European Journal of Molecular & Clinical Medicine

Turmeric is a spice made from the rhizomes of the ginger plant Curcuma (Curcuma longa, Curcuma aromatica, Curcuma amada, Curcuma caesia, and Curcuma angustifolia) (Zingiberaceae). Rhizomes are horizontal underground stems that produce both roots and shoots. Turmeric's vivid yellow colour is primarily due to fat-soluble polyphenolic pigments known as Curcuminoids. For this study, ethanol was used to extract the rhizomes of five Curcuma species (Curcuma longa, Curcuma aromatica, Curcuma amada, Curcuma caesia, and Curcuma angustifolia). Flavonoids, tannin, saponins, and diterpenoids were among the phytochemicals found in the plant species. Plants have therapeutic qualities due to the phytochemical substances they contain. Non-nutritive plant chemicals with disease-preventive characteristics are known as phytochemical components. Curcuma, rhizomes, plant species, phytochemical contents, qualitative phytochemical screening

Background: Paediatric subtrochanteric fractures constitute 1% of all the fractures in children. Subtrochanteric fractures in paediatric age defined as 10% length of total femur below lesser trochanter. Mostly these fractures are unstable type. There are various treatment options available for management of this fracture depending on the age group of the patient. But there is no well defined management for adolescent subtrochanteric fractures.
Method: This study includes 20 patients present to orthopaedic emergency with closed subtrochanteric fracture without distal neurological deficit. Patients were managed operatively after informed consent with proximal humerus locking plate under regional anaesthesia. Postoperatively patients were kept non weight bearing with in bed exercises. Patients were followed at 2weeks, 6weeks, 12weeks, 24weeks and 36 weeks. Patients were evaluated functional and radiologicaly.

BACKGROUND
Chronic Otitis Media(COM) is the bacterial infection of the mucoperiosteum of the middle ear cleft that has persisted for 12 weeks and above, characterised by persistantotorrhea, tympanic membrane perforation with varying degree of hearing impairment. In mucosal COM there is permanent perforation of pars tensa with or withoutinflammation of middle ear and mastoid. Pneumatization refers to both the process by which the epithelium expands into developing bone and the resulting interconnected aircellswithin thetemporal bone.
 
25 patients attending ENT OPD, with profuse unilateral ear discharge lasting for more than 3 months were selected by purposive sampling method from April 2021 to March2022 and was subjected to detailed history taking and clinical examination. All the active mucosal COM patients were treated with conservative medical management. ThepatientsweresubjectedtoHRCTtemporalboneandresultswereanalysed.

Staphylococcus aureus is an important  bacterial pathogen responsible for a wide range of  infections. Methicillin resistant Staphylococcus aureus is defined as a strain of S. aureus that is resistant to all β-lactams  including penicillins and cephalosporins ⁽²⁾.  Methicillin resistant Staphylococcus aureus (MRSA) is known to cause community acquired and nosocomial infection. . This study aims to utilize antibiogram typing to detect various phenotypes of Staphylococcus aureus in a tertiary care setup using WHONET software.

Thoracic trauma is the third leading cause of death, after head and spinal cord injury. The incidence is increasing due to many factors. Trauma to thoracic region has a wide spectrum from chest wall injury to vital organs within the thoracic cavity. Management varies from non-invasive to invasive. A prognostic scoring system makes it easier to manage by directing resources, improved outcomes and decreased hospital stay was reported following scores and protocol based intervention in trauma victims. The available thoracic trauma scores are Wagner Score, Abbreviated Injury Scale Chest, Lung Injury Scale, Pulmonary contusion score, Ribs Score, Thoracic Trauma Severity Score, Modified Early Warning Signs. Due to difficult applicability of some scores, lack of significance for predicting outcome or resource limitation, there is no universal scoring system. The Chest Trauma Score (CTS) is derived from number of above factors, found that this simple score can predict the possibility of poor outcome like complications and mortality in thoracic trauma patients

Background: The perinatal and maternal outcome grossly depends upon the fetal weight at term gestation. In urban setup, ultrasound is easily available for birth weight estimation. In rural setup USG are not easily available and clinical methods are still used for birth weight estimation as it don’t require any costly equipment and they are easy to use and give immediate estimation of expected birth weight.
Methods: It is a Hospital based observational study done between August 2019 to December 2021 conducted at the Department of Obstetrics and Gynaecology of Dr Vasantrao Pawar Medial College, hospital and research center, Nashik, Maharashtra. All subjects with singleton pregnancy with reliable gestation scan with no fetal anomalies were included.
Estimated fetal weight (EFW) was calculated by Johnson’s formula as clinical method and Hadlock formula using Ultrasound was used. EFW were compared with the actual birth weight.

Background: Through the selection of resistant mutants, activation of latent resistance mechanisms, or acquisition of resistance determinants genes, bacteria may become more resistant after exposure. All of these processes may be sped up by antibiotic pressure.Objectives: To evaluate appropriate investigations and ascertain the condition of antibiotic resistance. Methods: After a thorough search of the online journals, 103 documents were found in total, and 54 of the papers were initially chosen. Then, 22 similar/duplicate articles were removed, leaving 41 investigations that were initially available. After reviewing the submissions' abstracts and titles, 17 more articles were disqualified. Finally, 21 papers that satisfied the inclusion and exclusion requirements were selected, including study articles and control trials.Results: All the 21 articles reported extensive antibiotic resistance to antimicrobial therapies, especially in cases of gram-negative bacterium. Conclusion: Finding strategies that can effectively lessen the burden of bacterial resistance towards antibiotics is the primary concern, whether they are applied in a variety of settings or are precisely tailored to the resources available and the most effective pathogen-drug combinations in a given environment.

BACKGROUND-Various comorbidities may show positive association with CLBP including respiratory disorder, cardiovascular disease, diabetes mellitus, anemia, obesity and mental health conditions. AIMS &OBJECTIVES-1.To study the clinical and aetiological profile in patients with chronic low backache 2.To study the association of various comorbidities with chronic low backache with special reference to axial spondyloarthritis. MATERIALS AND METHODS-Present study was a prospective one. All cases with chronic low backache  >18 years were included as subjects. Those excluded were patients with acute lower backache, age < 18 years, lower backache due to trauma, congenital causes of lower backache, those with a history of spinal surgery and bed ridden patients. Disease activity of Axial Spondylitis was determined using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and the functional assessment was done using Bath Ankylosing Spondylitis Functional Index (BASFI). In addition to X-ray L-S spine, MRI L-S spine was done in all patients.  Statistical analysis was done by SPSS software, version 19.RESULTS-Mean age of participants in this study was 46.89 years. Male to Female ratio was 2:3.Comorbidities were Hypertension in 25 (25%) Diabetes 11 (11%) COPD 9 (9%), dyslipidaemia 12 (12% hypothyroidism 3(3%), anemia 3 (3%), Coronary artery disease in 7(7%), Cerebrovascular Accident (CVA) 2 (2%), anxiety 4 (4%) and depression 2 (2%). 11 (11%) had axial spondyloarthritis, 5 (5%) osteoarthritis and 1 (1%) had rheumatoid arthritis. Axial Spondyloarthritis was significantly higher in males( P- value 0.025) and in age group less than 40 (<40 years) (P- value 0.002).There was significant association of anemia with axial spondyloarthritides(P-value 0.031). In patients with axialspondyloarthritis  was significant association of BASDAI(P- value-0.003),BASFI (P-value 0.001) and ASDAS( P -Value 0.009)with comorbidities. CONCLUSION- On the basis of our study we conclude that lower back pain is a multifactorial phenomenon.

Galeazzi fracture is the fracture of middle to DISTAL third of Radial shaft associated with disruption or subluxation of distal radio ulnar joint [DRUJ]. This injury was described 1^st by Astley Cooper in 1826 and later named after Riccardo Galeazzi who published his series of cases in 1934 and has been termed as a fracture of necessity and treated with open reduction internak fixation [ORIF] with compression plates with or without pinning of DRUJ.
Objectives: The purpose of our study is to study the functional outcome of DRUJ instability in patients with Galeazzi fractures treated with transfixing K wire for DRUJ instability.
Materials and Methods: 23 patients of Galeazzi fracture treated with transfixation with K wire for DRUJ stabilization after stabilizing radius fracture at MMCRI Mysore from September 2020 to November 2022 with age between 18 to 70 years. Functional outcome for DRUJ instability were performed at 3 months after surgery and results were analysed by using QUICK DASH score.
Results: 23 patients with Galeazzi fracture were followed up in this study, 23 patients were treated with K wire transfixation for DRUJ stabilization after fixing Radius fracture. Patients followed up at 6 weeks for removal of K wire applied for DRUJ stabilization. Functional outcome of DRUJ stability measured at 3 months after surgery with range of movements of writs joint and QUICK DASH score 95.6% of patients had good functional outcome.
Conclusion: This study showed that Galeazzi fracture patients treated with open reduction of Radius fracture followed by transfixing K wire for DRUJ instability had good functional outcome results.

Tennis Elbow [Lateral Epicondylitis] is one of the most commonly encountered musculoskeletal entities in OPD with incidence of 4-7 per 1000 with a peak at 35-40 years. Overuse activity may be the cause of disease.
Conservative Management includes activity modification, RICE Regime [Rest, Ice Compression, Elevation], NSAIDs, Corticosteroid Injection. Corticosteroid Injection works by suppressing inflammatory process. Platelet Rich Plasma [PRP] has been promoted as biologic autologous blood derived product. It works by releasing high concentrations of platelet derived growth factors [PDGF]. These growth factors stimulate stem cell recruitment, increases local vascularity and directly stimulates production of collagen by tendon sheath fibroblast thus enhancing tendon healing

The treatment of intra-articular displaced calcaneal fracture is debatable. We conducted comparative study to operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and non-operative) and were regularly followed for a period of 12 months. The outcome measures were assessed by Modified Rowe’s Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient’s job was noted after one year and compared with pre-injury status. 46 calcaneal fractures were studied. 22 of them were operated and 24 were treated conservatively. Out of 22 operated cases, Bohler’s angle was restored in 18 cases and these had good results with all three outcome scores at 1 year follow up and remaining 4 cases showed fair results. 24 cases treated with cast also showed fair results. The overall outcome of operated cases were better than non-operated cases Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler’s angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative treatment.

More than 15.9 million people in 200 countries have been impacted by the COVID-19 pandemic brought on by the extremely contagious SARS-CoV-2 virus. The highly contagious coronavirus spreads through droplets made by talking, sneezing, coughing, and even breathing. Another potential source of contamination is indirect contact with contaminated surfaces. PFT is a useful method for evaluating respiratory diseases. The most frequently used test is spirometry, which is the primary diagnostic method for airway illnesses such asthma and chronic obstructive pulmonary disease (COPD). Measurements of lung volumes, diffusing capacity, and exercise physiology tests balance out the other examinations. The purpose of this study was to examine how the lungs functioned following COVID infection.
Method: This one-year prospective study was conducted at a tertiary hospital which included 50 subjects. The subjects were assessed for 100-M walk test, FEV1, FVC and FEV1/FVC ratio post covid infection. The data was noted and analysed for association with severity.
Results: The study had predominantly males and the overall mean age was 52.68± 7.7 years. The severity was noted ranging from ground glass appearance, paving’s, consolidations and opacities. The PFT parameters at the end of COVID infection were certainly reduced based on the severity.
Conclusion: We could conclude increased severity led to significant PFT changes hampering a person directly and vice-versa. Larger population- based studies are required to justify the study findings.

World Health Organization (WHO) defines the term diabetes mellitus as- 'a metabolic disorder of multiple etiology characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both.’ Non-communicable diseases associated with changes in lifestyle and diet has become a major public health problem in both the developed and developing countries.
Objectives: To study prevalence of high risk individuals for Type 2 Diabetes Mellitus with Indian Diabetes Risk Score in Bank Employees of Urban Maharashtra.
Methods: The type of present study is a Cross Sectional community based descriptive study. Calculated sample size came to 400. The number of bank employees in each strata were calculated. There were 807 bank employees in government banks, 411 bank employees in co-operative banks and 397 bank employees in private banks. So it was decided by stratified random sampling that 200 subjects would be from Government banks, 100 subjects would be from Co-operative banks and 100 subjects would be from Private bank.
Results: The prevalence of high risk individuals for type 2 diabetes mellitus using IDRS score developed by V Mohan was 26.5% in the present study. The prevalence of already diagnosed diabetes mellitus cases was more i.e. 11.5%.
Conclusion: IDRS score was significant with age group,body mass index and family history of diabetes mellitus, waist circumference, tobacco addiction and alcohol addiction. But it did not significantly vary with gender and type of family

To determine the S.S.I. risk variables. should be familiar with S.S.I.'s bacteriological profile. To research the microorganisms obtained from wounds' antibiograms. To understand their post-operative effects.
Method: After consultation with the institute's ethical review board, a prospective observational study was conducted by Department of Obstetrics and Gynaecology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India, from June 2021 to May 2022. The microbiology lab provided a sterile swab to collect pus or discharge from the injury site for culture and sensitivity testing. 5731 surgeries were done in130 patients (22.68%) had surgical site infections (S.S.I.).
Result: 83 (63.86%) of 130 patients developed S.S.I. between 6-10 days, followed by 33 (25.38%) before 6 days. Staph. aureus was the most frequent organism, followed by E. Coli in 30 (23.08%), Klebsiella in 17 (13.08%), Pseudomonas in 11 (8.46%), Citrobacter in 4 (3.08%), and Acinetobacter in 2 (1.54%). 50 (38.46%) were sensitive to Piperacillin + Tazobactum, 42 (32.32%) were sensitive to Cefoperazone +Sulbactum, 18 (13.84%) were sensitive to meropenem, Gentamycin was 8 (6.15%), Amikacin was 6 (4.61%), Clindamycin was 3 (2.32%), Linezolid was 2 (1.53%), and 1 case was only sensitive to Levofloxacin.
Conclusion: Reducing the incidence of postoperative infections in women has the potential to lower both healthcare expenses and the severity of their complications. This is feasible if the bacteriological profile and antibiotic sensitivity of the hospital's most common organism are recognized, and if the patient's risk factors for S.S.I. are identified and classified. It is possible that our S.S.I. analysis will reveal pervasive species and sensitivity trends among the sample population and the organization under examination.

Background
During the first month of 2020 and the outbreak of a new coronavirus disease (COVID-19), Almazar District Sanitry, Epidemiological Welfare, and Public Health Service (Service) staff took the necessary measures to prevent the disease. The purpose of the research is to evaluate the effectiveness of the work performed by the Sanitary Epidemiological Welfare and Public Health Service and public health staff during this pandemic by analyzing the epidemiological chart and survey.
Methods
A retrospective study of 1900 “epidemiological cards” from the epidemiology department of the Sanitary Epidemiological Welfare and Public Health Service activity in Almazar district and
a questionnaire to its staff and employees was selected based on the analysis of the epidemiological investigation was conducted. The questionnaire was selected using Google Docs, and in Google Docs the questionnaire was created and sent through social media channels. A Likert scale was used to mark (1=yes, 2=partially, 3=no, 4=difficult to answer). The data from the sanitary epidemiologicalWelfare and Health service were analyzed using the SPSS program.

Agriculture is essential to the Indian economy. Population growth faces the most serious threat to food stability. Population growth raises demand, facing farmers to produce more to keep up with the demand. Crop yield prediction technology can assist ranchers in improving efficiency and productivity. Correct manure rates are required for the cultivation of oilseed crop yield. When nutrients are scarce or over-fertilized, yields are significantly reduced and the environmental burden is enhanced. To resolve these concerns, our proposed work employs machine learning techniques in the prediction of the yield of oilseed crops using organic manure as well as the amount and type of agricultural manure to be used for a specific crop in different districts of Tamil Nadu. The training set consists of actual yield data from 1961 to 2007 and the validation set consists of data from 2008 to 2019. The proposed algorithm’s results are compared to those of other machine learning algorithms namely bagging, random forest, linear regression and naive bayes with accuracy rates of 98.5%, 96.5%, 94.5%and 92.5% respectively. According to the study, bagging (Bootstrap Aggregation) outperforms other algorithms for crop yield prediction, while the boosting algorithms perform better for recommendation systems for determining which crop to plant, which type of organic manure to use and how much manure to use in a specific area and time.

Introduction: The spinal cord and the components that support it may be impacted by various tumours and illnesses that resemble tumours. 15% of all tumors are comprise of craniospinal tumors. If not identified early and properly treated, they can impact both adults and children and result in serious neurological abnormalities and a number of morbidities.

The study is an attempt to explore the relation of Mirror neuron and Sanskrit Language. Sanskrit language is one of the very peculiar, scientific as well as sacred language in the world. Neuro scientists, philosopher and linguistic scholars explore the magnificent dynamics and the importance of Sanskrit language, moreover its potential influence in human brain. For the past three decades, researchers have been very much interested in Neuroscience and language learning, which guide very excited rather than complex relation in the respective arena.  Mirror neuron, a specific brain cells in frontal lobes of premotor cortex in human brain. The Mirror Neurons have relative intenseto learn and adopt others intentions in closely action based language learning.In this intellectual concern, when we learn and practice Sanskritcreate great influence in the receptor sense which has been well mapped in the previous studies.  The study will explore the intrinsic relations and powerful influenceof Sanskrit Mantra and mirror neuron in the brain.

Context: Oral cavity is one of the most common sites for both neoplastic and non-neoplastic lesions especially in India.
Aims: The aim of the study is to analyze the demographics and various patterns of different oral lesions and its association with tobacco chewing and reverse smoking in a Tertiary care hospital in Srikakulam, Andhra Pradesh.
Materials & Methods: A prospective cross-sectional study was carried out for a period of 2 years in the Department of Pathology, Government Medical College, Srikakulam. The study included 92 cases of oral lesions.

Malnutrition is a multi-dimensional issue, underreported and untreated major public health problem. Elderly population is a vulnerable group who needs medical attention, the rise in inflation combined with the slowdown of the global economy likely adding more and more health concerns towards older patients. The objective of the study is to evaluate the nutritional status of elderly patients and to correlate the sociodemographic variables and chronic diseases in relation to nutritional status.

Background: A special study design known as the frontal assessment battery (FAB) was developed to evaluate frontal lobe impairment. Numerous researchers have used the FAB test to evaluate the integrity of the frontal lobe because Parkinson's disease (PD) is frequently linked to difficulties with cognitive and other higher mental functions. The Mini Mental State Examination of Folstein (MMSE), on the other hand, is another regularly used test used to evaluate mental status; however, because it does not only examine frontal brain functioning, its validity has been questioned in PD.
Material and Methods: The goal of the current study was to compare the FAB test with the MMSE scale and see whether the test could be applied to Indian patients.
Results and Conclusions:The FAB test was found to correspond with the patient's age and educational level. Despite the fact that the MMSE research is not regarded as a test that can only evaluate the condition of the frontal lobe, the results also correlated with that study's findings. To the best of our knowledge, this is the first study of its kind to be conducted in India.

Alpha two agonists such as clonidine and dexmedetomidine have been popular in anaesthesia practice as adjuvants to provide sedation, anxiolysis, analgesia and controlled hypotension. Dexmedetomidine is eight times more selective for alpha 2 receptors than clonidine. Aim: The present study was undertaken to compare effects of clonidine and dexmedetomidine on haemodynamic stability, anaesthetics requirement and recovery profile in spine surgeries under general anaesthesia. Material and Method: A total 100 patients of American Society of Anaesthesiologists (ASA )grade I and II, age between 18 to 60 years, who were schedule for thoracic and lumbar spine surgery under general anaesthesia were included in the study. They were randomized in two groups of 50 patients in each. Group A received injection clonidine 2ug/kg bolus IV over 10 min followed by normal saline infusion and group B received injection dexmedetomidine 1ug/kg bolus IV over 10 minutes followed by dexmedetomidine infusion of 0.5ug/kg/hr. Assessment of haemodynamic parameters, anaesthetic requirement and recovery profile was done. Results: With clonidine and dexmedetomidine the intraoperative haemodynamic parameters remained stable without any statistical difference. Both the drugs were equally effective in reducing anaesthetic agent’s requirement and in reducing blood loss while comparable with respect to recovery profile and adverse effects. Group B had lesser extubation time (9.72±4.1 minutes) than group A (11.44±4 minutes) which was statistically significant however it was not clinically significant ,whereas the time to achieve aldrete score of > 9 was comparable between two groups. Conclusion: Dexmedetomidine and clonidine have similar effects on haemodynamic stability, anaesthetics requirement and recovery profile.

Aripiprazole is a bitter drug, freely soluble in organic solvents but it is practically insoluble in water & its solubility is pH dependent. Therefore, In order to ensure adequate bioavailability, aripiprazole and betacyclodextrine are subjected to three different weight ratios (B5 1:1, 1:1.5, and 1:2).ARP-BCD complexes, are prepared by solid dispersion technique to improve dissolution & bioavailability of this poorly water soluble drug. Batch B5 (ii), in which the drug was complexed with β-Cyclodextrin in the ratio (1:1.5) shows 100% drug release within 60 minutes &  it releases above 90% drug within 10 minutes .Wet granulation technique was implemented to compressed tablets of best resulted ARP-BCD complex B5 1:1.5( B6), Finally the compressed tablets were evaluated for their different parameter, like, crushing strength, friability, disintegration time, and dissolution, In vivo disintegration time, Bitterness Index, resulted a successful formulation. .Batch B6 (iv) the combination of MCC (ceolus KG 802) & xylitol as a filler shows best disintegration characteristics, acceptable friability, good mouth feel, sufficient hardness and 100% dissolution profile. To the optimized batch of B6 (iv)  Acesulfame potassium ,and other sweetners and flavours were added. The intensity of the bitterness was found out by comparing the bitter index level of prepared 3 batches i.e. X1, X2, and X3. .Batch X3 with 2% sweetening & flavouring agent produces tasteless tablets with good & pleasant mouthfeel.So it was concluded that by means of addition of 2% of sweetening & flavouring agent the bitter taste masking was achieved upto the required level.

Diabetesis characterized by chronic hyperglycemia & disturbances of carbohydrate, lipid and protein metabolism. In subtypes of Diabetes Mellitus, type II diabetes mellitus is the most common endocrine and metabolic disorder. DM is a condition of increased oxidative stress and requires antioxidant.
Aim: To assess the association between of oxidative stress and lipid abnormalities in type 2 diabetes mellitus patients in comparison with healthy subjects.
Materials & Method: This is a case control study, conducted in Department of Biochemistry,
Era’s Lucknow Medical University, Lucknow, U.P., India between January 2022 to June 2022.  
A total of 90 cases of type II diabetes mellitus & 90 cases of healthy subjects between  the age
of 30 and 60 years were enrolled in study. Fasting blood glucose, glycated hemoglobin  (HbA1c),
 total cholesterol (TC), triglycerides (TG), high density lipid (HDL) and  malondialdehyde (MDA)
 levels were assessed.
 
Results: The mean age of type II diabetes mellitus cases were higher 55.2±10.1yr and 45±14 yrs in healthy subjects. The body mass index was higher 29.7±3.8 kg/m² and 24.8±5.3 in healthy controls. Significant difference was observed in FBS, Hb1Ac, TC, TG, LDL, HDL along with VLDL & MDA. With TC, LDL, VLDL, FBS, HbA1c shows positive correlation between MDA and HDL.
Conclusion: Increased blood glucose levels along with dyslipidemia in patients with diabetes causes oxidative stress leading to atherosclerosis.Early detection and treatment of lipid abnormalities may be used to minimize risk for atherogenic cardiovascular disorder & cerebrovascular accident in patients with diabetes.

Alteration in the level of Serum Sodium, Potassium and Chloride
in hepatic encephalopathy. Correlation of these levels with severity of hepatic encephalopathy
due to various causes. The role of Serum Sodium, Potassium and Chloride as a predictor for
grading of severity of hepatic encephalopathy.
Methods: Prospective observation study, All children with hepatic encephalopathy, they were
admitted in paediatrics ward of Patna Medical College and Hospital, Patna, during the period
of Jan 2018 to Dec-2019.
Conclusion: The present work is the study to evaluate changes in the Sodium electrolyte level
in children suffering from hypokalaemia. The of HE contesting of 70 male children and 50
female children were included in the study group.

Background and Objectives: The term malnutrition refers to both undernutrition as well as overnutrition. Undernutrition is a condition in which there is inadequate consumption, poor absorption or excessive loss of nutrients. Overnutrition is caused by overindulgence or excessive intake of specific nutrients. By using WHO guideline, to identify the children with SAM from the patients admitted in department of Pediatrics, PMCH, Patna.
Method: This observational study will be carried out on admitted patients in upgraded department of Pediatrics, PMCH, Patna from January  2018 to November  2019.
Conclusion: Prevalence of Malnutrition is almost similar in both the sexes with slight male dominance. Most of the malnourished child are in the age group of 6 to 12 months, and mean age of presentation was 20 month.

Background:- Ability to develop multiple drugs resistance and biofilm formation have made Acinetobacter species an important hospital-acquired pathogen and a challenge to their effective management.
Objective:- Through this study we can isolate different Acinetobacter sps. and study their antimicrobial susceptibility patterns. Isolated resistant Acinetobacter was further analyzed for the detection of Extended-spectrum β-lactamases (ESBLs), Metallo β-lactamases (MBLs), Carbapenemase production.
Materials and Methods:- Various clinical specimens which were submitted to the Department of Microbiology, Patna Medical College & Hospital, Patna, Bihar were studied for antibiot ic susceptibility testing, detection of ESBL and MBL production by standard microbiologic a l methods.
Results:- The pre-dominant Acinetobacter species isolated was A. calcoaceticus-bauma nnii Complex (Acb complex) 167 (52.1). Among those, all A. species 127 (44.7%) were multidr ug resistant (MDR). In which 12 (4.22%) were ESBL producers and 36 (12.8%) Carbapenemases producers. The majority of A. species were resistant to cefotaxime 72.6% and cefepime 78.4%. Conclusion:- Drug-resistant Acinetobacter formed a substantial proportion of this hospital’s samples. This situation warranted stringent surveillance and adherence to infection prevention and control practices.

Background: Teneligliptin, a new DPP4 inhibitor, was approved in India in 2019 and has been shown to improve blood glucose and lipid profile. The purpose of this study was to compare the efficacy and safety metformin with teneligliptin combination versus metformin with glimepiride which is the most common combination prescribed in diabetes. Material and Method: This was an interventional, open-label, randomized trial on T2DM patients presenting to the OPD of the general medicine department at AIIMS Patna. A total of 326 patients were enrolled with a 10% dropout rate then they were randomly assigned to one of two groups: Group A (163) received metformin (500 mg) with teneligliptin (20 mg), while Group B (163) received metformin (500 mg) with glimepiride (1 mg). Both combinations were once daily and were evaluated to improve glucose and lipids at regular intervals. ADRs of both groups were also recorded. Result: The comparison of blood glucose indices between the two groups was significant at the end of the six-month treatment period. HbA1c (p=0.02), FBG (p=0.02), and PPBG (p=0.03). When the group’s lipid profiles were examined at the end of treatment, there was a significant difference seen in HDL (p=0.001), LDL (p=0.12), and TG (p=0.01). The common ADRs were nausea in both groups while gastritis and weight loss were most common in Group A and hypoglycemia and diarrhea were mostly seen in Group B. Conclusion: In this study, both combinations were well tolerated, but patients who received metformin and teneligliptin showed better control of their lipid profile and glycemic index

Background and Objectives: Premedication in paediatric patients undergoing surgery is very much essential to lessen the trauma of separation from parents, to allay apprehension regarding anaesthesia and surgery, to co-operate for venipuncture, mask acceptance and to facilitate induction of general anaesthesia. Midazolam is an ideal premedicant with many desirable properties such as sedation, anxiolysis, minimal cardiovascular and respiratory effects, anterograde amnesia. Hence the present study was undertaken                   to compare between intranasal midazolam and oral midazolam with respect to onset  of sedation, effectiveness and safety. Methodology: The study population consisted of 100 ASA grade I and II patients aged between 2-8 years posted for various elective surgeries at NMCH, Patna. The study population was randomly divided into 2 groups of 50 patients each.
Conclusion: Thus from the above study, we conclude that Onset of sedation was significantly faster with intranasal administration                               compared with oral route. Midazolam administration by either route was equally.  effective and no statistical differences were seen between them. All vital signs were stable throughout the procedure in both groups and no significant differences were seen.

Hydatid disease is a zoonosis caused by Echinococcus tapeworms. Hydatid disease has wide geographic distribution and is considered a public health problem in developing country.
Objective: The present study was carried out to evaluate the demographic characteristics, clinical presentations, and management of the patients of the hydatid disease
Material & Method:The current study is a retrospective study for the patients attending a tertiary care hospital Rajasthan between august 2017 to august 2022. The information was gathered from medical records. Data was entered in Microsoft Excel and used SPSS version 22
Results:36 diagnosed patients of hydatid disease underwent during the study period, 72.2% of them were males and half of the patients were > 40 years of age. 69.4% residing at rural areas and 47.2% was belonged to lower socio-economic class. Liver was the most common site (80.5%) of involvement. Abdominal pain (94.4%) followed by nausea/vomiting (47.2%), was the most common complaint, whereas abdominal mass (58.3%) followed by palpable liver (33.3%) were the most common physical finding in our study population. Cystobilliary fistula was the common post-operative complication in hydatid disease. Surgery was the treatment of choice.
Conclusion:In hydatid disease liver was the main organ involved, abdominal pain and lump were main presenting complaints. Open surgery was the mainstay of treatment.

Despite changing strategies, meconium staining of the amniotic fluid (MSAF) happens in approximately 10-15% of childbirth. MAS develops in approximately 4-10% of the infants born from a MSAF milieu. Of these neonates who develop MAS, one third require ventilatory support, 10% develops air leak and in spite of appropriate management strategies,5-10% of them have a fatal outcome. Of the babies who suffer persistent pulmonary hypertension of the newborn (PPHN) 5-6% are related to MAS2. As per sample size 70 cases have been studied. Their outcomes were assessed. Term> 37 weeks both inborn and outborn cases were included. Preterm< 37 weeks and babies with congenital malformation were excluded in this study.Out of 70 babies taken into the study, 60 were inborn & 10 were outborn. Mean birth weight was 2.8 Kg. 72.9% were delivered through LSCS and 17.1% through instrumental and 10% through NVD. There was mortality in 5.7% 47.2% were classified as severe MAS. Most common complication in MAS was HIE (15.7%) followed by sepsis (11.4%) and PPHN (8.6%). Most common radiological features was hyperinflation (41.4%) followed by Consolidation (30%).

Respiratory distress is one of the most common reasons an infant is admitted to the neonatal intensive care unit. Fifteen percent of term infants and 29% of late preterm infants admitted to the neonatal intensive care unit develop significant respiratory morbidity; this is even higher for infants born before 34 weeks ‘gestation. Certain risk factors increase the likelihood of neonatal respiratory disease. Maximum admissions were on day 1 of life constituting 65.3%, followed by on 4 to 5 days old occupying 21.3%, 13.3% were among 2 to 3 days old In the present study majority were presented Transient tachypnea of new born constituting 40%, next common was Meconium aspiration syndrome occupying 18.6%, Birth asphyxia 17.3%, Respiratory distress syndrome13.3%, Neonatal sepsis 5.3%, Congenital heart disease2.6%, Congenital pneumonia and Congenital diaphragmatic hernia counts 1.3%.

Vertebral compression fractures are the most common type of osteoporotic fracture. In the acute stage osteoporotic vertebral fractures cause severe back pain, disabilities in activities of daily living and deterioration in the quality of life. The efficacy of brace application for the treatment of osteoporotic compression fractures remains unclear. The purpose of this study was to compare the treatment outcome in patients with osteoporotic compression fracture with or without brace. We randomly assigned 42 patients with acute osteoporotic compression fractures within 2 wks of injury to the Brace and No Brace groups. Patients are followed up with clinical and radiological assessment till 6 months. The primary outcome was the Oswestry Disability Index score and secondary outcome measures were VAS for back pain, Body Compression Ratio and angle of kyphosis during the follow up interval. The Oswestry Disability Index score after compression fracture in the brace group was superior to that in the No brace group. During the follow-up assessment period, there was significant difference among the groups for the overall Oswestry Disability Index scores (p<0.001) and visual analog scale for pain scores for back pain. However, the Oswestry Disability Index scores and the visual analog scale scores for back pain significantly improved with time after the fractures (p< 0.001) in both groups. The body compression ratios significantly decreased (p=0.0414) and the cobbs angle significantly increased (p =0.0181) with time in No Brace group compared to traetment with Brace. The overall tolerability of the orthoses was good. Thereby, the use of an orthosis may represent an efficacious nonpharmacologic treatment option for spinal osteoporotic fractures.

Early stabilization of open fractures provides many benefits to the injured patient. It protects the soft tissues around the zone of injury by preventing further damage from mobile fracture fragments. It restores length, alignment, and rotation. All patients attending the orthopedic out-patient department and casualty of medical college and hospital with complaints of an open fracture grade II, IIIA, IIIB and meeting inclusion and exclusion criteria will be selected for the study. A written informed consent will be obtained from selected patients. Result was considered excellent in patients with full rom, and with no evidence of any complications. Result was considered good in patients with near to full rom, with no complications Result was considered fair in patients with restricted rom, with complications like infection and delayed union Result was considered poor in patients with non-union

In most circumstances, determining the cause of an open fracture is simple. A severe bleeding laceration overlaying or near the fracture of the underlying bone is common in injured patients. Because too soft tissue loss, broken bone may be revealed in some circumstances. However, not all open fractures are visible and proper diagnosis and treatment requires a thorough examination of the patient, a thorough review of the patient's medical history, the reading of radiographs, and sound clinical judgment. All patients attending the orthopedic out-patient department and casualty of MGM medical college and hospital with complaints of an open fracture grade II, IIIA, IIIB and meeting inclusion and exclusion criteria will be selected for the study. A written informed consent will be obtained from selected patients. According to Gustilo and Anderson open fracture Classification, majority of the fractures belonged to grade II (76.66%), followed by III A (16.66%) and III B (6.66%).

Meningiomas are most common tumours of human population, most cases being incidentalomas. Giant meningiomas (>50mm) demand thorough evaluation and planning for management to avoid untoward events. This study was mainly undertaken to understand technical factors and challenges faced in dealing with giant meningiomas.
Methods: The data of the 45 giant meningioma cases, diagnosed and operated on during the study period, was collected from the preoperative, intraoperative and postoperative periods. The data of neurological examination was also collected retrospectively. The data was compiled and analyzed.
Results: Majority of the patients were female and middle aged. Seizures was the most common presentation. The predominant location of the lesion was in parasagittal region and maximum size was upto 90 mm. Neuronavigation was used for precision of craniotomy. Venogram was not routinely performed even in tumors having sinus involvement. More than half of the cases had Simpson grade 1 excision, almost one third had grade two excision. Most of the higher grade excisions were seen in tumors abutting major venous sinuses. Posterior fossa lesions were found to have relatively more complications. Two patients had morbidity and one patient had mortality in this study.
Conclusions: A good pre-operative planning including temporary CSF drainage if required, is essential for good results. The size of the lesion does not necessarily seem to influence the outcome.

Nearly 20-25% of pregnant women have some degree of vaginal bleeding during the first 20 weeks of pregnancy and about 50% of these progress to an actual abortion. Progesterone is a hormone that aids in the preservation of pregnancy. It has been reported that spontaneous pregnancy failure decreases with increasing maternal serum progesterone levels. Predicting continuation of pregnancy is crucial in cases of threatened abortion in order to provide appropriate care and effective management.
Objectives: To study the role of single serum progesterone levels on day of threatened miscarriage to predicting continuation of pregnancy. To study the relationship between continuation of pregnancy in early threatened miscarriage and maternal age, gestational age, presenting complaint and associated risk factors.
Material & Methods: The place of study is Institute of obstetrics and gynecology, Egmore, Chennai, Tamil Nadu, India. The study involved 160 study participants, pregnant women with less than or equal to 12 weeks of gestation with complaint of spotting or bleeding PV. After obtaining informed consent basic sociodemographic and clinical history was recorded. 3 ml of venous blood was collected from the pregnant women. Serum progesterone and hemoglobin levels were assessed from the obtained blood samples. The data were analyzed.
Results: The results from our present study showed that the mean age for the study participants was 25.3± 4.08 years. Majority (76.6%) of the participants were in the age group between 20-30 years of age. Primi mothers constituted 47.5% of the study population. The most common presenting symptom in the study population was bleeding vaginum and Spotting per vaginum which constituted 46% of the total study population each. Anemia was observed in 22.6% of the study population. The mean hemoglobin value was 10.23±1.1. The mean serum progesterone value was 19.76±9.3. Increased values of serum progesterone levels had a significant association with the continuation of pregnancy while no significant association was noted between hemoglobin levels, body mass index and outcome of pregnancy.
Conclusion: Serum progesterone levels could be used as an effective diagnostic tool in aiding the diagnosis of viable pregnancies. The estimation of serum progesterone levels at a single point also alleviates the patients of inconvenient procedures and is also a cost effective alternative.

The frequency of cirrhosis is about 20–40 cases per 100,000 populations, and this indicator is steadily increasing. At present, it is one of the six main causes of death at the age of 35–60 years in economically developed countries. Foreign and domestic scientists are working on the development and synthesis of new drugs of chemical and natural origin for the treatment and prevention of liver diseases of various origins, in particular liver cirrhosis. Many studies have shown an important pathogenic role in the occurrence and progression of some liver diseases with changes in the intestinal microbiota. Therefore, antibiotics, prebiotics and probiotics are an effective treatment for liver diseases, which can correct the intestinal microbiota.

Periodontitis is a chronic inflammatory multifactorial disease that causes destruction to periodontium. Periodontal therapy plays a vital role in restoring lost periodontal structure. Lack of periodontal treatment ultimately leads to progression of periodontal destruction; thus, tooth mobility and loss of tooth occurs. Replacement of missing teeth by dental implant is considered as gold standard treatment method over the past decades. At present, Osseointegrated implants are the most widely used with various short comings. To overcome this, development of tissue engineered periodontal ligament cells surrounding the implant (Ligaplants) has now become the new therapeutic and promising tool in field of implant dentistry. Ligaplants improves the biological performance and increase the life of dental prosthesis, hence considered as new dimension in the field of implant dentistry. This review article highlights the existing and scientific literature available on ligaplants.

The study aimed to evaluate and compare the article type and research design of publications in the Journal of Indian Society of Periodontology (JISP) and Journal of Periodontal and Implant Science (JPIS) and the change in trends from 2011 to 2020.
Materials and Methods: All the scientific publications during the evaluation period were screened and categorized as background resources, case reports, and original articles. The original articles were classified into Primary research and Research syntheses /Summaries, with the former further sub-typed based on research design. Chi-Square / Fisher's exact tests were used to compare the category-wise distribution of publications between the journals and the change in trends within the journals for the block years of 2011-2015 and 2016-2020.

Background: Immediate implants have provided the opportunity to achieve better and faster functional results. PRF (Platelet rich fibrin) and Sticky bone graft possess inherent property of accelerating soft and hard tissue healing and regeneration especially in indecisive implant cases. GTR (Guided tissue regeneration) along with PRF serves as a reliable treatment modality as it promotes sustained osteogenic effect. They prevent the collapse of the socket by reducing the crestal bone loss and enhance the soft tissue aesthetics
Case Description: In this case report, a 25-year-old female patient reported with non-vital 11 and external root resorption. The mobile tooth was atraumatically extracted Flap elevation exposed fenestration defect. Immediate implant was placed in relation to 11 followed by placement of Sticky bone graft, PRF and GTR membrane in the defect space.
Conclusion: Immediate implant showcases several advantages over conventional implants. The success depends on careful case selection, diagnosis, asepsis, atraumatic extraction and preservation of labial cortical plate and good oral hygiene maintenance during follow-up period.
Clinical Significance: Successful placement of immediate implant in an aesthetic zone presenting with a fenestration defect, using platelet rich fibrin and sticky bone graft is the uniqueness of this case report

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

Background: Neonatal hyperbilirubinemia is one of the most common clinical condition seen in neonates in the first week of life. In substantial number of cases, the significant hyperbilirubinemia may reach to a level which is toxic enough to cause brain damage and can lead to kernicterus. The prevention of poor outcomes necessitates early detection of neonates who are at risk of developing significant hyperbilirubinemia. The objective of this study was to determine the critical cord serum bilirubin and albumin levels and bilirubin/albumin ratio for early prediction of significant hyperbilirubinemia in healthy term newborns.
Material and Method: This prospective study included 200 full-term healthy neonates. Measurement of cord bilirubin, albumin and bilirubin/albumin ratio was done to predict significant hyperbilirubinemia in healthy term newborns based on serum bilirubin measurements made at 24 hours,72 hours and day 5 of postnatal life.
Results: ROC curve analysis demonstrated that cord serum total bilirubin cut off value of ≥2.255 mg/dl had a good predictive value with a sensitivity of 87.5% and specificity of 98.81% and cord serum albumin cut off value ≤ 2.950 g/dl also had a good predictive value with a sensitivity of 87.5% and specificity of 95.24%. Cord bilirubin/albumin ratio cut off value >0.835 had the best predictive value out of the three parameters with a sensitivity of 87.5% and specificity of 99.40%.
Conclusion: Cord serum bilirubin, albumin and cord bilirubin/albumin ratio could be early predictors for significant neonatal hyperbilirubinemia.

Background and Aim: Screw loosening is one of the most common clinical dilemmas seen in the post operative phases of implant therapy. Screw loosening can lead to ultimate failure of the prosthesis thus entire treatment. Several factors are discussed by different researchers which are responsible for screw loosening. Therefore, this in vitro study was conducted to comprehensively assess the effect of different types of implant abutment with varying loading stresses on early screw loosening.  
Materials & Methods: This study was conducted in the department of Prosthodontics wherein total sixty implant abutment samples were included. Group 1 consisted of twenty standard types abutment. Group 2 consisted castable abutment. Group 3 consisted of CAD-CAM assisted implant abutment. A customized rectangular metal jig was fabricated in which implant fixture fits comfortably. Abutments were tightened over the implants with maximum of 30 Ncm. Dynamic stresses were applied independently on each sample assembly and unscrewing torques was noted carefully. P value less than 0.05 was considered significant (p< 0.05).
Statistical Analysis and Results: Statistical analysis was completed by using statistical software Mean torque value (Unscrewing Torques before Cyclic Loading) for group 1, 2 and 3 was 19.37, 17.82 and 17.43 respectively. Mean torque value (Unscrewing Torques after Cyclic Loading) for group 1, 2 and 3 was 18.17, 16.92 and 16.55 respectively. The measured standard deviation was 0.381, 0.637 and 0.032 for group 1, 2 and 3 respectively. P value was highly significant for group 1. The comparison among the 3 study groups using one-way ANOVA showed highly significant level of significance. Two sample t- test assessments of mean score and standard deviation in three groups showed highly imperative values.
Conclusion: Within the limitations of the study authors confirmed that there was not any significant different in the initial screw loosening stresses with various abutment systems. All the three experienced implant abutment systems showed insignificant change in screw loosening stresses after undergoing cyclic loading.

Assessments in education should be reliable, acceptable and cost effective. Formative assessment motivates and guides the student through learning with effective feedback. Regular formative assessments improve performance in the summative assessment.
Objectives-- To study the effect of continuous formative assessment on summative assessment in the study group and to compare the scores of summative assessment between control and study groups of first year MBBS students.
Materials and methods-50 first year MBBS students were divided randomly into two groups of 25 each (study group and control group).The study group underwent weekly formative assessments on the topics covered in the week. Both the groups underwent the summative assessments. A questionnaire was designed, pretested and finally used to record different opinions of the students and data was collected, analysed and interpreted. A cross sectional descriptive study was conducted in 2019 for the 2018-19 Batch of MBBS students
Results- The summative scores of study group compared to control group is highly significant. (Independent student’s t-test t=3.54, df=48, p=0.001.
Conclusion-Formative assessments with regular feedback improve performance in the summative assessment.

Suicidal behaviour in medical students might be brought on by mental pressures and the adoption of inadequate coping mechanisms.
Objective: The purpose of this study is to assess the prevalence, risk factors, and effects of coping strategy elements on suicidal behaviour among medical students.
 Methodology:Medical College students participated in a three-month institution-based cross-sectional survey from October to December 2022. Using the stratified random sampling procedure, a total of 350 study participants were chosen and then distributed proportionally to each academic year. The Patient Health Questionnaire-9, Suicidal Behaviors Questionnaire-Revised, and sociodemographic information were then included in a self-administered questionnaire that the participants were required to complete (SBQ-R). The risk factors and their correlation with suicidal conduct were identified using the chi-square test and the student t test.
Results: A total of 62 (17.7%) respondents reported having suicidal behaviour and an SBQ-R cutoff score greater than 7. The age range of the participants was 18 to 35 years, with a mean age of 22.28±  1.87 years . Depression, academic performance dissatisfaction, smoking and alcohol use were the found risk variables substantially linked to greater suicide conduct. (P<0.05) In the study population, psychological resilience (68.6%), religion, and humour (60.3%) were the coping mechanisms that were employed more frequently than supportive techniques (54%). Coping with mental disengagement and coping with supportive techniques were examined as a protective factor for suicide behaviour. Mental disengagement (denial, drug use, venting, behavioural disengagement, and self-blame) was a seldom employed coping strategy (21.7%) among medical students. ( (P<0.05)
 Conclusion: The prevalence of suicidal conduct among medical students is worrying, and research has shown that risk factors include depression, alcohol and tobacco use, as well as inadequate coping mechanisms. The data suggests that the initial steps in preventing suicidal conduct should be quantification of the problems, early treatment, and proactive student counselling to assist them adopt the proper coping mechanisms.

Background:  In natural and artificial dentitions, the plane of occlusion plays a significant role in fulfilling the criteria of function and aesthetics. It is essential to determine the orientation of the plane of occlusion to restore or re-establish the lost occlusal plane as it was initially possible.
 
AIM: To determine whether a similar correlation exists between the Porion Nasion Anterior Nasal Spine (PoNANS) angle and the occlusal plane-Frankfort horizontal (FH) plane angle.
 
Materials and Methods: For this in vivo study, twenty healthy dentate individuals aged between 20 – 40 years with Angles class I molar relation having good temporomandibular joint and no congenital or development deformities were selected. Digital lateral cephalograms of the selected individuals were obtained. Cephalometric analyses performed with AUTOCAD software and reference points [Porion (Po), Nasion (N), Anterior nasal spine (ANS), Orbitale (Or)] were marked. PoNANS and occlusal plane‑FH plane angles were derived from marked reference points. Graph plotted with resultant values determining the X axis (PoNANS angle) and Y axis (occlusal plane‑FH plane). The correlation coefficient was calculated to determine the correlation between the Porion Nasion Anterior Nasal Spine (PoNANS) angle and the occlusal plane-Frankfort horizontal(FH) plane angle. Later, a t-test was applied to determine the significance of the correlation coefficient. Regression analysis was performed, and the equation was derived with the help of which the value of 'Y' can be obtained when the value of 'X' is known.

Purpose: To evaluate the causes of visual impairment in adults attending our Government tertiary care hospital, in India for the purpose of blindness disability certification to aid in better planning and prevention of blindness activities in India.
Methods: The study was a non-interventional cross-sectional record-based analysis on 411 adults with permanent visual impairment attending Ophthalmologyout patient department of Mandya Institute of Medical Sciences, Mandya, India for blindness disability certification during July 2019 to Dec 2020. Patients demographic data, educational background, need for disability certification and area of residence all noted after complete ocular examination and categorised depending on the etiology and percentage of visual impairment. Groups analyses and P<0.05 was taken as level of statistical significance.

Pulmonary hemorrhage is a very rare and a serious complication of leptospirosis. It is the leading cause of death in leptospirosis.Leptospirosis is a worldwide zoonotic disease caused by genus Leptospira, has been reported in India since 1931.¹ the incidence in southern India being 25.6%.²
We herein report an uncommon case of severe pulmonary hemorrhage and multiple organ failure due to leptospirosis in an elderlysouth Indian farmer, who was previously healthy. Giving history of working in paddy field barefooted and came in contact with rat feces,contaminated water. Complaints of fever with myalgia and hemoptysis brought the patient to the hospital. Patient developed severe respiratory distress, requiring mechanical ventilation. Prompt diagnosis of leptospirosis as a rare differential for pulmonary hemorrhage, appropriate antibiotics, escalated the patient recovery, extubated, and was discharged on the 8^th day of admission.

BACKGROUND: An adnexal mass is a common gynaecological problem. Hence evaluation of adnexal mass is of particular importance in gynaecological practice and often present diagnostic and management dilemma.The aims and objectives of the study were to find out different types of adnexal pathology clinically, correlation of clinical finding with histopathology, correlation of ultrasonography finding with histopathology.
METHODS: The study was carried in the Department of Obstetrics and Gynecology,Gandhi medical college  from 1^st February 2019 to 31^st January June 2021. This study was a hospital based observational study which included 150 patients . All cases underwent an ultrasound examination . Following surgery, specimens were sent for histopathological examination and the reports were correlated with pre-operative clinical and ultrasonography findings.

Tracheal intubation using a laryngoscope is considered to be the gold standard of airway management during administration of general anesthesia because of its several advantages including delivery of anesthetic gases and oxygen via positive pressure ventilation without inflation of stomach, minimal risk of aspiration, access to tracheobronchial tree for pulmonary hygiene and drug administration (e.g., inhaled bronchodilators), improved surgical access to head and neck.

Eclampsia is one of the most common entity in pregnant women all across the globe including India. Cases with posterior reversible encephalopathy syndrome in this condition has been rarely reported in literature. Its clinical manifestations is similar to eclampsia with predominant weakness and altered consciousness. In addition, there is a need to look for neurological abnormalities. Treatment of this condition is symptomatic after early recognition and physicians should be vigilant and aware of this condition.

A comparison of physiological changes induced by prone position over Wilson’s frame and Horizontal Bolsters in Lumbar spine surgery – A randomized prospective study
 
BACKGROUND:
Ideal patient positioning involves balancing surgical comfort, against the risks related to the patient position. There is paucity of information on effect of prone position on blood loss and intra-abdominal pressure (IAP) and how these changes correlate with respiratory airway pressures. The study was designed to compare Wilson’s frame and horizontal bolsters to find a better technique for better intraoperative optimisation of the patient. 

Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract
during pregnancy after the period of viability until delivery of fetus¹. The World Health
Authority defines antepartum hemorrhage as bleeding after 28th week of pregnancy. On
an average 2 to 5% of all pregnancies are complicated by antepartum hemorrhage.
Antepartum hemorrhage accounts for about 22-25% of maternal mortality¹.
Causes of antepartum hemorrhage include placenta previa (PP) and placental abruption (AP).
vasa previa, marginal vein bleeding, trauma due to foreign body or genital lacerations and cervical polyp, cervical carcinoma, local lesions of vagina and cervix and systemic diseases like leukemia & bleeding disorders

Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged.  VAP can cause patients to have difficulty weaning off the ventilator and to stay in the hospital longer, which results in a huge financial burden to patients and a huge demand for medical resources. Several strategies, such as drugs including chlorhexidine, b-lactam antibiotics and probiotics, have been used to prevent VAP in clinic. The incidence and the mortality rate of VAP have been decreased with the development of preventative strategies in the past decades, but VAP remains one of the most common causes of nosocomial infections and death in the intensive care unit. Current challenges in the management of VAP involved the lack of a gold standard for diagnosis, the absence of effective preventative strategies, and the rise in antibiotic resistance. Therefore, in order to reduce the incidence of VAP and improve the outcome of patients with mechanical ventilation, it is necessary to clarify the risk factors of VAP for clinical prevention and control of VAP. This article reviews the risk factors of VAP occurrence reported in recent years, including patient characteristics, increased mechanical ventilation time and prolonged length of hospital stay, disorders of consciousness, burns, comorbidities, prior antibiotic therapy, invasive operations, and mentions the corresponding preventive measures. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.

The gold standard method of airway management for general anaesthesia and resuscitation is tracheal intubation with laryngoscope. Airway manipulation or instrumentation is noxious producing adverse reflex mediated cardiovascular changes. Tuoren video laryngoscope was designed with highly angled blades that pass around the tongue and allow a “look around the corner” to the glottis opening. The view obtained includes tip of the blade and therefore allows visual guidance of the tip of the blade into the vallecula. This present study was undertaken to evaluate and compare the efficacy of Macintosh laryngoscope and Tuoren video laryngoscope with respect to time for intubation.
Methods: The present prospective randomized comparative clinical study was conducted in a tertiary care hospital amongst 100 patients belonging to ASA physical grading I and II of either gender, aged 18- 60 undergoing elective surgical procedures under general anaesthesia. They were randomized in to two groups: 1. Group ML (Macintosh laryngoscope): 50 patients and 2. Group VL (Tuoren Video laryngoscope): 50 patients.
Results: The mean age of patients in Group ML was 39.48±10.07 years and Group VL was 37.34±10.56 years.  6 Patients from Group ML required BURP while, 6 patients required lifting force in Group ML In this study, 4 patients required use of stylet while 6 patients required use of bougie in Group ML.  38 (76%) patients in Group ML and 23 (46%) patients in Group VL had slight difficulty during intubation. (IDS Score >0 & <5). The mean time taken for intubation in Group ML was 30.12±2.03 sec. and in Group VL was 20.9±1.59 sec.  The mean basal HR in Group ML was 80.36 ±11.09 and in Group VL was 81.38±10.44. Mean HR after intubation at 1 min in Group ML was increased to 97.80±12.12 while it was 87.56 ± 10.78 in Group VL. A statistically significant difference was seen in both the groups (p=0.001). Mean Arterial blood pressure after intubation at 1 min in Group ML was decreased to 106.82±5.55 while it was further decreased to 94.64± 6.61 in Group VL.
Conclusion: Finally, we conclude that Tuoren video laryngoscope when compared to Mcintosh laryngoscope improves the visualization of the larynx, is associated with less difficult airway maneuvers, lesser airway morbidity, takes less time for intubation and reduces the stress response to laryngoscopy

Upper extremity surgeries are being mostly done under regional anesthesia using supraclavicular brachial plexus block under ultrasound guidance. Subjective methodsto assess the block success take time and are not very reliable.
Aims- To use perfusion index values for prediction of successful ultrasound guided supraclavicular brachial plexus block.
Materials and methods- This prospective observational study was done on 70 patients who underwent upper limb surgery. Ultrasound guided supraclavicular block was given using 20 ml of 0.5% ropivacaine in all patients. Assessment of sensory and motor block was done at every 5 minute interval. The perfusion index was noted at baseline and at 5, 10, 15, 20, 25 and 30 minutes using separate pulse oximeters on index finger of both blocked and unblocked upper limbs. The perfusion index (PI) ratio was calculated as ratio of PI at 10 minutes and PI at baseline.
Results- There was increase in perfusion index (PI) and PI ratio in the blocked arm compared with the unblocked arm with statistically significant difference.
Conclusion- Perfusion index (PI) and PI ratio at 10 min are good predictors of success of supraclavicular block which can be used non invasively in all patients

Grey scale ultrasonography can be used as a first line imaging modality along with histopathology for evaluation of cervical lymphadenopathy. Morphologic features like size, shape, hilum and necrosis within the lymph node and vascularity are analysed. We wanted to identify the role of Grey scale ultrasonography and colour Doppler in characterisation of enlarged cervical lymph nodes, evaluate findings in benign and malignant cervical lymphadenopathy and assess the sensitivity, specificity, predictive value, likelihood ratios and accuracy in malignant and benign cervical lymph node enlargement.
METHODS
This was a cross sectional study with diagnostic test evaluation. All suspected cases of cervical lymphadenopathy referred for sonological evaluation to the Department of Radiodiagnosis of Vinayaka Mission’s Medical College were included in the study. About 75 patients included in the study, underwent Grey scale and colour Doppler sonography of cervical lymphadenopathy.
RESULTS
When three criteria were positive for malignancy, the sensitivity and specificity of grey scale ultrasonography and colour Doppler were 100 % and 73.80 %, and when four criteria were positive, the sensitivity and specificity were 72.73 %, and 90.48 % respectively. When we analysed individual variables, status of hilum (absence / presence) has reasonably good sensitivity and specificity, positive predictive value, negative predictive value and accuracy (90.09 %, 92.90 %, 90.09 %, 92.90 % and 92.0 % respectively). In our study the important criteria positive for malignant lymph nodes were size > / 11 mm in short axis diameter, round shape, absent hilum and peripheral and central + peripheral type of vascularity of cervical lymph nodes. For benign lymph nodes, oval shape, presence of hilum and central vascularity were the important criteria noted.
CONCLUSIONS
Grey scale ultrasonography can be complemented by colour Doppler ultrasonography (USG) in patients presenting with cervical lymphadenopathy to differentiate between benign and malignant lesions by reducing unnecessary biopsies by more accurate discrimination.

Autism is one of the heterogenous neurodevelopment disorder classified under Pervasive spectrum Disorder is characterized by three core deficits i.e. impaired communication skills, impaired social interaction (reciprocal) and repetitive, restricted, stereotyped behavioral patterns. Early identification of toddlers at risk for developing autism and timely referral and appropriate intervention strategies is crucial to achieve better outcomes for these children. Thus, the present study was conducted at tertiary care centre to assess the percentage of toddlers (16months – 30months age group) attending well baby clinic in Pediatric OPD who screens positive for risk of having Autism spectrum disorder (ASD) by using M-CHAT R/F.
Materials and Method: The present descriptive cross sectional study was conducted among toddlers belonging to age range of 16-30 months visiting well baby clinic during the study period. All the parents were enquired regarding the condition of child and activity using M-CHAT R/F questionnaire. Association of Autism spectrum disorder with various factors was assessed using Chi square test. Multivariate analysis was done to determine the independent factors associated with ASD. P value of less than 0.05 was considered statistically significant.
Results: A significant association of moderate risk of autism spectrum disorder with younger age (16 to 24 months) and male gender (83.3%) (p<0.05). However, no association of Autism spectrum disorder with socioeconomic status of the family (p>0.05) was found. The risk of ASD was significantly higher in children belonging to less than 24 months of age (OR-1.28; 95% CI-1.013-1.55, p<0.05) as compared to children above 24 months of age.
Conclusion:  The present study concludes that a significant association of moderate risk of Autism spectrum disorder with younger age (16 to 24 months) and male gender and the risk of ASD was significantly higher in children belonging to less than 24 months of age as compared to children above 24monthsofage. Early identification and introduction of appropriate intervention strategies might help in preventing the long term complications in the form of neuro cognitive dysfunction and intellectual ability of the child

Postmenopausal bleeding (PMB) is defined as bleeding from the genital tract, more than 12 months after the last menstrual period in a woman, not on hormone replacement therapy (HRT). PMB occurs in approximately 10% of Postmenopausal women. Endometrial cancer is the most common gynaecological malignancy but, in India, 80-90% of the women have benign conditions like endometrial or cervical polyps, endometrial atrophy, infection or simple endometrial hyperplasia. Every woman of PMB requires thorough evaluation, clinically and pathologically to exclude malignancy.
Aims and Objectives: To find out causes of PMB on the basis of history and clinical examination and to correlate the clinical findings with imaging studies, mainly Endometrial thickness (ET) on Transvaginal sonography (TVS) and Histopathological examination (HPE), if required.
Materials and Methods: This study was a prospective study carried out on outdoor/indoor patients admitted in Department of Obstetrics and Gynaecology at tertiary care hospital from January 2020 to June 2021.
Result: Majority (28.57%) of the patients with PMB were from 46-50 years age group. Diabetes mellitus (22.85%) and Hypertension (21.42%) were the major risk factors associated with PMB. On TVS, 44.28% patients had ET between 5-10mm. Majority of patients had no pathology (51.43%) while remaining had fibroid (15%), adenomyosis (11%), Endometrial Hyperplasia (8.57%), Fibroid polyp (1.42%) and cervical polyp (1%). Atrophic endometritic was the most common benign cause, seen in 30% of the patients. Malignant etiology for PMB was seen in 11.47% of the patients. Out of 70 patients, 68.57% of the patients underwent surgical management, 30% patients underwent Conservative Management and 1.4% patient had radiotherapy.
Conclusion: PMB is a symptom of varied aetiologies, benign and malignant. Therefore, careful histologic examination to identify the aetiology should be emphasized. Accurate diagnosis makes it much easier to counsel the patient about further course of management.

The aim of study is provide basic data about the histological features of the liverof two species of birds, which differ in their classification, habitat, nutrition and activity. The birds were omnivorous Black francolin(francolinus)  and carnivorous Barn Owl (Tyto alba). To make this purpose a 10 mature healthy males birds were bought from the local suppliers at common markets at Al-Samawa city .(5 birds from each species) , all birds were anesthetized and dissected directly. The results of histological study, our results explained that the liver in the two species of birds were surrounded by a thin layer of dense connective tissue called Glissons capsule, this capsule different in size in owl and francolin thick layer in francolin  than of owl . The hepatic parenchyma in studied birds were not clearly identified divided into distinct lobules due to absence of indiscernible hepatic connective tissue septa. The basic unit of the parenchyma of liver is hepatocyte which arranged in radially around the central vein as a hepatocords consists from two – several cell in thickness in barn owl, but in francolin bird, hepatic cells are composed of chains of hepatic cell. The lobules surrounded by portal area peripherally which made from dense connective tissues , it constitutes of portal vein, hepatic artery, and bile duct, in addition to lymphatic vessels which lining by endothelium.The histochemical study showed formed differ size of glycogen granules in cytoplasm of hepatocytes and  The glycogen appears as pink-color deposits as identified throughout the cellular parenchyma of the liver especially in francolin,while glycogen appears less frequent in owl.

Sacrococcygeal Pilonidal sinus disease (PSD) is an infection of skin and subcutaneous tissues in natal cleft of buttocks, which is formed by anchorage of deep layers of skin overlying the coccyx to the anococcygeal raphe. It affects predominantly young males of working group. The disease is known for its long duration of lagging symptoms and a propensity towards chronicity, leading to significant loss of working hours besides being a economic burden on society. Many procedures have been devised and others are still being evolving, rather being ratiocinating in isolation, striving for the ever alluding perfect. Rhomboid or limberg’s flap is one of the procedures that offers all the advantages of off-midline closure with a surgical site infection and recurrence rate in ranges of 0%-6%. It flattens the cleft and a healthy flap covers the excissed area.  Recently modified Limberg’s flap has been shown to fair better in post operative wound complications and recurrences. This study was undertaken to study the benefits of modified limberg’s flap as compared to primary midline closure.
Methods: The patients were divided into two groups a Limberg’s Flap Procedure Group (LFG) and Primary Midline Closure group (PMC).  Out of 86 Patients, 31  in LFG and 55 in PMC were included in the final results. Patients were analysed for the surgical site infections, recurrence rate and time to complete wound healing and length of stay in hospital. All the procedure were done by same surgical team. Only chronic symptomatic PSD patients were included in this study.
Results:  65(86%) were males and 11(14%) females. No significant difference was observed between treatment groups as regarding the distribution of demographic parameters such as age, sex & BMI. The median BMI was however in range of 28-29kg/m2 which falls in obese criteria according to revised guidelines for Indian population. The median duration of symptoms before patient underwent treatment was about a year in both groups. The duration of surgery in LFP about a hour, mean 50±9.6 which was significantly longer than the PMC, mean 30±6.5 minutes p>0.001; the reason being the extra time needed for flap preparation and the need for a perfect marking, so that the alignment matches seamlessly.  Minor wound infections, were present in 6(19%) of the LFP as against 17(38%) patients. 1(3%) patient had a complete wound dehiscence in LFP as against   5(11%)in PMC group. The median time of complete wound healing was 14 (9-24) days in LFP versus 22(19-35) days in PMC group, the difference was significant with a P-value of 0.02. Patients with LFP had a longer hospital stay median of 3 (2-6) days as against 2(2-3) days in PMC group, the difference however was not statistically significant.  The recurrence at the median follow-up of 1 year was 1(3%) for LFP and 4(9%) for PMC with a P value of 0.64.   
Conclusion: LFP is preferred approach in patients with chronic PSD with low incidence of overall recurrences, a low wound infection rates and a shorter overall healing time. The operative time is however longer when compared to PMC

Diabetes mellitus (DM) is one of the important health problems affecting the major populations worldwide. Diabetes mellitus, endocrine disorder which involves multiple organ systems and leads to significant morbidity and mortality due to accompanying complications. Thyroid diseases and diabetes mellitus are common endocrine disorders. The present study is carried out for the assessment of thyroid dysfunction in type 2 diabetic patients by measurement of serum T3, serum T4 and serum TSH levels.
Materials & method: This study was conducted in Department of Biochemistry in association with Department of Medicine, Index Institute for Medical Sciences & Research Center, Indore. A total of 300 subjected were enrolled into the study. They were divided into 2 groups, 150 age and sex matched healthy subjects were taken as group I (controls) (HbA1c: 5.5 to 6.5 %) and 150 type 2 diabetes mellitus subjects were taken as group II (HbA1c: >7.5 %). Age of the study subjects was 30 to 70 years. Under aseptic conditions, 5 mL Fasting venous blood sample is collected from all subjects in vacutainers, Serum sample was used for the estimation of Fasting sugar (GOD-POD method) by using ERBA EM360 fully analyzer, thyroid profile by ELISA method, and EDTA sample is used for estimation of HbA1c by using Resin Binding Method. Data were expressed as mean ±SD. P value
Results: fasting blood sugar and HbA1c levels were significantly increased in T2DM (group II) subjects compared with controls (group I). T3 levels were significantly decreased and TSH levels were significantly increased in T2DM subjects compared to controls. HbA1c is positively correlated with TSH.
Conclusion: In this present study, we have observed that the abnormal thyroid hormone levels among type 2 diabetics. Therefore, there is a need for the routine assay of thyroid hormones in type 2 diabetes mellitus in order to improve the quality of life and reduce the morbidity.

This research study investigates the impact of ageing on the shape and size of Meissner’s corpuscles in the great toe of the human foot. By using histological sections of thick skin were taken from 53 samples of different age groups and five samples from the foetus. we have measured H&E-stained alternate sections of thick skin of different age groups. the Meissner’s corpuscles were measured by using ImageJ software. Results: The morphometric parameters, including ranges of horizontal length (48.07mm to 46.63mm), vertical length (102.42mm to 137.41mm), perimeter (267.02mm to 354.42mm), area (4131.24mm² to 5598.56mm²), capsule thickness (5.29mm to 10.79mm) and depth (9.2mm to 10.79mm). We did not find MC in foetal samples of a particular age group. We have also observed that the shape of the MC varies from oval, ellipsoid in shape, discoid, dumbbell shape, cylindrical, large oval shape, bean shape, inverted cone shape, triangular in shape, coiled spring shape, cone shape, and spindle in shape.

The vocabulary Dermatoglyphics was originally used by Harold and is extracted from the Greek terms derma, which means skin, and glyphics, which means curved. A 1926 graduate of Tulane University,  Cummins. The Papillary or the Epidermal Ridges on the fingers and the pattern on the finger create the imprint known as a fingerprint. Material and methods: We were taken fingerprint through ink pad on white paper and analyzed with the help of a powerful magnifying hand lens and recorded it in a prepared format. Result: There was significant association between finger print pattern and blood group of males as the p-value of the significance of the association was 0.000038 (less than 0.05) in females was 0.0000048 (less than 0.05). Conclusion: There was significant association between finger print patterns and blood groups of male and female participles as well as in total as all the p-values are less than 0.05

The heart is a hollow muscular organ situated in the mediastinum of the thoracic cavity. Coronary arteries are the first branch of aorta, most commonly originating below the junction between the bulbous and ascending part of aorta. The right and the left coronary arteries take origin from ascending aorta from its anterior and left posterior aortic sinus respectively. Aim and Objectives- To observe the anatomical variations in left coronary artery. Material & Methods:The study was carried out on 120 human cadaveric hearts from the Department of Anatomy, IMC&H Indore (M.P.), AFMS&RC Faridabad (Haryana), DYSPGMC Nahan (HP). Result- In the present study Left Coronary artery (LCA) originated from Left posterior aortic sinus in all the specimens. Bifurcation of LCA was observed in 88.33% of specimens, trifurcation of LCA in 10% of specimens, quadrifurcation and pentafurcation of LCA was also observed in 1% of specimens respectively

Diabetes is a long-lasting metabolic condition characterized by abnormally elevated fructose (or sugar levels) levels. Diabetes may have a disastrous effect on the heart, capillaries, eyes, lungs, and nerves over time. The most common kind of diabetes, that often affects adults, occurs when the body gets resistance to or inadequate insulin production. Type 2diabetes has been more prevalent in countries of all income backgrounds during the previous three decades. Type 1 diabetes, previously known as high blood sugar or renin - angiotensin - aldosterone mellitus, is a chronic condition in which the gastrointestinal insulin acts as a self-regulating hormone. Micro vascular and macro vascular problems linked with type 2 diabetes are debilitating and possibly fatal. Cardiovascular problems occur in up to 80% of individuals with type 2 diabetes and account for around 65% of fatalities in this group   Methodology: The study design was descriptive design. Total 200 sample were selected for data collection. A Non-probability purposive sampling technique was used to collect data from the samples. Tool was constructed to identify the demographic variables, and a set of structured questionnaires prevention of micro-vascular and macro vascular complication among client with Diabetes Mellitus. Result: Knowledge on micro vascular- and macro vascular problem prevention. The significant results are that 147 (73.5%) of clients had average knowledge, 33 (16.5%) had strong knowledge, and 20 (10%) had low understanding. The mean degree of knowledge for micro- and macro vascular problem prevention is 13.18, with a standard deviation of 3.94. Conclusion: The results indicated that the majority of clients have only rudimentary information about the prevention of micro- and macro vascular complications. There really was no significant correlation between knowledge about micro- and macro vascular complication prevention and selected socio-demographic variables among clients with Diabetes Mellitus.

Anemia is a major public health concern globally and in India despite numerous health programme organized across the country for decades the national prevalence rates of anemia are reaching new heights as is evident from the national family health survey (NFHS 5).
World Health Organization (WHO), defines anemia as having hemoglobin (Hb) levels lower than 12.0 and 13.0 g/dL in females and males, respectively. The “Dependent Population” defined as People, below 15 years of age group and 65 years and above.  Thus, in age group below 15 years and above 65 years, it is indeed necessary to identify anemia, stratify the type and its severity and search for etiology accordingly. 
Aim: To evaluate etiology, morphological types and grading patters of anemia in pediatrics and geriatric patients. 
Material and methods: The present study was two-months hospital based prospective study of all diagnosed cases of anemia to access the etiology, morphological type and associated grading pattern of anemias in pediatric and geriatric age group from September 2022 to October 2022, which included 56 cases. 
Result: During a period of 02 months, out of the 56 patients, 20 belonged to the pediatric age group (upto 15 years) and 36 belonged to the geriatric age group (65 years and above) were evaluated for anemia. Male to female ratio, out of 20 pediatric patients, was of 3:1. Majority of our patients (55 %) belonged to age group of 06-10 years. Similarly, out of 36 geriatric patients, 17 patients were female (47.3%) and 19 patients were male (52.7%) with male to female ratio of 1.1:1.  Majority of our patients (77.78 %) belonged to age group of 65-75 years. Clinically, majority of pediatric patients presented with nutritional deficiency (30%) and majority of geriatric patients presented with generalized weakness and fatigue (20%). Majority of pediatric age group showed moderate degree of anemia (50%) and in geriatric age group for 36 blood samples were evaluated out of which majority of them showed moderate degree of anemia (47.2%) and severe (47.2%) equally. Morphologically out of 20 blood samples of pediatric age group displayed Microcytic anemia (50 %) with most common etiology being, iron deficiency anemia was observed in 06 cases (30%) with serum ferritin levels below 15 ng/ml and out of 36 geriatric patients’ anemia of chronic disease was observed in 13 cases (36.11%) with most common, etiology being, renal disorder.
Conclusion: Anemia remains a major health concern in both dependent age groups. Early detection of anemia and definite characterization for the underlying etiology should be taken in consideration for the overall improvement in the quality of life in both dependent age groups. 

Bone marrow examination plays an important role in diagnosis of haematological as well as non-haematological disorders.  It is one of the diagnostic investigations of cases of Pyrexia of unknown origin, cytopenia, abnormal red cell indices, malignant haematological disorder and suspected bone marrow metastasis as its leads to an etiological diagnosis in most of the cases. BMA is mainly performed for cytomorphological examination.
Aim: The aim was to study the Clinico-morphological spectrum of bone marrow aspiration and Biopsy examination and its correlation with biochemical parameters;and to assess the diagnostic value of bone-marrow examination.
Material and methods: It is an observational study with retrospective and prospective design. The study was conducted at in Department of Pathology, Heritage Institute of Medical Sciences, Varanasi. All eligible participants age group 3 month to 85 years were included. Data collection was done from November 2018 to April 2022. Bone marrow examination was performed for all cases. The parameters assessed after bone marrow examination were cellularity, myeloid to erythroid ratio, cytomorphological details of all cell lineage.
Results: In present study, commonest indication of bone marrow examination was unexplained anaemia followed by cytopenia and malignant haematological disorder. Distribution of bone marrow cellularity was normocellular in most of the cases. Dimorphic anaemia (26.21%) was most common finding followed by Micro normoblastic picture (22.33%) & Megaloblastic changes in 18.45% cases. Other finding was Acute leukaemia in which AML was most common finding.
Conclusion: Bone marrow study reproducible procedure used for the evolution of Haematological and non-haematological condition. Various studies shows the BME is an essential investigation for the diagnosis and management of many disorders of blood and BM.

Despite the rarity of these illnesses, some interstitial lung disease (ILDs) individuals may experience a progressive-fibrosing phenotype. A deterioration in lung function, increased respiratory symptoms, a limited response to immunomodulatory treatments, a reduction in quality of life, and perhaps an early death are all consequences of progressive fibrosis. We in the current study tried to evaluate theclinical, radiological, and functional profile of patients with interstitial lung diseases reporting to our tertiary care hospital.
Methods: Consecutive patients with the diagnosis of ILD as per guidelines with multidisciplinary modality were included in the study. A thorough medical history was obtained, followed by a comprehensive clinical examination.  A complete hemogram, blood sugar levels, renal function tests, arterial blood gas analysis with calculation of the alveolo-arterial (Aa) gradient, spirometry with measurement of the carbon monoxide diffusion capacity (DLCO), six-minute walk distance (6MWD), post-exercise desaturation, and radiological investigations like chest roentgenograms (CXR) and high-resolution computerized tomography (HRCT) thorax were reported.
Results: Average duration of symptoms in patients was 42.54 (6.1) months. End-inspiratory Velcro crackles were the most common examination finding in 138 (98.57%) followed by clubbing in 78 (55.7%). Post-exercise desaturation was found in n=26 patients (89.66%). The common diagnosis was idiopathic interstitial pneumonias (IIP) n=17(58.62%). Other common etiologies were granulomatous diseases like sarcoidosis in n=2(10.34%) hypersensitivity pneumonitis in n=2(6.89%) and connective tissue disease associated with ILD in n=5(17.24%). Rest n=3 cases included occupational ILD, drug-induced ILD, and topical pulmonary eosinophilia in one case each.
Conclusion: Interstitial Lung disease (ILD) is a chronic respiratory disease, and its diagnosis must be done with a multidisciplinary approach without the requirement of a lung biopsy. Interstitial pulmonary fibrosis has a poorer prognosis compared to Nonspecific interstitial pneumonia despite optimal treatment. Cases with connective tissue disease-associated ILD, hypersensitivity pneumonitis and sarcoidosis show exceptional response to therapy

Ankle fractures represent 10% of all fractures making it a second most common fracture of the lower limb after the hip. Typically, low energy injuries with the majority occurring due to simple falls or Sports. Accurate reduction of fractures around ankle joint is important for a painless ankle joint. The aim of this study is to evaluate the functional outcome of surgically managed closed malleolar fractures of ankle in adults and to evaluate restoration of the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation. Determining ankle stability for planning fracture management is very critical. Stable fractures can be managed conservatively but outcomes of unstable fractures are always better with surgical management.  

Hypothyroidism is the most prevalent thyroid condition associated with pregnancy, affecting 3-5% of all pregnant women. The thyroid-stimulating hormone (TSH) density larger than the reference interval prescribed for pregnancy for each experimental level, or  TSH concentration levels larger than  2 to 6 mIU/L in the first trimester and larger than 2 mIU/L in the consecutive trimesters, is typically considered to be subclinical hypothyroidism, that is higher prevalent than overt hypothyroidism. Although this is not the generally recognized definition, some researchers have said that overt hypothyroidism is characterized by a serum TSH greater than 11 mIU/L and subclinical hypothyroidism as a serum TSH between 6 and 10 mIU/L. As soon as overt hypothyroidism is identified, levothyroxine therapy should quickly bring blood TSH concentration into the reference limits for pregnancy. Different professional organizations have different recommendations for treatment for people with subclinical hypothyroidism due to conflicting information from observational research and clinical trials addressing the advantages for the mothers or the kid. Similarly, widespread monitoring and diagnosing of all pregnant ladies for subclinical purposes is recommended because the advantages of treatments are still unknown. Additionally, more than 55% of women with originally diagnosed hypothyroidism need to take more levothyroxine throughout gestation. This might be solved by improving and enhancing the levothyroxine prescription on the confirmation of pregnancy

One of the key ways The Joint Commission establishes standards for sustaining The National Patient Safety Goals are used to ensure patient safety throughout all healthcare settings (NPSGs). The Joint Commission reviews the NPSGs on a regular basis to verify that health-care organizations are focusing on avoiding significant causes of patient harm. Surgical infection prevention, prescription mistakes, inpatient suicide, and particular clinical difficulties like as falls and persistent wounds are also areas of study’s. Along with accessibility, acceptability, efficacy, efficiency, and people centeredness, one of the features of high-quality treatment is patient safety. It includes a variety of factors that are critical to providing high-quality health care. It's about safe surgical treatment and delivery, as well as safe injections, blood, pharmaceutical, medical device, and organ, tissue, and cell transit and donation. It also covers biomedical waste management, infection control in hospital settings, and much more. Objective to determine how well staff nurses understand patient safety objectives. And to determine whether there is a link between education level and certain demographic characteristics. Methodology: A non-experimental Descriptive design carried out among 100 staff nurses. Non-probability purposive sampling technique was used and was statically analyzed after collecting the data through structured questionnaire was prepared for data collection. Ethical clearance was taken from the Institutional ethics committee. Data analysis was done using descriptive statistics. Results The goal of this study was to determine how much information people had of staff nurses in a chosen hospital in Pune about patient safety objectives. The major findings are 67 (67%) of staff nurse having average knowledge, the remaining 33 (33%) had good knowledge and 0(0%) had poor knowledge. There was no statistically significant relationship between staff nurse understanding of safety objectives and selected socio demographic characteristics

Oral contraceptive pills because of their availability and reversibility they are most extensively used from of contraception globally. Unfortunately issues with compliance which is linked to knowledge of proper use and the frequency of adverse events restrict their effectiveness. When women begin taking the pill for the first time they may experience prescription adverse effects. These negative effects normally fade after a few months. Title: “A study to assess the knowledge regarding side effects of oral contraceptive pills among married women using oral contraceptive pills residing in selected areas of Pune city Objective: To assess the side effects of oral contraceptive pills among married women. To associate the findings with selected demographic variables. Materials and Methods: The study adopted Non-experimental Descriptive design carried on 200 women and was conducted in selected areas of Pune city. Non probability sampling technique was used and was statistically analyzed after collecting the data through structured questionnaires regarding knowledge on side effects of oral contraceptive pills used for the data collection. Self structured questionnaire was used. Ethical clearance was taken from institutional ethics committee. Data analysis was done using descriptive statistics. Results: The present study result showed that knowledge concerning side effects of oral contraceptive pills among the married women Majority 80% were having good knowledge, 17% were having average knowledge and 3% were having poor knowledge. The study recommended that married women are aware about the side effects of oral contraceptives pills, there is need for giving new current knowledge in forms of health education, media, and information at health settings 

Introduction: Sevoflurane is one of the general anesthetic having  a  rapid  onset and offset of action. Hence anesthetist can control the depth of anesthesia rapidly. Intravenous propofol with rapid induction and  recovery  is a  popular  induction  agent nowadays for surgical anesthesia. Objectives: To compare the effect of sevoflurane and propofol for inducing anesthesia in short elective surgeries. Methods: The study was conducted at Government Medical College,Nizamabad,Telangana,India. Hundred patients prepared for elective short surgery were taken into the study. After pre-anesthetic medication, one group of patients were induced with : O2:N2O  (50:50)  +  Sevoflurane  3-4%  and the other group induced with:  O2:N20  (50:50)  +Propofol 3-5 mg/kg.Parameters like relavant intra-op details, ease of procedure, hemodynamic changes, recovery, and complication rate were compared between both groups.Results: Parameters like jaw opening, attempts for LMA and ease of insertion was comparable in both the groups . Time to loss of consciousness and time  to  LMA insertion was significantly shorter with Propofol. Mean pulse rate and MAP was significantly higher in Sevoflurane group.  Conclusion:  Inhaled Sevoflurane is better for LMA insertion and intra-operative hemodynamic profile during anesthesia was stable.Sevoflurane can be considered as an alternative induction agent when inhalational induction is required. We should keep in mind that  caution  still needs to be continued when sevoflurane is used.

Uveitis is a term used to describe inflammatory processes of the portion of the eye known as the uvea, which is composed of the iris, ciliary body and the choroid; however, any area of the eye can be inflamed. Uveitis is most often idiopathic but has been associated with traumatic, inflammatory, and infectious processes. Patients may present with concurrent systemic symptoms or infectious diseases to suggest an etiology affecting more than just the eye. Idiopathic cases of uveitis account for 48 to 70% of uveitis cases.
Materials and methods: This prospective and observational study was undertaken with all new uveitis cases attending the Department of Ophthalmology, Tertiary care Teaching hospital over a period of 1 year. A standard clinical protocol and detailed investigations were to find out the specific cause of uveitis. All patients above 18 years of age either gender having uveitis. Patients who could not be worked up completely as per protocol or did not give consent for the study were excluded.
Results: Anterior uveitis presented in 42 (60) cases, 12 (17.1%) patients were idiopathic followed by Tuberculosis in 5 (7.2%) and HLA B27 in 6 (8.7%) patients. Intermediate uveitis was idiopathic while specific diagnosis made in 2 patients; i.e. sarcoidosis in 9 (12.9%) patient and ulcerative colitis in 1 (1.4%) patient. Posterior uveitis comprised of tuberculosis associated posterior uveitis was most common etiology seen in 1 (1.4%) patients. Out of 1 patients of tuberculosis related posterior uveitis; 2 patients had multifocal choroiditis and 1 patient had tuberculoma with serous retinal detachment. Panuveitis recorded in (n=2) patients, 1 (5.7%) patient was suffering from Vogt-Koyanagi-Harada’s (VKH) disease and other was idiopathic.
Conclusion: Our study recommends that patients with uveitis should undergo comprehensive ocular and systemic investigations to find the underlying etiology. All the patients must be managed according to the type of uveitis, they are suffering from and a watch should be kept on all the possible likely complications which will help a lot in preventing blindness from uveitis

Repairing a hernia in the groin is a routine surgical treatment, and for the vast majority of patients, the healing process after surgery is straightforward. Some patients, however, continue to complain of chronic groin pain or discomfort (CGP) (or months or even years after hernia treatment. This is a complication that is becoming recognized as a substantial source of morbidity following groin hernia surgery and is growing more common.
Aims and objective: To evaluate the chronic pain after laparoscopic and open mesh repair of groin hernia
Material and methods: This research included all of the patients who voluntarily chose to have a repair of their groin hernia performed with a prosthetic mesh. These patients were asked about any pain or discomfort they experienced as a result of the groin hernia repair, as well as whether or not it prevented them from participating in daily physical or sporting activities like walking, lifting a bag of groceries, playing golf, or more strenuous sports like jogging and football. The questionnaire was given out between 6-12 months after the procedure was performed. Laparoscopic TEP repair was conducted under general anaesthesia without securing the Prolene mesh in the preperitoneal area. The procedure was performed via the transperitoneal access port (TEP). The Lichtenstein procedure was used to accomplish open mesh repair under general anaesthesia, with the exception of patients who had substantial cardiorespiratory illness or those who wanted to undergo local anaesthesia.
Results: From the group of 200 patients, 160 (80%) provided a response, 20 (10%) passed away due to factors unrelated to hernia repair, and 10 (10%) did not provide any information at all. Out of the total of 160 patients, 80 (or 50%) had laparoscopic TEP, while the remaining 80 (or 50%) underwent open mesh repair. Three-fifths of the 160 patients, on average, complained of having persistent pain or discomfort in the groin area. Nine of these individuals (5.62%) claimed experiencing pain, whereas 47 (29.37%) just reported feeling uncomfortable. CGP was seen at a considerably higher frequency after open mesh repair in comparison to laparoscopic TEP repair. CGP prevented 38 patients, or 23.75 percent of the total, from participating in daily physical or sports activity.
Conclusion: After groin hernia surgery, patients reported having chronic pain or discomfort in 35% of cases. This occurrence was substantially more likely after open mesh repair than after laparoscopic TEP repair. In 23.75 percent of the patients, it had a negative impact on their ability to participate in active or sports activities, and this was exacerbated following open mesh repair.

Perforated peptic ulcers (PPUs) is related with short-term mortality and morbidity in up to 30 and 50% of peptic ulcer patients, respectively, due to subsequent peritonitis and sepsis. Immediate surgery is the most important aspect of treatment since delay in surgery considerably increases mortality. We conducted this study with an aim to compare the intraoperative findings and postoperative outcomes of cases undergoing open repair surgical approach and laparoscopic repair surgical approach for PPUs.
Methods
We conducted this retrospective study in the department of General Surgery at the tertiary care hospital, North India 3 months (June 2021 to August 2021). The cases of both gender (age 15-70 years) with criteria of clinical diagnosis and radiological evidence of perforated peptic ulcer were the study subjects [treated with open repair method (n=90) or laparoscopic repair method (n=160)]. In our hospital, a thorough clinical examination was performed in all patients with PPU.  A pretested proforma was designed to collect the details of cases from the patient case sheet. The collected data was entered in MS Excel sheet and was analysed using the same. Tests were considered significant if p>0.05.
Results
In present study, the cases underwent open and laparoscopic repair were matched for the gender, age, body mass index, comorbidity, and ASA score for comparing the outcomes of open and laparoscopic repair of the PPU. In our study, the operative time was significantly higher in cases whose PPU was repaired with laparoscopic method (111.62±31.89 min) as compared to the cases who underwent open repair technique (87.46±28.95 min). In our study, the surgical site infection (SSIs) rates were higher in open repair group (14.4%) as compared to the laparoscopic repair group (5.6%). In our study, the mortality rates were higher in open repair group (3.3%) as compared to the laparoscopic repair group (0.0%).
Conclusion
A common surgical emergency is a perforated peptic ulcer. In order to repair the defect and flush the peritoneal cavity, patients with perforated peptic ulcer disease typically need emergency surgery. Fewer postoperative complications including a lower rate of surgical site infection and lower mortality are advantages of laparoscopic surgery versus open surgery.

From the beginning of time, tuberculosis (TB) has been one of the most significant contributors to poor health, and now it is one of the most common infectious agent that results in mortality. While it most often affects the lungs, it may also manifest in other locations. Around 45 percent of the world's TB burden may be attributed to the Indian subcontinent. Around fifteen percent of all cases of tuberculosis are classified as extrapulmonary tuberculosis (EPTB).
Aims and objective: To study the clinical diagnosis of abdominal tuberculosis
Materials and methods: It was determined that abdominal TB affected 50 individuals. Each patient had a full battery of diagnostic procedures, including an in-depth interview and physical examination, blood work (including a complete blood count and erythrocyte sedimentation rate [ESR]), regular biochemical testing, a skin test [Mantoux], a chest X-ray, and an (USG).
Results: There were 50 patients with abdominal TB (mean age 35.25±3.69 years; 20 females, 30 men). It showed that abdominal discomfort and weight loss were the most common of them. Anemia was found in 35 patients, which is 70% of the total, an increased ESR was found in 33 patients, which is 66% of the total, and hypoalbuminaemia was found in 25 patients, which is 50% of the total. Additional results included leucocytosis in three individuals (representing 6%), a positive CRP in nine patients (representing 18%), and increased transaminases in eleven patients (representing 22%). Four of these 12 patients were chronic HBV carriers, two of them had immunity to HBV, and two of them tested positive for anti-HCV antibodies. Seven individuals, or 14%, had completely normal results on all of their laboratory testing. Ten (or twenty percent) of the patients had positive results from the Mantoux skin test. Ascites was present in 21(42%) of the cases. The ascitic fluid analysis that was done on those individuals revealed that it had an exudative nature. Moreover, acid-fast bacilli were discovered in the smear of just one patient, and BacTec was only used to culture the ascitic fluid of one patient (4%).
Conclusion: When it comes to the diagnosis of abdominal tuberculosis, neither the clinical symptoms, laboratory, radiographic, and endoscopic procedures, nor the bacteriological and histological results give a gold standard by themselves.
Ascites, abdominal tuberculosis, CRP

Kligman's formula (Triple Combination) or modified Kligman's is a topical drug for that combines fluocinolone acetonide 0.1 %, hydroquinone 4%, and tretinoin 0.05%, and is now the only US FDA-approved medication for the treatment of melasma topically. It has recently gained widespread popularity among the general public for a variety of uses. When used incorrectly, it might produce negative consequences and undesirable side effects.
Methods: 
A cross-sectional, observational study was performed using Kligman's formula misuse questionnaire in a  convenient sample of 2634 participants. The statistical analysis included descriptive analysis, and tests of association (chi square and Fisher’s exact test).
Results: 
knowledge regarding triple combination cream is poor. 2% of the respondents correctly chose skin melasma, 1.3% chose hyperpigmentation, and 10.3% chose acne post pigmentation, however, as these conditions are all approved indications for using triple combination cream, only 18% chose at least two of them. Acne post pigmentation was the most common reason for using triple combination creams (42.5%), followed by other causes of pigmentation (21.1%), inflamed acne (13.8%), melasma (12.3%), and other non-reported causes (10.3%). Social media was the most prevalent source of cream-related information among non-users (23.1%) and the second most common source among users (35.9%).
Conclusions: 
knowledge regarding triple combination cream is poor. Kligman’s formula misuse and its adverse reactions is a concern in Saudi Arabia. The diversity in sources of informations of using Kligman’s formula is negatively affecting the correct use of it. Therefore, we recommend using social media websites, malls, and television to raise awareness for the correct way to use Kligman's formula and how to avoid its misuse

Cerebrovascular pathologies due to atherosclerosis are the most common cause of morbidity and cardiovascular diseases and the 3rd widely known cause of mortality after cancer (Silvennoinen HM ,2007). Cerebrovascular pathologies are responsible for 95% of stroke, and ischemic stroke is the cause of approximately 80% of stroke cases due to cerebrovascular pathologies. Cardiac thromboembolism is responsible for only 1/5 of transient or permanent cerebral ischemia, and 4/5 is due to atherosclerosis (Landewehr P ,1995). It is stated in the literature that extracranial carotid artery atherosclerosis ranks third among the causes of ischemic stroke. (Ooi Y.C, 2015).

COPD is a leading contributor of morbidity and mortality worldwide. Smoking and inhaling harmful chemicals and particles from indoor and outdoor air pollution are the main environmental exposures that cause COPD. Non-smoking related COPD affects more people in developing countries than it does in developed countries. This study was initiated primarily to assess the response of standard treatment in COPD among smokers and non-smokers. The proportion of COPD patients whose condition was not caused by tobacco smoking was also assessed. Non-smoking related chronic obstructive pulmonary disease (COPD) is a neglected entity.
Material and Methods: This was an observational, prospective, case-control study. All patients were diagnosed for COPD, aged 18 years or above, were included in this study. Patients were divided into case (non-smoker COPD) and control (smoker COPD). Standard treatment for COPD would be given to both groups according to latest GOLD guidelines for COPD. Treatment response was evaluated in both groups.
Results and Discussion: In this study 49.1% patients were smokers while 50.9% patients were non-smokers, which is in accordance with the worldwide trend of half of the patients of COPD being due to risk factors other than smoking. It was found that smoking COPD occurs at an older age. There was no significant difference in pulmonary function test values, 6-minute walk distance (6MWT), COPD Assessment Test (CAT) score and Modified British Medical Research Council (mMRC) grading between the two groups.
Among serological tests it was found that Total Leucocyte Count (TLC), Neutrophil-Lymphocyte Ratio (NLR) and Packed Cell Volume (PCV) were statistically higher in the smoker COPD group than the non-smoker group.

Background and objectives:Spontaneous reporting of adverse drug reactions (ADR) is vital for pharmacovigilance. It is important to gain knowledge regarding adverse drug reaction in the undergraduate level. The present study was conducted to assess the knowledge, attitude, and practice (KAP) of ADR reporting among medical students both undergraduate and Post Graduates. Materials & Methods:This was a cross sectional questionnaire-based study conducted among medical students in a teaching hospital, of south India. There was a total of 24 questions of which 10, 8 and 6 were related to Knowledge, Attitude and Practice respectively. Data was analysed using SPSS (Statistical Package for Social Science) version 28 for descriptive and analytical statistics.

BACKGROUND:. The hand-sewn bowel anastomosis may be performed as a single layer suturing technique or double-layer technique of anastomosis. The most scientific way to conclude the superiority of one method over others is evidence-based medicine. Hence, we conducted a retrospective study in our institute to compare single- layer interrupted extra mucosal intestinal anastomosis with a double-layer conventional method of intestinal anastomosis. METHODS: Retrospective, Comparative study on 53 patients, who underwent intestinal anastomosis, from August2019 to July 2022. Patients were allotted into two groups. single-layer anastomosis were grouped under Group A, and double-layer anastomosis were grouped under Group B. Outcomes were analyzed in terms of time taken for anastomoses, hospital stays, cost-effectiveness and complications. RESULTS: The mean age in group A was 41.4 years, and in group B was 41.25 years. Both males and females were equally affected. The ileal stricture was seen in 12 (23.07%) cases; and resection of ileum and ileo-ileal anastomosis was performed in the maximum number of cases. In group A mean duration to perform single-layer anastomosis was 19.04 minutes and 28.8 minutes in Group B. The mean difference
European Journal of Molecular & Clinical Medicine
ISSN2515-8260 Volume10, Issue 03, 2023
770
between two groups was 9.76 minutes, and the P-value was <0.001, which is highly significant. An overall complication in the form of anastomotic leak was noted in 7 patients (13.4%) including both A and B group; 2 (3.8%) cases in Group A and 5 (9.6%) in Group B and the difference was statistically significant. The mean duration of hospital stay in Group A was 7.32 days and Group B was 7.92 days (difference was statistically insignificant). CONCLUSION: Single layer interrupted extra mucosal intestinal anastomosis is a better procedure when compared to continuous double layer conventional method of intestinal anastomosis as it takes less time for construction, cost effective and has low risk of developing complications.

In our country, a large part of patients still neglects inguinal hernia due to the low level of public awareness about the danger of obstruction and strangulation. Even with better pre and postoperative care, improved anesthetic management and advanced surgical techniques, the emergency repair of an obstructed hernia is associated with poor prognosis and a high rate of postoperative complications. This study is to assess various risk factors and therapeutic strategies for better outcome of the patients presented with an obstructed inguinal hernia at our setup. A total of 74 inguinal hernia patients with obstruction were evaluated. Majority of the patients were in the fifth and sixth decade. More than 50% of cases belong to low socio-economic strata, who do heavy work. Right-sided Indirect hernias were more common than others. Chronic cough, constipation, prostatic enlargement are common causes of increased intra-abdominal tension seen in more than 60% of cases. All of the cases were operated as an emergency procedure. Viable bowel was seen 75.46% of cases. Bowel resection and end-to-end anastomosis were done in all cases of nonviable bowel. Patients presented early with the only obstruction, had an excellent prognosis; But the danger group, where symptomatology is vague and associated with strangulation had a higher rate of complications and mortality.

Background: An important well-known event of respiratory failure (RF) is frequently associated with severe exacerbations of chronic obstructive pulmonary disease (COPD). Moreover, the hypercapnia presents during an acute episode of RF, which is found to have higher mortality rate. Objectives: To investigate the role of NIV applied to COPD patients with acute HRF who presents with acute exacerbations and require hospitalization. Material and Methods: This study was a prospective, observational study which was carried out at Apollo Gleneagles Hospital, Kolkata during the period of study was 18 months (from January 2019 to June 2020). A total of 90 patients were recruited in the study. All COPD cases presenting in the Emergency Department during morning shift for arterial blood gases (ABG) data from patient at baseline, i.e., at arrival (0hr) and follow up at the time interval of 2 and 12hrs and patients presenting with Acute Exacerbations of COPD were included in the study. Results: A total of 90 patients were admitted to the emergency department of Apollo Gleneagles hospital due to AECOPD presenting with HRF, was evaluated and treated with NIV for a better outcome concerning ABG parameters. The maximum value (27.80%) was obtained for the age groups of 51-60 years followed by age groups of 61-70 years (21.10%) and a minimum frequency value (3.30%) was observed for the age groups of 91-100 years. The mean ± standard deviation of age value was 66.37 ± 13.64 years. The data on the distribution of ICU admission (% frequency), a maximum value showing ICU as NO groups (55.4%), and a minimum value of about ( 44.6%) of YES groups as ICU admission were obtained among total studied patients. Overall hospital duration revealed that the minimum duration of hospitalization of 1 day and maximum value of 14 days were recorded and the mean ± standard deviation of the duration of hospitalization value was 4.59 ± 3.31 days. Conclusion: In the present study, patients present in the age groups of 51-60 years were observed more susceptible and management through NIV was found to be more beneficial. Moreover, the duration of hospital stays, and ICU admission were found to have reduced in number after NIV treatment.

Glaucoma represents a group of diseases characterised by optic neuropathy which is consistent with remodelling of the connective tissue elements of the optic nerve head and with loss of neural tissue which leads to the eventual development of distinctive patterns of visual dysfunction. Although the intraocular pressure level is one of the primary risk factors for development of glaucoma, it does not have a role in the definition of the disease.
Aims: To evaluate the relationship between blood pressure, intraocular pressure and ocular perfusion pressure in patients with systemic hypertension.
Material and Methods: We studied 400 eyes of 200 hypertensive patients and compared them with 200 eyes of 100 non-hypertensive control subjects. We had aimed at finding the relation between blood pressure, intraocular pressure and ocular perfusion pressure in hypertensive patients and assessing the risk factors for developing primary open angle glaucoma in hypertensive patients.
Result:

Mean Intra Ocular pressure in hypertensive patient is higher than that of non hypertensive patient's  P<0.001
Mean ocular perfusion pressure is higher in hypertensive patients than non hypertensive patient's P<0.001
Intra ocular pressure has correlation with systolic and diastolic blood pressure.
Intraocular pressure has correlation with Diastolic ocular Perfusion pressure and mean ocular perfusion pressure with mean ocular perfusion pressure having positive correlation with Diastolic blood pressure and negative correlation with glocoma status.

Conclusion: A positive association exists between blood pressure and intraocular pressure, but similar association could not be established between blood pressure and primary open angle glaucoma. A significant association was seen between low diastolic blood pressure, low diastolic ocular perfusion pressure, low mean ocular perfusion pressure and glaucoma

Utilization of Mother and Child Health service is a concept of expressing the extent of interaction between the service and the beneficiaries for whom it is intended. It will depict the health infrastructure and services given to them.
Material and Methods: A cross sectional study was conducted in the urban slums of Purnea, Bihar. among 300      post natal mothers. Data was collected from mothers using a pre-tested, semi-structured questionnaire. Study period 15 Jan  2022 To 15 Feb  023
Conclusion: There is poor utilization of maternal services and decreased awareness about early registration, postnatal visit, decreased acceptance of IFA tablets and postpartum contraception. While all the mothers said they had increased the food intake during postnatal period particularly after the puerperium period. And the type of food consumed more during pregnancy and lactation was fruits, fish, milk etc.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by novel coronavirus SARS-CoV-2 predominately involving the respiratory system. Bronchoalveolar lavage (BAL) is a safe, easily performed, minimally invasive and well tolerated procedure which explores large areas of the alveolar compartment providing cells as well as non-cellular constituents from the lower respiratory tract. It opens a window to the lung.Alterations in BAL fluid cellular and non-cellular components reflect pathological changes in the lung parenchyma. The information obtained from BAL fluid analysis, if considered carefully can have a reliable diagnostic criterion.

Urinary Tract Infection (UTI) is an infection of one or more structures in the urinary system. The urinary tract includes urethra, bladder, ureters, prostate and kidneys. Clinical presentation of UTI varies from asymptomatic infection to full blown pyelonephritis. Some symptoms may be non-specific and frequently symptoms overlap in patients with lower UTIs and upper UTIs. Present study was undertaken to isolate and characterize pathogens causing UTIs in patients attending, DMCH Darbhanga,  a rural tertiary care hospital and to study the antimicrobial sensitivity pattern of the urinary isolates, so as to provide a basic guideline in treating UTIs.
Methodology: A total of 500 midstream urine (MSU) samples were taken from both male and female patients who had clinically suspected UTI .They were asked to collect a fresh sample of MSU in a sterile container after cleaning the genitals with soap and water. The sample was transported to the microbiology laboratory and processed by wet film microscopy, Gram’s stain and semiquantitative culture in blood agar and MacConkey’s agar .All the isolates were identified by standard procedures and antimicrobial susceptibility test was done for the bacterial isolates.
Conclusion: The most common uropathogen isolated in our study was E. coli. Pseudomonas aeruginosawas the second major pathogen isolated from UTI. In the present study, overall incidence of UTI observed among males is marginally higher than that was observed in females. High rate of UTI was observed in children of 0 – 9 years of age.

Attention deficit hyperactivity disorder (ADHD) is a chronic and pervasive condition that begins in childhood and is characterized by inattention, impulsivity, and hyperactivity. ADHD is also often associated with extreme temperamental characteristics such as negative mood, short persistence, low frustration tolerance, excitability, and a quick temper. Of particular clinical significance is that parents of children with ADHD very often experience considerable stress in their parenting roles. Such stress typically is much greater than that found among families of normal controls.
Materials and Methods: Study had a longitudinal designed. 52 mothers and 48 fathers of 6-12 years aged children with psychiatric diagnosis of ADHD, who had come or referred to psychiatric clinic in Sir T. hospital Bhavnagar were eligible to participate and were randomly recruited in the study, in time phase of 12 months. All the children who were brought to the clinic with chief complaints of inattention and hyperactivity were evaluated using the DSM V criteria to confirm the diagnosis. Ascertainment of ADHD diagnosis was made using gold-standard criteria based on the Diagnostic and Statistical Manual of Mental Disorders, edition 5. Depression, Anxiety and Stress Scale - 21 Items (DASS-21) was employed for the present purpose to tap emotional distress of caregivers of ADHD children. p<0.05 is considered to be statistically significant.
Results: 100 participants containing mothers and fathers of children with ADHD child were involved in this study Out of 100 participants 19% of them suffering from depression, 11% were suffering from anxiety and as much as 43% of them suffering from stress in their daily life.  Which indicate significantly higher mean stress score in mother compare to father.
Conclusion: Our study shows significantly higher prevalence of stress and anxiety in mother compare to father. Variable like level of education also significantly affect level of stress and anxiety in parents with individual with higher level of education having lower prevalence of stress and anxiety in their life.

This study's objective was to investigate how the small intestine develops in cape hares  by  the histological and histochemical techniques. The investigation was conducted on (15) samples of the small intestine, five at the age of one day, five at the age of fourteen days, and five at the age of adulthood, shortly following the slaughter, samples were collected from various regions of (duodenum, jejunum, and ileum). Ten samples from each area were collected and fixed in 10% formalin for 24 hours before being subjected to standard histological procedures and having the sections stained with H&E, PAS, AB, PAS-AB, and Masson's Trichrome to identify the various components. The current study revealed a large number of vacuolated enterocytes and immature cells in one-day-old pups, but no Peyer's patches, Brunner's gland, or Crypts of Lieberkuhn were discovered. Instead, there were clumps of immature epithelial cells with large and pale nucleus near the bases of the villi. The vacuolated cells vanished in both the 14-day-old and adult forms, and the villi took on their mature morphology with wide bases and tiny points. In the duodenum, the villi were fashioned like leaves, while those in the jejunum and ileum were conical. Simple columnar epithelium with many goblet cells lined the mucosa in all the segments of small intestine, and the goblet cells found in all ages, Crypts were present firstly in 14 day age. In 14 day and adult The Brunner's glands in the first part of the duodenum were of the serous type. At the end of the adult hare ileum was Peyer's patch. All ages had the sacculus rotundus dispersed with multiple lymph nodule that contributed to immunological response in the gut, nerve plexuses in each of submucosa and muscularis found in all ages.

   The current study was conducted for the period from November 2021 until May 2022, which aims to study an epidemiological and diagnostic study of the parasite Entamoeba histolytica and to measure some immunological parameters of those infected with the parasite. The results of the microscopic examination of 1933 samples infested with 327 samples of tissue-forming amoeba parasites, with an infection rate of 17%. In the month of October, it was 8%, and the results showed that the highest percentage of infection with the tissue-dystrophic amoeba parasite was in the liquid stool samples, which amounted to 68.6%, respectively, and the lowest percentage was in the solid stool samples, which amounted to 2.4%. Males are higher than females, reaching 53.5% and 46.5%, respectively. The results also showed that the highest percentage of amoeba parasites was for the age group 21-30 years, which amounted to 23.9%, and the lowest percentage for group >50 reached 11.6%. The ELISA technique increased the concentration of interleukin-2 in serum for those infected with the histiocytic amoeba parasite, as the ratio reached 61.4 ng/ml compared with the serum group of healthy people, which amounted to 4.1 ng/ml. The results showed high concentrations of TNF-a and anti-IgE in serum for those infected with E. Histolytica parasite, it reached (28.7 and 29.3) ng/ml, respectively, compared to the healthy serum, where the concentrations of TNF-a and IgE antibody reached 25.3 ng/ml.

Vitamin D has a significant role to play in bone metabolism and neuromuscular function. Several researchers have indicated that Vitamin D deficiency may be possibly related to musculoskeletal pain including chronic low back pain.
Aim: We aimed to examine the relationship between the levels of vitamin D and patients with chronic low back pain and to investigate its effects on pain and functional capacity.
Materials and Methods: Two hundred and sixty patients (Female/Male:110/150) with complains of low back pain for more than three months, aged between 18 to 60 years and both genders, participated in the study. Visual Analog Pain Scale (VAS) was used to measure the state of pain. Pain-related functional capacity was evaluated using Modified Oswestry Disability Questionnaire (MODQ). Patients were classified into three groups based on their serum vitamin D levels: Sufficient ( 30 ng/mL), insufficient (20.1-29.9 ng/mL) and deficient ( 20 ng/mL).

Surgery is an event that causes anxiety among the majority of patients. In addition, laryngoscopy and intubation cause disturbance in the heart rate and blood pressure rhythm. Together preoperative anxiety and intubation can prove harmful for some patients.
Aim: To observe the clinical effects of Clonidine on anxiety & cardiovascular parameters (pressor response) during direct laryngoscopy and tracheal intubation.
Material and Methods: A single-centre, parallel-group, two-arm, 1:1, double-blind, placebo-controlled, randomised, intervention study. A total of 100 participants: 50 in the clonidine group and 50 in the placebo group were enrolled in the present study. Participants in the clonidine group were given oral clonidine at a dose of 200 micrograms 90 minutes before induction.
Results: The increase in heart rate and mean arterial blood pressure was significantly less among patients given clonidine in comparison to placebo. In addition, participants given Clonidine showed fewer fluctuations in their heart rate and blood pressure throughout the surgery. Participants given Clonidine were more less anxious before surgery in comparison to those given the placebo. None of the participants given Clonidine had any adverse effect.
Conclusion: Clonidine is effective at attenuating the haemodynamic response to laryngoscopy and intubation. In addition, Clonidine has an anxiolytic action.

Autologous Platelet Rich Plasma injection is now widely accepted treatment in
the treatment of lateral epicondylitis. Prior studies on PRP injection treatment in lateral
epicondylitis have not emphasized on the injection technique used to deliver PRP to the site of
maximum tenderness on lateral epicondyle. PRP can be delivered by either single injection at
the point of maximum tenderness or by peppering technique at the point of maximum
tenderness. Which injection technique is more effective in treating lateral epicondylitis needs
to be further studied.
Aims and Objective: To compare the outcome of treatment of lateral epicondylitis with PRP
with single injection technique and peppering injection technique in terms of improvement in
functional outcome and pain.
Materials and Method: A comparative study was conducted in 62 patients with lateral
epicondylitis treated with PRP injection by single injection technique (31 patients) and PRP
injection by peppering injection technique (31 patients). Patients were followed up at the 2nd
week, 4th week, 8th week and 12th week and assessed with Patient Rated Tennis Elbow
Evaluation (PRTEE) Score and Visual Analog Pain Scale (VAS) Score during follow up.
Repeated measures of ANOVA was used determine the statistical significance of scores during
follow up in both groups. The mean scores of PRTEE and VAS score with single injection
technique were compared with that of prepping injection technique using unpaired t test.

The research objective was to compare the clinical and radiological results of single-bundle versus double-bundle arthroscopic anterior cruciate ligament (ACL) replacement.
Method: 80 patients with isolated ACL injuries had surgery between July 2020 and July 2021, with groups for single bundle (SB) and double bundle (DB) reconstructions each consisting of 40 individuals. The GNRB arthrometer, the International Knee Documentation Committee, and the Lysholm scale were used to evaluate the results. The lateral pivot-shift test was used to evaluate rotational stability. To compare the repaired ACL graft orientation, postoperative magnetic resonance imaging (MRI) was done.
Result: The average follow-up was 18.2 months for the DB group and 14.8 months for the SB group. The mean Lysholm score was 94.12±2.66 in the SB group and 93.12±3.30 in the DB group at the time of the final follow-up (P value = 0.201, statistically insignificant). According to the objective IKDC scores, all of the patients in both groups were in grade A or B. The mean differential anterior tibial translation in the SB group was 1.44 ± 0.5 mm and in the DB group it was 1.16 ± 0.7 mm (P = 0.104, NS). In the DB group, all of the pivot shift tests were negative, whereas in the SB group, three patients showed positive results. According to an MRI of surgically repaired knees, both groups' mean sagittal and mean coronal ACL graft-tibial angles were equivalent (P value > 0.04, NS).
Conclusion: At an average of 15 months of follow-up, there was no statistically significant difference between the single-bundle and double-bundle ACL repair groups in terms of knee stability, knee ratings, subjective assessments, or MRI examination of graft inclination angles.

The cuffed endo tracheal tube was considered as the gold standard for provision of a safe glottic seal, especially for laparoscopic procedures under general anaesthesia. Proseal laryngeal mask airway (PLMA) has a dorsal cuff, in addition to the peripheral cuff of LMA, pushing the mask anterior providing a better seal around the glottic aperture and permitting high airway pressures without leak. The drain tube which lies parallel to the ventilation tube allows drainage of passively regurgitated gastric secretions away from the airway and serves as a passage for the gastric tube.
Objectives:  Primary Objective:  To compare LMA-Proseal with Endotracheal Tube for ease of insertion.  Secondary Objective:  To compare LMA-Proseal with Endotracheal Tube with regard tohaemodynamic changes in patients undergoing laparoscopic surgeries under general anaesthesia.
Methodology: In this Hospital based prospective observational study,sixty ASA PS 1 or 2 patients requiring laparoscopic surgeries were allocated into two groups, 30 each (n=30) based on the technique of ventilation, either using LMA-Proseal or ETT. Prior to induction, patient and airway characteristics were recorded. The primary outcome was the ease of insertion, which was defined in terms of number of attempts and time for insertion.
Results: In this study, the ease of insertion of LMA-Proseal was comparable to ETT. Both were of 100% single insertion and time taken for insertion was 16±2SD for LMA-Proseal and 16±2.5SD for ETT. The hemodynamic changes were found to be more with ETT than LMA-Proseal. Oxygenation and ventilation were maintained in both groups. Success rate of first attempt insertion (group P 86.7% and group E 76.7%) and time taken for insertion of Ryle’s tube were less with LMA-Proseal (p value 0.002).
Conclusion: This present study suggests that the use of LMA-Proseal for ventilation in patients undergoing laparoscopic surgeries under general anaesthesia is better compared to ETT. The ease of insertion was comparable and hemodynamic responses were less than with ETT.

Paediatric pulmonary TB is the most neglected aspect of the present case scenario and is completely different from adult TB. Compliance to TB treatment in children is important to prevent drug resistance and mortality which includes multiple patient-related and healthcare-related factors. Globally treatment non-compliance remains the major hindrance to achieve complete cure and interventions done to improve treatment compliance will be a major breakthrough.
METHODS: In this cross-sectional observational study, a semi-structured questionnaire was used to find out the socio-demographic factors and the factors determining treatment compliance among paediatric pulmonary tuberculosis subjects registered at treatment units under DTCO, Hyderabad, Telangana. MMAS-8 scale which was validated had been used to assess treatment compliance. Chi-squares and fisher’s exact test were used for statistical analysis.
RESULTS: Out of 88 paediatric pulmonary TB respondents that have been registered under 19 TUs, 15 children (17%) have shown treatment non-compliance. The study revealed children with age <5 years (30.7%), males (18.5%), Hindus (27%), high school going (30.4%), with positive migration history (22.2%), underweight category (19.4%), lower socioeconomic class (19%), treatment access from private health setup (20%) and parents with lack of basic TB knowledge (19%)  have shown greater non-compliance. Reasons for missing out on medication in this study were forgetfulness, adverse drug reactions, lack of paediatric drug formulations, lack of prior awareness, and feeling cured.
CONCLUSION: In-spite of robust TB programs and free supply of medicines by the government still there is a significant non-adherent population constituting 17% of the total pulmonary TB respondents. The above mentioned factors for treatment non-compliance should be addressed with careful attention to achieve complete treatment compliance

The purpose of this study is to Correlate the characteristic pattern of lesions
affecting posterior horn of medial meniscus in MRI with Arthroscopic findings and calculate sensitivity, specificity and accuracy in diagnosis of ramp lesions.
Methodology:It is a 2-year prospective study conducted in department of orthopedics, Rajarajeswari Medical college and Hospital, Banglore. Patients who were diagnosed with meniscal injuries were posted for arthroscopy surgery after obtaining the informed consent.
In this study we compared MRI findings with arthroscopic findings of medial meniscal ramp lesions of knee. The data is prepared and sensitivity, specificity, accuracy of MRI were calculated.
Results:A total of 112 patients of knee injuries were evaluated in which the Medial
meniscus was injured in 64.96% of cases. The MM tear with ramp lesion was present in 26(65%) cases, of which 5 (12.5%) cases had grade I tear, 8 (20%) cases had grade II tear and 13 (32.5%) cases had grade III tear. The sensitivity, specificity, PPV and NPV were calculated and we found Sensitivity 88.89%, Specificity 84.62%, Positive predictive value 92.31%, Negative predictive value 78.57%, Accuracy 87.50%.
Conclusions:The Meniscal Ramp lesions need to evaluation of the knee injuries accurately
is very crucial for the proper management and outcome. MRI shows moderate sensitivity, specificity and accuracy in the diagnosis of ramp lesions in posterior horn of medial meniscus with more false positives and false negative values. Common causes of false positive findings in MRI is due to misinterpretation of intra meniscal signal changes (grade II signal changes) or normal anatomy as tears. The arthroscopic evaluation of ramp lesions was done using a postero-medial and trans-notch view and other accessory portals.

The purpose of this study is to evaluate the level of CRP in the serum as a potential biomarker of the disease activity in pulmonary TB.
Materials & Methods: In this particular research, there were a total of fifty cases of pulmonary TB, split evenly between males and females. After receiving their signed agreement, everyone was enrolled in the study. Cases that had extrapulmonary TB or secondary tuberculosis were not included in the study because they did not meet the exclusion criteria. Information such as age, gender, and other demographics was recorded. 2 ml blood was withdrawn from the patient and was sent was quantitative analysis to assess the CRP level.
Results: There were 52% newly detected cases of pulmonary TB, 22% undergoing anti-tubercular treatment, 14% cured cases, 8% treatment defaulters and 4% treatment resistant. The difference was significant (P< 0.05). The mean CRP level (mg/dl) in the newly detected TB patients was found to be 53.55±6.11. Those undergoing anti-tubercular treatment had a mean CRP value of 43.69±4.85. CRP in patients who had completed their treatment was 4.63±1.33. Defaulters had a mean CRP of 66.74±5.28 and the treatment resistant had a mean CRP of 86.11±4.98. The difference was significant (P< 0.05).
Conclusion: The authors discovered that CRP levels were elevated in TB, but that these levels dropped and returned to normal by the time therapy was complete

Regional nerve blocks with local anesthetics provide intra operative anesthesia as well as Postoperative analgesia. Our study has been undertaken to compare the onset time, duration and analgesic efficacy of clonidine with dexmedetomidine when added as adjuvant to bupivacaine(0.25%) for brachial plexus block by supraclavicular approach.
Methods: 60 patients aged 18-65 years belonging to ASA PS –I & II of both sexes undergoing elective upperlimb surgeries under Brachialplexus block were included in our study. Patients satisfying the inclusion criteria were allotted into 2 groups of 40 each. Group 1: Bupivacaine 0.25%( 35 cc) + clonidine 1 mcg/kg, Group 2: Bupivacaine 0.25%( 35 cc) +dexmedetomidine 1mcg/kg.
Results: The mean time for onset of sensory block in group A was (20.23 ±1.104 ) mins and that observed in group B was (14.83±1.744) mins. The mean time for onset of motor block in group A was( 18.43 ±1.135) mins and (12.67±1.539) mins in group B. . Mean duration of sensory block in group A was (476.77±9.313) mins and in group B was (730.13±52.208) mins. The mean duration of motor block in group A was (420.60±8.896 )mins and in group B was( 649.6±45.040 )mins. The mean duration of analgesia in group A was (522.23±11.047) and in group B was (757.13± 44.044) All the above differences were statistically significant with a p value < 0.05%. 

The lumbar plexus is a network of nerves which comprises of the ventral primary rami of the first, second, third and fourth lumbar spinal nerves (L1 - L4).Awareness of the possibility of encountering multiple variations may prevent post-operative complications. This would also be useful information for Anatomists, Anaesthesiologists, Gynaecologists, Orthopedicians and Surgeons.
Aim-: The aim of this study was to evaluate the incidence and variation in the formation of femoral nerve.
Material and method-: The study was carried out on a total of 60 lumbar plexuses taken from 30 cadavers in the department of anatomy index medical college (MP), and govt medical college, doda (J&K). For the purpose of providing a more transparent depiction of the observed variation, each item has been photographed with a digital camera.
Result-: The normal origin of the FN is from the dorsal divisions of the L2, L3, and L4 roots. Atypical branching pattern of femorsl nerve was found in 5 out of 60 (8.33%) plexuses.
Conclusion-: This study found distinctions that could aid anatomists, anaesthetists, gynaecologists, orthopaedicians, and surgeons perform nerve blocks, abdomino-pelvic surgeries, and caesarean sections. These changes can also assist clinicians treat psoas major muscular abscess, groin pain syndrome, testicular pain, psoas muscle infarct (specifically in diabetics), and other conditions that might cause lumbar plexopathies.

Cardiac dysfunction is a predominant complication of hypertensive disease complicating pregnancy especially affecting left ventricular systolic and diastolic function example Ejection fraction, Fractional shortening, E/A ratio, Isovolumetric relaxation time, Deceleration time. These changes usually return to normalcy after delivery by six weeks postpartum in Normotensive patients.
Aim: To study the cardiac function in preeclamptic pregnant women by transthoracic echo in comparison with normal pregnant women in 32-38 weeks of gestation.
Methodology: This is a prospective observational study conducted in government institute of obstetrics and gynaecology hospital Egmore, chennai and government ISO Kasthurba Gandhi hospital chennai in 125 pregnant women and 125 preeclamptic women. The study subjects underwent echo at 32 38 weeks by using parameters such as ejection fraction l, factional shortening isovolumetric relaxation and deceleration time. This study also evaluated bmi, age, gestational age blood pressure and time of delivery. All preeclamptic patients were followed up to 6 weeks postpartum with echocardiography
Results: The average values of the following parameters were high in preeclamptic women as compared to normotensive controls.
BMI in preeclampsia women 28.71 +/- 4.89 and in Normotensive 27.9 +/- 2.9 (with p value 0.13). Fractional shortening was 28.5 +/- 2 in preeclamptic women and in Normotensive 33.26 +/- 1.62 with P value <0.01.
Isovolumetric relaxation time was in 126.02 +/- 58.6 in preeclamptic women and in Normotensive 99.76 +/- 4.66 with P value <0.001.
Deceleration time was in 230.06 +/- 17.23 in preeclamptic women and in Normotensive 203.34 +/- 6.74 with P value<0.001.
All echo values were highly significant.
Conclusion: Echocardiograph was rarely performed on all preeclamptic pregnant patients in developing countries like India. By performing echo on preeclamptic patients we will be able to detect left ventricular dysfunction early, start treatment, prevent complications and reduce morbidity and mortality. This study shows that echocardiography is extreme valuable and should compulsorily be made a part of all antenatal investigations..

The hypertensive disorders of pregnancy are among the leading causes of maternal and fetal morbidity and mortality. This study was conducted to assess early neonatal outcome in low- birth weight babies in mothers with hypertensive disorders.
Materials &Methods: 70 women with hypertension delivering low birth weight babies were divided into 2 groups of 35 each. Group I was vaginal delivery group and group II was caesarean delivery group. Parameters such as types of hypertensive disorders in pregnancies, early neonatal outcome and neonatal complications were recorded.
Results: Pre-eclampsia was seen in 12 in group I and 14 in group II, eclampsia 8 in group I and 7 in group II, gestational hypertension 10 in group I and 8 in group II and chronic hypertension with superimposed preeclampsia 5 in group I and 6 in group II. The difference was non- significant (P> 0.05).APGAR at 1 minute (4-6) was seen in 20 and 22, APGAR at 5 minutes (7-10) was seen in 15 and 13, neonates & groups I&II NICU admission was present in 26 and 24 and NICU admission was absent in 9 and 11 in neonates in group I and II respectively. Neonatal complications observed were RDS in 3 and 5, birth asphyxia in 6 and 3, intraventricular haemorrhage (IVH) in 3 and in group I and II respectively. The difference was significant (P<0.05).
Conclusion: Caesarean delivery offers no short-term survival advantage compared with vaginal delivery for low- birth weight vertex in PIH patients.

The present study aimed to compare the haematological and biochemical indices between Dengue patients, and assess the relationship of these indices inprognosis and severity of Dengue fever.
Materials and Methods: A total number of 40 children with confirmed diagnosis of Dengue fever who visited and some of them were admitted Sri SathyaSai Medical College and Research Institute in Chennai were selected in this case-control study. Haematological, biochemical and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and outcome of the disease were assessed in this study.
Results: The number of children confirmed diagnosed with Dengue fever were 40, they were further divided into three different group based on severity of the disease. Haematological and biochemical variables were statistically significant in these three different groups. Neutrophil count, platelet count, lymphocyte count, and haemoglobin concentration were also higher in the dengue fever with warning signs patient group (P=0.001). NLR and PLR were significantly higher in severedengue patients compared to the mild patients (P=0.01). NLR had a significant relationship with the severity of the disease. Multivariable analysis for diagnostic values of NLR and PLR showed that the NLR and PLR were significant at 2.336 (95% CI: 1.636–3.336) and 1.4 (95% CI: 0.28-0.29), respectively.
Conclusion:Platelet-to-Lymphocyte Ratio (PLR) and Neutrophil-To-Lymphocyte Ratio (NLR) can be used as a prognostic marker for Dengue disease given the significant difference of PLR and NLR between mild Dengue patients and severe Dengue patients.

Blood transfusion is an important mode of transmission of infections to recipients. It is of utmost importance to know about the prevalence of various TTIs (transfusion transmitted infections) among blood donors. The aim of the study is to analyze the seroprevalence of HIV, HBV, HCV and Syphilitic infections in the pre-transfusion blood which will help in taking measures to prevent the transmission of infections.
Material and Method: A retrospective study was carried out over a period of 04 years from January 2018 to December 2021. Serum samples were tested for P24 antigen and antibodies to human immunodeficiency virus (HIV) Type 1 and 2, hepatitis B surface antigen (HBsAg) and hepatitis c virus (HCV) using ELISA with the 3rd and 4th generation kits while testing for syphilis was done using Rapid plasma reagin test.
Results: Out of total 35,174 donors, 6,168(17.54%) were replacement donors and 29,006(82.46%) were voluntary donors while majority of donors were male (92.97%). The seroprevalence of HIV was 0.1% in the total blood donors. No female donor was found to be positive for HIV and Syphilis. The low seropositivity among blood donors is attributed to pre-donation counseling in donor selection. The seroprevalence of HBV, HCV and syphilis was 0.54%, 0.04% and 0.04% respectively.
Conclusion: All blood donations should be screened for TTIs to ensure safe blood transfusion to the recipients. With the implementation of strict selection criteria and use of sensitive screening tests, it is possible to decrease the incidence of TTIs among recipients of blood and various blood products.

The common causes of spinal trauma are blunt injuries -motor vehicle accidents, falls, diving accidents, sport injuries, assaults. Penetrating injuries like stab wounds or gunshot wounds are rare causes of spinal trauma. MRI is an excellent diagnostic modality for evaluation of spinal trauma. Our study is to evaluate the role of magnetic resonance imaging (MRI) and MDCT as a non-invasive diagnostic tool in patients with acute and chronic spinal trauma and to compare these findings with those of patients’ clinical profile . Restrospective observational study on clinically indicated 50 patients with a history of spinal injury and who had undergone MDCT and MR imaging of spine from 2019 to 2021 were included in study after informed consent. The study group consisted of 38 male patients and 12 female patients. The group included was from 14years - 85 years.

Abortion is the termination of a pregnancy prior to the possibility of the baby being born alive; it may happen naturally or it can be induced. Just 10% of clinics in Turkey make use of general anaesthesia (GA), whereas 58% of clinics make use of local anaesthesia (LA) with or without oral premedication, and 32% of clinics make use of intravenous sedation in conjunction with LA
Aims and Objectives:  This study compares the several ways of performing the paracervical block during the first trimester of pregnancy termination and examines whether variations in placement of local anesthetic in paracervical blocks influence effectiveness using local anesthetic is superior to saline.
Material and methods: This is a prospective comparison research on 200 pregnant women who arrived to either an outpatient clinic for prenatal care with a first-trimester abortion or an emergency department prepared for a D&C procedure. Two hundred women with ASA I-II who were diagnosed to undergo an abortion by ultrasonography and who presented for termination of pregnancy by suction and curettage. Group A: One hundred women were randomly assigned to have a PCB injection of five millilitres of lidocaine solution containing two percent (100 milligrammes) in each side of the cervix at the three and nine o'clock positions. Group B: One hundred ladies were given GA. During the GA, an intravenous bolus of propofol ranging from 2.5–4 mg/kg was administered as an intravenous anaesthetic in combination with an intravenous dose of 1 g/kg of fentanyl administered through intravenous route.
Results: The results of this study showed that pain assessment during D&C in group A: PCB was most commonly moderate during dilatation and mild pain during aspiration and curettage (50, 80, and 55%, respectively), whereas immediately after the procedure, 95% of the patients felt mild pain according to the VRS. The VAS was used to analyse the patient's level of pain, and the results showed that the dilatation caused a pain score of 3.74±2.41, the aspiration caused a pain score of 3.44±0.83, the curettage caused a pain score of 4.22±1.24, and the pain score immediately after the treatment was 2.72±0.59. The results of this investigation demonstrated that after one hour, pain ratings were lower in the sample that was treated with LA (2.18±0.63) than GA (3.02±1.04), and the difference between the two groups was statistically and clinically significant (P=0.001)
Conclusion: With the stipulation that we wait a few minutes before initiating the treatment, we have determined that the PCB is preferable to general anaesthesia. Our decision was reached after much deliberation. This is due to the fact that the PCB assures the patient's comfort while avoiding the harmful effects of general anaesthesia

Tranexamic acid prevents fibrinolysis by blocking the lysine binding sites on plasminogen molecules. Its a safe and efficient supplement to other uterotonics already in use to reduce bleeding during and after LSCS. Material and Methods: 500 patinets grouped into cases and controls were taken, cases were given Tranexamic acid in addition to third stage management and blood loss was calculated by gravimetric method and changes in hematocrit in both groups. Patients vitals were monitored and checked for any adverse drug reactions. Patients with medical, surgical complications, blood disorders, h/o allergy to TXA, abnormal placentations, multiple pregnancies, polyhydramnios, pregnancy with myoma were excluded from the study along with those who were transfused blood within 24hrs of LSCS. Results: Tranexamic acid significantly reduces bleeding from time of placental delivery to 2 hours postpartum in LSCS, similar to studies done by Gohel-Mayer, Yehia, Goswami, Goswami and others. Conclusion: Tranexamic acid has been shown to significantly reduce the amount of blood loss during & after lower segment cesarean section without any serious adverse effects.

Urinary tract infection (UTI) is one of the leading causes of morbidity encountered in clinical practice. Emerging resistance of the uropathogens to the antimicrobial agents due to biofilm formation is a matter of concern while treating symptomatic UTI which leads to longer stay in hospital and increased cost of treatment. Detection of biofilm producer strains will guide the clinician in modifying antibiotic therapy for better clinical management and also help in designing adequate control measures as the isolates are also resistant to variety of disinfectants.
Aim: The present study was conducted to compare three methods Tissue Culture Plate (TCP) method, Tube method (TM) and Congo red agar (CRA) to detect biofilm formation by uropathogens and to correlate their susceptibility pattern with biofilm formation.
Materials and methods: A total of 150 culture positive significant isolates from urine samples were subjected to biofilm detection by TCP method, Tube method and CRA method. TCP was considered as gold standard method. Impact of biofilm production was correlated with the antibiotic resistant pattern.
Results: Out of 150 culture positive significant bacterial isolates, Gram negative organisms were isolated from 122 (81.33%) specimens and Gram positive growth was seen in 28 (18.67%) samples. Escherichia coli was the commonest Gram negative organism isolated (42.66%) while among Gram positive isolates, maximum biofilm production was shown by Enterococcus faecalis (66.66%). The gold standard TCP method detected 51 (34%) isolates as strong and 11(7.33%) isolates as moderate biofilm producers and remaining 88 (58.67%) isolates were weak/non-biofilm producing bacteria.
Conclusion: From our study we can conclude that TCP is the most reliable method for detection of biofilm formation in comparison to TM and CRA.

Thyroid dysfunction is one of the most common endocrine disorders affecting women of reproductive age group including pregnancy. Over the past several years it has been proved that maternal thyroid disorder influences the outcome of the mother and fetus, during and also after pregnancy.
Methods: A total of 385 pregnant women satisfying selection criteria attending the antenatal care during the first trimester were studied. The demographic details were collected and TSH, free thyroxine and free triiodothyronine were estimated.
Results: The present study showed a higher prevalence of thyroid abnormalities which is 33.51% in pregnant women during the first trimester.
Conclusion: The prevalence of thyroid abnormalities was significantly high in women with family history of thyroid abnormalities whereas no statistically significant difference was noted with maternal age and parity. Screening of women in early pregnancy for thyroid disorders is beneficial in preventing adverse fetal and maternal outcome.

The purpose of this study was to evaluate AC angles using gonioscopy, Van Herick technique and AS-OCT, focusing on their potential role in clinical practice.
Methods: The Cross-sectional study was conducted and patients of more than 40 years of age attending ophthalmology outpatient department at Govt. Medical College, Patiala. 100 patients were included in the study. Data was collected from the patients more than 40 years of age willing to participate in the study. Patient data was collected according to the Performa. Medical history and history of any ocular disease was also noted.
Results: 40% of the patients belonged to 60-70 years age group, followed by 50-60 years (37%), 40-50 years (12%), 70-80 years (10%), and >80 years (1%). Majority of the patients belonged to 50-70 years (77%). 56% were females and 44% were males. 53% patients had VH grading (nasal) 3 followed by grade 4 (26%), grade 2 (10%), grade 1 (8.5%), and grade 0 (2.5%). 52% patients had VH grading (Temporal) 3 followed by grade 4 (26%), grade 2 (10%), grade 1 (9.5%), and grade 0 (2.5%). The agreement value between the nasal and temporal VH grading was found to be 98%.
Conclusion: The van Herick method appears to have good sensitivity and specificity, whereas the AS-OCT method has poor sensitivity, yet high specificity. The Van Herick method, because of its high sensitivity and high negative predictive value can be used as a screening tool in detecting angle closure. ASOCT on the other hand, having a high specificity can be used to confirm angle closure and detect the mechanism of closure to some extent.

Corona virus disease 2019 (COVID 19), caused by the novel corona virus is a rapidly spreading and devastating infection which has become a global pandemic. The present study assessed the severity of disease in Covid-19 positive patients.
Aims and objective: To study the different haematological parameters and infection biomarkers in COVID-19 patients. To evaluate the role of hematological parameters in determination of COVID-19 disease severity.
Materials & Methods: 600 Adult (age >18 years old) patients who were diagnosed with COVID‐19 according to WHO interim guidance were screened, between Feb 2020 and Feb 2021 (one year). Data of complete hematological parameter and infection biomarker was collected from records of Central Pathology Lab at Bundelkhand Medical College Sagar, M.P., India.
Results: Out of 600 patients, males were 380 and females were 220. Out of 600 patients, 540 survived and 60 died. There was significant difference in value of Hb, TLC, ANC, NLR, PLT, MCV, RDW, PT, aPTT, D- Dimer, Ferritin and CRP level in patients admitted in ward, HDU, ICU, between genders and those survived and died.
Conclusion:The study concluded that leukocytosis, neutrophilia, elevated Neutrophil to lymphocyte ratio, APTT, D- Dimer, serum ferritin, CRP and RDW-SDassociated with severity of covid-19 disease.

To study the intraoperative and immediate complications of Laparoscopy and Mini- laparotomy techniques in interval tubal sterilization.
Methods: A prospective comparative study with a 600-person sample size was conducted from January 2018 to June 2019 at the Department of Obstetrics and Gynecology, Andhra Medical College, Department in Visakhapatnam. Women who are having interval mini-laparotomies and interval laparoscopic tubal sterilizations in a hospital.
Results: In this study, out of 600 patients who underwent tubal sterilization, the majority of them were in the age group 20-25years. In both the groups in this study, parity of 2 or more were common i.e., 49.5% (Para 2) in laparoscopic group and 48 % (Para 3) in minilaparotomy group. HBsAg positivity was the most common co-morbidity, with 41 patients in mini- laparotomy group. Total of 25 (6.75%) patients had undergone surgery in the past in the laparoscopic study group. Adhesions (3.25%) were the most frequent incidental pelvic pathology found during laparoscopy. Fibroid was seen in1.75% cases of laparoscopic group. Mean duration of surgery was significantly less in the laparoscopic group as compared to the mini-laparotomy group, with 10.92+14.20 min, 19.62+8.90 min. respectively. Mesosalpinx bleed (3.0%) was the most common intraoperative complication in both laparoscopy and mini-laparotomy group. Among patients undergoing laparoscopic tubal sterilization the proportion of intra operative conversion to a laparotomy to complete the operation was 6 out of 300 patients included in the study (5%). Post-operative complications such as Fever (57.50%), Wound discharge (13%) and abdominal pain (28.50%) were more commonly seen in the mini-laparotomy group than the laparoscopy group.
Conclusion: Finally concluded that, overall complications (i.e. when combined intraoperative and immediate post-operative complications) were more common in Minilaparotomy group when compared to laparoscopy group.

To survey and critically analyse the number and cause of surgical site infections post cesarean sections in my hospital for a period of 1 year and to provide data to aid in formulating recommendations to reduce their incidence. To assess the incidence of SSIs after cesarean sections and to explore causative and risk factors. To identify the common causative pathogens and their antibiotic sensitivity profile.
Methods: The study was a cross sectional observational study conducted in a tertiary care teaching hospital between July 2020 and June 2021 with sample size of 305 post operative patients after a cesarean section. Nature of wound complication and the postoperative day of occurrence of complication was noted. Baseline and special investigations like wound swab for culture and sensitivity were sent. The patients were followed through daily dressing and wound fortification techniques used were noted. The duration of hospital stays, and status of repaired wound were noted.
Results: The incidence of wound infection in our present study was 10.1%. The present study shows that Obesity, Anemia, Diabetes, HTN are associated with higher incidence of wound infections. The present study shows that PROM is associated with increased number of wound infections. The use of non-absorbable sutures like nylon and prolene instead of absorbable sutures like vicryl didn’t reduce the incidence of wound infections. Most of the wound infections occurred on 4^th and 5^th postoperative day. Most cases of wound infections occurred in cases operated for previous LSCS. Secondary suturing along with higher antibiotics proved to be effective in treating wound infections. 99% of cases with wound infections after treatment had well healed wounds.
Conclusions: The most common organism isolated was Pseudomonas followed by Klebsiella. The organisms are most sensitive to Piperacillin and tazobactam followed by Amoxyclav. Strategies for prevention of SSI must aim to correct anemia prior to delivery, avoid prolonged hospital stay prior to delivery, to correct maternal comorbidities prior to surgery and strict adoption of asepsis. Higher antibiotics should be started preoperatively for PROM cases. SSI surveillance must be done as a part of healthcare associated infections audit which aims at improving quality control measures and infection control practices

The LMA is an ingenious supraglottic airway device that is designed to provide and maintain a seal around the laryngeal inlet for spontaneous ventilation and allow controlled ventilation at modest levels of positive pressure. LMA has gained extensive popularity for airway management during surgery. Aim and Objective : To compare Sevoflurane and propofol for laryngeal mask airway insertion and pressor response in adults. Materials and Method : This is Prospective randomized study, conducted in Department of Anaesthesiology, Bhaskar Medical College, Moinabad, for duration of one year, included 60 patients admitted for vascular, reconstructive, gynaecological, and day care surgeries, randomly allocated into two groups of thirty each Group‘S’ for Sevoflurane and group ‘P’ for Propofol using an automated computer generated list,  after following inclusion and exclusion criteria and approved by institutional ethical committee. Results : There were 25 male and 35 female in the study and there was no significant difference was observe in the age group between the group. In our study mean time taken from induction to successful laryngeal mask insertion was significantly shorter with propofol compared with sevoflurane. In our study mean time taken from induction to successful laryngeal mask insertion was significantly shorter with propofol compared with sevoflurane. With the sevoflurane group, the LMA insertion has taken 68.12±0.49 seconds while propofol has taken 54.76 ± 0.16 seconds. Jaw relaxation has taken a long time in the sevoflurane group with P<0.001, which is highly significant. Conclusion : There was Delayed jaw relaxation with sevoflurane when compared to propofol delayed LMA insertion, thus time taken to insert LMA was more in Group S compared to group P. Hemodynamically all the patients from group S were stable compare to propofol but quality of anaesthesia provided was superior in group P

Journey of a human begins when there is a successful meet of a healthy sperm and an egg during fertile period. It is well-thought-out to be a distinction of new joyful foundation for the married couple. Ongoing with the antenatal days for a budding fetus certain changes do occur in mothers’ body also in anticipation of new incoming child. These changes would but obviously need medical help to land up in an effortless and well deserved post-natal period.Hence study was undertaken to observe complications in antenatal and post-natal period of booked and unbooked cases of pregnant women coming to our hospital. We had also observed complications during this period in both the groups which may benefit to build further strategies of health care sector for making a healthier mother-children society of our country.
Material methods: All the patients who were getting admitted during their labour were finally considered for the collection of data. Primarily subjects were provided with informed and written consent to participate in the study after that patient’s demography data was recorded to make the final observations. While recording data primarily age, height and weight of the patients were recorded amongst booked (496) and unbooked (508) categories. Then starting with history of present illness obstetrical history, gestational age, mode of delivery, complication during and after pregnancy, and perinatal complications was recorded.
Conclusion: we conclude that there are many factors which determine the pregnancy outcome and many of them are rectifiable which will help in evading so many maternal deaths. By providing the standard maternity and child care services much can be done for betterment of pregnant women. By considering differential data amongst booked and unbooked pregnant women for complications in antenatal and post-natal period of pregnant mother for many years is evident that morbidity and mortality can be reduce my adequate antenatal care facilities to these future mothers. Reference centers should be developed close to the homes with better equipped clinical facilities, proper instrumentation and trained staff which will benefit the outcome of pregnant women to make a healthier future of our Nation

In patients less than 60 years of age, even with displaced femoral neck fractures, head preservation using early closed reduction and internal fixation (CRIF) with multiple annulated hip screws (CHS) is one of the accepted methods of treatment. Though union rate is improved, vascular impairment of the head following this fracture, resulting in osteonecrosis, remains as an unsolved problem.
Aims: The incidence rate of osteonecrosis, whether they are same across groups, or higher in one of the groups and the incidence rate of union and non-union, whether they are same across groups, or higher in one of the groups.
Materials and Methods: The present study was a Case-control/ Retrospective study study. This Study was conducted from June 2020 to June 2022 at Department of orthopaedic, kumar hospital and research institute, Khemnichak, patna, Bihar 27.
Result: In CHS + bone graft Group, 35 (77.8%) patients were Excellent Final MHSS, 8 (17.8%) patients were Good Final MHSS and 2 (4.4%) patient were Poor Final MHSS Grading.
Conclusion: From the discussion submitted above it is clearly evident that till date we could not give a satisfactory treatment to our patients of displaced femoral neck fractures and this is more relevant for younger patients of less than 60 years of age for whom we cannot advise THA

For a long time, it has been difficult to design websites with a clear structure that users can easily navigate. One major cause is the gap that might exist between web developers' and consumers' views on the optimal structure for a website. Although many techniques have been presented for relinking web sites to enhance their navigability by analyzing user navigation data, the totally rearranged new structure may be very unexpected, and the cost of confusing people after the changes has not been quantified. In this article, we will discuss how to tweak a website without completely overhauling it. To enhance user navigation on such a website while making as little changes as possible to the site's present structure, we offer a mathematical programming approach. Extensive testing on a real-world data set that is available to the general public shows that our approach not only improves user navigation dramatically with minor adjustments, while also being efficiently addressed. Further, we have shown that the model scales up well by testing it on extremely large synthetic data sets. We also create two measures for assessment and employ them to measure the enhanced website's effectiveness on a live data set. These evaluations show that the new structure is much easier to navigate for users. Interestingly, we discover that users who are more severely bewildered are now more likely to experience the benefits of the new structure.

ML-based simulations have been shown to be helpful in predicting intraoperative outcomes in order to enhance judgment on the course of action. ML strategies are being used in this research to predict future COVID cases, and they are being evaluated to identify whichever algorithm is most appropriate for the COVID sample. This research confirms how ML algorithms can anticipate the proportion of upcoming Covid-19 individuals who will be harmed. Forecasting models such as LR, Random Forest, SVR, KNN, DT, and Elastic net were used to make the projections. For the upcoming 10 days, the number of newly infected cases is predicted by each model. The consequences display that the Decision Tree achieves top amongst those simulations, trailed by Linear Regression and K-NN, which are good at predicting new confirmed cases. Whereas SVR performs worst among those models using the dataset that is currently available.

Forecasting the Stock worth Movements is one among the most popular topics in Finance True profits for sellers and customers will be enormous as a result of stock prediction. It is frequently said that prognosis is turbulent rather than stochastic, suggesting that it could be meticulously predicted. Examining each stock firm's historical development. Firms benefit from forecasting the stock market. To determine the long run values of company stocks, is associate indicator of the state of the Economy, and helps to form personal wealth. Costs of shares might have an effect on thanks to several factors such as well as enterprise news, and governmental, cultural, and environmental issues. Machine Learning Models are getting used to predict the long run stock worth values, Create the Dynamic Panel to see and compare the anticipated price with the particular price over a period of time.

The eyes speak without words which enhance the beauty of
face. The malposition of eyeballs leads to unacceptable cosmetic problem for the people of
both sexes and all age groups. To analyse and compare the morphometric measurements of
right and left orbital cavity in adult dry skulls and to see the statistical significance in it. To
assess the influence of other parameters over bony orbital volume and to evaluate its
significance. Methods: The quantitative morphometry of orbital cavity was studied in 40
adult dry skulls and computed tomographic images of brain belonging to 60 patients (30
males and 30 females). Adult dry skulls with intact orbital cavities and the computed
tomographic images of brain reported as ‘normal study’ were only included in this study. At
DMCH Darbhanga, Study duration of Two years.
Conclusion: The quantitative morphometry of orbital cavity is utmost important without
which reconstructive surgeries are not possible. The study of these morphometric parameters
in computed tomographic scans is mandatory for the assessment of fractured orbital cavity by
comparing it with normal orbital cavity. So in the present study, the morphometry of orbital
cavity was studied by two methods.

The cerebral ventricular system contains a series of
interconnecting spaces and channels which originates from the central lumen of embryonic
neural tube. Cerebrospinal fluid filled ventricular system is an essential part of the brain. The
evaluation of the size of the encephalic ventricle has great importance in diagnosis and
monitoring of several pathologies. Hence this study wasundertaken, To examine the range in
size of the normal lateral ventricles of the humanbrain.
Methods: The study was done for the duration of Two years. Data for the present study was
collected from the CT images done in the Department of Radiology, DMCH Darbhanga. The
study group includes 100 males and 100 females.
Conclusion: present study, it was concluded that there was great variation in measurements
of parts of lateral ventricles of brain which showed statistically significant correlation with
one another. The left lateral ventricle was shown to be larger than right in either sex while
both lateral ventricles were larger in males.

Chronic kidney disease (CKD) is a serious global health with a high global prevalence problem leading to end-stage renal disease (ESRD) and dialysis. Retinal microvascular abnormalities are common in chronic kidney disease as diabetes and hypertension  account for more than half of all patients with renal  failure. The escalating prevalence of diabetes in India, which has already home to over 77million, is also likely to herald an increase in the onset of sight threatening Diabetic retinopathy(DR) in CKD Patients
The aim of this study is to evaluate the  sight-threatening diabetic retinopathy changes in  these CKD Patients.
Materials and Methods
This study was conducted in the Dialysis Unit, nephrology department of Govt. Villupuram Medical College Hospital  from May 2022 – Jan 2023. This was a cross sectional, non-interventional, hospital based study. Total  108 patients having end stage chronic kidney disease on maintenance haemodialysis were examined.
Results
 Datas are collected as ratio and proportions on the prevalence of diabetic retinopathy in chronic kidney disease patients undergoing dialysis. Of the 108 screened among 359 patients, 48/108(44%) were found to be Normal. Diabetic retinopathy seen in 46 of 108 screened, Hypertensive Retinopathy in 9 pts,Glaucoma in 2% of  patients, Cataracts , BRVO and others seen in (3%).
Conclusion Data shows that severe forms of diabetic retinopathy is more linked to long standing history of diabetes causing kidney damage even among those with good glycaemic control. Hence it is advisable to include ophthalmoscopy and fundus evaluation as the screening tool in all CKD patients, so that we can predict the development of diabetic retinopathy and treat them in early stages

The three middle ear ossicles form an articulated chain, connecting the lateral and medial walls of the tympanic cavity. They amplify and transmit the sound vibrations to the cochlear receptors in the inner ear. Any malformations of these ossicles cause hearing problems. To study the morphometric measurements and morphological features of all the three ear ossicles of both the sides.
Method: 50 formalin fixed human temporal bones were dissected to remove ear ossicles for the study by dissection method. At DMCH Darbhanga.
Conclusion: The knowledge of variations of the ossicles and its morphometric data will help the otologist during reconstructive surgery and provide necessary information for the prosthesis designer. Comparisons of morphometric values of newborn ossicles with that of adult values suggest that these ossicles complete their morphometric development in foetal life

and Objective: Anatomists and orthopaedics have long been interested in the femoral neck anteversion angle (FNA) since it is widely recognised as an important factor for hip stability. To study radiological correlation with the morphometric Femoral neck anteversion angle.
Method: The cross sectional study with purposive sampling. 100 Dry Femora of known sex and side available at Department of Anatomy, The study was conducted after receiving approval from the Ethical Committee of DMCH Darbhanga. Study duration of Two years. Conclusion: In the present study, the mean FNA angle measured Physically and Radiologically were 13.22° and 15.65° with Standard Deviation of 4.20 and 4.65 respectively. The range was from 5°-27° on physical measurement and from 6°-29° on radiological measurement. 

Acute diarrheal diseases are one of the leading causes of morbidity and mortality globally. Diarrhea can be caused by a variety of bacterial, viral, and parasitic organisms through faeco-oral contamination. Lack of health care services, public awareness, maternal education, poor environmental sanitation and hygiene, poor water and food hygiene, poverty, malnutrition, inappropriate feeding practices making situation even worst in developing countries. So, this study was undertaken to study risk factors for acute diarrhea disease.
Objective: Tostudy various risk factors like demographic profile, parental factors and feeding practices in children under 5 years of age groups having acute diarrheal condition.
Methodology: A cross-sectional study enrolled total 400 children under 5 years of age having acute diarrhea according to WHO definition. Data was collected using proforma. Parents (esp. Mothers) were enrolled regarding their education and personal hygiene and habits.
Result: Among the 400 children, majority around 71.4% were between 6 months to 2 years of age group coming from lower-middle socio-economic class. Around 76.5% children came from overcrowded place. Only 30% children were given exclusively breast feeding till 6 months and 41.2% children were given bottle feeding and 72.1% children between 2 years to 5 years were given packet food on daily basis even-though coming from lower socio-economic class. Less number of children having diarrhea where good hand hygiene was present and good hand hygiene practice was more in higher educated mothers. Health education and preventive measures on diarrhea was given to community during the interview.
Conclusion: Promoting health education and hand washing practice in parents (esp. mothers) are utmost priority. Awareness about exclusive breast feeding till 6 months of age and knowledge about complimentary feeding is important part in prevention of acute diarrhea in children.

Placental insufficiency is a concern in pregnancy brought on by preeclampsia. There is an increase in maternal and fetal mortality as a result. The aim of the study was to study the morphological variations of human placenta in complicated pregnancy and to compare the same with the uncomplicated or normal pregnancy. Materials & Methods: This research makes use of an observational methodology. After obtaining permission from Institutional Ethics Committee studied at the Department of Anatomy at Indore Medical College & Hospital, Indore. There was a total of 220 human placentas used in this study; 110 were from healthy pregnancies serving as controls, and the remaining 110 were from pregnancies complicated by preeclampsia. The morphology of every sample was analyzed. Results: Variation in placental shape was observed, with both groups producing organs with extra lobes. Significant decreases (p < 0.001) were seen in pre-eclampsia for both placental shape, thickness and maternal surface cotyledons. While pre-eclampsia group did have a thinner placenta, the difference was not statistically significant. The cotyledon count in pre-eclampsia group was drastically higher than in uncomplicated group. (p < 0.05). Conclusion: In this investigation, we found that preeclamptic placentae exhibit distinctive morphological alterations. Placental insufficiency, a condition associated with preeclampsia, appears to be the cause of these alterations. However, more extensive placental research using histological and morphometric methods with bigger sample sizes are needed before any conclusion can be drawn

Study of diagnostic yield of induced sputum & bronchoscopic sample in sputum smear negative tuberculosis in tertiary health care centre.
Material and methods: 50 patients >18 years of age admitted to Chest ward with features of TB were included in this study. All the sample was sent to Intermediate Reference Laboratory, M.R.T.B. Hospital/Chest Centre, Indore. Subjects were included on the basis of their diagnosis of TB as per NTEP guidelines. Patients with sputum smear negative for MTB by ZN staining, clinically symptomatic patients suspected of pulmonary TB, cough more than 14 days, willing to participate and willing to give written consent and age more than 18 year were included in this study.
Results: In present study, most of the participants 23(46%) belong to age group 18-40 years. Out of 50 participants 31(62%) were male and 19(38%) are female. 19(38%) participants are educated and 31(62%) participants are uneducated. Most of the participants 39(78%) are Hindu by religion followed by Muslim 07(14%). Majority of the participants in present study 35(70%) reside in rural area, 23(46%) of the participants belong to lower middle economic social class. Out of 50(100%) AFB negative sample, 4 sample found positive in inducedsputum sample, were as 35(70%) sample was positive in BAL CBNAAT. The sensitivity and specificity of induced sputam(10.25% and 24.59% and BAL-CBNAAT( 89.74% and 75.40%).
Conclusion :According to the present study, as compared to sputum induced for AFB detects 4(8%) positive cases and BAL CBNAAT detects 35 (70%) positive cases. In a large proportion of cases, fiber optic bronchoscopy (BAL) aids in the early detection of pulmonary tuberculosis that’s produces negative smear tests. Fiberoptic bronchoscopy is crucial in the diagnosis of patients with tuberculosis who were unable to generate sputum or whose sputum smears was negative. In some circumstances, it is both helpful and required.

Comparative study on the effect of VIT-D supplementation on the treatment course of pulmonary tuberculosis.
Material and methods: Patients presenting with sign and symptoms suggestive of pulmonary TB, diagnosed as TB and who were receiving the treatment from the study institute. TB Score, Smear Conversion, Health Related Quality of Life, Changes in the level of C-Reactive Protein, Erythrocyte Sedimentation Rate (ESR), and Haemoglobin concentration and Serum Vitamin D levels were measured. At the beginning of the treatment patients were divided in the following two groups based on the mutual decision of the treating physician and the participants. 100 patients were include in this study and divided into two equal groups.  Supplementation Group: Patients advised category I DOTS therapy and Vitamin D supplementation. Routine Care Group: Patients advised category I DOTS therapy.
Results: The mean time to sputum conversion was shorter among patients given Vitamin- D (9.7 weeks) in comparison to control group (11.2 weeks), however, the difference was not statistically significant (p=0.0621). After being on treatment for 8 weeks; the TB score decreased to 4.90 in the Vit-D group and 6.6 in control group, the difference was statistically significant. (p-0.0012). However, there was no statistically significant difference in the TB score at 12 weeks of treatment (p=0.342). After taking the treatment for 8 weeks, the quality-of-life score was 15.1 in Vit D group and in control it was 13.4, the difference is statistically significant (p-0.004). At 12 weeks also the difference in QoL score was significant (p<0.001) among the two groups. Consequently, the overall change in Quality-of-life score was also statistically significant. (p<0.001). The change in Serum Vit-D values was almost similar between both the test and control groups at 0 weeks (42.979 and 40.788 respectively) and the difference is not statistically significant. (p=0.213). At 8 weeks duration the Serum Vit-D level was 62.419 in the test group and in control it was 37.788, the difference is statistically significant. (p<0.0001) and at 12 weeks also the change is significant. (p<0.0001).
Conclusion: The rate of seroconversion was faster among Vitamin D group. Vitamin D supplementation can safely and efficiently raise the proportion of sputum smear and culture conversion. However, it may not have enough positive impacts on the time to sputum conversion. The participants who received vitamin D saw a speedier improvement in quality of life and a quicker reduction in the intensity of TB-related symptoms.

To hepatoprotective effect of  N-acetyl cystein on the patient receiving at in tertiary care centre.
Material & Methods:  Study will be conducted on 50 newly diagnosed pulmonary TB and treatment naïve patient from the Department of TB and CHEST at Index Medical College, Research centre and Hospital, Indore and all the tests will be performed with due permission from the Institutional Ethical Committee and informed consent from the subjects or their legal relatives. Subjects were included on the basis of their diagnosis of TB as per RNTCP guidelines. A rise of five fold in ALT over upper normal limit in the absence of symptoms and any increase in serum bilirubin.
Results: For the Sample size of 50 patients, 24 used the NAC drug & 26 were not administered NAC Drug. Without the use of NAC Drug : The Mean SGOT variation was observed from 40.23 to 123.65 from the 1st week to 3rd week, Mean SGPT from 34.31 to 77.38 and Mean Bilirubin variation was from 0.37 to 0.48. As per the study, to study the hepato-protective effect of N-acetyl cystein on liver injury induced by anti TB drugs 24 patients were administered NAC drug. It was observed & documented that Mean SGOT variation from the 1st  week to the 3rd week, the change was from 26.92 to 29.92, Mean SGPT variation was from 23.67 to 29.0 and the Mean Bilirubin variation observed was from 0.40 to 0.46. The percentage change is very visible on comparison of the use of NAC drug vis-à- vis NAC drug not administered. The percentage change of SGOT was 111.15% in NAC   used   patients (p-value 0.0036) & 307.36% in patient not given NAC drug (p-value 0.0009). SGPT percentage change was 122.51% (p-value 0.0005) as compared to 225.56% for Patient not on NAC drug (p-value 0.0009) and Bilirubin percentage change was 115.30% for patient on NAC drug (p-value 0.0050) & 127.31% for patient not on NAC drugs (p-value 0.0301).
Conclusion: Isoniazid, rifampicin, and pyrazinamide, the first-line antituberculosis (anti-TB) drugs are associated with hepatotoxicity. Patients treated with antituberculosis drugs may experience hepatotoxicity ranging from simple hepatic enzyme elevations to severe clinical hepatitis. According to our study results, it could be concluded that NAC acts as an effective antioxidant in the prevention of ATT-induced hepatotoxicity. Administration of NAC produced a significant hepatoprotective effect and effectively reduced lipid peroxidation.

To study the correlation of venous blood lactate level and 6 minute walk test in stable COPD
Patients in tertiary health care centre
Materials & methods: Study was conducted on 50 patients from the Department of Respiratory
Medicine at Index Medical College, Research centre and Hospital, Indore and all the tests was
perform with due permission from the Institutional Ethical Committee and informed consent from the
subjects or their legal relatives. Subjects was included on the basis of their diagnosis of COPD as per
GOLD guidelines & laboratory test of venous blood lactate level.
Result: Fifty participants were recruited and 74% of them were male. The median age of all the
participants was 60.48 years.Based on the Severity classification, 12(24%) of them were mild,
21(42%) moderate, 7(14%) severe and 10(20%) very severe.The participants were under regular
treatment. The median of 6MWT was 280.00 m (IQR 67-53.25, 375–205 m). For Normal Lactic acid
the Mean 6MWT was 336.75 mtrs for 12 samples of Group A of COPD Severity Group, 20 of Group
B, 4 of Group C & 1 of Group D. For Abnormal Lactic acid the Mean 6MWT was 171.92 mtrs for 0
samples of Group A of COPD Severity Group, 1 of Group B, 3 of Group C & 9 of Group D.
Conclusion: In conclusion, in COPD patients 6MWT is useful test to assess severity of disease. Our
study has shown that 6MWT correlates well with pulmonary function and quality of life in patients
with COPD. 6MWT can be used as a novel index in the evaluation of functional status of COPD.
More importantly, steps might give additional indication in addition to distance traveled about the
risk of lung hyperinflation. Considerably more work will be needed to investigate the link between
steps and hyperinflation in patients with COPD.

Acute encephalitis syndrome (AES) is an important cause of mortality and morbidity in children. We undertook this study for better understanding of predictors of outcome in terms of neurological sequalae in children with AES.
Methods: It was a prospective observational study. We studied 100 patients of AES admitted in PICU of Maharaja Yeshwantrao Hospital Indore from June 2021 to July 2022.  WHO case definition of AES was adopted while enrolling cases. All the demographic details, clinical characteristics and laboratory parameters were noted in a predesigned proforma. We evaluated their clinical characteristics, laboratory features and outcomes at the time of discharge. Modified Rankin Scale was used to assess the neurological disability at the time of discharge. Outcomes were assigned score between 0 and 6.The outcome was correlated with above mentioned variables.
Results: Out of 100 patients, 54/100(54%) patient high mRS score of 5 and 6(poor outcome) 12/100(12%) of the patients had score of 3-4 and 34/100(34%) patients had mRS score of 0-2(good outcome). Low GCS at admission, shock and inotrope requirement and need of mechanical ventilation were significantly asscociated with high mRS and poor outcome. Deranged Biochemical parameters like blood glucose abnormalities, deranged liver enzymes and deranged electrolytes were associated with high mRS and poor outcome.
Conclusions: This study explains correlation of clinical presentation, laboratory parameters and therapeutic intervention required with neurological outcome of AES. Low Glasgow coma score, deranged biochemical parameters, Shock and inotrope requirement and need of mechanical ventilation are predictors of a poor outcome. 

Surgically induced astigmatism (SIA) is a major obstacle in achieving good UCVA following cataract surgery. The size, location and architecture of the incision are considered very important for postoperative astigmatism. We aimed to compare the surgically induced astigmatism after phacoemulsification by temporal clear corneal versus superior clear corneal approach.
Methods: This was a prospective, randomized, interventional, parallel-group study that included 112 eyes of 112 senile cataract patients, undergoing phacoemulsification with foldable acrylic IOL implantation through an un-sutured 2.8 mm clear corneal incision at Ophthalmology department of Government Medical College Patiala, from February 2022 to July 2022. Patients were randomized into 2 groups: Group 1 underwent temporal incision phacoemulsification and Group 2 underwent superior incision phacoemulsification. Complete ophthalmological examination was done preoperatively and postoperatively after 7 days, 4 weeks and 6 weeks, including manifest refraction using an auto-refractometer and Snellen chart.
Results: The mean age of all participants was 59.09±12.8 (males vs. females; p=0.31). The mean preoperative astigmatism in all participants was 0.67 ± 0.39 (temporal vs superior incision; p=0.66) and at 6 weeks 0.87 ± 0.64 (temporal vs superior incision; p=0.21). Surgically induced astigmatism was found to be 0.73 ± 0.56 in temporal incision and 0.91 ± 0.36 in superior incision (p=0.04).
Conclusion: 2.8 mm clear corneal temporal incision phacoemulsification surgery causes less surgically induced astigmatism and mean total astigmatism as compared to 2.8 mm clear corneal superior incision phacoemulsification surgery

The geriatric age group, defined as any individual above the age of 60 years, is expected to double from 7.7% in 2001 to 12.30% in 2025.,¹ Altered mental status is a challenging entity, where atypical manifestations poses greater challenge for diagnosis and treatment
Aims: To analyze the clinical profile and etiology of elderly patients presenting with altered mental status A prospective, descriptive study of 247 elderly patients who presented with altered mental status were admitted to the wards/ICU. Detailed history was obtained from the attender, including comorbid conditions, activities of daily living, polypharmacy, physical disabilities. Comprehensive geriatric assessment, MMSE, GCS was performed and documented. Laboratory, radiological and other investigations were reviewed in order to make a conclusive diagnosis and care plan and patients were followed up, until discharge from the hospital
Results: 247 elderly patients were included with a mean age was 71 years out of which 86.4% had comorbidities and 14.17% had psychiatric illness. 37% consumed alcohol and 33.19% were on medication with probable cause delirium. (78.3%). The mean GCs was 9.68. The most common etiology were metabolic disturbances (60.7%), followed by septic etiology (30.7%), cerebrovascular disease (12.55%), delirium (10%) The mortality rate in this study was 13.9%
Conclusion: Majority patients had one or more comorbid conditions, drowsiness being the most common (68.01%). 14.5% had focal neurological deficits. Metabolic and septic encephalopathy were the most common. 20.6% had multiple causes of altered mental status. Septic encephalopathy with a worst outcome (23.07%) deaths.80.5% of patients were discharged.

Anaemia is defined as a decrease in the number of red blood cells (RBC) or the haemoglobin (Hb) content of blood, or a decrease in Hb's ability to bind oxygen. Anaemia in children differs from that in adults in that it is more pronounced and develops more rapidly. In developing regions, up to 51% of children aged 0-4 years and 46% of children aged 5-12 years are anemic.
Aim: To evaluateanaemia in paediatric age group using different haematological and biochemical investigations.
Material and method: The present study was conducted among 250 patients with anaemia in the age group of 0 to 18 years. Various haematological (CBC, GBP, Bone marrow aspiration, HPLC) and biochemical (Serum ferritin, Serum iron, TIBC, Vit. B12 and Folic acid) investigations were done on the blood samples received. Data so collected was tabulated in an excel sheet and was analysed using SPSS software version 22.
Results: Maximum patients were diagnosed with iron deficiency anaemia. 34 patients were diagnosed with vitamin deficiency anaemia (Vit. B12, Folic acid or both). Maximum (26.4%) number of Vit. B12 deficiency anaemia patients were from 13- 18 age group whereas maximum (17.6%) number of  Folic acid deficiency were found in 7-12 years.
Conclusion: Anaemia can be detected early using biochemical and haematological assays. Children's anaemia prevention programmes should be established in conjunction with initiatives to meet their dietary needs.

The purpose of this study was to evaluate the level of endo-perio lesions’ knowledge and awareness among dentists in Bhatinda city.
Materials and Methods: The study includes 156 dentists who responded to the survey among 180 dentists. Twelve questions about demographic data, risk factors, and the definition of the disease were asked in the two-part survey. The data was examined using the T test, Chi-square test, and Mann-Whitney U test in Minitab 17 statistical software.
Results: Periodontists and endodontists were shown to be considerably aware of endo-perio lesions (p=0.001 and p <0.001, respectively). It was discovered that general practitioners were largely unaware about these lesions.
Conclusion: Other than endodontists and periodontologists, general dentists were found to have less knowledge of endo-perio lesions.

Acute pesticide poisoning has become major public health problem world-wide. Among pesticides organo-phosphorous compounds have become a boon to farmers to control pest and insects affecting plants and crops, and also the widespread use and easy availability of this toxic substances have resulted in many cases of accidental  and  suicidal poisoning. The aim is to find out demographic social and clinical profile which will help to reduce the risk of poisoning Aim & Objective: 1. To study incidence, clinical, social and demographic profile of organophosphorus poisoning patients. 2. To study the complication and outcome of organophosphorus poisoning patients. Methods: Study design:  Cross sectional Observational Study. Study setting: Medicine ward of tertiary care center. Study duration: From 01/01/2019 to 30/06/2020. Study population: The study population included all the cases with OP poisoning admitted at a tertiary care center.  Sample size: 107 Results: Most common age of presentation was 21-30 years with 52(48.60%) patients followed by 31-40 years 19(17.76%) patients. There were 78(72.9%) patients were male and the rest 29(27.1%) were female. Male: Female ratio was 2.69:1. A large no. of study patients were having Social and domestic problems 42(39.25%) followed by patients with other reasons like alcohol abuse, Chronic illnesses, Psychiatric disorders, Failure in examination etc in 20(18.69%). Most common mode of the poisoning was suicidal in 80.37% of the study patients followed by accidental in 15.89% cases. There were 3.4% case of homicidal OP poisoning. Most common symptom of the presentation was Excessive salivation in 77 (71.96%) followed by Nausea/ Vomiting 61(57.01%),while 43.93% patients were having breathlessness. Among different signs present in the study patients miosis was the most common 55(51.40%) followed by fasciculations 51(47.66%), bradycardia 48(44.86%), increased bronchial secretions 29(27.1%), neck muscle weakness in 28(26.17%). Oro nasal frothing was present in 9.35% of the study patients. Respiratory failure developed in 6(5.61%), 4 (3.74%) each suffered from Aspiration pneumonia and Circulatory collapse. Out of 107 study patients 93(86.92%) were alive after the treatment was given while rest 14(13.08%) succumbed to death. Conclusion: Our study outlines the various demographic groups susceptible to organophosphorus poisoning and the various factors responsible. Our study also highlights the importance of early presentation, reflected by our comparatively lower mortality rate. Health education of farmers and agricultural labourers is important for reducing incidents of poisoning.

Diabetes is one of the most prevalent chronic diseases: in 2010, one study
reported that 285 million adults worldwide had diabetes and this figure is projected to
rise to 439 milion by the year 2030. Aims and Objectives: To study the Clinical profile
and Factors associated with Diabetic foot at Tertiary health care center. Methodology:
This was a prospective study of consecutive Diabetic patients with foot complications
admitted in the surgical wards of Surgical department of a tertiary health care center
during the period of January 2016 – January 2017. A total of 168 cases were analyzed
during this period. Detailed history and thorough clinical examination was done in all
cases. All details of the clinical features and associated features and all the details of
investigations carried out were noted. Statistical analysis was done by Chi- square test
calculated by SPSS 19 version software. Result The majority of the patients were in the
age groups 60-69 were 30.00%, followed by 50-59-24%. The majority of the patients
were Male-52.98% and Female were 47.02%. There was significant family history of
diabetes mellites in 68.00% of patients (p < 0.01). The majority of the patients developed
lesions by Trauma i.e. 69.00% and Spontaneously in 31.00%, this was statistically
significant (P<0.01). As per Clinical Pattern Abscess was present in 3% cases, cellulitis
in 25% Cases, Ulcer in 52% cases and Gangrene in 29 % Cases and Joint involvement
in 5%. Most of the patients presented with Wagner Grade II type of foot lesions. i.e.
58.33%. Hence early and effective management can save the limb. The arteriopathy was
present in 89% as compared to absent 11% (P<0.01). Neuropathy was present in 26%as
compared to absent in 74% of patients presenting with diabetic foot lesions. Patients
with Neuropathy presented with Higher Grades of Diabetic foot lesions. Conclusion: It
can be concluded from our study that the majority patients were in the age group of 60-
69, the associated factors were family history, history of trauma, presence of
arteriopathy and neuropathy etc.

An important factor in determining whether a specific low birth weight neonate
is preterm or has growth retardation is the estimated gestational age. So, this study was an
attempt to determine the correlation between anthropometric parameters of newborns with a
period of gestational age.
Material and Methods: A hospital based cross sectional study was done among 200
consecutive live births delivered at tertiary care centre. The anthropometric parameters like
birth weight, length, foot length, head circumference, chest circumference, mid upper arm
circumference were recorded and analysed with gestational age using correlation and
regression analysis.
Results: At p value of 0.05, the neonatal anthropometric measures showed a positive
correlation with GA in completed weeks. The multiple linear regression analysis showed that
Birth weight, length and head circumference had significant linear relationship and the
regression equation derived as follows: GA = [41.325 + 1.603 (𝐵𝑖𝑟𝑡ℎ 𝑤𝑒𝑖𝑔ℎ𝑡)] +
0.125 (𝐿𝑒𝑛𝑔𝑡ℎ) − 0.437 (𝐶ℎ𝑒𝑠𝑡 𝑐𝑖𝑟𝑐𝑢𝑚𝑓𝑒𝑟𝑎𝑛𝑐𝑒).
Conclusion: The anthropometric parameters had a positive correlation with gestational age
and there was an increase in all parameters of birth weight, length, head circumference, chest
circumference, foot length, and MUAC with respect to gestational age. So, these
measurements can be used as a better screening tool for the assessment of prematurity in low
resource settings.

Background: To correlate the obstetrics outcomes in term pregnancies by admission cardiotocography (CTG) testing. Methods: A total of 200 consecutive low risk obstetric patients meeting the inclusion criteria were subjected to admission CTG testing in this descriptive observational study. The CTG tracing was categorized based on updated FIGO criteria (2015). Specific obstetrics outcome measures were studied and correlated with the admission CTG testing. Result: Incidence of normal trace was 71%, suspicious 21% and pathological 16%. Out of 200 cases 133 (66.50%) had vaginal delivery, 48 (24%) had LSCS and 19(9.50%) had instrumental delivery. There was increased incidence of operative delivery in suspicious and pathological tracings. Conclusion: The result of admission cardiotocography testing could be used to identify patients who requires early interventions to prevent adverse neonatal outcome

Chitin is a very important biopolymer found in arthropods, fungi and some algae. Nowadays, the sources of finding, extracting and applying new sources of chitin and its derivatives are expanding. In this research, the structure and morphology of chitin extracted chemically on the basis of Calliptamus italicus L. were studied

This article discusses the role of emotional intelligence and its development in the work of a forensic psychologist, as well as the improvement of its specific socio-psychological factors. research; in the development of emotional intelligence of forensic psychologist experts, their relationship with the legal system is revealed.

The burden of dysmenorrhea is greater than any other gynecological complaint. The effects extend beyond individual women to society, resulting in an important loss of productivity annually. Thus, World Health Organization estimated that dysmenorrhea is the most important cause of chronic pelvic pain. Adenomyosis and endometriosis are the most frequent causes of secondary dysmenorrhea in young women.
Aim: The aim of this study was to evaluate the causes of secondary dysmenorrhea by diagnostic laparoscopy and find out the prevalence of endometriosis as a cause of secondary dysmenorrhea.
Methodology: A total of 35 women with persistent dysmenorrhea and negative imaging findings were subjected to diagnostic laparoscopy after proper investigations and informed consent.
Results: In all 35 cases that underwent laparoscopy, 26 women had endometriosis (74.2%). There were 6 women diagnosed with PID (17.14%), one woman with adenomyosis, and two women with ovarian cysts. Among women with endometriosis, 53.8% had ovarian endometriomas, 76.9% had endometriotic lesions, and 34.6% had adhesions. Endometriosis was found maximum (42.9%) in the ovaries followed by POD (40%), uterosacral ligaments (17.1%), fallopian tubes (11.4%), bladder, and pelvic peritoneum 2.9% each. Histopathology was sent for 30 cases and only 24 cases reported back with biopsy reports. Biopsy-proven endometriosis and laparoscopically diagnosed endometriosis were analyzed and compared. The sensitivity of laparoscopy was found to be 77.78%, and the specificity 33.33%.
Conclusion: Endometriosis should be suspected in women of the reproductive age group with secondary dysmenorrhea. Laparoscopy is the most reliable technique for the diagnosis of endometriosis.
Laparoscopy should be combined with histopathological examination since endometriosis is likely to be overdiagnosed or underdiagnosed if only visual diagnosis is used.

COVID-19-causing SARS-CoV-2 is global. respiratory distress. COVID-19 exhausts oxygen in the lungs. COVID-19 patients worry about their own and their family's health, being alone, losing their job, feeling helpless, and dying, which causes anxiety, depression, physiological stress, decreased physical performance, and decreased physical activity. Respiratory rehabilitation helps chronic pulmonary disease patients breathe. Rehabilitating COVID-19 patients is rare. Thus, this study compares the male and female effects of physiotherapy management on performance, anxiety, and stress in hospitalized COVID-19 pneumonia patients

Insight has been reported as one of the most relevant factors associated with medication adherence. It is the key element in schizophrenia and Bipolar Affective Disorder outcomes through its direct effect on disability and adherence. Poor adherence to prescribed regimens can result in serious health consequences. Aim: The purpose of this study is to explore the relationship between insight and medication adherence in patients with schizophrenia and Bipolar Affective Disorder (BAD). Method: A cross-sectional study was conducted for a duration of 6 months on 60 patients (30 patients of bipolar affective disorder and 30 patients of schizophrenia). Patients of schizophrenia and BAD from inpatient and outpatient department fulfilling the inclusion criteria were selected. Socio-demographic data is collected using specially designed proforma. Insight was assessed using Beck cognitive insight scale (BCIS) , treatment adherence by Drug Attitude Inventory scale (DAI). Result: In this study it was observed that, correlation between insight and drug adherence scores in patients of schizophrenia and bipolar affective disorder is positive and strong and statistically significant (P value- 0.001). This study shows that Insight is an important factor which decides the drug adherence. There may be many other factors which influence the drug adherence. However, insight has a direct association with drug adherence in patients of bipolar affective disorder and schizophrenia.

Intravenous regional anaesthesia with conventional large dose of local anaesthetic is associated with serious systemic toxicity when the tourniquet deflates unexpectedly during the procedure or when it is deflated intentionally at the  end of surgery. Therefore modifications in IVRA have been done with the use of low dose of local anaesthetic to decrease systemic toxicity and addition of muscle relaxant and opioid to local anaesthetic to get the same quality analgesia as high dose local anaesthetic. Hence the present study is carried out to compare the sensory and motor characteristics, and side-effects during intra- operative and post-operative period between the patients who received 0.5% lignocaine    alone and those who received combination of 40 ml of 0.25% lignocaine with 1 mg butorphanol and 2mg atracurium in intravenous regional anaesthesia for upper limb surgeries  . AIM: 1 .  TO COMPARE THE SENSORY AND MOTOR CHARACTERISTICS IN INTRAVENOUS REGIONAL ANAESTHESIA  IN BOTH THE  GROUPS 2.  TO  COMPARE THE SYSTEMIC SIDE EFFECTS IN THE TWO GROUPS. METHOD: 60 ASA class 1 and 2 patients scheduled for elective upper limb surgeries were randomly allocated to receive IVRA either with 40ml of 0.5% lignocaine alone (Group A, n = 30) or combination of 40 ml of 0.25% lignocaine with 1 mg butorphanol and 2 mg atracurium (Group B, n = 30). The sensory and motor characteristics, cardiovascular & respiratory parameters and side effects were studied during the intra-operative and post-operative period. RESULT: The time of onset of sensory loss & motor block ,the time of complete sensory block, and the time of  complete motor block were significantly delayed in group B.  But the quality of analgesia was similar in both groups after 10-15 minutes of the injection  of  anaesthetic solution. There was no significant difference between two groups in the time of return of full motor power and full sensation There was no significant difference in cardiovascular & respiratory parameters and incidence of side  effects between the two groups. CONCLUSION: The study indicated that the triple combination of 40 ml of 0.25% lignocaine, 1mg butorphanol  and 2mg atracurium produces the same quality of analgesia as 40ml of 0.5% lignocaine in IVRA. Thus, this modified technique of intravenous regional anaesthesia allows a reduction in the dose of local anaesthetic agent thus reducing the potential toxicity of the local anaesthetic agent.

The burden of dysmenorrhea is greater than any other gynecological complaint. The effects extend beyond individual women to society, resulting in an important loss of productivity annually. Thus, World Health Organization estimated that dysmenorrhea is the most important cause of chronic pelvic pain. Adenomyosis and endometriosis are the most frequent causes of secondary dysmenorrhea in young women. Aim: The aim of this study was to evaluate the causes of secondary dysmenorrhea by diagnostic laparoscopy and find out the prevalence of endometriosis as a cause of secondary dysmenorrhea. Methodology: A total of 35 women with persistent dysmenorrhea and negative imaging findings were subjected to diagnostic laparoscopy after proper investigations and informed consent. Results: In all 35 cases that underwent laparoscopy, 26 women had endometriosis (74.2%). There were 6 women diagnosed with PID (17.14%), one woman with adenomyosis, and two women with ovarian cysts. Among women with endometriosis, 53.8% had ovarian endometriomas, 76.9% had endometriotic lesions, and 34.6% had adhesions. Endometriosis was found maximum (42.9%) in the ovaries followed by POD (40%), uterosacral ligaments (17.1%), fallopian tubes (11.4%), bladder, and pelvic peritoneum 2.9% each. Histopathology was sent for 30 cases and only 24 cases reported back with biopsy reports. Biopsy-proven endometriosis and laparoscopically diagnosed endometriosis were analyzed and compared. The sensitivity of laparoscopy was found to be 77.78%, and the specificity 33.33%. Conclusion: Endometriosis should be suspected in women of the reproductive age group with secondary dysmenorrhea. Laparoscopy is the most reliable technique for the diagnosis of endometriosis. Laparoscopy should be combined with histopathological examination since endometriosis is likely to be overdiagnosed or underdiagnosed if only visual diagnosis is used

The purpose of root-end cavity preparation is to remove irritants from the root canal system inaccessible to the operator via a coronal entry. However, this predisposes the tooth to microcrack formation which further increases the possibility of bacterial contamination and susceptibility to root fracture. Aim: To evaluate and compare the dentinal microcrack formation after root-end cavity preparation with bur and ultrasonic tips using different imaging techniques. Methodology: Forty atraumaticaly freshly extracted, single-root premolars were collected for the study. All the samples were decoronated and working length was established. Biomchanical preparation was done till F4 protaper and obturated using single cone obturation technique. Root resection was carried out and number of cracks was evaluated using Stereomicroscope, Dental Operating Microscope and CBCT. Samples were then divided into four groups of 10 teeth each depending on the instrument used for retrocavity preparation: Group 1 (control): no preparation was done, Group 2: retrocavity prepared with stainless steel ultrasonic tip, Group 3: retrocavity prepared with diamond coated ultrasonic tip, Group 4: retrocavity prepared with stainless steel round bur. Samples were immersed in methylene blue dye and number of cracks were again evaluated using the three imaging techniques. Percentage increase in the number of cracks was calculated and data was subjected to statistical analysis using Wilcoxon and Kruskan Wallis Test. The level of statistical significance was set at 5% . Results: With stereomicroscope and Operating Microscope, maximum increase in the percentage of microcracks was observed in Group 2 (Stainless steel retrotip) followed by Group 3 (Diamond coated retrotip) and Group 4 (Stainless steel bur). Conclusion: Within the limitation of the study, it was concluded that there was increase in the percentage of microcracks after root end resection and root end cavity preparation. Stainless steel ultrasonic tips produced more dentinal cracks as compared to diamond-coated ultrasonic tips followed by stainless steel bur. Also, more number of microcracks was observed in stereomicroscope as compared to Dental Operating Microscope.

To evaluate the levels of Serum Fasting blood glucose, IR and Serum Ferritin in diagnosed PCOS patients and normal controls.
Material and methods: The current study was conducted in urban tertiary hospital based a Case-control analytic cross-sectional study in Departments of Biochemistry and Gynecology & Obstetrics of Faculty of Medicine and Health Sciences, SGT University, Budhera, Gurugram, India on 160 subjects aged between 18 to 45 years comprising of 80 healthy control and 80 patients with clinically diagnosed cases of PCOS, acted as study group. The blood samples of controls as well as study groups were withdrawn and Clinical evaluation included anthropometry, Hight, Weight, Body Mass Index (BMI) and waist-to-hip ratio (WHR) were calculated. Circulating levels of fasting glucose, insulin resistance, and Serum Ferritin level were determined by Chemiluminescence based immunoassay (CLIA) on fully automated Biochemistry analyzer MAGLUMI 1000.
Results: It is observed that the out of total 160 subjects with both control and study group PCOS patients were included in the study. The age of these control group was ranged from 18 to 45 years, with a mean of 26.23±5.58 years and PCOS study were found 27.76 ±6.54 years. The findings of anthropometric measurements of the subjects of both PCOS syndrome (n=80) and non-PCOS (n=80). As expected, mean levels of BMI, Weight, Height showed marked difference and were statistically significantly increased (P<0.0001) in both the groups. The serum levels of serum Fasting blood glucose level, insulin resistance, and Serum Ferritin were significantly increased (P<0.0001) in subjects with PCOS and without PCOS compared to controls.
Conclusion:These results demonstrated that elevated level of serum ferritin was associated with insulin resistance in PCOS women.

Hearing is a critical part of speech and enhances our day to day activities. It is an integral part of our personal, social and economic status and hence improves the quality of life.  The study was conducted to find out the prevalence of sensori-neural hearing loss in Type -2 Diabetes Mellitus and the association between glycosylated haemoglobin and Sensori-neural hearing loss in these patients.
Methodology: This study was conducted as Cross-sectional observational study, based on 100 patients who presented to the ENT and Endocrine Out Patient Department of Peoples Medical College and Research Centre between 1^st December 2020 to 31^st March 2022.This study suggests that there is necessity of introducing routinely periodic assessment of auditory functions in patients of Type-2 diabetes mellitus for early detection and prevent further complications.
Results: This study was conducted on a total of 100 diabetic patients, showed , the association between age group and degree of hearing loss was statistically significant with a p-value of 0.03 by Pearson Chi-square test and Association between degree of SNHL and levels of HbA1C was statistically significant by Pearson Chi-square test. In our study, it was seen that as HbA1c level rises, degree of SNHL also rise .
Conclusion: Thus we would like to conclude that routine evaluation of the auditory system can help in the early diagnosis of sensorineural hearing loss in type 2 diabetes mellitus, good glycaemic control is key to prevent or delay occurrence of SNHL.We also suggest regular audiological evaluation of all diabetic patients to improve the quality of life .

Attempts have been made to analyse the relation between hearing loss according to type of device and duration of device within a students of PCMS and RC. This study was undertaken at tertiary care centre for better understanding of students listening habits and compare it with normal individuals who do not use personal listening devices.
Methodology: This study was conducted as an  cross sectional comparative study on students studying in  People’s College of Medical Science and Research Center, Bhopal, during the study period of 18 months. All the cases (PLD users) and controls (Non PLD users) were subjected to history taking and detailed clinical examination. All the cases and controls were subjected to pure tone audiometry test.
Results: This study was conducted on a total of 1000 students, of them, 500 were PLD users and remaining 500 were non PLD users. We observed no significant difference in age composition,  sex and religion between the groups (p>0.05).Most common PLD used by students was ear plugs with majority of them using it for 2-3 hours per day above warning sign for more than 4 years and most common presenting symptoms was ear pain and headache. We observed a strong positive correlation of type of device, duration of device in years and hours and volume of device according to hearing loss.( P value significant)
Conclusions: According to our study head phones and ear plugs are safer PLD as compare to buds. PLD users may present with wide variety of otologic symptoms ranging from ear pain, headache to tinnitus and reduced hearing alone or in combination. PLD use is associated with accumulation of wax, tortuosity in EAC and otomycosis. Among PLD users, threshold of hearing is increased even if the users are not aware regarding their hearing status. Hearing loss of both the type i.e. sensorineural and conductive hearing loss, though mild is associated with PLD use. Here we concluded that PLDs should be used with caution, limit their duration of use and volume and keeping a watch on warning signs and symptoms

Obesity is a major public health problem in Indian healthy adults in urban and rural area. Cardio metabolic risk factors are frequently observed among those who have generalized obesity measured by Body Mass Index (BMI). However, there is limited study available on these risk factors in abdominal obesity in which normal BMI with central distribution of body fat, a phenotypically frequently observed healthy adults. So we conducted “A comparative study of cardio metabolic risk factors in generalized obesity, abdominal obesity and non-obesity  in Indian healthy adults”.
 Materials and methods: A Cross sectional study was conducted among healthy adults in age group 20 to 45 years of both sex and 600 subjects were selected from general public, hospital staff and patient attendants, out of which 200 were non obese, 200 abdominal obese and 200 generalized obese. Study was conducted from November 2021 to June 2022. Abdominal obesity  was defined as waist circumference >90 cm in males and >80 cm in females with or without generalized obesity and generalized obesity was defined as BMI >25 kg/m2 with or without abdominal obesity. Clinical and biochemical characteristics were collected using standard questionnaires and protocol. Data were analyzed using SPSS version 16.0. ANOVA test was applied for statistical significance. P value <0.05 was taken statistically significant.

We conducted this research to characterise the clinical-etiological profile of children with status epilepticus (SE) who are younger than 12 years old, as well as to investigate the risk factors and underlying causes of RSE, the course of the condition at the end of the hospital stay, and indicators of a good or bad outcome in SE.
Materials and Methods: This hospital-based prospective observational study is conducted from April 2022 to January 2023 in a paediatric intensive care unit of a tertiary care referral hospital in Bihar, India. The study included 111 youngers than 12-year-olds who were admitted in a row with SE. The principal investigator gathered and entered the data regarding the parameters in a standardised proforma after thorough review and necessary inquiries. The final result was documented after the patient's hospital stay. The acquired data were evaluated to find important variables that might predict the result and the risk factors for RSE.
Results: After infancy, the age period of 1-6 years was reported to have the highest prevalence of SE. Boys made up 51.4% of cases while girls made up 48.6%. Meningoencephalitis and febrile status were the two most frequent causes of status. Anaemia was revealed to be a risk factor (odds ratio=8.68) and to be strongly linked with RSE (pvalue =0.001). 9 (8.1%) of the kids died. Significantly, an adverse outcome was seen more frequently in children who remained pain responsive or unresponsive 6 hours following seizure control (p value 0.01). The advancement of RSE and worse result were substantially linked with delaying the administration of the first anti-epileptic drug (AED).
Conclusion: We discovered that RSE was substantially linked with anaemia and a delay in the use of the first AED. Additionally, there was a strong correlation between poor outcomes and kids who were still in pain or unresponsive 6 hours following seizure control

Unanticipated difficult laryngoscopy and tracheal intubation is a main concern for the anesthesiologist. Failure to maintain a patent airway after the induction of general anesthesia is the most common cause of anesthesia-related morbidity and mortality. The morbidity associated with difficult intubation can be reduced if a difficult airway is anticipated preoperatively. There are many bedside tests to predict difficult airway.
Aim and Objective: The main aim and objective of this study was to compare the sensitivity and specificity of the Mallampati technique with the lower jaw protrusion maneuver in predicting difficult laryngoscopy and tracheal intubation using the Cormack-Lehane grading of intubation as the gold standard.
Methods: A total of 275 patients undergoing thyroidectomy at MCH, Thiruvananthapuram, were selected as the study population. The airway was assessed by the Modified Mallampati Classification (MMC); classes III and IV were considered as predictors of difficult intubation. Lower Jaw Protrusion Maneuver Grades B and C were considered predictors of difficult intubation. A senior anesthesiologist with 5 years of experience assessed the laryngeal view by direct laryngoscopy using Cormack and Lehane grading. Grades 3 and 4 were considered difficult for laryngoscopy and intubation. The validity parameters, such as sensitivity, specificity, false positive and negative values, positive predictive value (PPV), and negative predictive value (NPV), were calculated.
Results and Discussion: MMC: Sensitivity 63.6%, Specificity 98.4%, PPV 77.8%, NPV 96.9%, Accuracy 95.6% LJP: Sensitivity 72.7%, Specificity 98.4%, PPV 80%, NPV 97.6%, Accuracy 96.4%
Conclusion: The lower jaw protrusion test has a higher level of accuracy, sensitivity, positive predictive value, and negative predictive value compared to the Mallampati test. Lower jaw protrusion appears to be a better choice for preoperative airway evaluation. So the LJP test can be added to routine preoperative evaluation of the airway, but it has the limitation that it cannot be performed in some patients, like the edentulous patients and patients with a low intellectual coefficient.

Children frequently have neurological issues such febrile encephalopathy and fever-related seizures. The majority of cases are caused by infections of the neurological system. The trifecta of encephalopathy, fever, and seizures is also associated with a range of inflammatory and infectious diseases. In addition to complex febrile seizures and febrile status epilepticus, age-related clinical phenotypes of fever-related epilepsy and encephalopathy include reversible splenial lesion syndrome (RESLES), infantile hemi convulsion hemiplegia epilepsy syndrome (IHHE), fever infection related epilepsy syndrome of childhood (FIRES), acute necrotizing encephalopathy of childhood (ANE), acute encephalopathy with delayed diffusion restriction (AESD).  For an accurate diagnosis and the quick application of immunomodulatory/ immunosuppressive therapy, awareness of these entities is crucial. We examine the pathogenesis, clinical manifestations, and therapeutic strategies of these fever-related encephalopathy and seizure disorders in this review

A common allergic reaction that more frequently affects youngsters is an asthma attack. Both the risk and the morbidity may rise as a result. It is a fatal illness that poses a serious threat to life. Children who have chronic asthma are more likely to experience drug-induced side effects, medication errors that aggravate their illness, and negative outcomes. Poor medication adherence, ignorance of the disease, and improper inhaler use can all result in a lower quality of life and make it challenging to treat a severe condition. Uncontrolled aggravation and lingering symptoms are the usual causes. Children who are in a serious state should be referred to a pulmonologist and instructed on the proper inhaler technique

Acute respiratory distress syndrome (ARDS) and multiorgan dysfunction that results in death are significant in COVID-19 infection, with a greater mortality risk in elderly people with comorbidities. Along with inflammatory markers (like C-reactive protein, Pro-calcitonin, Lactate-dehydrogenase, Ferritin, D-Dimer, Interleukin-6), neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR), and absolute-lymphocyte count(ALC) are new adjuncts in COVID-19 management.
STUDY DESIGN: Retrospective cross-sectional study at a tertiary care hospital of Indore.
METHOD:
The study included patients in third-wave who tested positive (RT-PCR/RAT) for SARS-CoV2 and hospitalized with routine blood investigations like complete blood count and differential values of serum biochemical tests C-reactive protein, D-dimers, liver-function test, renal-function test and ABG were done at admission.
STATISTICAL ANALYSIS: chi square and fisher’s exact test.
RESULTS:
A value >= 4.94 for NLR and >=263 for PLR was suggestive of severe COVID-19 disease. While absolute-lymphocyte count (<= 1210 lymphocytes/mcl) was suggestive of severe COVID-19 disease along with D-Dimer value of >0.6 ngFEU/l and C-reactive protein of > 16.6 mg/l.
CONCLUSION:
As COVID-19 pneumonia is secondary to inflammation, we showed that a more severe inflammation, as evaluated through inflammatory markers, correlates with more severe disease via different grading scores/systems (ARDS Grading, APACHE-2 Scoring, Covid-19 infection severity and Final outcome). Higher levels in NLR, PLR, CRP and D-Dimer while lower absolute-lymphocytes count should prompt the clinician to proceed aggressively in management of Covid-19 patients.

Postoperative analgesia is an important part of the anaesthetic care. For abdominal surgery, both subcutaneous infiltration and TAP block target on relieving somatic pain. Subcutaneous anaesthetic wound infiltration is easy to perform with low risk. As the advancement of ultrasound technology, performing the TAP block also becomes easier, safer and more accurate. This study is to compare the postoperative pain score, opioid consumption, side effects, and hemodynamic changes between these two analgesic methods in patients undergoing lower abdominal surgery. To compare bilateral ultrasound guided transversus abdominis plane (TAP) block with subcutaneous infiltration of local anaesthetic drug for analgesia after lower abdominal surgeries under general anesthesia.
 Study Design: -This study was an Observational hospital based study.
 Materials and methods- This prospective observational study, conducted at Gandhi Medical College and associated hospitals, bhopal, After obtaining Institute Ethics Committee approval and written informed consent, 60 participants were included in the study who were undergoing lower abdominal surgeries, 30 participants received 20 ml 0.125 bupivacaine (P) as bilateral ultrasound guided TAP block and 30 participants received 20 ml, 0.125% bupivacaine (P) as subcutaneous wound infiltration at the end of surgery performed under general anesthesia. The primary outcomes were pain scores at 1,2,4,6, 8,12 and 24 hours postoperatively and cumulative tramadol consumption over 24 hours. The secondary outcomes were time to first rescue analgesic, dose of rescue analgesic use and opioids-related side-effects.
 Statistical Analysis: The data entry was done in the Microsoft EXCEL spreadsheet and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software. For statistical significance, p value of less than 0.05 was considered statistically significant.
 Results: The mean time to first analgesia request in minutes were longer in TAP-block with 6.68±2.2 hours compared to mean time of 4.2±1.5 hours in the subcutaneous infiltration group. There were also statistical significant difference with regard to mean Tramadol consumption within 24 h between the two group with P-value<0.001. The mean post operative pain score in PACU at different intervals were significantly lower in TAP block group.
Conclusion: The first analgesia request was significantly longer in addition to less total analgesia consumption in the TAP-block group when compared to subcutaneous infiltration group. Furthermore the TAP-block showed extended pain relief with lower pain VNRS but for immediate and early postoperative pain relief subcutaneous infiltration group recorded lower pain VNRS score than the TAP-block group

The aim of this study is to Histopathological Study of Urothelial Carcinomas and Association with Various Risk Factors. Detailed history of the cases regarding age, sex, personal history, site, typeof procedure done were obtained for all 50 cases reported during the studyperiod from surgical pathology records. All transuretheral resection of bladderspecimen were processed entirely and representative sections were taken fromradical cystectomy specimen which were subjected for routine histopathologicalexamination. The following clinical and pathological parameters were evaluated:age, gender, tumor site, size, tumor grade, tumor stage and invasiveness of thetumor.

Sleep wake cycle is synchronized with the circadian clock fluctuations in Suprachiasmatic nucleus which are entrained with other diurnal rhythms in our body like feeding and fasting timings, temperature regulatory mechanisms and various hormonal level fluctuations. Due to change in our culture or lifestyle which lead to increased number of evening and night time work and leisure activities, less hours are available for sleep. Sleep deprivation alters both metabolism and endocrine function, including glucose tolerance and the hormone that controls hunger. This review looked at potential connections between sleep and factors that contribute to the pathogenesis of obesity.
Studies showed that suggested that sleep restriction has metabolic effects that predispose to weight gain. Sleep loss found to be associated with increase in appetite via increasing Ghrelin and endocannabinoids whereas decreasing Leptin hormone. Because of sleep disruptions, time spent awake gave more opportunity for night time snacking and daytime sleepiness which might lead to decreased activity level. Hence overall positive balance in spite of increased energy expenditure leading to weight gain. Increase in sleep debt subsequently leads to fatigue and daytime sleepiness making prone to sedentary lifestyle and can predispose to obesity.  Sleep disorders were linked directly with obesity severity in literature. The sleep fragmentation in sleep disorders like OSA might lead to excessive daytime sleepiness, lack of physical activity and increasing food intake by influencing food choices and hence, to obesity. OSA patients with CPAP therapy (continuous positive airway pressure) showed improvement not only in OSA severity but weight loss also. Therefore, scheduling sleep might improve the obesity and further consequences of obesity like cardiovascular disorders or metabolic syndrome etc. Hence, sleep should be considered equally important as nutrition and exercise.

Congenital Dislocation of the Knee (CDK) is a rare birth abnormality. It may be associated with conditions like Arthrogryposis, spinal dysraphism, Larsen’s, Beal’s or Ehler Danlos’ syndromes & with other deformities like developmental dysplasia of the hip or clubfoot. There are several differences of opinion regarding the management of this condition. Serial casting is a primary line of management for this condition which if started early can give good results & might avoid surgical intervention.
Objective: This study aims to study the functional outcome of Congenital Dislocation of the Knee treated with serial casting.
Materials and Methods: This was a prospective study of 3 Newborn babies with Congenital dislocation of knee at a Tertiary Care Hospital. All 3 children were treated with serial casting with above knee cast with increasing degree of knee flexion. Regular follow up was done. Investigations were done to rule out syndromic associations. Initial conservative management was planned.
Results: Mean follow up was 16 months. All 3 babies showed >90 degree of knee flexion with stable knee & 5/5 Quadriceps strength & thus had Excellent results. No surgical intervention was required.
Conclusion: Congenital Dislocation of the knee is a rare abnormality, for which primary line of treatment is serial casting & follow up. If failed or with poor results, surgical intervention can be planned. Early detection of other abnormalities & syndromic associations is of utmost importance.

Spinal anaesthesia is a safe and reliable technique for surgery of the lower abdo­men and lower limbs. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The choice of the correct local anaesthetic for spinal anaesthesia is therefore crucial in the ambulatory setting: the ideal anaesthetic should allow rapid onset and offset of its own effect for fast patient discharge with minimal side effects.
Aims: To compare the duration of sensory and motor blocks with use of chloroprocaine, and levobupivacaine as local anaesthetics in spinal anaesthesia.
Materials and method: The present study was a Prospective randomized open label double blind study. This Study was conducted From 18 months, from February 2018 to July 2019 at Department of Anaesthesia, Bankura Sammilani Medical College and Hospital. Total 72 patients were included in this study.
Result: We found that, In group-C, the mean duration of surgery (mean ±s.d.) of the patients was 43.7500 ± 5.6537 mins. In group-L, the mean duration of surgery (mean ±s.d.) of the patients was 44.5833 ± 4.3712 mins. There was no statistically significant difference in ASA gradings in between two groups (p=0.4865). There was no statistically significant difference in mean time to reach peak block height in between two groups (p=0.6142). In group-C, the mean two segment regression time (mean ±s.d.) of the patients was 57.0833 ± 8.5670. In group-L, the mean two segment regression time (mean ±s.d.) of the patients was 80.5833 ± 7.4234. There was statistically significant difference in mean two segment regression time in between two groups (p<0.001). There was statistically significant difference in mean time for regression to L1 in between two groups (p<0.001). There was   no statistically significant difference in PEAK BLOCK HEIGHT in between two groups. (p=0.4004).
Conclusion: we conclude that in patients undergoing unilateral knee arthroscopy, the use of chloroprocaine was associated with decreased time of duration of sensory and motor block and early recovery, early ambulation and early void. There were no statistically significant difference is noted in haemodynamic changes in between two groups. No adverse effects regarding allergic reactions, hypotension, shivering, bradycardia  and nausea and vomiting were  found during intraoperative and postoperative period.

The World Health Organization has dubbed scrub typhus as one of the world’s most underdiagnosed/underreported diseases that often requires hospitalization. Scrub typhus is a zoonotic, acute febrile illness that is endemic in the regional population, caused by Orienta. Tsutsugamushi, an obligate intercellular anaerobic bacterium, which was previously categorized in the Rickettsia genus, is naturally maintained in the mites of Leptotrombidiumgenus,belonging to the family Trombiculidae, by trans-ovarian transmission.
Aims: In this cross sectional, observational, descriptive study, an attempt has been made to document and review the clinical profile and complications in diagnosed cases of scrub typhus in this regional population, thus helping to create a better clinical and laboratory profile of this re-emerging disease for clinicians to work with.
Materials and Methods: It is a descriptive,crosssectional and analytical study. This Study was conducted from 18months at Department of General Medicine, BSMCH.
Result: Headache was present in 41(77.4%) patients, myalgia/arthralgia were complained by 46(86.8%) patients. 13(24.5%) patients had Platelet count of <1.5lac/cmm. Incidence of significantly raised (3 fold) SGPT(>100U/L) was found in 10(18.9%) patients, and that of SGOT was found in 11(20.7%) patients. Among respiratory symptoms, cough was present in 17(32.1%) patients, shortness of breath was in 16(30.2%) . On respiratory system examination,15(28.3%) patients had bilateral decreased VBS (subsequently found to have either B/L plural effusion or ARDS or pneumonitis). 6(11.3%) patients had B/L Infiltrates in chest X Ray, 10(18.9%) patients had B/L pleural effusion . In our study, 2(3.8%) patients had Oliguria. On neurological examination, 5(9.4%) patients had clinical features suggestive of Meningitis, 3(5.7%) patients had features suggestive of Meningoencephalitis. 1(1.9%) patient was found to have focal neurodeficit in form of left lateral rectus palsy. Only 1(1.9%) patient presented with Eschar in left thigh and associated left inguinal lymphadenopathy
Conclusion:We found that, in patients presenting with fever and respiratory symptoms having B/L infiltrate and/or B/L pleural effusion, suspicion of scrub typhus should be kept in mind

to compare the disease progression in retinitis pigmentosa-affected kids receiving vitamin A supplements to those who do not.
Study design and type: Non-randomised retrospective study
Methodology: The study comprised 55 children receiving vitamin A and 25 not taking vitamin A who had various hereditary forms of typical retinitis pigmentosa. The data analysis was done in December 2022 and the patient examinations took place between June 2016 to May 2022 We used age adjusted dose of vitamin A ≤15 000 IU/d. By using repeated-measures longitudinal regression, we may estimate the mean exponential rates of change of the full-field cone electroretinogram amplitude to 30-Hz flashes without and with confounding variables.
Results: The mean and SD age of the 55 kids in the vitamin A cohort was 9.1±
1.9years, and 38 (69%) of them were boys. The estimated mean rates of change using the unadjusted model were 0.0713 loge units/y (6.9% per year) for the group receiving vitamin A and 0.1419 loge units/y (13.2% per year) for the control cohort (difference, 0.0706 loge units/y; 95% CI for the difference, 0.0149-0.1263 loge units/y; P =.01). The modified model supported the observation that the vitamin A group saw a slower mean rate of decrease (difference, 0.0771 loge-unit per year; 95% CI for the difference, 0.0191-0.1350 loge-unit per year; P =.009).Regarding ocular safety, there were no differences between cohorts in the mean exponential rates of change in visual acuity and visual field area, nor in the incidences of falling to a visual field diameter of 20° or less or a visual acuity of 20/200 or less in at least 1 eye.
Conclusion: In children with retinitis pigmentosa, taking vitamin A palmitate supplements was linked to a slower reduction of cone electroretinogram amplitude. These results support the use of an age-adjusted dose of vitamin A in the treatment of the majority of children with the typical forms of retinitis pigmentosa, despite the relatively small sample size, retrospective, nonrandomized design, and potential biases.

Pilonidal disease is now considered an acquired dermatologic disease. Numerous surgical and non-surgical techniques have been suggested for the treatment of pilonidal sinus. It usually requires a radical surgical procedure with a long stay in hospital, discomfort and loss of earning. The purpose of this study was to observe the outcome of surgical and non-surgical management of pilonidal disease.
Material and methods: The present prospective observational study was carried out from November 2014 to October 2016 in Tertiary Care Hospital. It describes the clinical profile and outcome of sacrococcygeal pilonidal sinus managed by surgical methods and non-surgical method. The study included a total of 46 patients out of which 24 underwent surgical management and 22 underwent management by non-surgical technique.
Results: The majority of patients in both groups were in the age group 15 to 35 years. Students were more affected with Pilonidal disease in both groups. (54.54% & 50 %respectively). Discharge followed by pain was the most common presenting complaint seen in both the groups. 54.54 % (12) cure rate was seen with single sitting whereas27.27% (06) with two sittings and 18.18% (04) with three sittings. Wound dehiscence was seen as early complication in surgical group whereas skin ulceration was seen one case in non-surgical group. Conclusion: To conclude, non-surgical management of pilonidal sinus (Crystallized phenol injection) is an effective, feasible, low cost, simple, minimally invasive outpatient procedure with early recovery and return to work, better cosmetic outcome, less peri-operative pain and gives acceptable results.

Post-partum haemorrhage (PPH), an obstetric emergency that can complicate vaginal or caesarean deliveries & is associated with serious complications. Guidelines for the management of PPH involve a stepwise escalation of pharmacological & surgical approaches. In women who do not respond to uterotonics or medical treatment, a variety of procedures, such as uterine artery embolization, stepwise de-vascularization or obstetric hysterectomy, may be used. The Bakri balloon is an intrauterine device indicated to reduce or control PPH temporarily when conservative treatment is warranted. Here, we are presenting case series of primary atonic PPH & which were managed by Bakri Balloon Tamponade (BBT).
This case series included 91 women with PPH managed by Bakri balloon as a conservative therapeutic option. All 91 women were in age group between 19 years to 34 years. The causes of PPH were uterine atony, retained placenta & central placenta previa. The Bakri balloon was successful in controlling haemorrhage in 87 women (90.1%) who did not respond to medical management of PPH.
Bakri balloon is a simple, easy to use & effective method for conservative management of acute PPH. This device reduces bleeding, shortens the hospital stay & avoids the need for more aggressive procedures such as stepwise devascularization & obstetric hysterectomy

Implant treatment is highly popular as prosthetic replacement option for various clinical situations. However, clinical implant failures are also unavoidable events which need immediate attention. This study was conducted to evaluate post surgical complication associated success/failure in patients treated with ball and bar Supported Implant Overdentures.
Materials and Methods: The data collected from the clinical document record archives of department for implant over-denture patients with bar and ball attachments. Total 30 patients have been selected by systematic sampling procedure. Two study groups were having 15 patients each. Group 1 patients had received bar supported implant overdentures. Group 2 patients received ball supported implant overdentures. Post operative complications have been screened in their recall periods at an interval of 3 months, 6 months and 9 months. Record of failure or success status was noted in the different time periods in recall visits. Statistical analysis was done by software and inferences were recognized accordingly.
Statistical Analysis & Results: Total 30 patients were included in the study with 18 male and 12 females in the age range of 45 to 65 years. For Group 1, in 3 month post operative follow up period 13 out of 15 implants were declared successful. P value was highly significant here. In 9 month post operative follow up period, 10 out of 15 implants were declared successful. For Group 2, in 3 month post operative follow up period 14 out of 15 implants were declared successful. In 6 month post operative follow up period, 13 out of 15 implants were declared successful. In 9 month post operative follow up period, 11 out of 15 implants were declared successful. One-way ANOVA assessments for between groups, within groups and cumulative were done. P value was significant here (0.001).
Conclusion: Authors concluded that post operative complications are apparently unavoidable in implant therapies. In our study, ball supported implant over-dentures showed slight higher success rate compared to bar supported implant over-dentures. Additionally, there was a slight increase of failure rate with the increasing follow up timings.

To study of intrapleural  fibrinolytic therapy in loculated pleural collections
Material and methods: All 50 patients of parapneumonic effusions with persistent pleural fluid and poor chest-tube drainage (less than 150ml/day) despite an appropriately positioned and patent drain; multiple loculi or fibrin strands in pleura as depicted by ultrasonography or CT scan chest were included in the study. Imaging studies with either chest radiography, ultrasonography (USG) or computed tomography (CT) were performed before the initiation of IPFT to assess the quantification of fluid the site and size of loculations and the extent of associated pleural thickening, marking of chest wall for site of insertion of chest drain.
Results: In 52% (n=26) of patients, the pleural effusion is caused by tuberculosis since these patients are primarily from rural areas and have low socioeconomic level. However, there were 10% (n=5) cases of malignant pleural effusion and 20% (n=10) cases of pneumonia with complex parapneumonic effusion. 6% of cases (n=3) involved hemothorax, while 12% involved empyema. 54% of the group under investigation needed three cycles of IPFT, followed by 46% who needed just two cycles and 10% who needed three cycles. 25 participants were found to have had a 10% improvement in FVC, while 19 patients had a 20% improvement. Only six patients saw the maximal FVC improvement of 30%. After IPFT, the FVC might reach a maximum of 70%. According to USG chest imaging, 86% of subjects had effusions resolve to residual fluid less than 50 ml.
Conclusion: Studies have demonstrated that using intrapleural fibrinolytics is a good substitute for risky surgical treatments including VATS (video-assisted thoracoscopic surgery), thoracotomy, and decortication.

Many case reports have described anatomical variants of the pectoralis muscle. However, there has been little information published regarding this topic. So, the present study attempts to examine the different types of variations of pectoralis major muscle in terms of its origin, insertion, and nerve supply.
 Methods: The research was carried out on 40 cadavers ( 32 male and 8 female)  in the department of anatomy, B.J .G. M. College, Pune from 2013 to 2014.
Results: During dissection, out of the 40 cadavers, in a male cadaver left pectoralis major muscle variation was observed. Origin of the pectoralis major was found to be normal. However, a tendinous slip arising from deep lamina of pectoralis major muscle near its insertion on lateral lip of intertubercular sulcus of humerus was found. This tendinous slip along its course, was found to cross the musculocutaneous nerve, median nerve, brachial vessels, and ulnar nerve from lateral to medial side and blend with medial intermuscular septum 2.5 cm above the medial epicondyle of humerus. Then, it was found to be inserted on the medial epicondyle of the humerus. In all specimens of pectoralis major, the innervation by medial and lateral pectoral nerves was observed to be constant.
No other variations were noted in the specimens of pectoralis major muscle.
Conclusion: Anatomical knowledge of variations of Pectoralis Major muscle is important for plastic surgeons during reconstructive surgeries, neurologists, radiologists, orthopaedic surgeons, physiotherapists.

One of the most difficult and dangerous pregnancy problems is acute kidney injury (AKI). We discuss our observations regarding the clinical characteristics and results of 60 patients who had AKI due to pregnancy who were seen throughout the research period. Examining the prevalence, characteristics, and effects of acute kidney injury (AKI) during pregnancy in the Indian population was the aim of this study. Materials and Method: in the study the patients were women who were pregnant with AKI.Patients were examined using demographic data, a detailed history, a clinical examination, and laboratory tests. The main result was a change in maternal renal function, including progression to chronic kidney disease and restoration to normal renal function (CKD). The delivery method, pregnancy-related issues and maternal mortality were all regarded as secondary outcomes. Results: The present study included 60 patients in total, with an average age of 26 years. 41.2% of the individuals were primigravida, and 49.9% had severe anaemia. AKI was primarily brought on by pre-eclampsia and postpartum haemorrhage. During the three-month follow-up period, it was noted that the renal outcome had significantly improved, with 30 patients achieving full renal recovery and remaining patients developing CKD with mild to no recovery. Serum glutamic oxaloacetic transaminase and glutamic pyruvic transaminase levels were increased in all individuals but later recovered to normal. Conclusion: According to our study, women with AKI due to pregnancy frequently experience multi-organ problems and need mechanical ventilation and renal replacement therapy. As a result, managing AKI caused by pregnancy offers a challenge that necessitates an accurate assessment of the contributing factors to enable effective therapy

We have described a simple technique for loading and insertion of single piece foldable intraocular lens in cataract surgery. In this technique cartridge lumen is filled with viscoelastic solution and then intraocular lens (IOL) is placed over it. Left edge of the optic is pushed behind the ridge of the groove with McPherson forcep. Then the wings of the cartridge are slightly approximated and right side of the optic is pushed behind the ridge. This locks the optic behind the ridge of cartridge. The leading haptic is placed inside the groove. Now the trailing haptic is pushed in the groove, the tip of the haptic is pushed below the optic as much as possible. This will tuck the haptic not allowing to get it trapped in between the wings of cartridge and also do not leave space in between the haptic and cartridge lumen for a chance for overriding of plunger over trailing haptic or optic. Both wings of the cartridge are approximated properly. Cartridge is fitted on to the injector. Cartridge tip is inserted in a rotating manner through the corneal wound. While delivering IOL, injector is rotated in such a way that the lens is delivered in a desired horizontal placement.

Pediatric HIV is a major world health problem, which is progressing at an alarming rate. Ocular complications in HIV patients make management of such patients more difficult; if such manifestations can be picked up early, better management results could be achieved with such patients. Present study was aimed to study ocular manifestations in children (<12 years) with positive HIV status at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in children of 2-12 years of age, affected with HIV/AIDS, attending antiretroviral therapy (ART) center of the institute, underwent a thorough ophthalmologic evaluation for ocular involvement. Results: In present study, total 460 children underwent ophthalmologic evaluation, 88 children had ocular involvement (19.13 %). Majority were from 6-9 years age group (43.18 %), were boys (54.55 %) & mean age was 7.53 ± 3.81 years. Anterior segment manifestations noted were allergic conjunctivitis (20.45 %), dry eye (19.32 %), hordeolum (12.5 %), molluscum contagiosum (1‑bilateral) (4.55 %), blepharitis (4.55 %), herpes zoster ophthalmicus (without keratitis) (3.41 %). Posterior segment manifestations were retinal perivasculitis (13.64 %), CMV retinitis (4.55 %), isolated cotton wool spot (4.55 %), toxoplasma (3.41 %), choroidal tubercle (2.27 %), Roth spots (2.27 %). In children with CD4 count of 200-500 cells/mm³ ocular manifestations noted were hordeolum, blepharitis, molluscum contagiosum, optic neuritis while in children with CD4 count of <200 cells/mm³ ocular manifestations noted were CMV retinitis, herpes zoster ophthalmicus, retinal vasculitis. Conclusion: Ophthalmic manifestations of HIV infection are diverse. Both anterior and posterior segments of the eye can be involved. Early detection of the ocular manifestations of HIV/AIDS is critical since this has implications for the prognosis of the disease.

Childhood ophthalmic disorders have an important role to play in the child’s development, academic achievements, self-esteem and their quality of life. Recently there are no update on awareness among school teachers regarding the common pediatric eye disorders. Therefore this study was designed to assess the awareness among the teachers regarding the prevailing eye disorders. Objectives: To assess the awareness among primary school teachers about common pediatric eye diseases prevailing in the society and epidemiological factors associated with it. Methodology: This community based cross sectional study was conducted on the primary school teachers. Total 168 study subjects participated in the study. Data was collected using google form after obtaining consent. Data was auto saved in google database and analyzed with help of excel and SPSS 21 software. Results: This study included total 168 participants, out of which 93 (55.36%) were male and 75(44.64 %) were female. Level of adequate awareness among primary school teachers was about 34 percent. Female teachers and teachers with post graduate degree had adequate level of awareness and this association was found to be statistically significant. Discussion: Level of awareness was found to be less when compared to studies done in adult population. Also some factors like more awareness among more qualified teachers was in concurrence with finding from other studies. Conclusion: There is inadequate awareness among primary school teachers like minimum age of undergoing cataract surgery, exact distance of vision testing in school children, Primary treatment of congenital dacryocystitis and congenital glaucoma.

Caesarean section commonly induces moderate to severe pain lasting 48 hours after surgery. Prompt and adequate post-operative pain relief is an important component of caesarean delivery that can make the period immediately after the operation less uncomfortable as well as mother can initiate early breastfeeding that helps to contract the uterus and accelerates the process of uterine involution in the postpartum period. Various clinical studies have shown that ropivacaine is equal to bupivacaine in local anesthetic potency and is less toxic than bupivacaine in regard to the production of mild central nervous system and cardiovascular toxicity. Methodology- The study was carried out a tertiary care center on patients fulfilling the inclusion and exclusion criteria. Patients were randomly allocated in two groups i.e, Group A & Group B consisting of 50 patients in each. Spinal anaesthesia was performed at L3-L4 with 8–10 mg of a hyperbaric bupivacaine 5 mg/mL solution. Intraperitoneal instillation and incisional infiltration with 30 mL of 0.25% ropivacaine was performed in Group A. Intraperitoneal instillation and incisional infiltration with 30 mL of 0.25% ropivacaine plus epinephrine (5mics) (1:2,00,000) was given in Group B. The haemodynamic monitoring was done at every 15 mins in first hour of skin closure, in the recovery room, then at 2 hours, 4 hours, 6 hours, 8 hours, 12 hours and 24 hours after closure of the skin measuring heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and SPO2. Results- In both the groups, study drugs prolonged the duration of analgesia for similar duration in post-operative period. Hence, there is no difference between duration of analgesia provided by the study drugs post-operatively in both the groups and is statistically non-significant since p>0.05. Conclusion- 0.25% plain ropivacaine 30 ml and 0.25% Plain ropivacaine 30 ml plus epinephrine (1:2,00,000). Both given as intraperitoneal instillation and incisional infiltration, provide adequate post-operative analgesia for similar duration of hours.

To assess the overall accuracy of intra-operative diagnosis of ovarian tumors by imprint cytology technique and to compare those cases with histopathological diagnosis and to determine whether the addition of cytologic preparations provides useful information in the intra-operative management.Aims and Objectives: To establish the validity and reliability of imprint cytology and its accuracy in intra-operative diagnosis of ovarian tumors and to get an overview of the incidence of ovarian malignancies in our hospital. Materials and Methods: A Prospective study of 2 years conducted from November 2011 to October 2013. The study includes all cases of ovarian tumors and excludes patients who have received treatment and cases of functional ovarian cysts. Intra-operative imprint cytology diagnosis was compared with histopathological report.Results: A total of 30 cases were studied. Age range of the patients was 13 to 69 years. Out of 30 cases, 2 cases were excluded. On histopathological diagnosis out of 28 cases, 18 were benign, 1 was borderline,8 were malignant and 1 case with no tumor( Infected cyst) . On comparing the imprint cytology diagnosis with histopathological diagnosis, 25 out of 28 cases were concordant and the diagnostic accuracy of imprint cytology was 96.4%.Conclusion: Imprint cytology is a less expensive, simple and a quick method of diagnosis. Unlike frozen section it does not affect the utility of the specimen for histopathology. It is helpful especially in young patients who need conservative surgery in order to preserve fertility.

To Study the presence of micronucleus in urothelial cells of patients with normal and abnormal cervical visual inspection and to correlate with cytological and histological findings in normal and various intraepithelial lesions of cervix and cervical carcinoma. To assess the role of urothelial MN score in predicting cervical cancer risk.
Materials and Methods: A total of 350 patients with the complaints of post coital bleed, lower abdominal pain, menstrual irregularities who come in gynaecological out patient department of Rajindra Hospital and Medical College, Patiala were included in our study. Patient’s cervix was visually examined, pap smear taken and midstream urine sample collected for MN scoring. Incidence of micronucleus in urothelial cells recorded as micronucleus cells per 1000 cells by 4 cytopathologists.
Results: The mean Urothelial MN score ± Standard deviation was found to be 2.80±1.58 in inflammatory cases,4.55±1.63 in ASCUS cases,5.67±0.58 in ASC- H cases ,5.61±0.50 LSIL cases, 6.09±0.30 in cases of HSIL,6.50±0.53 in invasive carcinoma. A step-wise increase was observed in MN score from inflammatory to IC categories.
Conclusion: Urothelial MN score is a reliable and easy test that can be used along with routine cervical PAP to assess the risk of premalignant  and  malignant transformation in the cervix as a biomarker for predicting the risk of carcinoma.

Emergence agitation (EA) presents clinically as disorientation, restlessness, excitation, inconsolability, unnecessary movement, incoherence and thrashing during the initial recovery from general anesthesia. Beneficial effects of dexmedetomidine (DEX) against emergence agitation (EA) in adults remain controversial.
Aim and Objective : To compare the effects  of Dexmedetomidine and Fentanyl on emergence delirium and quality of recovery from general anaesthesia after laparoscopic surgeries. Material and Method : This was the Hospital based prospective, randomized double blind clinical trial. conducted on patients receiving IV dexmedetomidine versus IV Fentanyl among Patients undergoing laparoscopic surgeries under general anaesthesia. A Total 100 patients, allocated to two groups of 50 each (n=50), after following inclusion and exclusion criteria and getting informed consent form patients. p-value<0.01 was statistically significant.
Results: Mean difference between the group for age,  Time duration at PACU, Duration of Surgery was assessed by using t-test, and difference in the proportion between the groups were assessed by using chi-square test for proportions. p-value less than 0.05 was consider statistically significant at 5% level of significance.time taken for verbal response was statically significant between the groups and this time was more  in group D compared to Group F, also PACU stay was statistically significant and more time was taken in group D. Riker Sedation-Agitation Scale between the groups and we had more patients observed calm and cooperative in group D but in group F we have observed patients with agitated to dangerous agitation. Conclusion: Premedication with dexmedetomidine 1mcg/kg intravenously provides better quality and haemodynamic of extubation and reduces emergence agiation compared to fentanyl 1mcg/kg in adults undergoing laparoscopic surgeries.

Lower respiratory tract infection(LRTI) is a single largest cause of death in children worldwide. Hyponatremia is the most common electrolyte disturbance in admitted patients of LRTI. This study may help in prognostication of disease in terms of course, complication and possible outcome in these patients.
Objective: To estimate prevalence of hyponatremia in hospitalized patients of LRTI and to identify demographic, clinical and laboratory factors, complications and outcome associated with hyponatremia in patients with LRTI.
Materials and Methods: Children between 1 month to 18 years with LRTI admitted in department of pediatrics in a tertiary care centre in central India, as per inclusion and exclusion criteria were enrolled and their detailed clinical history, physical examination, routine investigations and serum sodium levels, complication, treatment were recorded.
Results: Out of 150 patients of LRTI admitted, hyponatremia was present in 43 cases (27%). Mild and moderate hyponatremia were present in 19.3% and 9.3% patients respectively. Hyponatremia was found to be more common in 1 to 5 years. Mean duration of hospital stay was longer in hyponatremic children. 69.8% of patients with hyponatremia on admission were found to have SIADH which was statistically significant. Mortality in patients with hyponatremia was 18.6%, which was significantly higher as compared to eunatremic patients where mortality was only 1.9%.
Conclusion: Hyponatremia is a common association among hospitalized children with LRTI. Serum sodium level at the time of admission can be used for timely identification and intervention of at risk LRTI patients and may help in reduction of morbidity and mortality

The aim of present study is to observe the effect of different doses of intrathecal tramadol as an adjuvant in subarachnoid block to prolong the duration of analgesia. All patients were evaluated thoroughly in preanesthetic checkup a day before surgery. During the preanesthetic evaluation a thorough general and systemic examination was done. The patients were examined clinically to note demographic data, baseline heart rate, blood pressure, respiratory rate, oxygen saturation of Hb. History of underlying medical illness, previous surgery, anaesthetic exposures and hospitalization was enquired.
Result: The mean onset time for sensory block in group A patients was observed as 4.62 ± 0.49 minutes and for group B patients it was 4.47 ± 0.51 minutes. We observed onset time for motor block in group A and B that was 5.85 ± 0.61 and 5.56 ± 0.61 minutes respectively. Duration of sensory and motor block in group A patients receiving Tramadol 25 mg was 173.32 ± 12.37 and 158.50 ± 10.71 minutes respectively whereas the duration of sensory and motor block for the patients in group B receiving Tramadol 40 mg was 182.03 ± 10.89 and 167.29 ± 11.09 minutes. The time for demand of dose of rescue analgesic by the patients in both groups was 244.68 ± 8.59 minutes and 306.53 ± 28.56 minutes, significantly higher in patients who received 40 mg tramadol.
Conclusion: The study was carried out in young healthy subjects of either sex belonging to ASA grade 1 and 2. A thorough pre-anaesthetic check-up was carried out. The procedure was explained and informed consent was taken.
Data on onset and offset of sensory and motor block, degree of muscle relaxation, postoperative pain free period were recorded. Vital parameters and incidence of drug related complications were also noted. Observations were tabulated and statistical tests were applied to find out the significance of observations. The observations recorded have been discussed to derive the conclusions.

The purpose of this study was to evaluate the detection rate of pulmonary nodules in ultrashort echo time (UTE) lung magnetic resonance imaging (MRI) and to compare it with computed tomography (CT) in oncology patients.
Methods: The study was performed at department of radiology. Approval of the thesis was taken by the Institutional Ethical Committee and the study was performed according to standard protocols. In this study of comparison of UTE lung MRI and HRCT lungs for detection of pulmonary nodules in oncology patients, 50 patients were subjected to HRCT lungs and UTE lung MRI using the sequence Fl3d_spiralvibe cor 1.25mm iso.
Results: 50 patients who underwent both a spiral 3D UTE examination of the lungs and thin-section chest CT were included (35 men and 15 women; mean age, 62.2 years; range, 30–79 years). The mean duration between chest CT and MRI was 22.4 days (range, 0–30 days). Among the total number of nodules detected in both lungs of all patients, nodules detected by CT were 241, and nodules detected by MRI were 212. The nodule detection rate by MRI was 87.96%.
Conclusion: Our study results indicate that lung MRI had a near-complete detection rate for nodules equal to or more than 5 mm in size. Hence, in oncology patients who are undergoing regular follow-up of the lung nodules, lung MRI using UTE can replace low-dose CT, which in turn reduces the radiation dose to the patient.

We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension.
Methods: The present study was conducted in department of radiology and 500 patients were included in the study. Patients with a CT scan within 90 days of MRI and RHC were included. In order to meet inclusion criteria, a diagnostic quality CT pulmonary angiogram (CTPA) with a slice thickness of less than 5 mm was required.
Results: We included 500 scans from 500 patients; 300 (60%) had RHC-confirmed pulmonary hypertension, with mPAP ⩾25 mmHg. Compared with the non-pulmonary hypertension group, the group with pulmonary hypertension had greater MPAD, RPAD, LPAD and PA:Ao in both respiratory cycles, whereas the PA angle was greater in the non-pulmonary hypertension group. In the subgroup with pulmonary hypertension, the median MPAD was 34.60 mm in inspiration and 34.65 mm in expiration, while in the non-pulmonary hypertension group it was 30.00 mm in inspiration and 30.50 mm in expiration. For the cohort as a whole, the areas under the receiver operating characteristic curves (AUCs) for inspiratory MPAD and inspiratory PA:Ao (for RHC-confirmed pulmonary hypertension defined as Mpap ⩾25 mmHg) were 0.741 and 0.750, respectively. For the cohort as a whole, the cut-offs MPAD ⩾32.5 mm and PA:Ao ⩾0.94 yielded the most favourable diagnostic profiles.
Conclusion: Findings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ⩾29 mm had high sensitivity and PA:Ao ⩾1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.

The aim of this study is to evaluate whether additional anesthetic and analgesic effect could be derived from administration of potassium chloride into brachial plexus sheath with bupivacaine.
Result: Mean and Standard Deviation of the Duration of Analgesia in both the groups. Duration of Analgesia was calculated from the completion of administration local anesthetic to the time when patients had VAS score >5 (time of first rescue analgesia). It was longer in Group A(study) as compared to Group B(control), with p  value 0.000 which was statistically highly significant.
The changes produced in SBP & DBP in group A (study) and group B (control) has been shown  in figure. Thus DBP was stable in both groups and the difference between group A (study) and group B (control) was statistically not significant.
Conclusion: Addition of Potassium Chloride to bupivacaine solution for brachial plexus block can modify the action of local anesthetic solution beneficially. The dose 0.2mmol of Potassium chloride used in present study significantly shortens onset of sensory and motor block and gives longer duration of sensory and motor and better quality analgesia of longer duration than local anesthetic alone in supraclavicular block. There were no clinically significant side effects noticed. Hence Potassium chloride can form an useful adjuvant for bupivacaine when used for brachial plexus block.

Caesarean section can be performed before labour, during first and second stages of labour.Present study was aimed to compare fetomaternal outcome in women undergoing caesarean section in first stage vs second stage of labour at a tertiary hospital. Material and Methods: Present study was prospective, comparative study, conducted in pregnant women, between 21-35 years of age, Singleton, term pregnancies, low risk & fit for vaginal delivery underwent emergency LSCS. Pregnant women were divided into 2 groups as group 1 (LSCS in the first stage of labour) & group 2 (LSCS in the second stage of labour). Results: Maternal complications such as blood transfusions (4 % vs 7 %), bladder high up (1 % vs 10 %), hematuria (2 % vs 17 %), unintended extensions (2 % vs 14 %), wound dehiscence (3 % vs 11 %) & febrile morbidity (4 % vs 16 %) were more among women underwent LSCS in second stage of labour, difference was statistically significant. Neonatal morbidities such as Apgar Score <7 at 5 min (2 % vs 6 %), Neonatal septicaemia (2 % vs 10 %), Intubation not for meconium (1 % vs 7 %), NICU stay >24 hrs (2 % vs 19 %) were more in women underwent LSCS in second stage of labour, difference was statistically significant. Fetal injuries (2 %) were noted only in women who underwent LSCS in second stage of labour. Conclusion: Maternal complications (blood transfusions, hematuria, unintended extensions, wound dehiscence & febrile morbidity) & neonatal morbidities (Apgar Score <7 at 5 min, Neonatal septicaemia, Intubation not for meconium & NICU stay >24 hrs) were more in women underwent LSCS in second stage of labour.

Pre-eclampsia is a disease of unknown etiology characterized by development of hypertension to the extent of 140/90 mm of Hg or more with proteinuria after the 20th week in a previously normotensive and non-proteinuric patient. Incidence of Pre-eclampsia varies from 8-10% in India, being 10% in the primigravidae and 5% in multigravidae. Objective: The present study, conducted in the department of Biochemistry of a tertiary care teaching hospital, proposes the value of serum copper levels as marker in etiopathogenesis and in assessment of the severity of pre-eclampsia. Methods: The serum copper levels were measured in sixty newly diagnosed pre-eclampsia patients admitted in the wards of Department of Obstetrics and Gynecology of the tertiary care teaching hospital and sixty age and sex matched normal healthy relatives of patients attending the Out Patient Departments. Result: The outcome of the study indicated that the levels of serum copper were increased statistically significantly in the pre-eclampsia cases group when equated to the normal pregnant control group. Moreover when levels of serum copper were correlated with the systolic and the diastolic blood pressure in pre-eclampsia patients, significant positive correlation was detected. Conclusion: Hence the result obtained concludes that serum copper level may be considered as an influence having a role in the etiopathogenesis of the disease and may also be used as severity indicator in patients with pre-eclampsia.

High BMI is associated with an increased risk of preeclampsia, gestational hypertension, macrosomia, induction of labour, caesarean deliveries and poor perinatal outcomes^.Low BMI has been shown to be associated with an increased risk of preterm deliveries, low birth weight and anemia and a decreased risk of preeclampsia, gestational diabetes, obstetric intervention and postpartum haemorrhage. Aim & Objective: 1. To assess correlation between maternal Body Mass Index (BMI) and perinatal outcome. Methods: Study design: Prospective observational Study. Study setting: Department of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital, Mumbai (NWMH), (Tertiary Health Centre). Study population: patients who delivered / underwent completion of pregnancy at the institute such cases were included in the study. Sample size: 100 Results: The highest number of patients belonged to the age group of 23-28 yr (61%%), followed closely by the age group of 29-35 yr (33%). Patient between age group 18-22 yr was only 6%. LSCS was performed in 48%, out of which Emergency LSCS constituted 40% & Elective LSCS constituted 8%. P-value for LSCS was 0.001 & for Emergency LSCS was 0.003 suggesting these are more common in BMI Group III & IV. Instrumental Deliveries were performed in 4% of patients out of which Forceps applied in 2% & Vacuum extraction done in 2% patients. Out of 90 patients, in 7 (7.78%) patients second stage of labour was prolonged. Meconium-stained liquor was found more commonly in BMI Group III with P-value for 0.028. Total of 25 patients were diagnosed to be suffering from gestational hypertension. 5 (20%) of them had postpartum haemorrhage & Blood Transfusion was needed in 3 (12%) them. Foetal Distress was found to be the most common complications affecting 18% of patients who participated in this study. P-value for Foetal Distress is 0.011 suggesting significant association being more common in BMI Group IV. Neonatal complications respiratory distress syndrome & Meconium Aspiration Syndrome were found in 4 % & 3% babies without any significant association in any of the BMI group. Conclusion: Vaginal Delivery was the most common obstetric outcome, Neonatal outcome was Live Birth among all the patients.

Vitiligo is a condition where white patches appear on the skin due to lack of melanin pigment. It can appear on any part of the body, but most commonly affected areas are face, neck, and hand. It can cause significant psychological and social distress in patient suffering from it. Methodology- The study was conducted at Central Research Laboratory and Department of Skin and VD, Sri Aurobindo Medical College and Post Graduate Institute, Indore, from Oct 2014 to Jun 2016. 84 known patients of vitiligo were recruited for the study. Patients were diagnosed to have vitiligo based on history, duration, progression of disease presence of depigmented patch and appearance of chalky white on wood’s lamp examination. DNA was extracted from EDTA blood using Himedia HiPurA kit. The IL1B -511C/T SNP was genotyped using polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) method. Results- C allele was observed in 53% of cases and 50.6% of controls whereas T allele was present in 47 % of cases and 53% of controls. No association of T allele with the presence of vitiligo was seen in present study (p = 0.910) Conclusion- No significant association of IL1B -511C/T (rs 16944) polymorphism at genotype level and allele level was seen with the vitiligo in this study. None of the model was found associated with vitiligo.

Vitiligo is characterized by a disappearance of epidermal and/or follicular melanocytes which result in pale white patches on skin. It is an autoimmune disease and can develop at any age and in any gender. People affected by vitiligo can experience low self-esteem and concern about their appearance, leading to disturbed mental state and thereby affecting the quality of life. Methodology- The study was conducted at Sri Aurobindo Medical College and Post Graduate Institute, Indore, Central Research Laboratory and Department of Skin and VD, from Oct 2014 to April 2016. 84 patients who were known case of vitiligo were enrolled for the study. Written informed written consent was taken from all the patients. Detailed clinical examination was done on all patients to rule out other systemic disorders. 5ml of blood samples were collected in plain and EDTA tube from peripheral veins under aseptic precautions. Serum was separated by centrifugation of plain tube at 2000rpm.DNA isolation process was done.Results- The frequency of CC, CT and TT genotype of IL1b gene in our study was 27.4%, 48.8% and 23.8% cases and that were in controls were 28.8%, 43.8% and 27.4% respectively. Conclusion- No significant association of Il1b -511C/T polymorphism at genotype level was seen with the vitiligo

: Skin is the largest sensory organ of the body and acts as a barrier against various harmful environmental agents. Dermatologic disorders are common in all countries but the spectrum varies greatly. The spectrum varies according to geographic distribution, gender, age, and coexisting disorder. We conducted this study to find out prevalence of various skin diseases, site of distribution, frequency of various skin diseases and gender preponderance of diseases. Material and Method: A descriptive retrospective, cross-sectional study was done in the Pathology Department of PDU Medical College, Rajkot, Gujarat, from December 2021 to November 2022 (1 year). The biopsies taken were fixed in 10% formalin and then processed and stained with Haematoxylin and Eosin stain (H&E). A convenience sampling method was used. Data was collected, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and systemic random sampling was used to achieve sample size. Results: In our one-year study, total 130 biopsies were studied. Males were more affected than females. Most common affected age group was 31-40 years of age. Out of 130 skin biopsies, 117 (90%) were non-neoplastic and 10 (7.8%) were pre-malignant and neoplastic. Histopathological diagnosis was inconclusive in 3 (2.31%) cases. The most common non-neoplastic histopathological pattern observed in our study was infectious diseases comprising of 46 (35.4%) cases In Infectious diseases Leprosy was leading cause especially Lepromatous Leprosy. Trunk and abdomen (40.80%) were most common site of involvement in skin lesions. Conclusions: Infectious diseases especially Leprosy is still a common cause of skin diseases in developing country like India and strong intervention should be taken for it’s prevention. Histopathological examination is the gold standard for the proper diagnosis as histomorphological features distinguish various skin lesions which are having overlapping clinical features.

The aim of this study is to evaluate whether additional anesthetic and analgesic effect could be derived from administration of potassium chloride into brachial plexus sheath with bupivacaine.
Result: Mean and Standard Deviation of the Duration of Analgesia in both the groups. Duration of Analgesia was calculated from the completion of administration local anesthetic to the time when patients had VAS score >5 (time of first rescue analgesia). It was longer in Group A(study) as compared to Group B(control), with p  value 0.000 which was statistically highly significant.
The changes produced in SBP & DBP in group A (study) and group B (control) has been shown  in figure. Thus DBP was stable in both groups and the difference between group A (study) and group B (control) was statistically not significant.
Conclusion: Addition of Potassium Chloride to bupivacaine solution for brachial plexus block can modify the action of local anesthetic solution beneficially. The dose 0.2mmol of Potassium chloride used in present study significantly shortens onset of sensory and motor block and gives longer duration of sensory and motor and better quality analgesia of longer duration than local anesthetic alone in supraclavicular block. There were no clinically significant side effects noticed. Hence Potassium chloride can form an useful adjuvant for bupivacaine when used for brachial plexus block.

To evaluate the levels of serum amylase, lipase and creatinine phosphokinase in prognosis of organophosphorus poisoning.
Materials & methods: A total of 50 subjects were enrolled. Complete demographic and clinical details of all the subjects were obtained. Blood samples were taken and serum amylase, lipase and creatinine phosphokinase levels were evaluated. Correlation of these biochemical variables were assessed with the outcome of organophosphorus substance consumed. Results were subjected to statistical analysis by using the SPSS 23.0 version for statistical analysis. A P value of ˂0.05 was considered to be statistically significant.
Results: Mean age of the patients was 25.8 years (27 males and 23 females). Most of the patients were either farmers or housewives. Mean serum amylase among subjects who survived and expired was 96.3 IU/L and 284.8 IU/L respectively. Mean serum lipase among subjects who survived and expired was 94.8 IU/L and 211.7 IU/L respectively.  Mean serum creatinine phosphokinase among subjects who survived and expired was 584.7 IU/L and 1574.8 IU/L respectively.
Conclusion: Serum Amylase, Lipase and Creatine Phosphokinase Levels were significant.
serum amylase, Organophosphorus Poisoning, Creatine Phosphokinase