European Journal of Molecular & Clinical Medicine

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 epidemiological Welfare and Health service were analyzed using the SPSS program.

Background :
The umbilical cord is the lifeline of the fetus and one of the most important parts of the fetoplacental unit. Short cord length has been associated with delivery complications and adverse fetal outcomes.
Aims and objectives: To find out the correlation between umbilical cord length and fetal outcome.
Methodology :
This is a prospective study conducted in the Department of Obstetrics and Gynaecology of Government Medical College, Srikakulam from November 2022 to January 2023. All cases admitted in the labour room and fulfilling the inclusion and exclusion criterias were taken into the study. The length of umbilical cord was measured after delivery along with other parameters like sex, weight and length of new born, Apgar score and postnatal follow up. Statistical analysis was done using chi-square test and a value of p<0.05 was considered statistically significant.
Results:
Short cord length was associated with low Apgar at 1 min and 5 min(p value 0.03) and lower birth weight of the new born(p value 0.03). Adverse perinatal outcomes like stillbirth and NICU admissions were more common in the short cord group (p value 0.02).
Conclusion :
The present study showed that there is a positive correlation between cord length and birth weight of the babies, the Apgar score at 1 and 5min, NICU admission and perinatal outcome. Measurement of umbilical cord length offers an explanation when no apparent intrapartum complication is found for adverse perinatal outcome.

Background
Transfusion-transmitted infections threaten the safety of patients who require a blood transfusion, which in turn imposes serious challenges for the availability of safe blood products that are still affordable in healthcare systems with limited resources.
Aim of the study
The aim of the study was to determine the seroprevalence of transfusion-transmitted infections in blood donors at TMU Blood Bank and access the level of safety.
Method
A laboratory-based descriptive, cross-sectional study was conducted from June 2022 to Dec 2022. A qualitative study was carried out to access serological analysis of replacement and voluntary donors at TMU Blood Bank. The total number of donors screened during this period was 776. The donors were requested to fill out a detailed questionnaire and were screened for HIV, HBV, HCV, and Syphilis with a rapid immune-chromatographic kit. The results were expressed in tables and figures.
Results
Out of 776 donors, 676(98.7%) were replacement and only 10(1.29%) were voluntary donors. Male donors were predominant constituting 676(87.12%) and only 100 (12.88%) female donors. The seroprevalence of TTIs in the present study was 1.42%. Syphilis (0.77%) was the most prevalent TTI followed by HBV (0.51%). A low prevalence of HCV (0.13%) was found and HIV was not detected in any donors in the present study. The highest prevalence of TTIs was observed in the young age group of 18-25 years followed by 26-40 years.

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.
blood gases (ABG) data from patient at baseline, i.e., at arrival (0hr) and follow up 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 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.

Introduction: Cerebral sinus venous thrombosis (CSVT) is an uncommon condition.Its clinical presentation is varied and often dramatic. Although recognized for more than 100 years. The annual incidence is currently estimated to be 3-4 cases per 1 million people.3 out of 4 people with CSVT are women. It accounts for 10-20 % of the etiology of young strokes in india. Objectives:To study the Clinical features and imaging studies of cerebral venous thrombosis.To study the prognosis based on clinic radiological features.Methodology: Forty patients aged >18 years suspected to have cerebral venous thrombosis based on clinical history and examination were evaluated but only those with confirmed diagnosis (based on neuroimaging) of cerebral venous sinus thrombosis were taken up for the study.Meticulous history, clinical examination, laboratory investigations were carried out in all cases of cerebral venous sinus thrombosis. Cerebral venous thrombosis was confirmed by CT scan (or) conventional MRI (or) MR venogram.Results : Most common radiological finding was hemorrhagic infarction seen in 55% of cases. Empty delta sign was noted in 47.5% of cases. Cord sign was noted in 22.5% of cases. Radiologically most common sinus involved was superior sagittal sinus in 70% of cases followed by transverse sinus in 42.5% of casesLMWH was given in 65% of cases and intravenous unfractionated heparin infusion in 35% of cases, whereas 10% of the patients required decompressive craniotomy.The presence haemorrhagic infarct is associated with bad prognosis.Overall outcome is good with 69.44% of the patients having complete recovery at the time of discharge and overall mortality rate was 10%.Conclusion : The present study emphasizes that CVST is not an uncommon condition. It is an important cause of stroke especially in the peripartum settings and is one of the common causes of stroke in young people.Management with unfractionated heparin, LMWH and oral anticoagulation is appropriate.

Background : antepartum haemorrhage is a grave obstetrical emergency . it is a leadind cause of perinatal death. Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. The aim of the present study were to study perinatal outcome in patients with APH. METHOD: The study was a prospective and observational study conducted in The NSCB Medical College, Jabalpur from January 2020 to June 2021. Cases of pregnancy complicated with APH were taken. Cases with bleeding before 28 weeks and after delivery of the baby were excluded. Data collected from the records present in Labour ward complex and Medical record section. RESULTS:    out of 193 cases, were 105 (54.40%) live birth and 88 (45.59%) intra-uterine fetal death /still born . amongst patient belonging to abruptio placenta (118), 68 cases had live birth and 50 cases had IUFD. Conclusion: perinatal mortality in pregnancies complicated with APH can be prevented by early diagnosis, proper antenatal planning and terminating the pregnancy in a well-equipped tertiary care center.

Oral cavity in humans act as one of the most frequent areas for the development of overgrowths. These overgrowths can be categorized on the basis of their etiopathogenesis, site, size and their extent.  These enlargements mostly effect a particular region and are localized in nature,  like pyogenic granuloma, irritation fibroma, peripheral ossifying fibroma, peripheral calcifying fibroma. These overgrowths seldom occur in aggressive forms and frequently occur due to chronic irritation or stimuli over the particular area. [1].
Irritation fibromas are basically provoked fibrous connective tissue overgrowths which are benign in nature and appreciated mostly in oral cavity. Particularly, in  “Inflammatory hyperplasic lesion there is an increase in the size of an organ or tissue due to a local response of tissue to injury or an aggravation in the number of constituent cells.” The trauma may occur from vigorous entrenchment of any foreign substance or irritant into the oral tissues [2].
These lesions are most commonly hyperplastic reactions that occur in response to chronic irritation or stimuli. The most familiar location of occurrence include, buccal mucosa, gingiva, tongue and lips but they also have the predilection to occur at other soft tissue locations in the oral cavity [1].
 These overgrowths can occur in both genders and at any age but slightly a higher predilection is seen in middle aged females. Fibromas  mainly develop from the periodontal ligament or from gingival connective tissues. They are defined clinically as slow growing tumors which are well defined, spherical in shape, smooth surface, firm in consistency, have a broad base and may be sessile or pedunculated. Fibromas are generally painless overgrowths and gradually increase in size over the progression of time [3].
The  histopathological diagnosis of fibroma is mandatorily required to demarcate its difference from other clinically identical hyperplastic lesions or neoplasm of the oral cavity.   

Title: A comparison of I-gel with Baska mask airway for controlled ventilation in patients undergoing General Anaesthesia for surgeries less than three hours duration- A randomized prospective study
 
Background: Supraglottic airway devices (SADs) offer an alternative airway to traditional tracheal intubation or a face mask. The recently introduced Baska mask is a third generation SAD. The ideal SAD must have a high airway sealing pressure during spontaneous and positive pressure ventilation and low resistance to the flow of gases.
Aim: To compare I-gel with Baska mask in terms of insertion characteristics, efficacy haemodynamic response and safety in patients receiving controlled mechanical ventilation during elective surgical procedures.
Materials and Methods: The present randomized, double-blinded study was conducted on 60 patients of either sex and age of 18 years and above belonging to American Society of Anesthesiology (ASA) grade I and II with normal body mass index (BMI) randomly allocated to receive Baska mask (Group A -30) or I-gel (Group B-30) for airway management. Demographic data recorded. Various parameters measured were airway sealing pressure, insertion time, ease of insertion, number of insertion attempts, overall success rate and the incidence of airway trauma and complications were also recorded. Patient vitals including heart rate, systolic/diastolic blood pressures and peripheral capillary oxygen saturation were measured along with ventilatory parameters including inspiratory and expiratory tidal volume, end-tidal carbon dioxide, leak volume and airway pressures at various intervals. Paired and unpaired t-test were used to analyse numerical data and chi-square test for non-parametric data.
Results: Both groups were comparable in terms of demographic and clinical characteristics. Overall success rate was comparable in both groups. The insertion time was comparable for both groups (p value≥0.05). Oropharyngeal leak pressure was significantly higher for Baska mask (28.6±1.03 cm H₂O) than I-gel (25.1±1.34 cm H₂O; p value < 0.005). Ryle’s tube insertion was easy via I-gel than Baska mask. Hemodynamic parameters and post operative complications were comparable in both groups.
Conclusion: Both airways are suitable for elective surgeries under general anaesthesia. The sealing pressures of the Baska mask are superior to those of the I-gel and can serve as an exemplary, alternative airway device for the surgeries under controlled ventilation with minimum complications.

Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. India is the highest TB burden country in the world having an estimated incidence of 26.9 lakhs in 2019.
Patients with chronic kidney disease are more prone to develop active Tuberculosis owing to various factors. The predominant defect in such cases is immunodeficiency (1). Inflammation, oxidative stress, nutritional deficiencies including vitamin D deficiency play a role as well. To add to these immune cells like B cells, T cells, neutrophils, monocytes, and NK cells also have defective function thus resulting in inability to counter Myobacterium tuberculosis. Very often CKD patients also have coexistent conditions like Diabetes, HIV, renal transplant.  Profound immunodeficiency can start in stage 3 CKD thereby worsening further in later stages (2). Active TB may be acquired after new exposure or reactivation from previous exposure. Diagnosis of TB in CKD patients is not easy as disease presentation is quite different from non-CKD patients owing to immunodeficiency. The treatment is equally challenging due to drug interactions and deranged pharmacokinetics (3,4).

Medical education involves pre-clinical and clinical teaching to build a strong knowledge foundation and clinical experience for the medical students. COVID-19 pandemic has imposed challenges for medical education facilities, with the need to shift from tradition class room teaching to E-learning modality. This paradigm shift could generate changes in students’ perception of this way of teaching and their perception might be different from the one found in studies previous to the pandemic

Introduction- Performing laparoscopic cholecystectomy is not always an easy task. Surgeons do face difficulties while performing laparoscopic procedures.  To overcome the challenges faced by the surgeons and minimize the intraoperative and post-operative complications several technological innovations and advancements in the technique and procedure of laparoscopic cholecystectomy have taken place since its emergence.
Methodology- The present prospective observational study included 80 patients. As per SNOSE method, they were further divided into GROUP-I (n=40): Patients who underwent three-port laparoscopic cholecystectomy and GROUP-II (n=40): Patients who underwent four-port laparoscopic cholecystectomy. The intra and post-operative parameters were recorded and compared.
Results-  Amongst the total 80 patients, the mean age was 45.79±13.97 years. In both the groups, the majority of patients were female. Adhesions were the most common complication seen intraoperatively. Infection at the port site was seen in 2 (5%) of Group-I and 3 (7.5%) of Group-II patients. None of the patients had VAS score >5 after 24 hours in either of the two groups. These clinical findings were comparable in both groups and showed no significant differences.
Conclusion- Both three-port and four-port laparoscopic cholecystectomy were shown to be safe and technically adaptive, with few serious problems. The surgeon should make the decision to do a three-port or four-port procedure should make the decision to do a three-port or four-port procedure, as neither appears to impact the surgical course or outcome.

INTRODUCTION: Varicocele is defined as an abnormal dilatation and tortuous Pampiniform plexus of veins. Only mode of treatment is surgical correction. Surgical procedure can be performed by open scrotal approach, open inguinal approach microinguinal or subinguinal approach, laparoscopic ligation or embolization of testicular vein by intervention radiologist. Advantages of laparoscopic varicocelectomy includes, safe, increased magnification, facilitating more accurate identification of vessels, lymphatics and the internal spermatic artery. An additional incision can be avoided in bilateral cases. AIM OF THE STUDY: To Compare Laparoscopic Varicocelectomy Versus Open Varicocelectomy. METHODOLOGY: Single centre, prospective observational descriptive study, on 50 patients, in Government General Hospital, Kadapa from December 2019 to December 2021. RESULTLS & CONCLUSION: Varicocele was common in the 3rd and 4th decades and a significant cause of male infertility and common on left side. Laparascopic varicocelectomy is safe and effective procedure when compared to open varicocelectomy with significant reduction in operative time,
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minimal post operative complications and decreased hospital stay, increasing the patient satisfaction and comfort towards the procedure. There was no much significant in open and lap surgery over the pre operative and post operative semen parameters

Several acute scrotal conditions can present in similar way, testicular torsion is by far the most significant. Testicular torsion is a true surgical emergency because, the likelyhood of testicular salvage decreases, as the duration of torsion increases. Other conditions that presents in similar way to testicular torsion include, torsion of appendix testis, epididymo-orchitis, trauma to testis, haematocele, strangulated inguinal hernia, Henoch-Schonlein purpura etc. A variety of investigations have been described in the management of acute scrotal conditions. These include an array of tests from a simple urine examination to more sophisticated forms like ultrasonography, Doppler studies and radionucleotide scanning. In case of epididymo-orchitis conservative approach yields good results and prevents complications. But ultimately for acute scrotum scrotal exploration remains as gold standard approach. Aim: To study clinical presentation, differential diagnosis and management of acute scrotum. METHODOLOGY: Prospective study, in Department of general surgery, Government General Hospital, Kadapa from 22nd december 2018 to 21st december 2020 in 100 cases. RESULTS: In present study most common condition is epididymo-orchitis with 35 cases(35%) followed by fournier’s gangrene30(30%), Pyocele16(16%), haematoma 10(10%), torsion 8(8%) and scrotal wall abscess 1(1%). Symptom wise pain and swelling were the presenting complaints in all the patients involved in the study. CONCLUSION: Torsion is common in younger age group. Epididymo-orchitis is common in young and middle age groups where as fournier’s gangrene was common in elderly age groups. USG colour Doppler should be done in all cases except
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in clinically obvious cases of Fournier’s gangrene. Conservative management is the main stay of treatment in the case of epididymo-orchitis. Thorough debridement followed later by graft cover or secondary suturing is effective treatment in case of fournier’s gangrene.

Tuberculosis (TB), an infectious disease is a major public health challenge costing one human life every 20 seconds globally [1]. There is wide variation in the sensitivity of ZN smear microscopy, ranging from 20% to 80% across various studies [7,9], whereas, the new molecular based methods have shown promising sensitivity in TB detection. Keeping the above points in view, also no such study was done earlier from this region. The present study was undertaken to determine the accuracy of sputum ZN smear microscopy in diagnosing pulmonary tuberculosis as compared with the sputum GeneXpert MTB/RIF assay as the reference test at our set up. In the present study, a total of 70 patients were included, in which 60(86%) were male and 10(14%) were female. A total of 65(92.9%) patients sputum samples detected MTB DNA by GeneXpert MTB/RIF and 5(7.1%) samples were negative. In these 65 positive patients, 55(85%) were male and 10(15%) were female. Older age group was most affected 24(37%) and children and young adults were least affected as only 6(9%) patients in each age group. Sputum ZN smear microscopy is a highly specific but moderately sensitive test for the diagnosis of pulmonary tuberculosis. This study recommends the sputum GeneXpert MTB/RIF test in preference to sputum ZN smear microscopy for the diagnosis of pulmonary tuberculosis.

Background: Hypothyroidism is a condition caused due to decreased synthesis, metabolism or
decreased action of thyroid hormone which can be due to various causes. Primary
hypothyroidism is due to conditions affecting the thyroid gland itself. It accounts for
approximately 99% of cases, with < 1% being due to TSH deficiency known as central or
secondary hypothyroidism Objectives: To clinically suspect and diagnose cases of
hypothyroidism.To measure serum ferritin levels in newly diagnosed hypothyroid patients.To
look for a correlation between serum ferritin level and T3, T4 and TSH levels.Methodology:
30 patients with clinically suspected hypothyroidism were confirmed by measuring fasting
serum T3, T4 and TSH levels.Complete Blood Picture, Liver Function Tests, Renal Function
Tests and Urine Pregnancy Test done to rule out other causes that could alter thyroid function
test.After an overnight fasting of 8 hours, 2ml of venous sample was collected in a red cap
vacutainer under aseptic conditions and serum T3, T4 and TSH levels were measured using
chemiluminescence immunoassay (CLIA) .In patients with confirmed hypothyroidism, serum
ferritin levels were estimated.For this, 2ml of venous blood sample was collected in a red cap
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vacutainer under aseptic conditions and serum ferritin levels was measured using CLIA
Results:The mean serum T3,T4 and TSH levels were 0.5203 ng/ml,3.50 ug/dl,40.02 uIU/ml
respectively.The overall mean serum ferritin was 34.24 ng/ml.The mean serum ferritin among
patients in whom correlation was seen was 8.2 ng/ml.The mean serum ferritin among patients
in whom correlation was not seen was 45 ng/ml.A significant negative correlation of 0.01 was
found between serum ferritin and TSH levels indicating that patients with lower serum ferritin
had higher serum TSH levels.Conclusion :Patients presented with weight gain and fatigue,
serum ferritin had a significant negative correlation with TSH indicating that lower ferritin
levels were associated with higher TSH levels.

In India prevalence of thalassemia ranges between 3-18%, particularly in certain communities like sindhi, Lohanas, gouda, etc. Regular blood transfusion with chelation is the main treatment since most patients cannot afford bone marrow transplants. Growth failure is the major complication in children with transfusion-dependent thalassemia major (TM) children even after giving chelation.
Aim & objectives: To study anthropometric measurements in TM children.
To study the correlation of growth failure with pretransfusion hemoglobin (PTHB) and serum ferritin levels.
Material and methods: TM children on deferasirox for at least five years were included in the study. weight, height, and BMI were measured and z scores of less than 2 were taken as underweight, stunted, and thin respectively. Z- scores were correlated with pretransfusion hemoglobin and serum ferritin. children having pretransfusion hemoglobin between 9-10.5 gm/dl was taken as adequately transfused. Growth parameters were also compared between adequately and inadequately transfused children.
Results: 36(56%) were Underweight (weight z score below 2),28(43%) children had stunting (Height z score below 2) and according to BMI 24(36%) (BMI z score below 2) children were classified as thin. All the stunted children were in the 6-8 age group. correlation for PTHB with height for age z-score was positive and significant (spearman’s r=0.345, p=0.005), with weight for age z score was positive but insignificant and with BMI was negative and insignificant. Corelation of serum ferritin with height for age z score and weight for age z score was positive but insignificant and with BMI was negative and insignificant.
Conclusion: Growth failure in children with thalassemia major requiring regular blood transfusions, in first decade is possibly due to inadequate transfusion rather than inadequate chelation. It is recommended to maintain pretransfusion haemoglobin in range of 9-10.5gm/dl to reduce the severity of growth failure.

In anaesthesia, circulatory stimulation during tracheal intubation are caused by the stimulation of laryngeal and tracheal tissues from both direct laryngoscopy and placement of the ET tube in the trachea. These stimuli often evoke sympathoadrenal responses characterized by changes in Blood pressure, Heart rate, Cardiac rhythm, ST segment changes, and may lead to pulmonary oedema and rupture of cerebral aneurysm. In the present study that was carried out in the Institute, we compared the efficacy of Oral Clonidine versus Intravenous Fentanylin attenuating the cardiovascular stress response to laryngoscopy and tracheal intubation.
Material and Methods: The present Prospective and Comparative study was carried out at a Tertiary Care Hospital amongst 100 patients those who were randomly allocated to two groups, Group C: Patients in this group received- 5 microgram/kg of Oral Clonidine with 2 sips of water 90 minutes prior to surgery. Group F: Patients in this group received 100ml of normal saline over 10 minutes and 2 microgram /kg of fentanyl in 5ml of normal saline, 5 minutes prior to laryngoscopy and intubation.
Results: Out of 100 subjects, 32% subjects were in the age group 21 to 30 years and 22% in 41 to 50 years. The mean heart rate during Laryngoscopy in the groups Fentanyl and Clonidine were 108.58 and 91.56 respectively. The mean SBP during Laryngoscopy in the groups Fentanyl and Clonidine was 139.84 and 124.78 respectively and the mean SBP at 1 minute after intubation was 137.14 and 121.94 respectively. The mean DBP during laryngoscopy in the groups Fentanyl and Clonidine were 91.18 and 82.68. and at 1 minute after intubation, it was 88.36 and 78.52 respectively. The mean MAP at 1 minute after intubation in the groups Fentanyl and Clonidine were 101.54 and 92.98 respectively
Conclusion: Oral Clonidine 5 μg/kg proved to keep the hemodynamics in stable manner during laryngoscopy and endotracheal intubation and up to 30 mins post-intubation. Fentanyl in the dosage of 2 μg /kg given 5 minutes before laryngoscopy and intubation attenuated the hemodynamic changes, but was not equally effective in reducing the increase in heart rate and blood pressure.  

Accurate open reduction and internal fixation of metacarpal fractures are required in unstable fractures where closed treatment technique yield poor functional outcome which usually is less than 5% of hand fractures.
Mini plates and screws when used in properly selected cases provide rigid fixation allowing early mobilization of joints and hence good functional outcome.
Patients and methods: In 25 patients with closed metacarpal shaft fractures treated with mini plates and screws between December 2017 to December 2019 at Vijayanagara institute of medical sciences Ballari. The functional outcome was assessed using Disability of Arm, Shoulder and Hand (DASH) score and Visual Analog Score (VAS) over a period of two years in prospective manner.
Results: In our study of metacarpal shaft fractures treated with plate osteosynthesis all the cases showed bone union (100%). The functional result is Excellent in 84% of the patients (21 of 25 cases), good in 12% of cases (3of 25 Cases), poor in 4% of cases (1 of 25 cases). 2 patients developed superficial wound infection which settled with daily dressing and antibiotics and this does not affect the final outcome.
Conclusions: Plate and screw fixation is a good option for treating closed metacarpal shaft fractures, where other modalities of fixation are less effective, the rigid stable fixation provided by plating withstands load without failure allowed early mobilization and achieved good functional results.

The onset of action of bupivacaine is between 4 and 6 minutes, and maximum anaesthesia is obtained between 15 to 20 minutes. The duration of anaesthesia varies according to the block; the average duration of peridural block is about 3.5 to 5 hours and for nerve blocks, it is about 5 to 6 hours. The short duration of action of fentanyl is associated with decrease in the concentration of the drug due to its rapid redistribution to inactive sites such as fat and skeletal muscles.86% is protein bound. High volume of distribution of 3 to 6 L/Kg. Context sensitivity half time is 260 minutes after a 4 hour infusion. Patients were prospectively randomized in to two groups with 30 patients in each group. All Patients were kept nil by mouth for overnight before surgery. To ensure that all the patients received the same medications before and during the surgery, a standardized anesthetic protocol and technique were used. In the operating room standard anesthesia monitors were attached to the patient to monitor: Heart rate, ECG, peripheral oxygen saturation, blood pressure. Intravenous access was obtained using a 20G/18G IV cannula. The minute to minute variation of averages of SBP was more pronounced in Group A, whereas the average SBP was more consistent in Group B. The minute to minute variation of averages of HR was very much higher in Group A, than in Group B.
Conventional dose of bupivacaine, low dose bupivacaine along with fentanyl, hemodynamic changes
 

Sub arachnoid blockade is the common form of centrineuraxial blockade performed for lower limb orthopaedic surgeries. The resulting nerve block using a local anesthetic agent ensures the patient well-being, while motor block facilitates the surgeon’s work. 0.5% hyperbaric bupivacaine is the most frequently used drug for SAB. After randomization patients were split into groups of 30 each by computer-generated random numbers, sealed in an envelop as slips folded in the OT complex. An independent observer picked up these slips and performed spinal or epidural anesthesia. Electrocardiogram (ECG), and a baseline reading of SpO2, heart rate (HR) and blood pressures, systolic (SBP) and diastolic (DBP) were recorded. This was an investigator and participant blinded study. The drugs that was given to the two different groups are as follows.
Group A: Patients were administered with 15 mg bupivacaine 0.5% (H).
Group B: Patients were administered with 7.5 mg bupivacaine 0.5% (H) + 25mcg fentanyl.
Mean of Time for Sensory Regression to S1 is lesser in group B patients as compared to Group A and is statistically significant with p value of 0.0002. Mean of Time for Motor regression to Bromage 0 is lesser in group B patients as compared to Group A and is statistically significant with p value of < 0.001.

Penile cancer is an uncommon illness in Western nations, but it accounts for around 42% of all urogenital malignancies in India. It has been connected with many variables including old age, improper hygiene, smoking, and absence of circumcision. This research aimed to examine the socio-demographic and clinical features of penile cancer patients who visited a tertiary referral hospital.
Methods: The records of all patients suffering from penile cancer who visited a tertiary cancer institution between the years 2009 and 2015 have been compiled into a database. In addition to describing the patients' socioeconomic, demographic, and clinical characteristics, bivariate analyses were carried out.
 Results: 121 incidences of penile cancer were reported throughout this time. The median age was 55 years on average. A penile ulcer (78.0%) with an exophytic mass (47.1%) and bleeding was the predominant factor in consultations. The glans was the most typical position (50.4%). In our analysis, 26.4% of patients received radical amputation; of which, 54.6% underwent lymph node dissection and had lymph node metastases.
Conclusion: Most of the individuals with penile cancer observed in this research had elderly age and had an absence of circumcision. Patients with lymph node metastases required more aggressive surgeries and had a higher incidence of recurrence than those without lymph node involvement. Robust studies are needed to identify risk variables in low-income communities.

To assess the accuracy of ultrasound in diagnosis of congenital uterine anomalies.
Material & Methods: This study of uterine morphology is being done on 30 females to assess the congenital anomalies of uterus. The records have been taken from the Radiology department, Al Falah Hospital, Faridabad,Haryana.
Results: Appearance of the uterus by the Two Dimensional Ultrasound was normal in 16 patients, subseptate in 3 pateints, Unicornuate in 0, bicornuate in 6, small uterus in 1, agenesis in 2 and arcuate in 2 patients.
Conclusion : A significant proportion of congenital anomalies of uterus are diagnosed during investigations for infertility. Accurate diagnosis helps in the appropriate counselling of women about their potential reproductive prognosis for planning any intervention with a view to improve the reproductive outcome.

Asthma, one of the most common chronic diseases, is characterised by symptoms of random airway blockage and has a range of overlapping phenotypes1. A crucial part of both health and sickness is played by ADAM33, a disintegrin and metalloproteinase glycoprotein engaged in intercellular and cell-matrix interactions.These proteins play a role in myogenesis, neurogenesis, the inflammatory response, and apoptosis in healthy individuals. They do this via altering cell adhesion and cell signalling or through proteolysis. It's significant that the airway epithelium also contains the ADAM33 protein, in addition to the smooth muscle and mesenchymal cells. Oxidative stress may have a role in the aetiology of asthma, a condition that affects the airways and is chronically inflammatory. Acute and chronic inflammation-related features of the airways in asthma include thickening of the airway wall, subepithelial fibrosis, and increased smooth muscle mass. These changes are linked to airway remodelling and may contribute to the development of airflow limitation by increasing airway resistance.

Novel Corona Virus disease, or popularly known as COVID-2019, is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). HRCT plays a crucial role in the diagnosis and follow-up of patients with COVID-19 pneumonia.
Aims- The main objective of this study was to determine the computed tomography findings in the covid survivors at 6 months after being discharged and to study the potential acute and chronic post Covid chest complications like lung fibrosis
Material and Methods- 100 Cases who were referred for follow up of CT scan after COVID -2019 positive report on RT-PCR test 6 months back in a tertiary care centre were included in this study.
Results- Patients older than 50 years, who were hospitalized, patients with acute respiratory distress syndrome and other co- morbidities, who were on mechanical ventilation, and a total chest CT score of 18 or greater on initial CT scans were more prone to fibrotic-like changes in the lung after 6-month follow-up.
Conclusion- Follow-up CT scans obtained within 6 months of disease onset showed fibrotic-like changes in the lung in one-third of patients who survived severe coronavirus disease 2019 pneumonia. These patients were older and had more severe disease during the acute phase. The younger patients showed normal follow up scans or only ground glass opacities

Abruptio placenta is the complete or partial separation of the normally implanted placenta before delivery of the fetus. It is one of the commonest causes of antepartum hemorrhage affecting maternal and fetal outcomes. Early detection and timely intervention of abruptio placenta in daily clinical practice are important to improve maternal and perinatal outcomes. The objective of the study was to find out the prevalence of abruptio placenta among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre.
Methods: A cross-sectional study was done among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre where data from medical records was taken after taking ethical approval from the Institutional Review Committee. Demographic details of the patients including age and parity were recorded. Convenience sampling was done.
Results: The results of my studies are summarized as follows:Overall incidence of Antepartum hemorrhage is 3.6% with abruptio placenta about 1.2. Hypertension is the most common etiology recognized in all studies.The incidence in our study is 54.8%.
Conclusions: The prevalence of abruptio placenta among pregnancies was similar to the studies done in similar settings

Scorpion sting envenomation is a medical emergency and can pose a life-threatening event in many tropical and subtropical countries all around the world especially in North Africa, the Middle East, Latin America and India, mainly in the rural areas. Scorpions are eight legged Arthropods, crab like arachnids,and are the most important venomous creatures after snakes belonging to order scorpionida and class Arachnida. Globally 1500 scorpion species belonging to 18 families have been described. Only 30 are considered dangerous to man, with 29 of them belonging to the family Buthidae.
Aims and Objectives: To evaluate the clinical, biochemical, and echocardiography profile of children less than 12 years with scorpion envenomation.
To determine the severity of envenomation by comparing clinical, biochemical and echo cardiography profile with treatment of scorpion envenomation in children less than 12 years.To evaluate the role of cardiac biomarkers and echocardiography in detecting myocarditis at the earliest.
Materials and Methods: This study was conducted in Pediatric Intensive care unit, Villupuram Medical College (GVMCH). It is a collaborative effort of Department of Pediatrics and Department of Cardiology at GVMCH. Institute ethical committee (IEC) permission was obtained.
Conclusion: Scorpion envenomation is one of the important casualty in ER in any tertiary care centre. Myocardial involvement and its consequence are the important cause of mortality and morbidity.
Our study clearly highlights the burden of disease in the community and further we recommend Government agencies to create awareness among public about Myocardial dysfunction association following scorpion sting envenomation through their strong public Health network. This will sensitize public to immediately rush to hospitals without taking any traditional medicinal approach after scorpion bite.

To examine whether or not preoperative ultrasonography results were related to surgical outcome in laparoscopic cholecystectomy.
Methods: After clearance from institutional ethical committee, 50 patients with diagnosed Cholelithiasis, who underwent laparoscopic cholecystectomy in department of General surgery HIMS, Sitapur from Janurary2021 to October 2022, were selected after meeting inclusion and exclusion criteria. Patients with Acute Cholecystitis, presenting within 72 hours of onset of pain and all patients, of any age group & sex after six week of acute phase of Cholecystitis with Cholelithiasis on USG were included in the study. A total of 50 patients were included in the study.
Results: More than one third of patients were 30-40 &>40 years of age (40%) followed by <30 (20%) years. Distended GB was the most common on pre-operative USG abdomen-Gall bladder(92%) and Multiple stone was the second most common on pre-operative USG abdomen-Gall bladder (72%). Easy operative status was among majority of patients (84%) and difficult was in 16% patients. Gall bladder with Operative status. Wall thickness>3 mm (p=0.009), Mucocele (p=0.02) and Chronic cholecystitis (p=0.001) were significantly associated Pre-operative USG abdomen: Gall bladder with Operative status. The mean hospital stay was 12.82±7.14 days.
Conclusion: GB Wall thickness>3 mm, Mucocele and Chronic cholecystitis  were significantly associated Pre-operative USG abdomen: Gall bladder with Operative status. Pre-operative USG abdomen: Calot’s with Operative status was significantly associated Pre-operative USG abdomen: Calot’s with Operative status. Intra-operative score was significantly higher among patients of Difficult than easy.

We determine if histopathological factors of the primary penile tumor can stratify the risk of the development of inguinal lymph node metastases.
Materials and Methods: Clinical records of 61 consecutive patients with squamous cell carcinoma of the penis who underwent resection of the primary lesion and either inguinal lymph node dissection or were observed for signs of recurrence (median follow-up 36 months) were reviewed.
Parameters examined included pathological tumor stage, quantified depth of invasion and, histological grade, in the primary tumor, and presence or absence of vascular invasion. Variables were compared in 19 lymph node positive and 42 lymph node negative cases.
Results: Pathological tumor stage, vascular invasion and histological grade were the strongest predictors of nodal metastasis on Univariate and multivariate regression analyses. 13 pT1 tumors none of them exhibited vascular invasion and 3 (23%) with lymph node metastases. Of 48 patients with pT2 or greater tumors 12 (25%) had vascular invasion and 16 (33%) had lymph node metastases. No other variables tested were significantly different among the patient cohorts.
Conclusions: Pathological stage of the penile tumor, vascular invasion and histological grade were independent prognostic factors for inguinal lymph node metastasis.
Prophylactic lymphadenectomy in compliant patients with pT1 lesions without vascular invasion and histological grade does not appear warranted.

A p16 protein is known to be overexpressed in human papillomavirus-positive head and neck squamous cell carcinoma specimens. p53 is a tumor suppressor protein detectable by immunohistochemistry in carcinogen-associated head and neck squamous cell carcinoma as a result of gene mutations. Epidermal growth factor receptor (EGFR) is a transmembrane tyrosine kinase receptor of the Erb-B family. The purpose of this study is to investigate the prognostic impact of p16 and p53 and EGFR expression in oropharyngeal squamous cell carcinomas.
Methods: This was an observational and cross sectional study. We retrospectively examined the relationship between prognosis, and p16 and p53 and EGFR expression levels of oropharyngeal squamous cell carcinoma specimens in 100 patients using immunohistochemistry.
Results: An increase in the TNM stage and pathological tumor size status correlated with an increase in EGFR expression. In the cases with lymphovascular invasion, the expression was detected at a higher ratio. Cases in which high levels of pl6 and p53 expression were observed did not show any lymphovascular invasions.
Conclusion: Expressions of p16, p53 and EGFR were considered to be most effective in early carcinogenesis stages of oropharyngeal SCC. In comparison with p16, p53 and EGFR expression levels were observed to be associated with poor prognostic parameters and were higher at later stages of oropharyngeal SCC carcinogenesis development

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. In patients with Type 2 diabetes, low grade inflammation is reflected by increased plasma levels of several biomarkers  such as C-reactive protein (CRP).Alkaline phosphatase (ALP) is a generally accepted clinical marker of hepatic or bone disease.It had been showed that elevated ALP acted as a prognostic indicator of decreased survival in diabetic patients with acute myocardial infarction (MI), possibly in association with decreased renal function in these patients

This study was undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS.
Methods: The present study was conducted in the department of skin. Sample size of 100 cases was included in the study. Patients (18 years or above) with clinical symptoms and signs suggestive of TSDF (redness, itching, acne, burning, swelling, photosensitivity, pigmentation and atrophy) and with history of application of TCS on the face for a period of more than one month were included in the study after obtaining written informed consent.
Results: In the present study, Females (80, 80%) constituted the majority as compared to males. Most of the patients belonged to the age group of 18–30 years (50, 50%) with a mean age of 32.8 ± 8.2 years. Seventy Five (75%) patients had received some form of formal education, while 25 (25%) patients were illiterate. Presenting complaints of the patients were redness in 80 (80%), itching in 70 (70%), pigmentation in 60 (60%), burning in 64 (64%) and acne in 35 (35%) patients. Duration of TCS application ranged from one month to 25 years with 50 (50%) patients having applied TCS for over one year.
Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse

Intubation and maintenance of the patient’s airway is one of the most important steps in anaesthesia practice and a fundamental responsibility of the anaesthesiologist. Difficult intubation has been associated with serious complications particularly when failed intubation results.
Materials and Methods: This study will be conducted in Department of Anaesthesiology at Tertiary Hospital, Bangalore. It is multispecialty hospital having all specialties with very good number of case load. Hospital have highly equipped Anaesthesiology department. The study will include 300 Adult patients posted for elective surgical procedures under General Anaesthesia.
Results: Three hundred apparently normal ASA grade 1&2 adult patients in the age group 18 - 60yrs of either sex posted for elective surgical procedures were prospectively studied.
DISCUSSION: In earlier days anaesthesia was induced by anaesthestic vapours given
through face mask. Due to inability to maintain a patent airway, adequate depth of anaesthesia for surgical procedures and its complication leading to morbidity and mortality led to development of safer anaesthetic practice by maintaining anaesthesia through endotracheal insufflation.
Conclusion: The present study has shown that the combination of modified Mallampatti test and thyromental distance is better than when used alone in predicting difficult intubation

As stated by Hippocrates - “Divine is the task to relieve pain”
Relief of pain during surgery is one of the components of balanced anaesthesia but this pain relief should be extended to the postoperative period also. According to Perkins and co-workers poorly managed acute pain like postoperative pain can lead to the occurrence of chronic pain.
Materials and Method: This clinical study was conducted on 156 adult patients of ASA physical status I to III in the age group of 18-60 years of either sex posted for elective lower abdominal or lower limb surgeries under spinal anaesthesia after taking informed consent at a tertiary hospital Vijayapur.
Results: Statistical tests used: anova, chi square test and tukey test.
Discussion: Spinal anaesthesia is currently wide spread popular anaesthetic technique available today. It has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anaesthetic.
Conclusion: Acute pain following surgical procedures is unique to the clinical practice of pain medicine. It is one of the few opportunities in which the cause of pain is known before its occurrence, the pain is reliably expected to occur and can be annulled effectively

Inguinal hernia repair is one of the more common types of surgeries performed. With appropriate techniques, the block provides excellent intraoperative anaesthesia and postoperative analgesia for hernia repair, thereby simplifying anaesthetic surveillance and postoperative care.
Aim and Objectives: To study the effectiveness of field block anaesthesia for inguinal hernia repair in our tertiary care settings.
Material and Method: A clinical study was undertaken for anaesthetising 50 patients aged between 18-60 years of age posted for elective inguinal hernia repair, consenting and co-operative for inguinal field block. Study was conducted at our institute for the period of one year, after getting consent from patients, approved by institutional ethical committee and followed inclusion and exclusion criteria
Results : Study included 50 patients, with mean of age was 39.36 years with SD of 12.68. All patients were hemodynamically stable throughout procedure and surgery. 36 patients had a excellent type of analgesia and relaxation. 8 patients complained of discomfort during surgical handling of the hernial sac or hernia repair. 4 patients were not comfortable with the above measures and needed fentanyl depending upon their body weight. 2 patients had no analgesia Conclusion:  Field block is effective technique of anaesthesia for inguinal hernia repair and it provides good quality of analgesia and relaxation intraoperatively.

The concept of providing relief from pain has been tardy in acceptance, however experience has shown that providing pain relief during labour reduces maternal stress and results in shorter labours and improved maternal outcome.
Aim and Objectives : To compare the maternal and neonatal outcome of programmed labour protocol with the conventional labour.
Materials and Method : This was a prospective study done in the department of obstetrics and genecology of our tertiary care centre for period of one year,  50 uncomplicated primigravida at term (between 37-42 weeks) were included in the study and compared with 50 uncomplicated control group. The cases were selected at random from the women admitted in labour rooms for delivery. Cases were selected after following exclusion and inclusion criteria and approved by institutional ethical committee.
Results: The mean duration of active phase of I stage of labour in the study and the control group were 134.23 min (38.76hr) and 219.46 min (54.69 hr) respectively. Mean blood loss in the study group is 101.42ml, while in the control group it was 152.36ml and these variable were statistically significant. there was significant difference observed, in relief score between cases and controls. But we didn’t find any significant difference in the birth weight between the groups.
Conclusion : Programmed labour can be used as a safe and effective method of labour analgesia where there reduction in duration of labour and gives more relief to mother from pain.

The lifetime prevalence of mechanical neck pain in the general population is estimated to be 45–54 percent, (Aker et al., 1996), with up to 30 percent of males and 50 percent of women reporting lifelong neck discomfort. (Saturno et al., 2003) In 2005, Saringovallis and Hollins calculated that between 13.4 percent and 22.2 percent of people experience neck pain at any given moment. Furthermore, according to reports, 14% of people with neck discomfort run the risk of developing chronic pain, which makes the condition very expensive in terms of lost productivity at work and medical expenses

It can be a difficult task to provide care to the patients living with mental health issues, especially with chronic diseases such as schizophrenia where the patient loses touch with reality.
Aim:
The aim of the research was to assess the level of perceived family burden, among the primary caregivers of chronic schizophrenia patients and socio-demographic correlates of caregiver's burden in schizophrenia. The study also evaluated the factors affecting the caregiver's burden.
Materials and Methods:
A descriptive research design was used for the study. The study population consisted of 100 primary caregivers of chronic schizophrenia patients who were attending the outpatient department of Government Erode Medical College Perundurai, Erode. A purposive sampling technique was used to select the samples. In order to collect the data, the tool comprised of socio-demographic variables, Burden Assessment Schedule of SCARF (BASS,1995) to assess the level of perceived family burden.
Results:
Mean age of patients was 29.7 SD (8.6) years. Of the 368 caregivers, 81.5% were parents, mean age was 58.1 years (SD 19.6). The result revealed that among the primary caregivers 48% are having mild burden, 36% of them are having moderate burden and 16% of them having severe burden. The association between the level of perceived family burden and demographic variables shows that age (c2=8.97), duration of illness (c2=7.69), and relationship with the patients (c2=7.44) are significantly associated with their level of burden. More aged, less income, duration of illness and wife group are having more burden than others.
Conclusion:
Caregivers of schizophrenia patients experience enormous burden and are potential “high risk group” for mental disorders. The caregivers should receive an adequate support for maintaining their own mental health. they should be provided support for maintaining their mental health. Particularly, vulnerable are females, elderly, low-income groups, and longer duration of care. They should be provided with adequate support.

PPROM is defined as preterm prelabor rupture of membranes which complicates the pregnancy and is associated with around 40% of all preterm births. It is associated with other maternal and neonatal complications like ascending infections leading to chorioamnionitis and other complications. Principal of management of a case of PPROM is still not clear that weather an active intervention should be done or it should be managed conservatively.
Materials and Methods: This retrospective study was done in Obstetrics and Gynecology department at TMMC and RC, Moradabad. Data of last five years, from (2018-2022) was collected and analysed.
Results: A total of 647 patients were admitted in last 5 years with PPROM out of which 375 patients were excluded as per our exclusion criteria, from remaining 272 patients 143 were managed conservatively and 129 were in active management group. There were more cases of clinical chorioamnionitis and neonatal infection in expectant group while the cases of respiratory distress syndrome and oxygen requirement at 24 hours were more in active management group. There were statistically significant difference in the duration of admission to delivery interval and need for neonatal antibiotic treatment in both groups and was more in expectant management group.

Conclusion: Active management of PPROM at 34 weeks had higher cases of neonatal morbidity while expectant management group had higher rate of chorioamnionitis, so in our opinion the active management should be delayed till 35 weeks of gestation

This study was performed to assess the prevalence of dry eye syndrome and diabetic retinopathy (DR) in type 2 diabetic patients and their contributing factors.
Materials and Methods: 90 type 2 diabetic patients referred to the Department of Ophthalmology Veer Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Pauri Garhwal, Uttarakhand, between December 2022 and February 2023 were consecutively selected. All patients were asked about other diseases and drugs. Dry eye syndrome was assessed with TBUT tests and Schirmer. Indirect and direct ophthalmoscopy were done for all the cases. Diabetic Retinopathy was graded according to early Treatment Diabetic Retinopathy (ETDRS) criteria.
Results: Of 90 subjects, 48 patients (54.88%) suffer from dry eye syndrome. Although dry eye syndrome was more common in older and female patients, this association was not significant. But there was significantly association between dry eye syndrome and duration of diabetes. Diabetic Retinopathy was found in 64 patients (71.11%) of which 15 (16.67%) patients had mild NPDR, 13 (14.44%) had moderate & 7(7.88%) had severe NPDR. PDR was seen in 29(32.22%) patients.
Conclusions: In this study the prevalence of dry eye syndrome was 54.88%. Diabetes and dry eyes appear to have a common association. Further studies need to be undertaken to establish an etiologic relationship. However, examination for dry eye should be an integral part of the assessment of diabetic eye disease.

Epidural analgesia is the most commonly used technique for inducing postoperative analgesia in lower limb surgeries. Higher concentrations of bupivacaine have been found to be greater motor blockade and it can be minimized by using lower concentrations of bupivacaine (0.1% -0.125%).
Aim: To evaluate the block characteristics, hemodynamic response, and post-operative epidural analgesia between 0.125% Bupivacaine versus 0.1% Bupivacaine in patients scheduled for lower limb surgeries.
Material and Method: This observational study included 60 ASA grade 1 and 2 patients posted for lower limb surgeries. In the study, Group 1 received 0.125% bupivacaine + 2 μg/ml fentanyl, and  Group 2 received 0.1% bupivacaine + 2 μg/ml fentanyl.
Result: The onset of sensory blockade was significantly earlier in patients of Group 1 (15.17 ± 1.46 min vs 19.07 ± 1.85min), and the onset of motor blockade was significantly earlier in patients of Group 1 (28.57 ± 1.71 vs 34.5 ±1.73). Duration of analgesia was longer in group 1 when compared to group 2.  
Conclusion:  0.125% bupivacaine with 2 μg/ml was more effective and provided a longer duration of analgesia as compared to 0.1% bupivacaine with 2 μg/ml for lower limb surgeries. 

India is emerging as diabetic capital of world as 2nd most affected country in the world. Common microvascular complications are neuropathy, nephropathy and retinopathy. It is most common cause of preventable blindness all over the world. Hence has been included in VISION 2020. Global prevalence of DR was found to be 22.27%. In India the incidence and prevalence of diabetes and thereby DR is increasing exponentially in urban as well as rural population and involves population from all socioeconomic strata. The present study was undertaken to study the clinical profile of DR in known diabetics. It aimed to know the various factors affecting progression and pathogenesis of DR, to grade the DR, to know the complications and visual morbidity due to DR in our institution

Knowledge of the normal anatomical measurements and variations of the spinal cord are essential in understanding the occurrence of various spinal disorders1. Studies documenting the normal morphometric data of spinal cord on Indian population are very scarce.
MATERIALS AND METHODS
The current study was a cross sectional observational study. Study subjects included were patients undergoing MRI conditions other than spinal cord pathology and healthy volunteers in the study setting. Sample size calculated was 60. All the eligible subjects were recruited into the study consecutively till the sample size was reached. Individuals of age group between 20 to 40 years undergoing MRI for conditions other than spinal pathology.
        
RESULTS
A total 60 people were included in the final analysis. The mean of age was 28.03 ± 5.75. Minimum age was 20 years and maximum was 40 years in the study population. Among the study population 41(68.33%) people were aged up to 30 years and 19(31.67%) were aged between 31 to 40years. Among the study population 30(50%) were males and remaining 30(50%) were females.
CONCLUSION
A single number cannot be used as the basis for evaluating spinal cord size. Each level should be compared with the normal range specific for that level. The large variation in cord size should be taken under consideration in morphometric analyses of the spinal cord.

Liposarcoma are malignant tumour of fatty tissue and are the malignant counterpart to benign lipoma. They are the second most common type of soft tissue sarcoma. There are 3 groups of liposarcoma well-differentiated (WDL) and dedifferentiated liposarcoma (DDL), myxoid/round cell liposarcoma, and pleomorphic liposarcoma. In all 3 groups, complete surgical resection is central in treatment aimed at cure and is based on grade. Radiation can reduce risk of local recurrence in high-grade lesions like dedifferentiated liposarcoma or minimize surgical morbidity in the myxoid/round cell liposarcoma group. Classification based on histological appearance is not always precise, especially because of the partial overlap of histological features of well-differentiated liposarcoma and Pleomorphic liposarcoma that may be better differentiated based on MDM2 expression on Immunohistochemistry. Detection of MDM2 and CDK4 amplification serves to determine the treatment modality. The differential diagnosis between well-differentiated liposarcoma and dedifferentiated liposarcoma from their morphologic counterparts is challenging

The advancement of modern Neonatology has led to more and more survival of babies at lower gestation age. Late preterm babies (born between 33 completed weeks of gestation and before beginning of 38 week of gestation) are the largest growing set of babies among premature babies. They look developmentally and physically more mature and hence often overlooked. They constitute one of the largest subsets of babies requiring hospitalization. This study was conducted to look at the readmission rates of late and early preterm babies in the first month of life with aim to look at various determinants of readmissions.
Aim: A study on readmission of late-preterm and early-term neonates in the first month of life following normal hospital discharge
Materials: Hospital based prospective observational study from Apr 2016 to Oct 2017 in a tertiary care hospital in western India to study the readmission rate of late-preterm and early-term neonates in the first month of life following normal hospital discharge.
Result: There were total 22 (7.1%) admissions among the study population, of which 13 (9.3%) were late preterm neonates and 9 (5.3%) early term neonates. Common causes of readmission were Neonatal hyperbilirubinemia in 12(55%) followed by feeding issues in 8 (36%), hypernatremic dehydration in 5 (23%) and late onset sepsis in 2 (9%) neonates.
Conclusion: Late preterm babies are vulnerable group of population as highlighted by their high rates of readmission. Jaundice and feeding problems were the most common diagnoses associated with readmission.

Vesicles and bullae are associated with various conditions in paediatric practice. These conditions may be Inherited, Drug Related, Infectious, Autoimmune and Miscellaneous. While Epidermolysis Bullosa (EB) is a type of Inherited Bullous disorder, Steven Johnson’s Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are drug reactions characterized by epidermal detachment and necrolysis presenting with macules, papules, plaques and flaccid bullae. Being rare in paediatric practice and of acute onset, they pose both diagnostic and management challenges. Our three patients had an Acute presentation with Blistering skin lesions at the onset.

Chronic orthopaedic infections are brought on by bacterial biofilms. Without adjuvant local antimicrobials, surgical debridement to remove biofilm may be inefficient because undiscovered biofilm pieces may stay in the site and reactivate the infection if left untreated. The levels and length of antibiotic exposure required to remove bacteria from clinical biofilms are still mostly unknown. For bacterial biofilms formed on bone and muscle in vitro, we calculated the minimal biofilm eradication concentration (MBEC) of tobramycin and vancomycin.
Method: CFU counts were used to characterizing the pathogen biofilms of S. aureus, S. epidermidis, E. faecalis, P. aeruginosa, and E. coli, which are commonly encountered in musculoskeletal illnesses. Serial log₂ dilutions (4000-31.25 µg/mL) of tobramycin, vancomycin or a 1:1 mixture of both medicines were applied to tissue specimens covered in biofilm for 5, 25, or 70 hours. To test bacterial survival after antibiotic exposure, tissues were subcultured. For each pathogen-antimicrobial-exposure-time combination, the MBEC was determined as the concentration at which there were no surviving bacteria.
Results: On tissue, all infections that were tested developed biofilm. Using MBEC on muscle or bone, tobramycin/vancomycin (1:1) was the most effective antibacterial treatment, often in the range of 200-750 µg/mL with 25 or 70hr exposure. For 53.2% of biofilms between 5 and 25 hours, 53.2% of biofilms between 25 and 70 hours, and for 76.6% of biofilms between 5 and 70 hours, MBEC decreased with exposure duration. In comparison to equivalent MBECs in muscle tissue, MBECs on bone were substantially greater (p <0.04). The majority of the time, tissue MBECs were lower than MBECs for the same pathogens on polystyrene tissue-culture plates that had previously been published.

One of the main problems in bone and joint surgery is still infection related to bone implants. In both the treatment and prevention of these infections, antibiotic-impregnated bone transplants appear to hold promise. Nonetheless, this field of research is characterized by a wide range of methodologies. An overview of the published literature is provided in this essay.
Method: The Medline database was searched, and articles were chosen based on pre-established exclusion criteria.
Results: The synthesis contained 45 papers. Studies were conducted on issues such as the type of bone graft, graft operations, elution profile, bacterial inhibition, oestotoxicity, incorporation, unique impregnation techniques, clinical use, and storage. From a therapeutic standpoint, large initial concentrations seem suitable for eliminating biofilm. It appears possible to treat an infection caused by a bone implant in a single step. When employing antibiotic-impregnated bone grafts, the literature suggests a reduction in postoperative infections as a preventative measure.
Conclusion: Both therapeutically and preventatively, local antibiotic treatment can be applied to bone grafts.

Introduction: The Venous Clinical Severity Score (VCSS) was designed to give more strength
to CEAP classification and to provide a method for serial assessment particularly to CEAP clinical
class 4 and class 6. Even though the VCSS has been very useful, several areas of deficiency are
also noted over time. VCSS was again revised by American Venous Forum with an intention to
improve the VCSS, and also by preserving its strengths. Aim of the Study: To Compare VSS
system with CEAP system postoperatively in assessing the outcome of varicose veins surgery.
Methodology: A Prospective Longitudinal Clinical Study done in 30 patients from November
2019 to June 2021in the Department of General Surgery, Narayana Medical College and Hospital,
Nellore. Duplex ultrasound for each patient to assess the following CEAP clinical class, CEAP 18-
point clinical score, VCSS, VDS. Patients were followed up in the post-operative period for 6
weeks and 6 months and CEAP class, CEAP score, VCSS score and VDS will be recorded to
assess the venous outcome at 6 weeks, 6 months. Results

Background: Blunt abdominal trauma constitute cases where there is an injury
to one or more abdominal viscera with or without hemoperitoneum in the absence of
external penetrating injury to the abdomen. Objectives: The aims of the present study
were - To discuss various aspects of Blunt Abdominal Trauma, To evaluate the ability
of US in detecting Haemoperitoneum, Intraperitoneal visceral injuries. Analysis of
sonographic findings and its correlation with clinical background, laboratory
investigations, conventional and contrast radiographic procedures, CT-scan and
operative findings wherever possible. To evaluate the role of US in the follow-up of
patients with BAT. Methodology: Prospective observational study on 40 cases with
blunt trauma in Government Hospital Kurnool.

To evaluate the role of vitamin D deficiency in benign paroxysmal positional vertigo.
Materials and Methods: One hundred and twenty eight patients of benign paroxysmal positional vertigo of both genders were included. Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and concentration less than 20 ng/ml was considered as deficiency. Patients were divided into 3 groups. Group I (treatment group -with serum 25-OHD deficiency) received Epley maneuver + supplemental vitamin D and group II (non- treatment group - with serum 25-OHD deficiency) received only Epley maneuver therapy. Group III (non-treatment group - with normal vitamin D level) also received only Epley maneuver therapy.
Results: Group I comprised of 18 males and 26 females, group II 20 males and 22 females and group III 21 males and 21 females. The mean(±SD) vitamin D level at baseline, 2 months and 6 months in group I was 11.4 ± 1.6 mg/ml, 34.1 ± 4.16 mg/ml and 35.9 ± 1.8 mg/ml respectively. In group II was 10.9 ± 1.4 mg/ml, 10.5 ± 2.01mg/ml and 11.6 ± 3.2 mg/ml. In group III was 33.5 ± 1.6 mg/ml, 34.8 ± 3.2 mg/ml and 35.2 ± 4.1 mg/ml respectively. The difference was statistically significant (P< 0.05). It was found that the intensity of BPPV decreased in group I, increased in group II and decreased in group III over the period of 2 months and 6 months. The difference was found statistically significant (P< 0.05).
Conclusion: The correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy regarding duration of improvement. Supplementation of vitamin D should be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal.

Distal radius fractures are the most common fractures occuring in upper extremity and can be usually treated with volar locking plate fixation. In 1.8% to 12% cases following the mentioned procedure rupture of flexor pollicis longus tendon is an identified problem for functional outcome. These ruptures can be caused by fracture malunion or plate prominence or poor plate positioning. To prevent this ruptures of flexor pollicis longus tendon its movement on distal radius has been evaluated. Several studies using longitudinal ultrasonography have found a relation between position of volar plate and movement of FPL (flexor pollicis longus tendon) at distal radius following volar locking plate fixation .These studies have found that flexor pollicis longus tendon runs longitudinally and also shifts dorsally towards volar plate. Few studies evaluated transverse ultrasonographic displacement of FPL in relation to varied wrist and finger movements, this would offer a more detailed understanding of FPL orientation at distal radius.Therefore in the  present study we performed a quantitative analysis with transverse ultrasonography of  displacement and location of FPL  on distal radius at varied wrist and finger movements in healthy individuals. We hope this study could help further knowledge of FPL kinematics and moreover could help to  suggest implant design, plate profile, and positioning of implant in the distal radius fractures  helping to prevent rupture of FPL and to develop a rehabilitation protocol for finger and wrist movements.

Present study was carried out to determine the fetomaternal outcome in relation to cord indices (Umbilical Cord Thickness, Cross Sectional Area and Coiling Index ) measured during the second trimester (18-24 weeks) ultrasonography.
Material & Methods: It was a prospective observational study conducted between JULY 1^ST, 2021 TO JUNE 30^th, 2022 at Department of Obstetrics and Gynecology, Gauhati Medical College and Hospital, Guwahati. During the study period, we included 500 consecutive women eligible to  participate in the study.
Results: The mean age was found to be 25.57 with a SD of 3.174, the minimum age being 19 years and maximum age was 34 years. In the study, 6(1.2%) participants, 464(92.8%) participants and 30(6%) participants were <10^th percentile (hypocoiled), 10^th to 90^th percentile (normocoiled) and >90^th percentile (hypercoiled) of coiling index. In the study, 35(7%) participants, 429(85.8%) participants and 36(7.2%) participants were <10^th percentile,10^th to 90^th percentile and >90^th percentile of cross sectional area. In the study, 30(6%), 447(89.4%) and 23(4.6%) were <10^th percentile,10^th to 90^th percentile and >90^th percentile of cord thickness. Abnormal cord indices are significantly associated with meconium stained liquor, LBW/IUGR, Low APGAR scores, increased NICU admissions, neonatal death, congenital anomalies and even intra-uterine fetal demise.
Conclusion: It has been concluded that abnormal cord indices are very strongly associated with adverse perinatal outcome and maternal complications. Hence, USG in the second trimester has a very potential value in screening these adversities

Since its introduction to musculoskeletal imaging in early 1980, MRI has revolutionized diagnostic imaging of the knee. It has, therefore, become the examination of choice in the evaluation of internal joint structures of the knee like menisci, cruciate ligaments and articular cartilage.
Purpose: The objectives of this study is to describe the most commonly injured ligament of knee, MRI features of various Ligament injuries and associations, and most common age group involved in ligament injuries of knee.
Materials and Methods: MR imaging studies of the knee were performed in 120 patients with history of painful knee joint and suspected ligament injury (men, women; mean age 33.86 years) using a 1.5 T MR machine. The sequences included coronal and sagittal PD, sagittal T2 FSE, fat suppressed T2 FSE, STIR axial and coronal. Knee MR studies were obtained to evaluate ligaments and menisci.
Results: Out of 120 casses ACL tears arePresent in 92 cases and absent in 28 cases. Among 92 cases 32 are complete ACL tear, 60 are partial ACL tears. Out of total 120 patients meniscal tears are seen in 98 patients and Among 92 patients with ACL tear, 78 patients had associated meniscal tear. Among 120 cases studied only 10 are having posterior cruciate ligament tear
Conclusion: MRI is a non-invasive and accurate technique for examination of the soft tissues and osseous structures of the knee. It has great capability in diagnosing meniscal tears and classifying them into grades and types which would avoid unnecessary arthroscopic examination. It is a very good modality to diagnose complete tears of the ACL. Disadvantages are the limited accuracy in evaluation of hyaline articular cartilage

The aim of this study is to study Observational retrospective study on maternal and fetal Outcome in preeclampsia in pregnancy.
Result: In our Study over 980cases. 200 patients was of severe preeclampsia.  780 was mild to moderate preeclampsia.  Out of with 100 have macerated iud.  400 have live birth. 200  have preterm birth. Neonatal Death 20. Birth asphyxia 160. In our study maternal age of mostly 20 to 35 taken. Mostly patient were reffered with poor antenatal counseling and coverage. They only have one to two antenatal visit.  Maximum cases 60% of preeclampsia seen at age of 26 to 35, >35 age 25 % cases and 15% below 26. In elderly primi almost 60% cases have preeclampsia. Eclampsia is mostly associated with young age primi.  Complications like HELLP syndrome mostly associated with severe preeclampsia.
Conclusion: Preeclampsia and eclampsia continue to be significant causes of maternal and fetal morbidity and mortality.Though prevention is not possible, it is important to recognise early warning symptoms and signs so that life threatening complications can be averted. Provision of quality antenatal health care services, increasing patient awareness about warning symptoms, investigations, timely delivery and intensive monitoring in the intrapartum and postpartum period have the potential to improve maternal and perinatal outcome. Education and empowerment of women and accessible health care especially to the socioeconomically deprived and rural population is the need of the hour

Dentures are removable prosthetic devices that replace missing teeth and their adjacent tissues. The fabrication of complete dentures can be challenging, as they must fit comfortably and function properly. One approach to complete denture fabrication is the neutral zone technique, which aims to create a natural relationship between the denture and the oral tissues. Here we present the case of a 67-year old woman who presented to us asking for a new set of complete dentures since her old ones worn out. She was completely edentulous and was observed to possess a severely atrophied mandibular ridge. We employed the neutral zone technique for construction of her dentures and, after a follow-up period of around 1 week, the patient was satisfied with the results and continuing with her daily activities without any complications at the moment.

The inguinal hernia is one of the most common surgical procedures performed by General Surgeons worldwide. The lifetime incidence of inguinal hernia is 27% in males and 3% in females. Inguinal hernias are one of the commonest problems encountered by the treating phsicians. Even though the learning curve for Lichtenstein hernioplasty is less, there is usage of a foreign body which may produce mesh reactions leading to various other surgical complications. Also the cost of the mesh is a little higher which may not be affordable for people belonging to low or very low socioeconomic class especially in developing countries like India. Desarda’s repair is a tissue based technique of hernia repair using an undetached strip of external oblique aponeurosis to strengthen the posterior wall of the inguinal canal.

Women are more vulnerable to mental disorders like depression during postpartum.  Depression if untreated during postnatal period may adversely affects both mother and child health.
Aims and objectives:
1.         To estimate the proportion of postnatal depression among women attending Maternal and Child Health Clinic in Teaching Hospital.
2.         To determine the risk factors associated with postnatal depression among women attending Maternal and Child Health Clinic in Teaching Hospital.
Methodology: A hospital based cross sectional study was conducted in Maternal and Child Health clinic in Teaching hospital among 100 postnatal women. A predesigned and pretested questionnaire was administered to postnatal women to screen for depression by EDPS.
Results: Among 100 study subjects 60% of them belonged to 21-25 years age group and 70% had first pregnancy at the age of 15-20yrs.
Conclusion: The proportion of depression was 15% among postnatal women and predictors of postnatal depression were women with more than one living child and who had female child in the recent delivery. 

The extensor compartment of the arm is occupied by triceps muscle, through which runs the radial nerve and profunda brachii artery. Triceps arises by three heads namely long head, lateral head and medial head. Triceps is innervated by radial nerve (C6, C7 and C8) with separate branches for each head. Triceps muscle and its main motor nerve namely the radial nerve have multiple connection modalities. Each of the motor branches to triceps might be used as a donor for nerve transplantation. Axillary nerve, ulnar nerve and ulnar collateral branch of the radial nerve are previously unrecognized sources of triceps brachii innervation. Additional study was directed towards                   exploring the anatomy of motor branches to three heads of triceps brachii.
Methods: The present study was performed on 52 upper limbs of 26 formalin embalmed         cadavers from department of anatomy, at PMCH, Patna. Study duration of Two and half years, by dissection method. The             nerve supply to each head of triceps was traced and carefully followed to the source of each nerve branch and noted.
Conclusion: Gross anatomical knowledge of innervations pattern of triceps brachii and variations of its motor supply are important to medical personnel especially to orthopaedic surgeons, radiologists, neurophysicians and physiotherapists for surgical treatment of traumatic nerve injuries, nerve grafting, neurophysiologic evaluation to diagnose peripheral neuropathy. 

The gross anatomy and metrical analysis was carried out in 60 human hearts taken from the cadavers (irrespective of sex and age). The morphological features of coronary sinus were investigated along with study of its metrical analysis. The formation, course, variation in its tributaries and termination to the right atrium were investigated and recorded. Material and Methods: This is morphological study was conducted by utilizing 60 human cadaveric hearts available in the Department of Anatomy, at PMCH Patna. Study duration of Two and half years.
Conclusion: The study of Coronary sinus utilizing 60 human hearts (irrespective of age and sex) preserved in formalin showed variations in its formation. The orifice of the Coronary sinus in the right atrium appeared mostly oval in shape and is guarded by semi lunar shaped valve in 59 of specimens and semicircular in one specimen

Worldwide diabetes mellitus affects more than 194 million people and the figure is expected to reach 333 million by the year 2025.With the maximum number of cases being in developing countries, diabetes mellitus is a global problem. India has the highest number of diabetic patients and is considered as the “diabetic capital of the world.” Diabetic foot is the most common complication of diabetes and is greater than retinopathy, nephropathy, heart attack and stroke combined. Diabetic foot is one of the most feared complications of diabetes. The ultimate result of diabetic foot disease is amputation and is associated with significant morbidity and mortality. It also has immense social, psychological & financial consequences for the patient and the family.
Objectives: To study the morbidity profile [limb salvage surgery, amputations] of diabetic foot. To study the microbiological profile [type of organisms], antibiotic sensitivity and correlate it with prognosis
Materials and Methods: This was a prospective study done on 100 diabetic foot patients in our own hospital over a period of Two years. Data was obtained from a questionnaire developed to record the medical history, examination details, investigations reports, treatment details and final outcome at the end of stay. Foot infection was classified based on Meggitt – Wagner, classification / grading. Wound swab was obtained using standard techniques and sent for direct smear study, culture and antibiotic susceptibility for appropriate antibiotics using standardized Kirby –Bauer disc diffusion test of clinical and Laboratory Standards. Conclusion: Based on the results of our study, it can be concluded that diabetic foot in various forms accounts for significant morbidity in the surgical wards. The factors     contributing mainly are poor glycemic control at the time of admission, presence of gangrene, associated risk factors like smoking, alcohol consumption and associated co morbidities(anemia, peripheral vascular disease, Hypertension, Ischemic disease).Diabetic foot infections are more prone for recurrence so preventive measures like diabetic control, foot care is needed.

Tendons are frequently used for reconstructive surgery. This includes tendons of palmaris longus, plantaris, the long extensors of the toes and fingers as well as the flexors of the fingers. The surgeon must base his or her selection of the donor tendon for grafting on what is needed, for example tendon size, length, and width. The most desirable tendons in reconstructive surgery are the palmaris longus and plantaris tendons. To study the presence, variations and relationship between palmaris longus and plantaris tendons. To compare the prevalence of absence in right and left sides.
Method: The study was done on 30 cadavers. The palmaris longus and plantaris muscles are indeed subject to variation, whether in the general anatomy, form, attachment, actions and/or prevalence. Parameters like muscle length, tendon length, total length, of both the muscle were measured using measuring tape and the muscle width and tendon width were measured using digital vernier caliper and recorded bilaterally and statistically analysed.
Conclusion: based on the morphology and prevalence of the palmaris longus and plantaris muscles in a North Bihar region, they are ideal for the use of flaps and/or tendon graft in reconstructive surgery.

Pain control after total knee replacement (TKR) is pivotal in postoperative rehabilitation. Usage of epidural analgesia or parenteral opioids can cause undesirable side effects hampering early recovery and rehabilitation. These side effects can be avoided by infiltration of an analgesic cocktail locally. Our study was performed to evaluate the benefits of a particular cocktail combination in patients undergoing TKR with respect to pain and knee motion recovery.
Materials and Methods: Fifty consecutive patients  who  underwent simultaneous  bilateral  TKR  were enrolled and received an intraoperative periarticular cocktail injection in the right knee (intervention) and normal saline in the left knee (control). Postoperative pain was recorded using the visual analog scale for each knee, and the time taken to achieve 90◦ of knee flexion was noted for each side. Data collection about post of pain and ROM was double blinded.
Results: The cocktail injected knee had significantly less pain when compared with the control knee during the first 48 hours and significantly shorter period to achieve 90◦ of knee flexion.
Conclusions: The use of intraoperative periarticular cocktail injection significantly reduces early post- operative pain and provides better early knee motion

The medial collateral ligament (MCL) is commonly injured in the setting of anterior cruciate ligament (ACL) injuries. Because the MCL has better healing capacity than the ACL, the general perception is that MCL injuries can be treated conservatively. Treating these injuries conservatively, however, can lead to residual valgus laxity. Furthermore, it delays time to surgery, which prevents acute treatment of concomitant ACL injuries using primary repair or acute reconstruction. Several treatment methods for MCL injuries have been proposed, including primary repair, augmented repair with autograft tissue, or primary reconstruction. In this surgical technique article, we present the technique of acute primary MCL repair with internal bracing with 2 limited/mini-open incisions. With this technique, early surgical intervention is possible, and early rehabilitation is safe because of the internal bracing. Advantages include fast recovery, avoidance of muscle atrophy because of early mobilization, prevention of residual valgus instability, and maintenance of proprioception.

Injuries to the popliteal artery from blunt or penetrating trauma are routinely found in trauma centres. Early detection of the possibility of arterial injury is crucial for the limb salvage.
Material and methods: We retrospectively reviewed the records of the patients who were managed for popliteal artery injury at our institution during the study period (2020-2022). 30 Patients were treated during the study period 2020-2022. Information extracted and analysed included demographic data, clinical presentation, physical examination, blood investigation, colour Doppler. Surgical data included vessel injury, technical aspects of repair, associated complications and outcomes.
Results: There were 30 patients: 22males (73.3%) and 8 females (26.6%). Mean age ± SD was 24.7 ± 5.8 years. Most patients (90%) were under the age of 30 years. Blunt trauma was the common cause of popliteal artery injury (60%) and penetrating trauma accounted for 40% which included traumatic and iatrogenic injuries during orthopaedic procedures. All the patients had associated skeletal injury. Concurrent popliteal vein injury with popliteal artery injury was seen in 36.6% of patients. All patients had undergone popliteal artery bypass with reverse great saphenous vein graft harvested from the contralateral lower limb and popliteal vein injury was managed with vein ligation. Mean ischemia time at presentation was 9.26 hrs ±3.91. Five patients had delayed presentation. Seven patients (23.3%) underwent amputation. Of these 5 sustained tibial plateau fractures and 2 both bone fracture associated with severe soft tissue injury. There were no intraoperative or in-hospital deaths. Associated skeletal injury was managed by orthopaedic department.
Conclusion: Popliteal artery injury represents a great challenge due to their complexity and low frequency. Early diagnosis and surgical repair is recommended. Despite technical improvements in management of popliteal artery injury, a high amputation rate is still seen, especially in patients with extensive soft-tissue injury, associated skeletal trauma especially with tibial plateau fracture. Liberal use of fasciotomies, perioperative anticoagulation, antibiotics and presence of orthopaedician for skeletal fixation play an important role to achieve acceptable outcome.

To determine various factors contributing to the complication related to CT guided lung biopsy. MATERIALS & METHODS: A cross-sectional study was conducted between September 2020 to October 2021. Total of 34 patients who had suspected radiological lung masses were included in the study. Histological sample were collected through co-axial system of core needle biopsy. Various factors affecting complication was assessed against patient showing complication.RESULTS:Total of 6 (17.65%) post-procedural complications were noted in study which include pneumothorax and lung contusion. Multiple risk factors affecting the rate of complication were considered like predisposed emphysema, depth of the lesion, angle of insertion of biopsy needle, gauze size of the needle used and repeatability of the procedure. “Depth of the lesion” was best predictor of complications at cut-off point of >1.1 cm. CONCLUSION: This study is an attempt to evaluate the factors contributing to the safety and complications of core needle CT guided lung biopsy. One must should keep in mind these factors to procure uncomplicated procedure

Postoperativeanalgesia remains a cornerstone in management of patients undergoing inguinal hernia repair. This study evaluates the analgesic efficacy of traditional wound site infiltration and recent ultrasound guided TAP block using VAS score. Sixty patients were divided into two Groups. Patients in Group 1 were given ultrasound guided TAP block with 20ml of 0.25% bupivacaine and patients in Group 2 received wound site infiltration with 20 ml 0.25% bupivacaine as per the discretion of anaesthesiologist. Postoperative parameters like VAS score, time to first rescue analgesia, total analgesic consumption, adverse events and hemodynamic parameters were assessed.
Methods: Sixty patients who met the inclusion criteria posted for elective unilateral inguinal hernia surgeries were divided into two Groups Group1 received ultrasound guided TAP block with 20ml of 0.25% bupivacaine and Group 2 received wound site infiltration with 20 ml 0.25% bupivacaine. Postoperatively patients were shifted to post-operative ward and monitored for post-operative pain using VAS score at various postoperative intervals; 2, 4, 6, 12, 18, 24 hours and secondary parameters such as duration of analgesia, time to first rescue analgesia, total analgesic consumption and adverse events were also recorded.
Results: VAS scores recorded at various post-operative intervals, total analgesic consumption were significantly lower in USG-TAP block Group compared to WSI Group which was significant statistically. The mean time requirement for rescue analgesia was shorter in the WSI Group (3.67h) than the USG-TAP block (6.43h) and was statistically significant.

This study's objectives are to identify and determine the prevalence of ESBLs producing gram-negative isolates from cases of neonatal sepsis that occurred in Indore, Madhya Pradesh; and also, to investigate the detection of antibiotic susceptibility pattern of gram-negative bacilli isolated in blood culture of neonatal sepsis. Methods: In terms of its methodology, the research can be categorized as an experiment that also consists of a descriptive component. Both of these components are included in the investigation. After receiving approval on an ethical level from the Institutional Ethical Committee of the Index Medical College Hospital & Research Centre (IMCH&RC), which can be found in the sentence before this one, it was carried.  Inclusion criteria: Neonates under 60 days old with a clinical history of sepsis were admitted to the Index Medical College Hospital & Research Centre in Indore for blood cultures. Neonatal blood was drawn. The blood was cultured for further examination. The study included inborn and out born infants who were admitted to the IMCH and RC's Neonatal Intensive Care Unit (NICU) with suspected clinical features of sepsis at admission or developed such features after admission for other reasons. The study included infants admitted to the NICU and other IMCH and RC departments. The infants were given antibiotics even though it was unclear. Results: 50% of the GNB isolates were positive for ESBL. ESBL positivity was significantly more prevalent (>50%) in E. coli, Klebsiella spp., and Enterobacter spp. than in Acinetobacter spp. (1%). Similarly, 89% of E. coli, Klebsiella spp., and Enterobacter spp.were MDR, with Acinetobacter spp. There was a variation in susceptibility status according to specific bacterial genus and antimicrobial agent, but in general, fifty five percent of the GNB isolates that were tested showed resistance to the antimicrobials that were included in the first-line AST panel. Conclusion: The present study concludes that MDR bacteria, ESBL, and carbapenemase-encoding AMR genes in GNB make patient treatment difficult

Since craniofacial morphology develops differently across racial and ethnic lines, the Facial (Proscopic) index is a useful anthropological parameter for classifying human populations. Aim: The aim of the present study was to identify prosopic (Facial) Index between male and female of Central India with Its clinical Importance. Materials & methods: A random sample of 400 students (200 males and 200 females) between the ages of 18 and 25 was taken after first obtaining approval from the ethical committee of the institution and then obtaining the participants' informed consent to take part in the study. The participants were given full disclosure regarding the nature of the study. The examination of these students did not take place until after they had provided their informed agreement to take part in the research. Everyone who agreed to take part in the study was in generally good health, and not a single one of them had ever previously undergone plastic or reconstructive surgery to treat facial deformities or injuries in the past. Results: Using Banister's categorization system, the study population is broken down into its several face phenotypes. The total facial index of an individual is used to determine this face phenotype's characteristics (Table 3). According to the figures in the table, mesoprosopic faces are the most prevalent in both genders, accounting for 47% and 44.5% of the population, respectively. Mesoprosopic faces also account for the majority of the population. After this comes the Europrosopic faces, then the Hypereuprosopic faces, and finally the Leptoprosopic faces. On the other hand, people who have hyperleptoprosopic vision make up a relatively small percentage of the population. Conclusion: This study could be a useful starting point for researchers who are interested in learning more about the people who reside in northern India because it provides demographic information about those people

Bacterial and Viral infections are often hard to be distinguished in daily clinical practice. Biological markers obtained from a routine examination play an important role to minimize time in providing diagnose and giving therapy. Recently, the use of Neutrophil-lymphocyte ratio (NLR)and platelet-lymphocyte ratio (PLR) is greatly considered to differentiate types of infection found in the patients presenting with fever.
Material and Method: This study uses prospective cohort study design and involves patients presenting with fever who are admitted in the hospital. The initial NLRand PLR is examined and categorized into types of infection foundi.e. grade I DHF and grade II DHF. The ANOVA test and t-test are performed to find out the difference among study groups.
Result: In the present study, a total of 104 patients were clinically suspected on the admission as dengue fever, 80 of these were serologically confirmed dengue positive. A 44 of these were grade IDHF infections. The average age was 42.1 years, the range being 23-65 years. Based on 2009 WHO clinical criteria, 34 were identified as Dengue with warning Sign, 27 as Dengue Without warning Signs while 19 were identified as Severe Dengue. Some of the frequently observed clinical features were fever, headache, thrombocytopenia, leukopenia and rashBoth NLR and PLR correlated severity of DHF.NLR and PLR had significantly higher values in grade II DHF patients.
Conclusion: Neutrophil-lymphocyte ratioand PLR have benefit to predict diagnosis for the patients presenting with a fever. Bacterial infection is associated with the high value of NLRand PLR generally has a lower value in viral infection cases.

Thalassemia are the most common single gene disorder worldwide. Mutations involving the beta globin gene in beta-thalassemia cause disruption in red blood cell maturation leading to ineffective erythropoiesis and multi-system involvement, including eye. In beta-thalassemia patient abnormal erythropoiesis leads to severe anemia, due to which repeated blood transfusions are required to maintain hemoglobin level at or above 10mg/dl. Multiple blood transfusions and ineffective erythropoiesis.
Aims:  To study the prevalence of ocular abnormalities in beta thalassemia major patients.
Materials and Methods: The present study was a Institution based descriptive, cross-sectional study. This Study was conducted from one and half year (February 2020 -August 2021) at Department of Ophthalmology North Bengal Medical College and Hospital.
Result: The present study showed that among 75 study subjects 93.3% had refractive errors in either eye and 6.7 % were emmetropic. The present study also showed that among 150 eyes 6% eyes had emmetropia, 69.66% had hypermetropia, 38.66 % eyes had myopia and 45.33% eyes had astigmatism. The mean axial length in our study was 21.78 + 0.73 mm, The mean anterior chamber depth (ACD) in our study was 3.00 + 0.48 mm, The mean (SD) lens thickness in right eye was 4.05 (±0.58) mm and in left eye were 3.90 ((±0.68) mm. In our study the mean (SD) K1 in right eye was 44.61 (±1.49) Diopter and in left eye were 44.87 ((±1.68) Diopter, whereas the mean (SD) K2 in right eye was 44.84 (±1.62) Diopter and in left eye were 45.07 ((±1.43) Diopter.
Conclusion: We included 75 patients of Beta Thalassemia Major patients. The male population was 56% and female were 44%. The mean age of the study subjects was 9.53 + 3.36 years (range 6 to 18 years).

Breast cancer is the most frequently diagnosed cancer as well as the leading cause of cancer death in women worldwide. As it is progressively affecting more women in productive age group, it is of utmost importance to help diagnose the disease at the earliest.
Aims: To find the accuracy of ultrasound in diagnosis of benign and malignant breast masses and to correlate the benign and malignant ultrasound features with tissue diagnosis.
Materials and Methods: The present study was a hospital based descriptive epidemiological study with cross sectional design. This Study was conducted from October 2021 - September 2022 at Department of Radiology, Murshidabad Medical College & Hospital. Total 94 patients were included in this study.
Result: Right breast was slightly more involved (44.7%) than left breast (40.4%) among the study participants. Upper outer quadrant of breast was commonest location for involvement (59.6%). FNAC suggests proportion of malignant breast lesion among 26.6% of the study participants.
Conclusion: Ultrasound was able to diagnose all the malignant cases missed by FNAC and in case of indeterminate reports by ultrasound FNAC was able to diagnose benign and malignant lesions accurately.

There are approximately 3000 species of snakes existing in Earth, of which only 600 species are poisonous. Snake population, venom composition and related human health hazards are variable in geographic areas and seasons.
Aims: To work out predictive factors of requirement of Invasive and Non-Invasive Ventilation in Neurotoxic snake envenomation.
Materials and Methods: The present study was a Prospective, observational and analytical study. This Study was conducted for one year at N.R.S. Medical College and Hospital, Kolkata
Result: In our study, Krait bite was responsible for maximum no. of envenomation in the study population (69%) followed by unknown snake bite (21.5%), whereas cobra bite was least among study population (9.5%) and Maximum no. of patients presented to Health Centre within 6 hours, where they were given initial 10 vials of ASV (69%).
Conclusion: Presence of dysphagia, pain abdomen, ophthalmoplegia, hypotension and others (neck weakness, limb weakness and unconsciousness) were found to be statistically associated with development of respiratory paralysis

CA125 is a biomarker that has potential utility across the spectrum: risk assessment, early detection, diagnosis, prognosis, monitoring and therapy.
Methods - Patient attending gynecological outpatient department of obstetrics and gynecology,vinayaka mission medical college, Karaikal were screened by history, clinical examination and symptomaticaly for adenaxal massess. Same were screened with abdominal and transvaginal sonography to a certain, the pelvic mass arises to the ovary. -Clinical history, bimanual examination, Transabdominal ultrasonography was done for all patients fulling inculsion and exclusion criteria. Serum CA125 were acertained by Chemiluminiscent or ELISA.
Results - 40 women were selected and evaluated to assess CA 125 and colour Doppler and their sensitivity and specificity in differentiating benign and malignant tumour.Ca125 has sensitivity and specificity of 92.31% and specificity was 70.37% respectively. There was statistically significant difference (P-0.001) in the resistive index and histopathology. The calculated pulsatality index in our study was found to be 96.30% specificity and 92.31% sensitivity. With considering both Resistive index and Pulsatality index the Doppler has sensitivity of 93.3% and specificity of 93%.

The COVID-19 pandemic has changed the lifestyle of all people. This study was conducted to study the impact of the COVID 19 pandemic on the quality of life among the general population in the rural area of Chengalpattu district, Tamil Nadu.
MATERIALS AND METHODS: This Community based Cross-sectional study done after the second wave of COVID 19 pandemic in India, included 424 participants from the rural health training center’s field practicing area of a tertiary care private hospital in Chgengalpattu district of Tamil Nadu. After obtaining informed consent, data were collected through house to house survey using the WHO-BREF questionnaire which assessed the quality of life including physical health, Mental health, Social relationship and Environmental domains. Along with it, socio-demographic details of the participants were also obtained. Collected data were analyzed using SPSS software version 21.
RESULTS: The Quality of life of the people is better with 52.4% of participant’s scores falling above the mean score of 253.59(+/- 57.81). 59.2% of the participants showed better physical health with a mean score above 68.21(+/- 21.7). 51.9% and 54.0 % of the participants had good mental health and social relationship respectively. 52.6% of the participants enjoyed a good physical environment during the pandemic with a mean score of 65.56(+/-16.9). There is a strong association between quality of life and socio-demographic factors like age (p = 0.00); Gender (p = 0.003); Marital status (p = 0.024); Education (p = 0.000 ); Socio-economic status during the pandemic (p = 0.000) and Occupation (p = 0.000 ), which was statistically significant.
CONCLUSION: Despite the pandemic 52.4% of the participants had a better quality of life. This may be due to subsidies and free rations from the government to the people. Also, people in the productive age group with better education and occupation had a good quality of life. This implies that, the government’s plan should focus on  better education to the children and improvement of employment opportunities

Diagnostic laparoscopy is a minimally invasive technique that provides information on the state of the uterus, ovaries, Fallopian tubes. It is considered as gold standard for diagnosing tubal and peritoneal diseases. Hysteroscopy helps in visualizing the uterine cavity and identifying the possible pathology in infertility. In combined hysterolaparoscopy complete evaluation and treatment is possible in the same sitting. Objective: To study the role of combined diagnostic hystero-laparoscopy in evaluation of female infertility.
Materials and Methods: This retrospective study was conducted in the Department of Obstetrics and gynaecology in a tertiary care centre in Chennai, Tamil Nadu from January 2017 to December 2017. Women aged 20-40 years with primary or secondary infertility with normal hormonal profile and without male factor infertility were included.
Results: In our study primary infertility was found in 75% of the 100 patients and secondary infertility in 25% of cases. Majority of patients of primary infertility (46%) and secondary infertility (44%) belonged to the age group of 25-30 years. The analysis of the duration of infertility showed that 66% of primary infertility cases had history of infertility between 1-5 years, 28% had infertility of 6-10 years. Among secondary infertility cases 64% had infertility between 1-5 years, 32% between 6-10 years. Abnormal laparoscopic findings were noted in 55% of cases of primary infertility and 52% in secondary infertility. Abnormal hysteroscopic findings were noted in 18% of primary infertility cases and 16% of secondary infertility. The most common laparoscopic findings in secondary infertility cases were adnexal adhesions (20%) and myoma (12%) and polycystic ovaries in primary infertility. In our study on chromopertubation 12% of primary infertility and 20% of secondary infertility patients had unilateral tubal block and 16% of primary infertility and 12% of secondary infertility patients had bilateral tubal block.
Conclusion: Hysterolaparoscopy is a minimally invasive, safe and effective procedure in comprehensive evaluation of female infertility as it helps in detecting tubal, peritoneal factors, endometriosis, adnexal adhesions and septate uterus. The above correctable abnormalities are missed by imaging procedures. Hysterolaparoscopy helps in formulating specific planning of management. While investigating the causes of female infertility combined simultaneous diagnostic laparoscopy & hysteroscopy should be performed in all infertile patients.

Surgical Site Infections (SSI) is one of the most commonly reported nosocomial infection which has an adverse impact on the hospital as well as on the patient.
Objectives:

To study the prevalence of Surgical Site Infections.
To identify the risk factors associated with the development of SSIs.
To identify the etiological pathogens and their antimicrobial susceptibility

Methodology: We conducted a one year cross sectional study on SSI in
IOG. 152 post lscs cases who developed SSI were included in the study. Factors like age, duration of surgery, co-morbidities, type of skin suture, pathogen and their antimicrobial sensitivity associated with SSI and their outcomes were studied. Swabs were collected from the infected surgical wounds and processed by the conventional microbiological methods. Antimicrobial susceptibility was done by Kirby-Bauer disc diffusion method and interpretation done by CLSI guidelines 2020.
Results: Among the 6650 cases of LSCS done in our hospital in the year 2021, 152 cases developed surgical site infection. Of which 67% of the population comprise of the age group 18-30 yrs, anemia, diabetes, hypetension were the predominant risk factors associated with SSI. About 37% of the cases needed wound resuturing remaining 63% of the cases were medically managed. The common pathogen encountered with SSI were E. coli, Klebsiella and MRSA. Around 82% of the organism were sensitive to Amikacin and 48% of them were sensitive to Gentamycin, about 43% of the pathogen were resistant to Ampicillin.
Conclusions: The overall prevelance of SSI in our hospital was 2.28% in the year 2021. Early diagnosis and prompt treatment of risk factors like anemia, diabetes and hypertension may prevent SSI and improve outcomes in infected cases. Decrease in the duration of surgery, decreases the incidence of SSI. Empirical use of antibiotics based on the common organism encountered and their sensitivity patters improves the outcome of SSI. Peroidic surveillance of SSI and measures to prevent it to be done on regular basis

The meniscus plays an essential role in the knee as a load-transmitter and shock absorber. Healthy meniscus is usually injured by a combination of compression and rotation of the tibiofemoral joint. Arthroscopic meniscal repair has gained popularity because of the shortened surgery time, a smaller incision, and better access to the tear portion, which is particularly difficult during open surgery. Four types of arthroscopic repair techniques: inside-out techniques, outside-in techniques, all-inside techniques, and hybrid techniques that combine multiple techniques. We are discussing the outcome of meniscal repairs on follow-up at 12 months in comparison with preoperative status.
Materials and methods: Between 2019 and 2021, this prospective study evaluated patients with meniscal tears who underwent arthroscopic meniscal repair and studied their outcomes postoperatively. The study included three types of meniscal repair: outside in, all inside, and hybrid techniques, including both outside in and All inside. Patients were assessed on the 3rd, 6th, and 12th month based on the International Knee Documentation Committee (IKDC) rating, Lysholm score, and Tegner activity levels.
Results: IKDC was preoperatively (50.14±13.17), postoperatively at 3 months (74.56±5.06), at 6 months (85.67±3.62) and 1 year (88.23±2.69)( with P-value (0.001). Tegner Lysholm score was preoperatively (58.23±12.28), postoperatively at 3 months (84.41±7.45) at 6 months (90.34± 5.24) and 1 year (94.32±2.86) (with P-value (0.001). There were no postoperative complications at 3,6, and 12 months’ follow-up.

AIMS: 1.To compare conventional DSE with strain rate imagining during DSE and find out objective markers of inducible myocardial ischemia in patients of chronic stable angina and                                                                          2. To determine how left ventricular diastolic filling pressure determined by (E/E’) during DSE by TDI is affected by presence of coronary artery disease and to find out cut off for inducible myocardial ischemia.
METHODS AND RESULTS: We selected 50 patients of known or suspected coronary artery disease. All patients underwent stress thallium as per standard protocol. Among 50 patients stress thallium was positive in 28 patients and negative in 22 patients. All patients underwent coronary angiography within one month of stress thallium. Stenosis of greater than 50% was considered as ischemia inducing. Significant coronary artery stenosis was observed in 33 patients (66%) and in 17(34%) patients coronary stenosis was less than 50 percent.Doubtaminestress was done in all patients and strain parameters were recorded using TDI at baseline and at peak doubtamine stress. All observations and comparisons were made at segmental level.Using 18 segment model in all patients 50 x 18 = 900 segment were identified.100 segments were excluded from analysis due to scintigraphic evidence of scar,echocarographic wall motion abnormalties and abnormal baseline strain pattern.

The aim of the present study was to identify the lipid pattern in chronic kidney disease patients.
Methods: The study was conducted in the Department of Medicine, Government Medical College and Rajindra Hospital Patiala, India, multi-specialty, tertiary care teaching hospital. This study was done for duration of 1 year from the date of approval of plan. 100 patients of chronic kidney disease coming to the Department of Medicine, Government Medical College and Rajindra hospital was included in the study.
Results: In the present study, majority of patients, i.e. 38 (38%) belonged to the age group 45-54 years, followed by 25 patients (25%) in age group 55-64 years, 23 patients (23%) in age group 65-74 years and 14 patients (14%) in age group 35-44 years.51 patients (51%) were male and 49 patients (49%) were females. Mean value of serum Triglycerides was 161 mg/dl, serum total cholesterol was 201.5 mg/dl, serum HDL was 34.6 mg/dl, serum VLDL was 31.8 mg/dl and serum LDL was 134.7 mg/dl. The mean values of the different fractions were obtained with respect to the co-morbid conditions present in the study sample were not significant. The mean values of the different fractions were obtained in both diabetic and non-diabetic CKD patients were not significant. A similar comparison in the mean values of the lipid profile was done in patients who were on dialysis and those who were being treated conservatively and it was found non-significant.
Conclusion: This study concluded that the mean values of the lipid profile in hundred CKD patients showed a borderline high range of serum triglycerides, serum total cholesterol and LDL, and decreased HDL. There was no statistically significant difference in lipid profile of male and female CKD patients.

To study clinical and demographic profile and visual prognosis of ocular trauma patients visiting ophthalmology department in a tertiary care centre of Punjab for a span of one year.
Materials And Methods: This prospective study was conducted on the patients of ocular trauma visiting Department of Ophthalmology, in Government medical college,
Patiala during a span of 1st April 2021 to 31st March 2022. 152 ocular trauma patients of all age groups reported to our institute and continued follow up for 2 months were included in the study. Data obtained was tabulated and analysed statistically.
Results: Out of 152 patients, 48.68% were between 31- 45 years of age. Males (74.34%) were predominantly affected. Road side accident (42.76%) was found to be the most common cause of injury. Closed globe injury (59.24%) was more common than open globe. Eyelids (36.51%) were the most involved ocular structure followed by conjunctiva (26.37%). The visual acuity observed in the affected eye at the time of admission was between 6/6 - 6/18 in 54.78% of patients. After treatment the 78.80% of the cases had final BCVA between 6/6 - 6/18.
Conclusion: Road side accident was the most common cause of ocular trauma. Younger age group and males are predominantly affected. Closed globe was the common type of injury and eyelids were the mostly affected ocular structure.

The aim of the present study was to assess the correlation of CA 15-3 level with Clinico Pathological parameters and molecular subtypes of breast cancer.
Methods: This study was a prospective study conducted in the Department of Pathology, Government Medical College Patiala, Punjab and included 75 cases, with the approval of the Institutional Ethics Committee.
Results: In the present study, patients were divided into 7 groups according to age. The highest no of cases were recorded in the 51-60 age group i.e. 5th and 6th decade (33.3%). The mean age was 50.36 ± 12.04 years. The range of age was 25 - 80 years of age. In present study value of CA 15.3 above 30 IU/L was taken as significant, it was observed that out of 75 cases, number of cases with positive CA 15.3 value are 34 (45.3%). In the present study, out of total 75 cases studied, maximum cases were noted of subtype IDC NOS i.e. 70 (93.3%) followed by Lobular (5.3%) and Medullary (1.3%) carcinoma of breast. In the present study maximum number of cases were noted in T2 stage (2-5 cm) i.e. 47 (62.7%) followed by T1 (21.3%) and T3 (11%) and minimum cases were noted in T4 stage i.e. 1 (1.3%). Out of 75 cases, maximum cases were noted in N0 stage i.e. 56 (74.6%) followed by 8 cases each of N1 and N2 (21.3%) and minimum cases were noted in N3 stage i.e. 3 (4%). Out of 75 cases, 2 cases of distant metastasis were noted. Out of 75 cases, maximum no of cases observed were of Luminal A subtype i.e. 33 (44.0%) followed by Basal (24%) and HER 2 enriched (15%) subtype. A minimal no of cases were observed in Luminal B (3%) subtype. As the tumour size increased the level of CA 15.3 also increased. p value was calculated and was found to be statistically significant between tumour size and Ca 15.3 level. (p value = <0.001). As the nodal involvement increased, the level of CA 15.3 also increased. p value was found to be statistically significant between nodal status and Ca 15.3 level. (p value = <0.001). There was a positive correlation between metastasis and CA 15.3 value which was found to be statistically significant with p value of <0.001.
Conclusion: The CA15-3 levels are associated with tumor burden indicators including tumor size and lymph node status and metastasis. The higher levels of CA 15–3 are more common in patients with larger tumor size, advanced axillary lymph nodal status and in metastatic breast cancer patients. No correlation was seen with histological grade.
Positive correlation was seen between serum CA 15.3 levels and luminal subtype of breast cancer. luminal A was the majority in molecular subtype and showed increased CA 15.3 levels

One of the earliest scoring systems for projecting surgical outcome was POSSUM. In general surgery, it was discovered that the P-POSSUM approach was more reliable for predicting death. Objectives - The chief objectives of present research are to examine the validity and assessment of the PF Portsmouth Possum Scoring in cases of exploratory laparotomy and to study the mortality rates using Portsmouth POSSUM scoring in patients undergoing laparotomy and to calculate  observed/predicted ratio for mortality based on Portsmouth POSSUM.
Materials and Methods: An observational clinical trial that was to be done in general surgery and SICU wards at the Department of General Surgery, MGM Medical College and Hospital, Aurangabad was prospective and non-randomized. The patients on admission were evaluated as per Portsmouth - Possum Scoring. Operative outcomes had been taken note off, and a tailored surgical procedure would be performed. The patients were then assessed and the data will then be analyzed using the linear technique of analysis. After that, the observed to anticipated (O:P) ratio will be determined.
Result: Using a linear analytic equation, the observed and P-POSSUM predicted death rates were compared. The obtained observed to expected ratio (O: E) was 1.5 (p=0.429), which was not statistically significant. Conclusion - P-POSSUM score includes the identification of high risk patients who would benefit from expedited surgical treatments or improved resuscitation during the pre and intra-operative phases.     

The Antiphospholipid syndrome (APS) is an autoimmune condition characterized by recurrent arterialor venous thrombosis and/or pregnancy morbidity in the presenceof persistently positive circulating antiphospholipid antibodies. Present study was carried out to study incidence of Antiphospholipid antibody syndrome and to study clinico-pathologic correlation of APS with special reference to Lupus anticoagulant.
Material & Methods: A prospective analysis was performed in 50 patients who were suspected to have Antiphospholipid syndrome as per the diagnostic criteria. Patients with history of thrombosis, recurrent miscarriages, or k/c/o SLE who were suspected of having Antiphospholipid syndrome were included in the study.
Results: Out of 50 patients which were included in our study, (24%) were males & (76%) were females. This showed that, there was a female predominance with F: M ratio of 3.16:1. The leading presentation was bad obstetric history (multiple miscarriages, etc.) in (56%) referred cases followed by Deep Vein Thrombosis in (10%) & Portal & splenic vein thrombosis in (10%) cases. (48%) cases showed prolonged aPTT while (52%) were normal aPTT. (32%) were DRVVT positive while (68%) cases were DRVVT negative. Thrombosis was leading presentation in (11.75%) dRVVT positive cases followed by (31.25%) of Bad obstetric history (12.5%) cases were BOH + DVT. Out Of 16 APS patients, (87.50%) cases had Primary APS & (12.50%) cases had Secondary APS.
Conclusion: we conclude that any obstetric / thrombotic event should be investigated further by aPTT / dRVVT testing to reduce morbidities associated with the complication

Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. The chronic hyperglycemia of diabetes is associated with damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Individuals with type-2 diabetes mellitus are reported to have a 2 to 3-fold increase in the incidence of cholesterol gallstones. Hence the study is undertaken to determine prevalence of gall bladder disorders in diabetic patients and association of different parameters which affect them.
Material & Methods: This was a hospital based case-control study carried out during the period of October 2010 to October 2012. Institutional ethics committee approved the study.The study comprised of known or newly diagnosed 101 patients of type-2 diabetes mellitus and 101 age and sex matched controls.
Observation & Results: In this study out of 101 cases gallbladder disorders were found in 36 (35.64%) cases. Out of these 26 (25.74%) had gallstones, 9(8.91%) had biliary sludge, 1(0.99%) had cholecystitis. Out of 101 controls gallbladder disorder was found in 9 controls. Out of these 6 (5.94%) had gallstones and 3 (2.97%) had biliary sludge. The mean fasting gallbladder volume in cases was 24.20±2.73 cc and in controls it was 18.96±1.98 cc. The difference in mean fasting gallbladder volume in cases and controls was statistically significant (p<0.05). The mean postmeal gallbladder volume in cases was 12.50±2.2 cc and in controls it was 7.68±1.70 cc, the difference was statistically significant (p<0.05). Also the mean gallbladder motility in cases was 48.53±5.66% and in controls it was 59.73±6.41%, the difference was statistically significant (p<0.05).
Conclusion: Present study concluded that gall bladder disease is significantly more prevalent among type-2 diabetics compared to controls. Large, poorly contracting gall bladders are frequent among the type-2 diabetics, regardless of the presence or absence of symptoms of gall-bladder disease. Type-2 diabetic patients with gallbladder disorders are significantly older. Prevalence of gallbladder disorders is significantly more in type-2 diabetic females than in type-2 diabetic males.

Gestational diabetes mellitus has emerged as a global public health problem with an exceptionally high estimated prevalence.The addition of biomarkers to predictive models of GDM may improve the ability to identify women at risk of GDM prior to its development.SETTING: SCB Medical College, Cuttack, Odisha, India

Hysterectomy is the surgical procedure of removing the uterus. It is one of the most common gynaecological operations and second most common after caesarean section. It can be performed by abdominal route, vaginal route, by applying minimally invasive techniques, or by a combination of the later two. The route chosen depends on the pathology and size of the uterus, presence or absence of adnexalpathology, surgeon's preference and expertise, patient's body habitus and medical co-morbidities, and hospital infrastructure.
Methods
The study was a hospital-based time bound prospective and observational study conducted in the Department of Obstetrics and Gynaecology at Gauhati Medical College and Hospital, Guwahati, Assam. 150 patients in the age group from 35-85 years with symptomatic benign uterine pathology excluding uterine descent and uterine size less than 16weeks were selected randomly. All the three routes of hysterectomy: Abdominal, Laparoscopic and Non Descent Vaginal Hysterectomy were assigned 50 cases each.
Outcomes measured were operating time, intraoperative complications, requirement of blood transfusions, post-operative VAS score, post-operative mobility, post-operative complications (febrile morbidity, bowel distension, urinary retention, wound infection) and duration of hospital stay.
Result
The most common age group undergoing hysterectomy was 40-49yrs with AUB-L being the most common indication. The mean operating time in NDVH (82.8±22.29) minutes was significantly less than TAH and TLH. Post operative VAS score was significantly lower in NDVH. All the post-operative complications were significantly higher in the TAH group. Mean duration of hospital stay was least in NDVH(3.28±0.70) days.
Conclusion
 From this study we have concluded that vaginal approach should be the procedure of choice for benign causes unless contraindicated, but at the end, route of hysterectomy is dependant  on multiple factors and should be individualized.

The aim of the present study was to assess the ability of dynamic contrast-enhanced MRI (DCE–MRI), and Diffusion-weighted image (DWI) to describe uncertain ovarian masses.
Methods: The present study was conducted in department of radiology and we did transabdominal ultrasound and transvaginal ultrasound for all cases. We investigated 50 patients with 50 adnexal lesions.
Results: The patient’s age ranged from 20 to 78 years old (mean 43.56 years). The main complaint was abdominal pain and/or abdominal distension; other cases came with different symptoms as subfertility or irregular vaginal bleeding. The histopathology of the assessed masses were 21 benign, 4 borderline, and 25 malignant. The age range for patients with benign tumors was 20 - 65 years (mean 39 ± 13 years) while those with malignant tumors, their age range was 21- 78 years (mean 46 ± 16.953 years). Benign masses included seven serous cystadenoma, six mucinous cysadenoma, three mature cystic teratoma, two ovarian fibroma, and fibrothecoma, and one tubo-ovarian abscess. There were four Borderline tumors (two serous and two mucinous). There were 25 invasive malignant masses (Nine Serous cyst-adenocarcinoma, six Mucinous cyst-adenocarcinoma, three Metastatic krukenburg, three Immature teratoma, two fibrosarcoma, and two clear cell carcinoma).
Conclusion: DCE-MRI and DWI have accepted ability to distinguish between benign and malignant ovarian mass.

The objective of the present study was to predict neonatal respiratory distress by evaluating the colour doppler of the foetal pulmonary artery.
Methods: This was a hospital based observational study conducted among 100 pregnant women who presented for institutional delivery in Obstetrics ward, Department of Paediatrics over a period of two years after obtaining clearance from Institutional Ethics Committee & written informed consent from study participants.
Results: 40 (40%) participants were < 2.25 & remaining 60 (60%) participants were > 2.25 Pulsatility index of pulmonary artery. 40 (40%) participants were < 0.9 & remaining 60 (60%) participants were > 0.9 Resistive index of pulmonary artery. 42 (42%) participants were < 0.305 & remaining 58 (58%) participants were > 0.305 AT/ET ratio of pulmonary artery. 60 (60%) participants required neonate oxygen support > 24 hours. AT/ET ratio had sensitivity of 95.31% (95% CI 86.91% to 99.02%) in predicting respiratory distress. Specificity was 93.48% (95% CI 82.10% to 98.63%), false positive rate was 6.52% (95% CI 1.37% to 17.9%), false negative rate was 4.69% (95% CI 0.98% to 13.09%), positive predictive value (PPV)was 95.31% (95% CI 86.91% to 99.02%), negative predictive value (NPV) was 93.48% (95% CI 82.1% to 98.63%), & total diagnostic accuracy was 94.55% (95% CI 88.51% to 97.97%). Foetuses with MPA PI < 2.25, 2 (5%) developed no respiratory distress & foetuses with MPA PI > 2.25, majority of 57 (95%) developed respiratory distress. Difference in proportion of PI between neonate respiratory distresses was statistically significant (P value < 0.001). Foetuses with MPA RI < 0.9, 2 (5%) developed no NRD & foetuses with RI > 0.9, majority of 57 (95%) developed NRD. Difference in proportion of RI between neonate respiratory distress was statistically significant (P value < 0.001).
Conclusion: The Study found that all parameters, pulmonary artery RI, PI, & AT/ET ratio showed good performance as predictors of RD development in neonates. It is recommended that a foetus with AT/ET <0.305 be delivered in a well-equipped hospital with respiratory support facilities, as it is at risk of developing neonatal RD

The aim of the present study was to find a correlation between histopathological, radiological findings, and immunohistochemical findings in neoplastic breast lesions.
Methods: This study was a prospective study conducted at the Department of Pathology, Government Medical College and Rajindra Hospital Patiala, Punjab. A total of 70 cases of neoplastic breast lesions over a period of 2 years, which had BIRADS score reports, received in the pathology department as trucut biopsies, lumpectomy, and mastectomy specimens were examined histopathologically and immunohistochemistry (ER, PR, HER-2/neu) was done.
Results: In the present study, the age ranges from 14 to 80 years. Out of 70 patients with breast lumps, the highest percentage (42.9%) was seen in females aged 21 to 40 years (30 out of 70). Mean+ S.D age was 37.06 + 17.04. The median age was 35 years. The most common BIRADS category was category 3 with 30 out of 70 cases (42.9%) followed by category 4 with 21 out of 70 cases (30%). 10 cases (14.3%) were seen in category 5. In 70 breast lump cases studied, a broad spectrum of histopathological neoplastic breast lesions like benign, borderline, and malignant were identified. In benign breast lesions, the most common was a fibroadenoma, which was present in 48.6% of the cases. Among malignant breast lesions, the most common was an invasive ductal carcinoma which was present in 30% of the cases. 4 cases with borderline histopathology were also identified. A comparison of all the parameters showed a high diagnostic accuracy of 87.14%, a sensitivity of 89.66%, and a specificity of 85.37% in BIRADS and histopathology. Immunohistochemistry revealed 77.14% ER/PR positive and HER2 negative cases, 17.14% HER2/neu positive, 5.7% triple-negative, and 5.7% triple-positive tumors.
 
Conclusion: The present study concludes that, there is a statistical correlation between radiological (BIRADS), histopathological diagnosis, and immunohistochemistry findings in neoplastic breast lesions. All these techniques have high sensitivity, specificity, and accuracy in making the final diagnosis.
The aim of the present study was to find a correlation between histopathological, radiological findings, and immunohistochemical findings in neoplastic breast lesions.
Methods: This study was a prospective study conducted at the Department of Pathology, Government Medical College and Rajindra Hospital Patiala, Punjab. A total of 70 cases of neoplastic breast lesions over a period of 2 years, which had BIRADS score reports, received in the pathology department as trucut biopsies, lumpectomy, and mastectomy specimens were examined histopathologically and immunohistochemistry (ER, PR, HER-2/neu) was done.
Results: In the present study, the age ranges from 14 to 80 years. Out of 70 patients with breast lumps, the highest percentage (42.9%) was seen in females aged 21 to 40 years (30 out of 70). Mean+ S.D age was 37.06 + 17.04. The median age was 35 years. The most common BIRADS category was category 3 with 30 out of 70 cases (42.9%) followed by category 4 with 21 out of 70 cases (30%). 10 cases (14.3%) were seen in category 5. In 70 breast lump cases studied, a broad spectrum of histopathological neoplastic breast lesions like benign, borderline, and malignant were identified. In benign breast lesions, the most common was a fibroadenoma, which was present in 48.6% of the cases. Among malignant breast lesions, the most common was an invasive ductal carcinoma which was present in 30% of the cases. 4 cases with borderline histopathology were also identified. A comparison of all the parameters showed a high diagnostic accuracy of 87.14%, a sensitivity of 89.66%, and a specificity of 85.37% in BIRADS and histopathology. Immunohistochemistry revealed 77.14% ER/PR positive and HER2 negative cases, 17.14% HER2/neu positive, 5.7% triple-negative, and 5.7% triple-positive tumors.
Conclusion: The present study concludes that, there is a statistical correlation between radiological (BIRADS), histopathological diagnosis, and immunohistochemistry findings in neoplastic breast lesions. All these techniques have high sensitivity, specificity, and accuracy in making the final diagnosis.
 

The main purpose of this study was to give detailed information on the position and normal morphological lower respiratory organs structure in goose which had received a little attention in the field of veterinary anatomy. fifteen  males  adult geese weighing 2-4 Kg were used. The goose was euthanized by the method of inhalation anesthesia .and its body cavity was opened to detect in situ position of thelower respiratory organs. The morphological results of this study show that the trachea appeared long empty cartilaginous flexible pipe , it has pale color and formed from over la The trachea is divided into right and left broncho-syringeal cartilage,  the primary bronchi (extrapulmonary) of the cobra geese consists of incomplete C shaped cartilages rings. pping series of complete tracheal rings which tightly connected to gather. The cartilaginous rings were ossified , these rings are ossify as age progressive the complete cartilaginous ring is to prevent the collapes of trachea due to the negative pressure , which may occur by the inspiration, it was long comparably the neck .
There were some similarities and some differences of the anatomical structures of lower organs of goose and that of other bird species.

The prospective randomised study to asses and compare toxicities, treatment response. The main sites of the oropharynx consist of the posterior and lateral pharyngeal wall, faucial arches, tonsillar fossa, soft palate, and base of tongue.  Nasopharynx begins at the posterior choana and slopes downward along the airway to the level of the free border of the uvula.  Hypopharynx (laryngopharynx) extends superiorly with the oropharynx and inferiorly with the cervical oesophagus. It is divided into the pyriform sinus, posterior pharyngeal wall, and post-cricoid region.

To assess the histopathological spectrum of upper gastrointestinal biopsies among patients with various upper GI symptoms and their association with H. pylori, alcohol and smoking.
Material and method: The present study was a cross-sectional study, carried out on patients of Ispat General Hospital from December 2014 to Nov 2015. Endoscopic biopsy was taken and followed by histopathological evaluation.
Results: Out of total 100 biopsies, 64 were gastric biopsies, 20 duodenal biopsies and 16 esophageal biopsies. 56% male, 44% female.Common age group more than 58 years (38%).56% smokers, 44%  nonsmokers and 57% alcoholic. Out of 16 esophageal biopsy, 9 diagnosed as squamous cell carcinoma, 4 esophagitis, 3 GERD. Out of 64 gastric biopsies, 33 diagnosed as chronic gastritis (33), hyperplastic polyp (7), ulcer (1), adenocarcinoma (23).69.70% cases of chronic gastritis were positive for H. pylori. Percentage of diffuse type of adenocarcinoma stomach was 69.5%. Out of 20 duodenal biopsies, 5 diagnosed as Adenomatous polyp followed by duodenal adenocarcinoma (4) and ampullary adenocarcinoma (1). Non-neoplastic lesion of duodenum included hyperplastic polyp (5) followed by duodenitis (4) and brunner gland hyperplasia (1).
Conclusion: We tried to highlight the importance of routine endoscopic biopsies in patients with upper gastrointestinal symptoms and stain for H. pylori should be routinely done for all cases of chronic nonspecific gastritis. Clinicians should be aware of increasing incidence of GERD and and diffuse type of adenocarcinoma stomach in eastern zone.

To assess prevalance of hearing loss and tinnitus among Diabetes mellitus type 2 patients in the cross-sectional study.
Materials and Methods: 120 patients were divided into groups based on their age, gender, the duration of their diabetes mellitus (10 years), and the types of diabetic medications they were using. In a soundproof room, thorough otoscopy examinations of their ears were performed, along with the tuning fork test, PTA, and other tests. A questionnaire was used to assess tinnitus.
Results: The total no.of diabetic patients considered for this study are 120. Out of which, 76 patients were identified with sensorineural hearing loss (SNHL). In these SHNL patients,48 were identified with mild SNHL(63.15%), 22 patients with moderate SNHL(28.94%), 2 with moderate severe SNHL(2.63%) and 4 patients with severe SNHL (5.26%).Tinnitus is seen in 35 patients (29.16%).The association of age (p=0.21) and sex (p=0.58) with Hearing loss (HL) and tinnitus were not statistically significant. Nevertheless, the duration of diabetes mellitus in relation to these ailments were statistically significant (p=0.07).
Conclusion: The patients with Diabetic mellitus were having higher degree of hearing threshold with B/L mild to moderate SNHL. Age and Gender of diabetic mellitus patients had no major correlation with HL and tinnitus. While the duration had major correlation with HL and tinnitus. These results infer that there is more prevalence of hearing impairment and tinnitus and develop at an earlier age in type 2 diabetes patients

To compare the effects of intrathecal Bupivacaine-Fentanyl (25 µg) combination with that of intrathecal Bupivacaine-Saline combination in patients undergoing Appendicectomy under spinal anaesthesia with regard to, Characteristics of sensory block, Duration of motor block, Quality of surgical anaesthesia, Haemodynamic and respiratory changes, Adverse Effects, if any.
Methods: A total of 60 patients aged between 20 to 40 years of either sex belonging to ASA Grade I & II posted for elective Appendicectomy under Spinal Anaesthesia were selected randomly for the study during the period starting from December 2021 to November 2022, at Department of Anesthesia & Critical Care, Dr B.R Ambedkar Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India. The Study was approved by the Hospital Ethical Committee.
Results: The incidence of intraoperative complications was compared in both the groups. The addition of Fentanyl to intrathecal Bupivacaine did not produce any significant cardiovascular changes (Bradycardia, Hypotension). Respiratory depression was not observed in either of the groups. Nausea & vomiting was seen in 16.6% of the patients in group BS as compared to 3.5% in Group BF. The incidence of pruritus was higher in Group BF but none of the patients required any medication. Postoperative analgesia was assessed by the VNRS score. A significantly lower VNRS score (superior pain relief) was observed in Group BF with average duration of analgesia being 5 hours. The patients were followed up for 24 hours and showed no neurological sequelae.
Conclusion: We conclude that the addition of 25mg of preservative free Fentanyl to hyperbaric Bupivacaine administered intrathecally to a patient undergoing Appendicectomy provides improved quality of surgical anaesthesia, haemodynamic stability and significant post- operative analgesia with minimal side effects. However, the study needs to be conducted on a larger population for further evaluation

The research will link these parameter levels and predict asthma severity to assist clinicians diagnose and treat asthma and avoid abrupt and severe airway blockage in patients with hyperirritability of airways and other allergic disorders, which are at high risk for deadly asthma. 
Method: Department of Biochemistry, Osmania general hospital, Hyderabad, Telangana, India, conducted the investigation on 80 asthmatics and 40 controls who participated in the research. Total Cholestrol, Triglycerides, HDL, LDL, VLDL, Calcium, and Iron were measured. SPSS 17.0 was used to statistically examine the data.
Result: In stable asthma patients, Cholesterol, LDL, Triglycerides, Calcium, Iron, and HDL were significantly correlated. Exacerbating asthma had lower serum very low density lipoprotein, higher serum calcium levels and has higher serum iron concentrations than stable asthma.
Conclusion: In order to help doctors in the diagnosis and treatment of asthma and avoid abrupt and severe airway obstruction in hyperirritable airways, the current research examined lipid profile, calcium, and iron in aggravating and stable asthma patients

Pregnancy and puerperium increases the risk of venous thromboembolism 4- to 5-fold over that in the non-pregnant state. Compared to non-pregnant, pregnant women have a two and a half times increased risk of developing pulmonary embolism. Venous thromboembolism is often fatal. Depending on reports estimate that 10%–30% of patients had mortality within 30 days. The purpose of this study is to estimate the prevalence of thromboembolism in pregnancy and puerperium, risk factors, need for anticoagulants, maternal and fetal outcome in a Govt. Tertiary care center in Chennai.
Materials and Methods: A prospective Descriptive study was conducted in Dept of Obstetrics & Gynaecology, Govt. Kilpauk Medical college, Chennai during February 2019-september 2019 among 200 antenatal and postnatal mothers. Descriptive statistics, Chi Square test were used. A p value of <0.05 was considered statistically significant.
Results: In BMI up to 23 having thromboembolism of 0%, in BMI from 24-29, incidence was thromboembolism of 9.5% and in BMI of 33-36 having thromboembolism of 0%. In patients having BMI between 24-29, risk of thromboembolism was observed high. Hence BMI was considered significant risk factor. One patient developed pulmonary embolism in postnatal period, emergency CTPA done, given LMWH for 3 months & patient revived.
Conclusions: BMI more than 26, multiparity, previous history of surgery, immovability, varicose veins, gestational hypertension, anemia, APLA positive and Eclampsia were the significant risk factors. Since pregnancy is a hyper-coagulable state, by identifying these risk factors and initiating LMWH, we can prevent the complications of DVT. Hence maternal morbidity and mortality can be reduced.

Background: Liver MRI is commonly used for detection and evaluation of focal liver lesions (FLL). Diffusion weighted imaging (DWI) is a functional MR imaging which qualitatively and quantitatively assess the diffusion property of lesion. DWI is a fast sequence that does not require contrast administration. So, it can be used safely as an alternative to contrast sequence in renal insufficiency patients. The study was done to evaluate the role of DWI in characterization of focal liver lesions and differentiation of benign and malignant lesions.
Materials & Methods: 40 patients with 52 liver lesions were evaluated with diffusion weighted imaging at tertiary level hospital on 3T Philips Achieva MRI machine. Informed consents were obtained from patients. DWI of liver was done using three b values (0, 500, 1000 sec/mm2). Qualitative and quantitative assessment of FLL was done using DWI and ADC map. All relevant clinical history, laboratory reports (AFP level), findings on other imaging modalities (USG, CT scan) and biopsy/FNAC were considered for final diagnosis of focal liver lesions.

Endometrium has a wide range of appearance as well as overlapping imaging features, adding to challenges faced while diagnosing endometrial lesions. Although USG is the first modality to detect the endometrial lesions, MRI provides more details about the lesion. Hence, we aimed to assess and compare USG and MRI in characterising endometrial pathologies and to compare their sensitivity, specificity, positive predictive values and negative predictive values for diagnosis using histopathology (HPE) as a gold standard.

Background- Depth of invasion (DOI) is an important factor in pre-treatment staging of tongue carcinoma according to AJCC 8th edition.The present study was planned with the aim of assessing the depth of invasion in tongue carcinoma. (HPE) DOI. The object of the study was to see the accuracy of the diffusion weighted imaging (DW-MRI) sequence over the conventiona lMRI compared with histopathology Methods- A total of 70 biopsy proven cases of squamous cell carcinoma of tongue patients, who received pre-treatment MRI including DWI sequence and surgical resection. The depth of invasion was estimated on T2 weighted fat saturated imaging (T2FS) and DWI MRI, measured by a perpendicular line between the reference line at basement membrane and maximum tumor thickness, then compared with the depth of invasion on the histopathology report. Data was collected and evaluated for T stage accuracy of conventional MRI & DWI MRI, then compared with histopathology using the Independent Chi-square test and correlation coefficient.

Background: Medical education is the most stressful compared to any other courses. Every student who enters medical school must come across a lot of hardships. Aims and objectives: The present study was undertaken to assess the mental well-being of the students so that can offer counselling to them with management strategies. Materials and methods: A total of 90 second-year MBBS students were part of the study after obtaining written informed consent. Depression, anxiety, and stress were assessed using a standard questionnaire called DASS. This is a self-administered questionnaire and is freely available online. Spatial and verbal memory test was used to assess the participants’ cognitive functions. These are standard tests available in the literature.

Background:A fall from a height is the second most common accidental death globally and a significant source of injuries to the individual, especially for the elderly. One significant category of injuries that can be avoided in older individuals is falls.Objectives: Tostudydifferentpatternofinjuriesonthebodieswhodiedincasesofdifferentfallfrom height.Tostudyrelationoffatalinjurieson thebodyandtheheightof fall.Tostudythedistributionofotherinjuriesassociatedwithfallsfromheight withrespect tomortality.Methodology :All cases of falls from height presented to the OGH mortuary in Hyderabad for autopsy will be chosen using a purposive sample strategy if they meet the inclusion and exclusion criteria. Each case will be examined in light of 1) Post-mortem results, paying particular attention to the reason of death, the length of time since the death, and the method of death. 2) Information gathered by the police and relatives 3) Hospital data in instances that were admitted 4)Laboratory investigations, such as toxicological (chemical) analyses and histology. 5) Inspect the crime scene or examine photos of the scene to determine the height of the fall and whether an obstruction was in the victim's direction of flight.

AIM: The aim of the study is to assess the specific antibody response in SARS-CoV-2 patients with and without comorbidities. MATERIALS AND METHODS: This is a prospective observational study conductedto measure SARS-CoV-2–specific antibodies in COVID-19 infected patients. The study included total 60 patients, 30 with co-morbidities and 30 without co-morbidities. Both inpatient and outpatient patients, with positive COVID-19 RTPCR were included and they were followed up at 21 daysand 4 monthspost infection. The blood samples were collected after obtaining the consent from the study participants. Serum was separated by centrifuging the blood samples and were further subjected to ELISA to detect specific IgG antibodies against N and S proteins of SARSCOV2. Data was entered in MS excel and analysed using SPSS 23.0 version software. RESULTS: In the study out of 60 patients, most patients i.e., 48.3% (29/60) were in age group of 41-59 years; followed by 36.7% (22/60) were in age group of <40 years and 15% (9/60) were in age group of ≥60 years. Mean age of patients was 36.4 ± 6.8 years. It was found that, anti-N IgG levels at 21 days were positive in 78.3% (47/60) and negative in 21.7% (13/60) with increase in seropositivity to 93.3% (56/60) and fall in negative rate to 6.7% (4/60) at 4months. On the other hand, anti-S IgG levels at 21 days were positive in 83.3% (50/60), negative in 16.7% (10/60) with positive rate of 96.7% (58/60) and negative rate of 3.3% (2/60) at 4months. Both the antibody assays, anti-N IgG, and anti-S IgG in successive time periods, demonstrated the significant increaseinseropositivityandmaintainedlongevityofantibodieswithtime.Inthestudy, 5/5 patients with IHD and 3/3 patients with COPD had 100% serologic response to both N and S proteins of SARS-CoV-2 at 21 days and 4 months. But no significant strong correlation can be established between the seropositivity and longevity of antibodies with various comorbidities due to limited sample size.

Here we are presenting anaesthetic management of 61-Year-old male patient with Cardiac Resynchronization Therapy Defibrillator (CRTD) in situ, posted for Open Reduction Internal Fixation (ORIF) of left tibia Fibula, without interfering in the function of CRT defibrillator.Right selection of mode of anesthesia and changing the CRTD mode into asynchronous one are few of all the important factors that could be practiced Perioperative care in CRTD implanted patients. General anesthesia is avoided and Sab-Arachnoid Block anaesthesia causing sympathetic blockage to avoid hypotension should be preferred. Patient was preoxygenated and premedicated with 2 mgbutorphanol and 1 mg midazolam following which modified rapid-sequence induction was done using 100 mg propofol and 50 mg rocuroniumintaveously. Maintenance of anaesthesia was done with oxygen, nitrous oxide, isoflurane and rocuronium. Patient surgery completed successfully without any post-operative complications.

Intrauterine growth restriction (IUGR) is a pathological condition in which a fetus has not achieved his genetic growth potential , regardless of size
Objectives –To study the perinatal outcome in growth restricted fetuses with the help of Doppler Velocimetry using Barcelona Staging.
Methods - Record Based Study from 7 June 2021 to 7 march 2022 will be analysed.
Results Out of 86 pregnancies,35 cases of abnormal doppler velocimetry were included under Barcelona staging and outcome was studied. 51.4% were of age group -20-24yrs. 57.1% were primigravidas. Most common associated risk factor is Preeclampsia and oligohydromnios. 68.5%,2.8%,14.2%,14.2%  were in Barcelona stage 1 ,2,3 and 4 respectively. Maternal and perinatal outcome were good in stage 1.Perinatal death 3 cases
Conclusion Management using Barcelona staging will be helpful for Obstetrician to determine the proper monitoring and timing of delivery

Caesarean section rate is increasing in the world, including India (28.1% according to Indian Council of Medical Research).¹ Because of this rising trends in caesarean section rate, World Health Organization recommends to conduct institutional audits to reduce C-section rate using Robson's ten group classification system, thus postulating the institutional protocols to reduce the C-section rate.
Objectives of the study are todescribe various indications of C-section as per Robson criteria ten group classification in our institute and to identify modifiable factors to reduce C-section rate in our institute.
Method: A record based study was conducted over a period of 12 months (July 2019 to June 2020) among the women who delivered through C-section in a government tertiary care centre, Mandya.All women who underwent C-section were classified according to Robson 10 group classification.
Results:  Out of total 7738 women delivered during study period, 3207 women (41.1%) underwent C-section. Largest contribution to the total C-section rate was group 5, 1329(41.1%) women underwent C-section. Second largest group was group 2 (nulliparous, induced or C-section before labour) contributing to 23.4% to overall C-section rates. Modifiable indications identified were failed induction (53.2%) in group 2, failure to progress (40.1%) in group1 and repeat C-section (group 5).

Diabetes has emerged as one of the most serious and common chronic diseases of our times, causing life threatening, disabling and costly complications, and reducing life expectancy. Type 2 diabetes (T2D) is a multifactorial disease affecting mostly adults older than 40 years. The aim of the study was to examine GST gene polymorphism influence on the risk of T2D, especially in young adults. Research design and methods: 50 diabetic patients and 50 healthy controls participated in this study.  GST gene polymorphism has been analyzed using TaqMan real-time quantitative PCR. Results The distribution of examined polymorphisms was similar in patient group and control group. Statistically no significant differences were demonstrated for GSTT1/M1 genotypes. We found a significant association with GSTT1 gene with lipid profile and blood pressure.  Conclusion: The results of our study suggest that GST polymorphism may be one of the risk factors for developing T2D Dyslipidemia and patients are at the high risk of coronary artery disease

Kindly transplant is the most valuable surgery to improve the survival and change in life style quality in the end stage of renal dises in living robotic donor nephrectomy reduces waiting time for resipent patient and avoid more Hemodialysis.
Aims: The aim of the study is to analyze the effect of graft kidney short and long time outcome. After Robotic living donor nephrectomy with minimal hospital stay.
Materials and Methods: This study conducted on patient admitted for renal transplant both the donor and resipent posted for OT for living robotic donor nephrectomy and also posted for open donor nephrectomy in Apollo malty specialty Hospital Kolkata all patient were older than 20 years both the donor and resipent in the study analysis of robotic donor nephrectomy of warm ischemia time on delayed graft function rate of decline in in serum creatinine in the first 10 days and change of creatinine at 3 month Acute and delayed graft rejection.
Result: It nephrectomy Robotic (Living) is a safe procedure immediate kidney allograft function was good with less chance injury in graft kidney, vein, artery, ureter it was performed successfully in all case with a short surgical time with also low morbidity and 0% moriality and minimal hospital stay very less chance in acute and delayed graft kidney rejection with grate cosmetic value.
Conclusion: In our study we found that, In nephrectomy Robotic (Living) was better procedure than open donor nephrectomy (Living).

Stoma is a surgically created intestinal opening on anterior abdominal wall. Its common forms include colostomy and ileostomy. History of stomas dates back to 1710 when Littre of Paris made first ventral colostomy for imperforate anus. After World War I a mortality rate of 60% due to primary repair of colonic injuries dropped to 30% in World War II due to the introduction of colostomy. Ileostomy gained popularity for ruptured appendix and appendicular abcess.
Aims: To compare the different methods of wound closure following stoma takedown in terms of superficial surgical site infection (SSI), to study other patient related factors like age, gender, nutritional status & other comorbidities which might be involved in developing complications at stoma takedown site and to study complications at stoma takedown site, other than SSSI, like abnormal wound healing & poor cosmesis, and their rates of occurrence in different wound closure methods.
Materials and Methods: This study was a prospective, observational, institution based, cross-sectional study. Ninety patients fulfilling the inclusion criteria and not having any exclusion criteria, from department of General Surgery of Bankura Sammilani Medical College and Hospital during the period of 1st November 2019 to 31st October 2020 were selected.
Result: In our study, patients with end colostomy (Hartmann’s procedure) have got the maximum count (22 out of 90; 24.44%), just followed by those with loop ileostomy (21 out of 90; 23.33%). Patients having loop or double barrel stoma (61 out of 90; 67.78%) had only one stoma-site post-operative wound as they didn’t require separate laparotomy for reversal. On the other hand, patients with end colostomy (Hartmann’s procedure) and end ileostomy with colonic mucous fistula at separate site (total 29 out of 90; 32.2%) required laparotomy for reversal.
Conclusion: It can be concluded that in a stoma takedown operation, use of purse-string technique during skin closure leads to decreased incidence of superficial surgical site infection at stoma closure site, in comparison to Linear primary suture & Delayed primary intention technique.

The aim of the study is to detect the effect of magnesium sulphate on neonates when given antenatally, detect gross neurological effect of magnesium among them.
Method: We studied neonates at our institution who were stratified by exposure to magnesium sulfate and compared by various neonatal outcome variables. The exposed population(n=75) was compared for various neonatal outcome variables with the non-exposed group(n=75).
Results: The study included comparable number of distributions in gestational age variation: 9.3%; early preterm, 13.3% each of moderate and late preterm, 62.7% term and 1.3% post-term. The proportion of perinatal asphyxia was found to be significantly higher among the group with antenatal magnesium sulphate (p=0.014); neonatal convulsions were found to be significantly lower (p=0.001). Different neurological events like requirement of intubation at delivery, hypotonia, hyporeflexia were found to be higher in proportion among exposed group but not statistically significant. Significant number of babies in MgSO4 group got admitted in SNCU (p=0.004) but intensive care was not required. NICU care were mostly required for non-exposed group (p=0.02). Use of nasal-CPAP (p=0.02) and invasive ventilation (p=0.034) were significantly higher among non-exposed group. Neonatal death was higher among non-exposed group; not statistically significant (p=0.26) Mean cord blood Mg2+ value was 2.73 mg/dl for those exposed and 2.26 mg/dl for non-exposed group.
Conclusions: Antenatal magnesium has significant effect on immediate outcome after birth and is slightly hazardous due to perinatal depression. This study depicts the need for studies of antenatal magnesium-sulfate protocols which may lead to maternal and neonatal benefits.

Autopsy means to see for oneself. It is derived from Greek word autopsia, autos(oneself)and opsis(eye). The main prerequisite of autopsy is to provide information about the cause and mode of death. It gives us information related to death of deceased to the investigating officer as well as family members. ^[1-3] Many times, there are certain findings which are not related to the primary cause of death. Histopathology is of great academic value in these cases it helps in finding rare lesions that go unnoticed when the person is alive.

29 patients were treated with this conversion of external fixator to ilizarov. 28 males and 1 female. Out of the 29 patients of open tibia fractures, 16 were case of polytrauma.21 patients were Gustilo and Anderson type 3B, and 8 patients were type 3A. 9 patients had less than 2 cm loss at presentation and 12 had more than 2.5 cm bone loss. 20 patients were associated with significant soft tissue loss at primary surgery or second look debridement.  20 patients needed corticotomy and bone transport. Pin tract infection was present in all patients, needed only appropriate antibiotics and through cleaning to control. External fixator index was 2.8days /cm of lengthening. Out of the 29 patients 16 patients were cases of polytrauma and had associated blunt abdomen, chest or other long bone injury. The index surgery was done after 6 pm in 17 cases and conversion to ilizarov fixator at mean time period 13 days (8 – 31 days). Radiological results were excellent in 19 cases but 16 of them had excellent functional score, 9 had good radiological score and 12 had good functional score and one case had poor radiological and functional score. 

This study designed for detection the prevalence of IBS and efficacy of different drugs in treatment of these cases. The total patients that examined were 640. Out of 160 confirmed patients with IBS, sixty persons at different ages from 21-45 years and both sexes were selected and divided into 4 groups each group contain 15 persons: The research is a cross-sectional analysis of a population sample of people visiting hospitals and health centers in Baghdad, Iraq. Patients were not eligible if they had a prior experience of a gastrointestinal illness other than IBS or if they had undergone gastrointestinal surgery. G1 control negative, G2 Patients were given mebeverine pills having 135 milligrams three times weekly for 8 weeks, G3 patients were given 3-6 × 10⁹ CFU per capsule, in equal representation of each probiotic were treated for 8 weeks, G4 patients were given tablet with a fine powder blend of three herbs: Mentha longifolia leaves (150 mg), Cyperus rotundus tubers (150 mg), and Zingiber officinale tubers (150 mg) (150 mg). For 8 weeks, the pills were given thrice weekly, once before each dinner and once an hour after eating. The current study showed that the age group 21-30 were highly infected when compared with another age groups. The results of treatment trails exhibited that mebeverine and herbs were most effected treatment as compared with probiotic treated group. The results of treatment trails exhibited that mebeverine and herbs were most effected treatment as compared with probiotic treated group

Alcohol Use Disorder is quite prevalent in general population. Sexual dysfunction in alcoholics is unrecognized and not reported by patients. Moreover sexual dysfunction can lead to stress which can further increase the consumption of alcohol and it can lead to poor quality of life.
Objectives: To study the prevalence of sexual dysfunction and quality of life among male patients of Alcohol Use Disorder
Methods: This was an observational, cross sectional, single-centered, interview based study of total 100 consecutive male patients aged 20-50 years admitted in psychiatry ward & coming to psychiatry OPD of Sir.T.Hospital, Bhavnagar. Interview was taken for diagnosis of Alcohol Use Disorder using DSM- 5(Diagnostic and Statistical Manual of Mental Disorders-5) Criteria. Every patient was assessed by proforma containing demographic details, questionnaires of SAD-Q (Severity of Alcohol Dependance), CSFQ-M-C ( Changes in Sexual Functioning Questionnaire – Male Clinical Version ) & WHOQOL BREF(World Health Organization Quality Of Life). Statistical analysis was done with graph pad in stat version 3.06(San Diego, California US). Proportion of participant was compared by using chi-square test, while scores of CSFQ-M-C, SAD-Q, WHOQOL BREF were compared by using Mann Whitney test. A p value of <0.05 was considered statistically significant.
Results: Frequency of sexual dysfunction among male patients of alcohol use disorder was 70%. Among the domains of sexual dysfunction; the highest frequency was seen for dysfunction in desire/frequency (84%), followed by premature ejaculation (82%), problems in pleasure (80%), difficulty in erection (68%) & least was decrease in libido (64%). Sexual dysfunction was not dependent on the amount( p value=0.1916), duration(p value=0.7038) & severity of alcohol dependence (p value=0.128). The quality of life was poor among patients with alcohol use disorder & it was dependent on severity of alcohol dependence ( p value= 0.0009, 0.0014, 0.0014, 0.0007)
Conclusion: Sexual Dysfunction had no correlation with the amount, duration of alcohol intake & severity of alcohol dependence. Patients with alcohol dependance had poor quality of life & it was related with severity of alcohol depandance.

The knowledge about the hip joint space width which is formed between the head of femur and acetabulum is essential for radiological practice in identifying the pathologies of hip joint like osteoarthritis and in orthopaedic surgeries.
Aim:Determination of mean values of hip joint space width.
Materials and Methods:Normal plain radiographs of pelvis with bilateral hip joints – AP view of both males and females between the 20 to 50 years of age were used for study.  A total of 200 x-rays (100 males and 100 females) were included in the study.
Inclusion criteria: a) Patients complaining of pain in hip, who had no joint pathology defined on the basis of radiological examination. b) Patients of age group 20-50 years.c)Patients without any deformity of hip joint. Exclusion criteria:a)Patients having history of pathologies like Osteoarthritis, Tuberculosis, Fractures around hip joint. b) Patients having history of Surgical intervention around this area.

The most prevalent cutaneous malignancy in white individuals is BCC, while SCC is the most prevalent among those with darker skin tones, including Indians. The head and neck region is predisposed to BCC. Unlike melanoma, BCC normally does not cause life-threatening disease, although it is locally invasive and can cause significant morbidity and complications. Surprisingly, recurrence in BCC is observed even after complete excision with a clear margin. Therefore, further studies are required for a better understanding of these recurrent cases and to improve the treatment approach.
Methods and Material: This retrospective study was conducted at the Plastic and Reconstructive Surgery department. The study included all patients admitted with BCC of the head and neck region for a period of fiveyears.
Results: A total of 42 patients with BCC lesions of the head and neck region, were identified. There were 24 males and 18 females. The majority of patients were noted in the 50 – 80 age group. Tumours most commonly involved the cheek region. The majority of the examined primary BCCs were nodular clinically. On confirmation by histopathology, most of the lesions were nodular. Multiple recurrences of the disease were observed in one patient.
Conclusions: The clinical and histological pattern of BCC in this area of India is presented in this study. The most likely risk factors in this population are ageing and long-term sun exposure. The primary risk factors of the recurrent disease are the site, histopathologic subtype, and margin status.

To determine whether shoulder pain is common and whether it affects individuals with uncontrolled diabetes mellitus' ability to do daily activities (DM).
Methods: All patients with uncontrolled DM (HbA1c > 9) who visited the diabetes clinic throughout the study period were included in this cross-sectional study, which was carried out over a period of four months from October 2021 to January 2022. A doctor from the Family Medicine Department conducted telephone interviews using the American Shoulder and Elbow Surgeons Assessment Form, a previously validated questionnaire.
Results: The study involved 285 patients in all; 156 (54.7%) of them were women, and 129 (45.3%) were men. Most of the patients (51.1%) were in the 45-64 age range. 41.1% of the patients had type I DM, while 58.9% of the patients had type II DM. 10.56 was the mean HbA1c value. 42.5% of the patients (109; 38.2%) who reported shoulder pain were between the ages of 45 and 64, and 44.1% were between the ages of 65 and 96. In contrast to the 176 (61.8%) participants who reported no pain at all, 70% of men and 54% of women had no shoulder pain (p 0.001). According to various age groups, the average shoulder pain intensity for all patients was 5.81 (SD=3.21), ranging from 4.71 (SD=3.15) to 6.13 (SD=3.29) and showed a significant correlation (p<0.05).
Conclusions: Physicians are becoming more concerned about early identification and treatment of shoulder dysfunction due to its rising prevalence. In order to enhance the patients' daily lives, it should be obligatory for diabetes care programmes to include screening, preventive, and rehabilitation measures for shoulder dysfunction

There is a number of pathological, epidemiological, molecular basis which could establish an association between the liver dysfunction and thyrotoxicosis. Thyrotoxicosis is defined as the state of thyroid hormone excess while Hyperthyroidism is the result of excessive thyroid function.
Aims: Assessment of liver function in the background of newly diagnosed thyrotoxicosis, comparison between liver function and different types of thyrotoxicosis and co-relation of clinical activity score (CAS) and liver function test (LFT) in Graves” disease.
Materials and Methods: The present study was a Institution based Cross-sectional study. This Study was conducted from 18 months (From 1st January, 2020 to 30th June, 2021) at Department of General Medicine, endocrinology outdoor of Calcutta National Medical College and Hospital, Kolkata.
Result: Chi-square (c² ) test showed that there was significant association between level of total bilirubin and types of thyrotoxicosis of the patients (p=0.0059).High level of total bilirubin was prevalent in significantly higher proportion among the patients with Multinodular Goitre (100.0%) as compared to other types of thyrotoxicosis (p<0.01)
Conclusion: In conclusion, the results of our study suggest that thyrotoxicosis is associated with abnormal liver biochemical tests in about two-third of the presenting cases and the most commonly elevated parameters are ALT and AST followed by ALP levels. Therefore, patients presenting with unexplained hepatic abnormalities require evaluation of the thyroid function

Pediatric burns are a significant international public health problem. Developing and developed countries report similar challenges regarding paediatric burn prevention programs. The study was done to analyses the burn mechanism, the age and circumstances in which children are burned, as well as their home environment variables. Retrospective study also identify demographics, etiologies, and mortality risk factors.
Methods and Materials This retrospective study included 344 children with age 0 to 15 years of age who were admitted in Burn Unit of GMCH of Guwahati with different etiologies of burn from 1^st January 2017 to 31^st December 2021. Study started after taking ethical clearance from ethical committee,the records from burn department of GMCH during this period of time.
Results Common age group admitted to burn Icu were 1-5 years which accounted for 43% of total admitted children followed by children with age group of 0-1 year(30%). The most common etiology of burns were found to be scald injuries(57%) followed by flame burns(30%). Maximum number of burns incidents took place in month of November (n=56,16.2%) followed byJanuary ( n=54, 15.6%) and December ( n=52,15.1).
Conclusions  Children should be taken care by parents or guardian specially those who are age group of 1-5 years as these are actively mobile but unaware of the danger they face. Parents should be given education and awareness about the prevention of burns in children

Brain is the most majestic and intricate organ in the human body. The ventricular system consists of a series of interconnecting spaces and channels within the brain which are derived from the central lumen of the neural tube. Third ventricle is the cavity of diencephalon that lies between the two thalami and is related to the most important structures of brain. Abnormality arising from any of these structures can obstruct the third ventricle affecting the cerebrospinal fluid  drainage. It is important to distinguish the pathological ventricular enlargement from age related ventricular enlargement.
Aims: To estimate the transverse diameter of third ventricle with respect to age using magnetic resonance and imaging in adults of Kashmiri population.
Settings and Design: Observational study
Methods and Material: The axial MR images of 100 patients were reviewed in the Department of Radiodiagnosis, GMC, Srinagar. The transverse diameter of third ventricle was taken at the level of interventricular foramen between the two thalami.
Statistical analysis used: SPSS
Results: The transverse diameter of third ventricle ranged from 2.1mm -8.29mm with a mean of 4.17mm. The results revealed a significant increase in the transverse diameter with increasing age.
Conclusion: Knowledge about the mean width of third ventricle in different age groups and in either gender may help to distinguish the pathological ventricular enlargement from age related ventricular enlargement.

In this study, 60 blood samples were collected from pregnant and aborted women infected with Toxoplasmosis, while 30 blood samples were collected from non-infected women. 5 ml of venous blood was collected and placed in SST (Serum Separating Tube) tubes for 10-15 minutes to separate the serum before centrifuged for 10 minutes at 3500 rpm. FSH and LH concentrations, as well as IL-12 and IFN-γ kinetics, were measured using ELISA. The study's findings revealed a rise in the concentrations of IL-12 and IFN-γ, which were (10.17±0.20 pg/ml) and (8.67±0.18 pg/ml) in the affected women, respectively. It was also discovered that the concentration of IL-12 did not change between the two age groups (20-30) and (40-31) for female patients, where it reached (10.15±0.25) and (10.32±0.33) pg/ml, respectively, whereas the high concentration of  IFN-γ was recorded within the age group (40-31) for female patients, which amounted to (9.61 ±0.51pg/ml) compared to its concentration in the age group (20-30) for female patients, whichamounted to (8.40±0.14 pg/ml). The infected women likewise had high LH concentrations and low FSH concentrations, which were (14.85± 0.94)) and (5.20±0.607) mlU/ml, respectively. There was no difference in the concentration of LH hormone for female patients in the two age groups (20-30) and (40-31), as it was (15.08± 1.28) (14.21 0.28) mlU/ml respectively., and no difference was shown in the concentration of FSH among the female patients in the age groups (20-30) and (40-31), its concentration was (5.58 ± 0.90) and (4.11 ± 0.13) mlU/ml respectively.

Complex renal cysts and masses occur in all age groups, right from WiIm’s tumor that commonly occurs in children, renal cell carcinoma (RCC) in adults; to the rarer multilocular cystic nephroma (MLCN), which is found in both the age groups, although with different sex predilections.
Objectives- To evaluate imaging characteristic of complex renal cysts and the role of USG (including Doppler) and CECT.
Methods- The study was conducted on 42 patients in the Radiology department of Command Hospital Air Force, Bangalore from December 2014 to July 2016. Cases were included in the study after taking informed consent. All patients were examined by CECT and  USG (including  Colour Doppler) whenever required. USG studies were performed using real time equipment utilizing 3.5 MHz curvilinear electronic probes and Colour Doppler, whenever required. In paediatric patients, 7.5 MHz linear electronic probes were used. CT examinations were performed using an MDCT scanner (Volume Zoom; Philips, Somatom  AR-HP I  Somatom Hi-Q systems  Forcheim, Germany) with a gantry rotation of 0.5 seconds. SPSS was used for analysis.
Results- there are 42 patients in our study, who on CT scan were seen to have cystic renal lesions of them, 33 (79%) patients were adults, with the oldest of our patients being 85 years old (mean age -40.3 years). 21(42%) were predominantly cystic masses and 28 (58%) were predominantly solid. Of the predominantly cystic masses 10 (20%) were unilocular cysts and 11 (22%) were multilocular cysts. we had 10 (20%) cases with unilocular cystic renal lesions. We excluded simple cysts less than 3 cm in diameter. Amongst these 10 patients with unilocular masses, 1(10%) patients had renal cell carcinomas and 9 (90%) had simple renal cysts (including complex benign cysts). Malignancy was seen in 1 patient, which though comprising only 10% of unilocular lesions is a significant number.
Conclusion- a suspected renal mass should undergo a USG as the first line of imaging. A confident diagnosis of simple cyst should make one stop from further imaging.

Chronic hepatitis C (CHC) may be seen in cancer survivors due to frequent blood component therapy and parenteral exposures during treatment. Considering the long term adverse effects of CHC, the study was carried to evaluate the response of combination therapy (Pegylated Interferon and Ribavirin) in cancer survivors affected with CHC as direct acting antivirals have still not been approved for children below 12 years age.
Methods: This was a retrospective study carried in cancer survivors below 12 years, who had CHC. They were treated with combination of Pegylated interferon alpha2b 60mcg/m²/week and ribavirin 15mg/kg/day for 24 or 48 weeks for Genotypes 3 and 1 respectively. Rapid viral response (RVR) and sustained viral response (SVR) were evaluated by PCR at 4 weeks of starting therapy and after 24 weeks of completing therapy. Data on coinfection with Hepatitis B was also evaluated.
Results: Of the 32 patients, 21 were leukemia/lymphoma survivors and 11 were survivors of solid tumours. Genotype 1 was seen in 22/32(69%) and Genotype 3 in 10/32(31%). Hepatitis B co-infection was present in 6 (18.7%) patients. RVR (100% vs 45.5%) and SVR (100% vs 62%) were significantly higher for Genotype 3 as compared to Genotype 1. SVR for HCV was not significantly different in those with HBV coinfection as compared to those without.
Conclusion: Pegylated IFN and ribavirin combination therapy is a successful modality for treating CHC in age group <12 years in childhood cancer survivors where long term morbidities due to Hepatotropic viruses affect the quality of life.

Organ donation has become a motivating factor for saving a life under many circumstances. The life expectancy has also increased with the advent of organ donation. The objectives of the study are to assess the knowledge about cadaveric organ donation among anatomists and their attitude and willingness towards cadaveric organ donation(COD).
Materials and methods : A descriptive cross-sectional study was conducted among anatomists in India during the months of January and February 2022. Data was collected by using a pre-structured and pre-tested questionnaire from 371 anatomists .
Results: 79.2 % knew the purpose of organ transplantation. 39 % participants strongly agreed for organ donation after their death. 29.6 % are willing to donate organs to facilitate the medical teaching.
Conclusion : Health care professionals can play great potential role in maximizing the limited organ supply for patients with end stage organ failure. Majority of health care professionals were well aware of COD. But, their attitude towards cadaveric organ donation is not as much as their level of knowledge. Hence, intensive education on the importance of organ donation is much needed nowadays

The object of the study were 97 patients, children with community-acquired pneumonia associated with mycoplasma and chlamydial infection aged from 1 to 7 years. Dynamic analysis has proven the benefit of differentiated treatment. In group II, during therapy on the 6th day from the start of treatment, a pronounced positive dynamics of physical data was observed. Analysis of the effect of differentiated treatment on the parameters of biochemical data of the examined patients revealed a positive effect on the studied parameters. There was a significant decrease in the content of NO₂(NO₃), HP, ONOO- and a significant increase in eNOS compared with the data of group I. After treatment, the concentration of MDA was 1.8 times higher than in practically healthy children and 1.4 times lower than in children who received basic therapy. A decrease in the level of MDA in the blood in patients with CAP associated with MI and CI during treatment states a decrease in free radicals and an increase in the intensity of AOS.

Covid-19 pandemic has significantly impacted the population's psychological and social well-being. This study was initiated to ascertain the psychosocial impacts of the COVID-19 recovery such as depression, anxiety, and bereavement, as well as to assist in ascertaining the psychosocial repercussions of the pandemic. Long periods of isolation can be costly on the economy, hence impact of the disease on quality of life in people who have recovered from Covid-19 was assessed.
Methods and Material:Across-sectional study conducted on patients who have recovered from Covid 19 and were visiting a tertiary health care center. Patients consenting for study were interviewed based on the ICD-10 criteria for depression and anxiety. DASS and WHO-QOL questionnaires were used to measure the severity of depressive, anxiety symptoms and quality of life. The data was analysed using SPSS (statistical packages for social sciences) version 20.0 software.
Results: Female population was 36% and male population was 64%. Oxygen support was required by 83% of the subjects. In the participants the severity of depression, anxiety and stress were recorded. There was total 48, 45 and 38 patients who reported to have depression, anxiety, and stress respectively. ICU admission was required by 40% of them. The association of oxygen support, with depression and stress was significant, with higher number of patients requiring oxygen support. While there was no association of anxiety and oxygen support.
Conclusions: Pandemic has had significant psychological sequalae on the participants, not only while they were infected but also chronically in terms of their quality of life.

These days, a lot of information is exchanged on social media, and it can be difficult to tell what information is accurate and what information is false. As soon as they read the content, people start sharing their problems or ideas without first checking your validity. Its spread is a result of this as well. The most common sources of misleading and unverified information are rumours and fake stories, which should be exposed as soon as possible to prevent their unexpected effects. Online forums are where most smart phone users choose to read tales. News websites disseminate breaking news and offer a source of confirmation. How to spread news and articles on social media platforms like WhatsApp groups, Facebook pages, Twitter, and other tiny blogs and social networking sites is the subject at hand. It is risky for the general population to take these rumours and news stories seriously. There is an urgent need to put an end to rumours, especially in growing nations like India, and to concentrate on legitimate, established issues. This essay demonstrates a paradigm and a technique for gathering misleading information. The proposed model's outcomes are contrasted with those of other models. The suggested model performs well and explains the results' accuracy to a maximum of 93.6% accuracy.

All phases of life, including pregnancy, are important for quality of life (QoL) and its determinants. Pregnant women's quality of life is impacted by the physical and emotional changes that occur during pregnancy, which has an impact on both maternal and baby health. As a result, evaluating the quality of life of pregnant women is becoming more popular in literature. Therefore, our goal was to describe pregnant women's quality of life (QoL) during physiological pregnancy and to find the factors that predict it in women who were using a public healthcare system.
Methods: At a hospital in India, the department of obstetrics and gynaecology undertook a cross-sectional study. SPPS v 21 was used to code and analyse the data. In order to determine whether the data were normal, the Kolmogorov-Smirnov test was applied, and non-parametric tests were performed as a result. The developers' suggested assessment of Quality of Life was conducted. The determinants of QoL were found using linear regression, and significant relationships were found using the Chi-square test. P values of 0.05 were considered significant for all analyses.
Results: The study had a participation rate of 433 pregnant women and a 98% response rate. The current cohort's QoL was very good, as evidenced by the mean QoL score of 19.85 4.89. A substantial correlation was found in the Chi-Square study between age, education, occupation, income, marital status, and trimester. According to research, education is a good predictor of QoL (p = 0.006, r = 2.157). Trimester, on the other hand, was found to be a poor predictor of quality of life (p = 0.013, r = -1.123).
Conclusion:  Pregnant women's quality of life must be improved via better understanding of their challenges and support. The current study focused on the trimester and educational level as the main predictors of QoL in pregnant women. When creating treatment plans and interventions for pregnant women, healthcare practitioners and governments should take the considerations into account.

Laparoscopic surgery has now become the most accepted surgical and safe technique for a number of surgery including cholecystectomy , appendcectomy , etc .Advantages over open procedures include lesser haemorrhoage , better cosmetic results , lesser post operative pain and better results . To compare the analgesic effect of intraperitoneal application of  bupivacaine and bupivacaine with dexmedetomidine in laparoscopic cholecystectomy . To assess the quality of analgesia by visual  analgesia scale score (VAS).
Material and Method: This study was an interventional, prospective, double blind, parallel group, randomised clinical study conducted on patients undergoing laparoscopic cholecystectomy surgeries. Institutional Ethical Committee Approval was obtained and written informed consent was obtained from all the patients before the screening in the study. Total of 162 patients were selected in which 81 were randomly allocated in each group using table of randomisation. Study Duration Period 2 Sep 2020 To 2 March  2021.
Conclusion: Hence our study showed that intraperitoneal instillation of dexmedetomidine 1 µgm/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the post-operative pain and significantly reduces the analgesic requirement in post-operative period as compared to bupivacaine 0.25% alone.

Epidural anesthesia have important role for surgeries of lower abdomen, pelvis and lower limbs as they offer excellent operating conditions and are relatively safe for patients. This is especially useful in patient who are at risk of pulmonary aspiration
Materials & methods: The  study  comprised  of  60  ASA grade  I and II patients,  of either sex,  age  group  20-70  years and weight  40-75 kg. undergoing elective  surgeries  on  lower  limbs,  pelvis  or  abdomen  with  no  contraindication to epidural  anesthesia were selected. All patients were admitted in Gynecology, Surgery and Orthopedics ward, was conducted in the Department of Anesthesiology ANMMCH Gaya.
Conclusion-: clonidine  will  definitely expand scope  and  improve  the reliability  and  efficacy  of  epidural  anesthesia.  The  major  clinical  place  of  clonidine  is  as  on  adjuvant  to other  analgesics and  local anesthestic  as shown  in  number  of  studies

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

Vecuronium has a slow onset of action (2-3min) which limits its use in situations requiring rapid establishment of airway. Rocuronium can provide good intubating conditions within 90sec but it is not used routinely because of high cost. Combination of rocuronium with vecuronium is known to produce synergism without producing any side effects. It provides rapid onset of action and acceptable intubating conditions. This study was undertaken to evaluate the clinical benefits of the combination of rocuronium and vecuronium in terms of better haemodynamics and acceptable intubating conditions over individual drugs.
Methods: 90 ASA grade I and II patients in the age group 20-60 years of either sex scheduled for elective surgeries done under general anaesthesia were recruited for the study. They were randomly allocated into three groups - group V, group R, group RV with the sample size of 30 in each. After induction with fentanyl-propofol-nitrous oxide- oxygen, group V received vecuronium 0.08 mg/kg, group R received rocuronium 0.6 mg/kg and group RV received a combination of rocuronium 0.3 mg/kg with vecuronium 0.04 mg/kg.
Conclusion: The combination of rocuronium and vecuronium can provide clinically comparable conditions for tracheal intubation as rocuronium alone without compromising haemodynamic stability, thus, can be an economic alternative to rocuronium for intubation

General anaesthesia with endotracheal intubation often results in postoperative sore throat, cough and hoarseness of voice. Benzydamine hydrochloride is a topical NSAID with analgesic, local anaesthetic, anti-inflammatory properties. We studied the effect of benzydamine hydrochloride gargling on the incidence and severity of sore throat, cough and hoarseness of voice in patients undergoing elective middle ear surgery under general anaesthesia with endotracheal intubation.
Methods: A prospective randomized placebo controlled double blind study, After institutional ethical committee approval, written informed consent was taken from all the patients after explaining the procedure. 120 patients of either gender scheduled for elective middle ear surgeries under general anaesthesia with endotracheal intubation, who fulfilled the inclusion and exclusion criteria were included. Patients were randomized into two groups -Benzydamine hydrochloride group and control group using sealed envelope method. Patients in Benzydamine hydrochloride group were gargled 0.15% of 20ml benzydamine hydrochloride solution and control group patients gargled 20ml of 0.9% saline for 30secs, 5mins before intubation.
Conclusion: Preoperative benzydamine hydrochloride oral gargle reduces the incidence and severity of sore throat, cough and hoarseness in patients who underwent elective middle ear surgery under general anaesthesia with endotracheal intubation

The provision of adequate analgesia is necessary after any surgery and is all the more important in children. Pain after surgery is inevitable. It has been recognized for some time that management of acute pain, especially postoperative pain, has been consistently and systematically inadequate, situation being worse in children.
Methodology: After careful pre-anaesthetic check-up children posted for elective sub-umbilical surgeries between age groups of 3-8yrs of ASA I & II were randomly divided into 2 equal groups. Group L received levobupivacaine 0.25% 1ml/kg + 2mcg/kg clonidine and Group R received ropivacaine 0.25% 1ml/kg + 2mcg/kg clonidine. Following intrathecal administration of these drugs, intraoperative hemodynamic changes, postoperative pain relieving quality and rescue analgesia were studied. Hemodynamic parameters were monitored in the intraoperative and postoperative period. Incidence of side effects were also noted.
Conclusion: Addition of clonidine as an adjuvant to both the groups were significantly increase in Post-operative analgesic quality with perioperative hemodynamic stability with minimum side effects. Thus making it evident the clonidine as an adjuvant to Ropivacaine and levobupivacaine can be safely used for single shot caudal block in children undergoing elective subumbilical surgeries.

The atlas (first cervical vertebra) has undergone many structural modifications. It is critically located and close to the ‘life centres’. For this study, one hundred dried intact human atlas vertebrae from the Indian population were measured using a digital Vernier calliper that provides accurate resolution up to 0.01 mm. The distance between the tips of the transverse process, the outer and the inner distance between the foramen transversaria and various diameters of vertebral foramen were measured.
Materials and methods: One hundred dried human atlases of unknown sex, obtained from the Department of Anatomy GMCH Purnea, and periphery medical colleges were studied. Study duration of Two years. All samples were drawn from the Indian population. Atlases with pathological features were excluded from the study. The following parameters were measured for each atlas using a vermier caliper, That provides accurate resolutuion up to 0.01mm. as the maximum vertical distance at midline, and the maximum transverse width of the facet of the dens was measured as the maximum transverse distance.
Conclusion- studied one hundred dried first cervical  vertebra deriving from the Indian population to give us the opportunity to analyse metrical data

Pregnancy adaptations are well tolerated in healthy women but it rapidly decompensate in pregnants with valvular heart disease resulting in maternal and perinatal morbidity². Multidisciplinary approach and proper guideline is a necessity to reduce the adverse outcome.
Aims and Objectives: Clinical and echocardiographic assessment of valvular heart disease during pregnancy, in south Indian population and its effect on maternal and fetal outcome. Thereby provide local layout of disease burden and help develop patient centric management plan.
Materials and Methods: 77 pregnant women admitted with valvular heart disease in Coimbatore Medical College Hospital were recruited during period of 2020-2021. Clinical  and Echocardiographic correlation with Maternal and fetal outcome were studied.
Results: In our study, 70.1% of pregnants had Rheumatic heart disease and 23.4% had Congenital heart disease, with ratio of 3:1; 70.3% were diagnosed during index pregnancy.
 Mitral valve was the most common valve involved (84.4%) with Mitral Regurgitation being the predominant lesion (62.3%); Aortic valve involvement (14.3%); Both Aortic and Mitral valve involvement (3.9%). Functional class deterioration were seen in pregnants with critical stenotic lesions and severe insufficiency. Increase in valvular gradient in stenotic lesions is associated with congestive failure. Maternal outcome:  63.6% had caesarean section; 31.7% had cardiac indications; 7.8% had instrumental delivery; 1 maternal death; 23.4% had Congestive Cardiac Failure. Fetal outcome: 71% had term delivery; 28.6% had preterm delivery; 11(14.3%) had fetal loss; 48% low birth weight; 5.2% Intrauterine growth retardation; Perinatal mortality was 7.5% in NYHA class I, II and 42.1% in class III, IV.
Conclusion: High transvalvular gradient, Depressed LV function and increased LV volume, especially in patients with stenotic lesion is associated with life threatening complications in the course of pregnancy. Regurgitant lesion have better tolerability and outcome as compared to obstructive lesion.  There was close association of NYHA class and maternal and fetal outcome, with higher risk in NYHA class III and IV.  

The main aim of this research is to conduct an updated review of the literature on guided endodontics based on the most recent scientific research to identify and describe the technique, its advantages, and its disadvantages. From 1 January 2000 to december 2022, a literature search was conducted using four electronic databases: PubMed, Scopus, Science Direct, and Web of Science. Out of 1088 results, 34 articles could be reviewed after duplicates were eliminated. Guided endodntics is a novel technique that is currently advancing. It is used in a variety of procedures, particularly in microsurgical endodontics, accessing and locating root canals in teeth with pulp canal obliteration, and removing glass fiber posts in endodontic retreatments. Additionally, it is unaffected by an operator's level of experience and requires less treatment time for the patients and is more precise and safer than conventional endodontics.

Hypertensive disorder of pregnancy is a global public health concern both in developed and developing countries. Aim: To find out the prevalence of hypertensive disorders in third trimester of pregnant women. Methods: A health care facility Cross sectional descriptive type of observational study was carried out to find out the prevalence of hypertensive disorders in 100 third trimester of pregnant women and associated factors at ANC clinic of RHTC, department of community medicine, SP Medical College Jaipur, Rajasthan, from sept. 2021 to dec. 2022. Results: mean age of 24.30± 3.26 years, Prevalence of hypertensive disorder was 10%. Out of 10, 6(6%) were preeclampsia, 2 (2%) Gestational hypertension, 1(1%) chronic hypertension, 1 (1%) Eclampsia. Conclusion: Primary care physicians have a critical role to play in the early identification and management of hypertension during early antenatal care.

This paper encompasses several themes revolving around the fatal COVID-19 pandemic that affected the entire world and resulted in the deaths of millions of people worldwide. In the beginning, the researcher gives a comprehensive description concerning the effects of the pandemic   and how doctors and medical professionals were able to save thousands of lives with the employment of mechanical ventilation in COVID-19-infected people. The second part details the two types of mechanical ventilation and how the two modals turn out effective in treating COVID-19 and its side effects. Later, the researcher discusses the how measures have been taken to improve the Quality of life (QoL) with the employment of mechanical ventilation for COVID-19 patients. This paper presents the proposition to address the primary QoL-related findings in patients requiring hospitalization after being affected by COVID-19. It also aims to determine the characteristics of QoL on patients that were given mechanical ventilation for some time. Overall, the paper offers an all-inclusive discussion regarding the improvements that are noticeable in patients that receive this contemporary treatment

Accurate knowledge of the gestational age is essential in management of all pregnancies particularly in cases of high risk pregnancies, electively planned induction of labour, elective caesarean section and to distinguish pre-term from term infants.
Aims: To assess the correlation between fetal transverse cerebellar diameter (TCD) and gestational age.
Materials and Methods: The present study was a prospective observational study. This Study was conducted from December 2021 to February 2022 at Department of Radio-diagnosis, Nil Ratan Sircar Medical College and Kolkata.
Result: In our study, TCD ranged from 15.17mm to 20.86mm between 15-20 weeks, from 21.97mm to 33.90mm between 21-30 weeks and from 34.35mm to 44.52mm and 100 singleton pregnancies of gestational age 15-40 weeks that   met the inclusion and exclusion criteria were taken for the study.
Conclusion: In this study, the relationship was established between TCD and gestational age between 15-40 weeks.

Polycystic ovary syndrome is a heterogeneous, multifaceted endocrine disorder of ovarian dysfunction in women of reproductive age group¹.Clinical manifestations of PCOS ranges from mild signs of hyperandrogenism in thin, normally menstruating women to the classic Stein-Leventhal syndrome.
Aims: To find out the correlations between ultrasonographic findings, clinical features and hormonal profile in patients of polycystic ovary syndrome.
Materials and Methods: The present study was a Cross-sectional study. This Study was conducted from January 2021 to February 2022 at Department of Radiodiagnosis, Nilratan Sircar Medical college & Hospital, Kolkata.
Result: FSH levels were low to normal in 85.3% of the patients with >=12 follicles, 86.8% of the patients with 2-9 mm follicular size, 87.3% of the patients with >=10cc ovarian volume and 94% of the patients with EMT>10mm. Mean FSH level is lower in patients with 2-9mm follicles compared to patients with >9mm follicular size.
Conclusion: Thus this study concludes that, ultrasonographic ovarian features like follicular number and ovarian volume show significant positive correlations with LH level as well as positive correlations with LH/FSH ratio.

This research aims to examine existing research on the relationship among (T2DM) type 2 diabetes mellitus and asthma in adulthood, the processes underlying this relationship, and the effects of T2DM on asthma management. It has been hypothesized that moderate levels of systemic inflammation or the application of antibiotics are to blame for the link between T2DM and asthma. It is noted that till now, there has been little scholarly research on the effects of this link on asthma management. The epidemiological statistics and routine healthcare procedures show that people with asthma also frequently have different kinds of diabetes mellitus (DM). The debate over the effects of an inflammatory disorder associated with asthma on glucose metabolism and the prevalence of persistent hyperglycemia and signs of inflammation in asthma patients remains debatable. It has been demonstrated that dysfunctional immune systems and genetic predisposition are related to asthma and type 1 diabetes mellitus (T1DM) and that obesity and insulin resistance (IR) plays a crucial role in promoting an excessively inflammatory nature and immune system reactions in type 2 diabetes mellitus. According to the findings, DM and asthma either impact one another's clinical manifestations, prognosis factors, and treatment options. Regardless of the probable involvement of metformin and the hyperglycemic adverse reactions to glucocorticoids, there is continuing debate regarding the efficacy and safety of anti-asthma and hypoglycemic treatment in this population of participants. Conclusion: Asthma and type 2 diabetes (T2DM) are two prevalent chronic diseases with a rising incidence that frequently interact in the same individual. It has been hypothesized that this cohabitation makes asthma management more severe. Since T2DM is a comorbidity linked with asthma, the research could promote legislative initiatives and therapeutic medical procedures that value this strategy with the objective to decrease the standard of life and other dangers to health. Consequently, the goal of the article being given is to examine what is known about the correlation between DM and asthma, their likely relationships with each other, and treatment possibilities.

Thyroid nodules are common entities, frequently discovered in clinical practice, either during physical examination, but also incidentally, during various imaging procedures. They are clinically important primarily due to their malignant potential. The literature indicates that the incidence of nodules is around four times higher in women than men.
Material and Methods : A total of 90 patients with thyroid nodules which were referred to Department of Pathology and Radio-diagnosis and underwent USG guided FNAC and TIRADS scoring were included. USG guided FNAC were examined and categorized according to Bethesda system. The Bethesda categories were correlated with TIRADS scoring in all 90 cases and with histopathological findings in 22 cases.
Results: A total of 90 patients were included out of which 83 were females. These thyroid nodules are predominantly found in females with right lobe preponderance in approximately 50% cases and in third–fifth decade of life. A total of 14 were categorized under TIRADS 1, 25 were categorized under TIRADS 2, 6 were categorized under TIRADS 3, 29 were categorized under TIRADS 4 and 16 were categorized under TIRADS 5. Out of the 90 nodules, 46 were categorized under Bethesda II, 6 were categorized under Bethesda III, 21 were categorized under Bethesda IV, 7 were categorized under Bethesda V and 10 were categorized under Bethesda VI. Proportion of risk of malignancy as TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 were 4.0%, 83.3%, 82.8% and 87.5%, respectively. In the present study, 86.36% sensitivity, 84.78% specificity, 84.44% PPV, and 86.67% NPV derived. Significant association was noticed between TIRADS and Bethesda system of classification (P < 0.001). On Histopathological diagnosis of 22 thyroid cases, sixteen out of 22 nodules (72.7%) were proven to be malignant by postoperative histopathological examination. On histopathological and Bethesda comparison, 93.75% sensitivity, 16.67% specificity, 75.00% PPV, and 50.00% NPV were observed (P <0.001). Concordence between Bethesda classification and TIRADS scoring system of USG guided FNAC of the lesions showed very good association in both benign (84.7%) and malignant (86.3%) lesion (p < 0.001).
Conclusion: The thyroid ultrasound report using the TIRADS criteria has a good concordance with the Bethesda cytology findings using USG guided FNAC. Correct interpretation by the two diagnostic modalities helps the clinician to stratify the thyroid nodules and reduce the risk of unnecessary invasive procedures in patients with low TIRADS score (TIRADS I AND 2) and nodules with high TIRADS score (TIRADS 4 and 5) should undergo USG guided FNAC and if Bethesda categories were suspicious of carcinoma or carcinoma should undergo surgery

Smoking is one of the leading causes of mortality and morbidity in both developing and developed nations, accounting for 8 million deaths globally with more than 7 million deaths directly related to tobacco use. Tobacco consumption increases the risk of lung diseases, stroke, cardiovascular diseases and cancer. There is a need to understand the prevalence, and factors associated with smoking in treatment-seeking psychiatric patients.
Aim and Objective of the study: To estimate the prevalence of smoking among psychiatric subjects and to study the factors associated with smoking and to find out the factors that encourage smoking cessation.
Materials and Methods: A modified version of the Global Adult Tobacco Survey (GATS) was used to capture data thatincluded sociodemographic information (age, gender, ethnicity, education, housing, income, etc.), and questions regarding their smoking status. A descriptive analysis of the data was done. The clinical diagnosis of the participant was captured as indicated in the electronic medical records which follows the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Participants were also asked if their smoking started before their psychiatric condition was diagnosed and if they have suffered from any of the smoking-related diseases.
Results and Discussion: Out of the total  a total of 400 subjects screened in our study, 380 participated in the study after informed consent. We evaluated the prevalence of smoking among the study participants and found that the prevalence of smoking was 48% (182), past-smokers 13% and non-smokers 39% respectively. Majority of the smokers were males. Family history of smoking was reported in 79% of the smokers and 83.2% in past smokers. 56% of the current smokers (n=102) had nicotine dependence and 37.5% of the past smokers (n=18) had nicotine dependence. There was no statistically significant difference (p<0.05) between current smokers and past smokers w.r.t nicotine dependence.
Conclusion: The factors associated with smoking included gender, employment, education and diagnosis of schizophrenia spectrum, depressive disorder and other psychotic disorders. Males were more likely to smoke as compared to females, male gender was statistically significantly associated with smoking. Subjects with primary education as the highest qualification had a higher likelihood of smoking than those with secondary and university education. Subjects suffering from depressive disorder were more likely to smoke in comparison to subjects suffering from schizophrenia spectrum and other psychotic disorders. Smoking cessation: 58% of the current smokers admitted that they had made at least one attempt to quit smoking in the past 12 months and 42% reported that they will try to quit smoking in next six months. Smokers have placed an opinion that by increasing the cost of cigarettes, and reducing the availability of cigarettes, and increasing the awareness about the health impacts of smoking could encourage smoking cessation. Past smokers claim that self-determination/motivation, family and spouse support, substitution of smoking with other type of foods helped them in cessation of smoking. Constant and constituent motivation of smokers by promoting awareness of smoking cessation educational programmes and policy changes are crucial in achieving successful cessation.

Suicide is a major health problem, and the global suicide mortality rate amounts to 1.4% of all deaths worldwide. Suicidal behaviour and suicidality can be conceptualized as a continuum ranging from suicidal ideation to suicide attempts and completed suicide.  
Aim and Objective of the study: The aim and objective was to study the sociodemographic data, psychiatric disorder, precipitating events, and mode of attempt in suicide attempted patients referred to consultation liaison psychiatric services.
Materials and Methods: All referrals to the psychiatry department, seen over a 6-month period were screened for the presence of suicide attempters. Those who fulfilled the criteria were evaluated by using semi-structured pro-forma containing sociodemographic data, precipitating events, mode of attempt, and psychiatric diagnosis by ICD-10.
Results:  In 6 months study period, 42 subjects were referred for attempted suicide, out of the total 360 psychiatry referrals. The prevalence of suicide attempters was 11.6% at our tertiary care hospital. Males were more than females. Among the suicide attempters, young adults (25 to 35 age group), educated, employed, married, and coming from an urban background were more represented compared to their counterparts. Around 28 % of subjects were found to have a past history of suicidal attempts and 16.7 % were having a significant family history of committed suicide/attempt.
Discussion and Conclusion: The prevalence of suicide attempters was 11.6% at our tertiary care hospital. The majority of suicide attempter patients had a mental illness. So, Early identification and treatment of these disorders could have prevented associated morbidity and mortality. The most common mode of attempt was found to be poisoning and drug overdosage. So, having a clear policy on the sale and possession of lethal agents is necessary to prevent or reduce suicidal attempts. Some of the study participants reported various stressful life events as immediate reasons for the suicidal attempt. These findings may suggest the need for training programs on problem-solving skills for this group of the population. In addition, public education on healthy coping mechanisms under stress and improving communication skills of youths are also crucial to prevent the suicidal attempt

One of the most frequent otolaryngological diseases is chronic otitis media (COM). Pathophysiological processes like bacterial infection and biofilm are carried by COM. It has been established that cholesteatoma, chronic otitis media with effusion, and atelectatic ear diseases are all associated with a reduction in the mastoid air cells.
Aims and Objectives: This research aimed to examine the connection between the volume of the mastoid air cells and the efficacy of the graft after tympanoplasty.
Material and Methods: Retrospective analysis of patients having type I tympanoplasty and antrostomy was done in this research. Of the 52 patients who fulfilled the criteria of the research, 32 (61.54%) were male and 20 (38.46%) were female, with a mean age of 28.96±SD (range 12-58) included in the study. At the first, sixth, and twelfth months, the patients were asked for a control visit during which otoscopic exams and audiometric tests were carried out. To determine the mastoid air cell volume, the temporal bone computed tomography pictures were viewed with a 4800 Dpi optic resolution scanner and transmitted to the computer system in JPG format.
Results: Although the well-ventilated group's graft success was found to be superior, no substantial difference between the groups' graft success at the first, sixth, and twelfth months (P > 0.05) could be detected. In terms of the preoperative and postoperative hearing improvements, there was no statistically significant variation between the three groups (P > 0.05).
Conclusion: In conclusion, no statistically significant relationship could be found between the preoperative mastoid cell ventilation and the postoperative graft success in patients who had undergone only antrostomy together with tympanoplasty as chronic otitis surgery.

Snake bite envenomation is a common, acute life threatening medical emergency in India. The persons at greatest risk are farmers and agriculture laborers. Bush cleaners, construction workers, scientists and entertainers who handle the snake are also at increased risk. Snake bite is predominantly rural and occupational hazard of farmers and land workers. Snake bite is completely treatable if treated in time. The present study was undertaken to evaluate the effect of snake envenomation on cardiovascular profile.
Method: Total 100 patients of more than 14 years old of confirmed case of snake bite were taken in this study excluding patients having ischemic heart disease, diabetes, valvular heart disease, known history of cardiomyopathy, deep vein thrombosis. All patients underwent physical examination, electrocardiogram, echo-cardiography, arterio-venous color doppler study and cardiac enzymes.
Result: Total 100 cases had envenomation. Most common ECG manifestation showed sinus tachycardia 65% followed by 25% patients have normal ECG finding, 12% ST-T changes due to myocardial injury, 7% had bradycardia only 2% patients have noted A-V block.⁸).⁷Most of the echocardiographic findings are normal. Only 9% patients have global hypokinesia.
Increase CPK-MB level seen in 5% cases. Increased troponin-I level seen in 12% cases.
Conclusion:
Cardiac complications are not prominent features of snake bite and the clinical picture is usually dominated by neurological, hematological and vascular damage by snake bite toxin. Most common cardiac manifestation in ECG was sinus tachycardia may be due to anxiety, followed by sinus bradycardia. Some patients developed myocarditic changes which were detected by serial ECG. Increase CPK-MB level seen in 5% cases. Increased troponin-I level seen in 12% cases. Most common echocardiographic finding was global hypokinesia.

To correlate and measure Serum Phosphorus, Vitamin D3, Uric acid levels in Patients of Acute Ischemic Stroke in first 24 hours.
MATERIAL & METHODS: Analytical Cross Sectional study involving data from 112 patients visiting JSS Hospital, Mysuru over a period of 18 months. 56 patients admitted to JSS Hospital with the diagnosis of acute ischemic stroke were compared with a control group comprising 56 patients. The presence of ischemic stroke was confirmed based on clinical signs, symptoms, brain CT Brain, and MRI stroke protocol. Blood samples were taken from  the patients in both the group in the first 24 h of admission to measure serum phosphorus, vitamin D3, calcium, and uric acid levels.
RESULTS: Totally 112 patients were registered for the study of which 56 were cases and 56 were controls. Serum phosphorus, vitamin D , serum uric acid levels of both the groups were analyzed and result was suggestive of elevated serum phosphorus and uric acid in stroke cases with significant p value (p<0.0001) whereas serum vitamin D level was low in stroke patients with significant p value (p<0.0001). Correlation of Serum Phosphorus , vitamin D and uric acid were independently associated in acuteischemic stroke .
CONCLUSION: The study states that Serum phosphorus, Serum Vitamin D and Serum Uric acid were associated with the development of Ischemic stroke suggesting that inflammation and the dysfunction of the vascular endothelium could lead to stroke. By considering all these parameters in high-risk individuals developing stroke one can predict the early recognition of stroke and take necessary preventive steps and thus decreasing the morbidity and mortality of the disease.
These biochemical blood parameters are easy to estimate and easy to interpret the results and cost effective, this can be used in resource poor setting situations compared to inflammatory markers such as Interleukins and cytokines.

Primary liver carcinomas are of two main types - Hepatocellular carcinoma (HCC) and Intrahepatic cholangiocarcinoma (ICC). HCC originates from hepatocytes while ICC originates from bile ducts. HCC is the 5^th most common carcinoma in the world and third most common death causing cancer but the most common cause of death in a patient with cirrhosis. In comparison to women, men are at risk to have HCC. HCC accounts for more than 80% of primary liver cancer cases worldwide (El-Serag & Rudolph, 2007). In USA five-year survival rate as per 2020 data on National Cancer Institute’s SEER database is 19.6 percent which can be further reduced to 2.5 % depending upon the severity of the disease

Placenta is vital for the survival of the pregnancy because it performs several irreplaceable physiological functions. Thus, placental abnormalities including its location and attachment to the uterine wall endanger the successful completion of the pregnancy.
AIM: To investigate if the placental location (determined by ultrasonography) is associated with adverse pregnancy (both maternal and foetal) outcomes.
Material and Methods: This was a single-centre-, hospital (outpatient) based, prospective-, cohort-, observational study conducted over 6 months by enrolling 84 pregnant women. The primary outcome was the incidence of adverse pregnancy (maternal and foetal) outcomes. The location of the placenta was determined by ultrasound conducted during the second trimester. Thereafter, women were followed up until the delivery.
Results: The most common location of the placenta was fundal (32.1%), followed by anterolateral (23.8%), and the low-lying placenta was the least common (0.23%). The mean age of the participants was 26.6 years and for most of the women, it was their second pregnancy. Overall, the most common complication/morbidity among the participants was gestational hypertension (40.5%), and the most common neonatal complication was foetal growth retardation (35.7%). Moreover, both adverse maternal and foetal outcomes were most commonly seen among pregnant women with the laterally located placentas.
Conclusion: The attachment of placenta to the uterine wall varies a lot and it influences the maternal and foetal outcome.