). (Z=1.4204).
Conclusion: We concluded that Perceived stress scale was positively correlated with BERA wave changes in infants attending neurophysiology laboratory at R.G. Kar medical college which is a tertiary care centre.

Beta thalassemia pose a significant health burden in India. The average prevalence of its carriers is 3–4% which translates to 35 to 45 million carriers in our multi-ethnic, culturally, and linguistically diverse population of 1.21 billion people according to the Census of India 2011. Quality of life (QOL) assessments are important and are frequently required when evaluating health outcomes.¹
Aims: To assess the socio-demographic profile and the factors affecting quality of life in thalassemia major patients.
 Material and Methods: The present study was a cross-sectional study. This study was conducted from 1^st April 2021 to 31^st March 2022 at Rajindra Hospital, Patiala. 113 participants were included for study. Pediatric Quality of Life Inventory™ (PedsQL™) 4.0 Generic Core Scale was employed for measuring quality of life.
Results: 31(27.4%) participants were 5-7 years of age, 35 (31.0%) participants were 8-12 years of age, and 47 (41.6%) participants were 13-18 years of age. QOL scores in different domains of PedsQL scale classified by age groups was found to be statistically significant amongst both child self-report and parent proxy- report.  
Conclusion: Evidence continues to accumulate on the importance of HRQOL in all aspects of patient care. QOL scores in different domains of PedsQL scale classified by age groups was found to be statistically significant amongst both child self-report and parent proxy- report. QOL scores in different domains of PedsQL scale classified by age at diagnosis was not found to be statistically significant amongst both child self -report and parent proxy- report except for mean school functioning domain in parent -proxy report where it was found to be statistically significant (p=0.041).

The goal of obstetrics is a pregnancy that results in a healthy infant and a healthy minimally traumatized mother. Much of the art of good obstetric care involves the delicate balance of avoiding cesarean delivery with all its attendant complications. Planned pre-induction cervical ripening and induction of labor has become an established part of modern obstetric practice. Different methods used for the induction of labor in women with an unfavorable bishops score are, mechanical methods such as trans cervical extra-amniotic Foley‘s catheter(FC)insertion, intra cervical balloon catheter and medical methods like vaginal prostaglandin(PGE2) and misoprostol(PGE1)are used for IOL in women with an unfavorable cervix for pre-induction cervical priming. The present prospective study was conducted in a teritiary care hospital after obtaining clearance from institutional ethical committee with no GMC/IEC/140/2019 to compare the efficacy of intra cervical Foleys catheter with Dinoprostone gel (PGE2) in cervical ripening and induction of labor, maternal and neonatal outcome. Maternal outcome compared in terms of pre-induction bishop score and change in bishop score after induction, need for reinstallation and augmentation of labor, the interval between intervention and delivery, mode of delivery, indication for cesarean section, induction delivery interval. Neonatal outcome compared in terms of apgar score at 1min and 5min, perinatal morbidity and mortality. Two hundred antenatal mothers with bishop score<5were randomly allocated to be induced with intracervical foleys catheter (group A) and PGE2 gel (group B). In this study, both Foley’s balloon dilatation and PGE2 gel group had patients of almost similar age group, parity, and gestational age. In the present study, in both the groups (foleys and PGE2 gel groups), post-datism was the commonest indication for induction- 52% and 45%, respectively, followed by pre-eclampsia-19%and 32%. The mean improvement in Bishop score was higher in the PGE2 gel group when compared to the Foley’s. The need for oxytocin augmentation to deliver was higher with Foley’s balloon dilatation when compared to the PGE2 gel group. The mean induction delivery interval in Foley’s group was 13.17hours. The mean induction delivery interval in the PGE2 gel group was 11.43hours. In both the groups, the maternal and fetal outcomes are found to be similar. In both the groups, the rate of normal vaginal and cesarean section delivery was also found to be equal. This study shows that prostaglandin E2 gel is a better and more effective agent than foley’s balloon dilatation in cervical ripening and induction of labour

Suicide happens in about 10% cases of schizophrenia, however,it remains poorly understood. Both positive and negative symptoms along with comorbidities like depression play an important role in suicide in schizophrenia. Hence it is prudent to study prevalence of suicidal ideation in patients with schizophrenia with a view to reduce the mortality. Aim of the study o study the prevalence of suicidal ideations among patients with  Schizophrenia and to study association with socio-demographic profile and clinical correlates  if any.
Material and methods: This study included 60 consecutive patients diagnosed as schizophrenia  as per ICD-10. Socio-demographic data was collected ,Positive and Negative Scale for  Schizophrenia (PANSS), Modified Suicide Intent Scale and Calgary Depression Scale were  applied on study population. The data was statistically analysed, chi-square and t-tests were  applied. A significance level of p<0.05 was accepted for all analyses. RESULTS: The prevalence of suicide ideations was 41.67% in schizophrenia. The mean age of onset,  31.23 years. There was a significant association with unemployment and illiteracy. The  mean Duration of illness of patients with suicidal ideation was 2.62 years and mean duration  of untreated illness was 1.76 years. There was significant association of suicide ideations  with both positive and negative symptoms and depression.
Conclusion: An early path to  care and treatment with early recognition of relevant signs and symptoms by clinicians and  overall improvement in socio-demographic statistics like literacy levels and employment  harmonized with better community-level awareness could help us significantly decrease  mortality due to suicide in schizophrenia.

FSWs in India have experienced high levels of physical and sexual violence from clients, madams (brothel owners) and police. recent evidence from India suggests reporting of sexual violence among FSWs lies between 20% to 63%. However, in a study from southern India, the reported prevalence of physical and sexual violence among FSWs ranged between 50% to 77%. Evidence from in south and western India further suggests high level of sexual violence was perpetrated by partners of FSWs. Moreover, FSWs experienced sexual violence were more likely to be vulnerable to both reproductive health problems and HIV risks.