Background: Low back pain and sciatica are very prevalent medical complaints. As a consequence of these adjustments, fewer hours will be worked and less of a toll will be taken on the national economy. A complete medical checkup is required before starting any kind of therapy for these people. Inadequate medical or surgical therapy may exacerbate symptoms, increasing the likelihood of this occurring. This research aims to learn whether and how acupuncture may improve standard PLID care. Methods: This inquiry took place at SUOXI Healthcare Limited in Shantinagar, Dhaka, Bangladesh. A 55-year-old male patient has been complaining of lower back discomfort for the last ten years. It had been seven years since he had found relief from the pain in his lower back, but now he was pain-free. The results of this research suggest that acupuncture may be helpful for those with PLID.

Background and Aim: Airway difficulty is common in pregnancy than in the general population due to anatomical and physiological changes during pregnancy. Spinal anaesthesia in pregnant women is associated with greater incidence of having hypotension. Although glycopyrrolate has been investigated previously as an adjunctive agent for preventing hypotension during caesarean section, few data are available for its use specifically when phenylephrine is used as the primary vasopressor. Our study aims to determine the effectiveness of prophylactic combined glycopyrrolate and phenylephrine boluses in maintaining the haemodynamics as compared to prophylactic phenylephrine bolus alone during spinal anaesthesia in caesarean section. Method: A prospective, double-blinded clinical study was conducted in the Department of Anaesthesia in collaboration with the Department of Obstretrics and Gynaecology from June 2020 to July 2022. Ninety respondents undergoing cesarean section were allocated into two groups. Group A (n = 45) received prophylactic injection of bolus glycopyrrolate 0.2mg immediately after spinal anaesthesia followed by prophylactic bolus of phenylephrine 75 mcgs intravenously (IV) and Group B (n = 45) received prophylactic bolus of normal saline 1ml immediately after spinal anaesthesia and bolus of injection phenylephrine 75mcgs IV. Then, for every 3 min, systolic blood pressure, diastolic blood pressure, and heart rate (HR) were measured for 30 min, and APGAR scores were measured. Result: There was no difference between systolic pressure upto 6mins between the two groups. But from 9mins, lowering of blood pressure was recorded more in group B. For diastolic pressure, it was found to be significantly lower in Group B. However, maintenance of pulse rate was observed better in Group A. Conclusion: Incidence of bradycardia was found to be reduced in group A as compared to group B. Haemodynamic stability was found to be more in the group where prophylactic glycopyrrolate was used.

Lemiere’s syndrome is a rare but life-threatening condition which is most often preceded by an oropharyngeal infection. The most common organism involved is fusobacterium necrophorum, which is a part of normal flora of oropharynx. This case report describes a rare case of Klebsiella oxytoca associated Lemiere’s syndrome in a patient with poorly controlled Diabetes Mellitus. To our knowledge there has been only one single reported case of Lemiere’s syndrome caused by Klebsiella Oxytoca and this should be considered among the possible organism causing Lemiere’s syndrome. Though rare Lemiere’s syndrome carries a high mortality rate. Therefore clinicians should be familiar with signs and symptoms of the disease as well as the preemptive examinations, procedures and treatments.

Background: Acute appendicitis is a frequently encountered surgical disease. Detection is difficult even with imaging and blood investigations. Total leukocyte count is a promising investigation. Its role in the confirmation of acute appendicitis is investigated and analysed in the present study. Methods: Patients having acute appendicitis treated by surgical intervention (appendicectomy) were included in the study. The leukocyte count measured before surgery was compared with histopathology findings of the appendix. Parameters of diagnostic accuracy of leukocytosis were measured by standard formulae. Results: The majority of patients with acute appendicitis are below 25 years old, comprising 70% of the total patients, and males have a higher incidence of acute appendicitis at 56.67% compared to females at 43.33%. Physical findings suggest that pain in the right upper quadrant, rebound tenderness, anorexia, nausea/vomiting, and fever are common in patients with acute appendicitis. The leukocyte count (TLC) test was found to have a sensitivity of 74.69% and specificity of 38.89% in identifying cases of inflamed appendix. The positive predictive value (PPV) was high at 91.67%, indicating that if the test identifies a case as inflamed appendix, there is a high likelihood that the case is truly inflamed. However, the negative predictive value (NPV) was low at 14.58%, indicating that if the test identifies a case as normal appendix, there is a low likelihood that the case is truly normal. Conclusions: Leukocytosis alone is not a helpful investigation to support the diagnosis of acute appendicitis

Introduction: Sickle-cell disease (SCD) refers to a group of inherited disorders affecting hemoglobin resulting sickle hemoglobin variant (HbS). A simple, low-cost, paper-based test for SCD offers advantages over existing technologies for screening programs in resource-limited settings. The primary aim is to test the efficacy of paper-based test as a simple low cost and electricity free test. The main objectives are to determine the sensitivity and specificity of paper-based screening test for SCD in compare to HPLC test and to validate the paper based test. Materials and Method: A comparative study was conducted in the Dept. of Physiology from April to June 2021 as ICMR approved STS project, after obtaining the ethical clearance (SVIEC/ON/MEDI/SRP/20027). A total of 60 samples (n=60) were collected from individuals ranged between 18-40 years for the study. Blood samples collected in EDTA anticoagulant vacutainers were used for SCD diagnosis by using paper-based test and then confirmed by HPLC test, using HPLC test as the gold standard test. Result and Conclusion: True positive(TP), false positive(FP), true negative(TN), and false negative(FN) were determined on the basis of result obtained from HPLC test. The result obtained includes TP=36, FP=4, T N=10 and FP=10. The sensitivity and specificity of paper-based screening test was evaluated to be 78.2% and 71.4% respectively for HbS (HbAS and HbSS). ROC curve was obtained and the area under curve is 0.88 for discriminating between HbAA from HbAS and HbSS by paper-based test. In conclusion, the paper-based test can be used as a substitute for screening HbS. The study validates the paper-based test as a simple low-cost and electricity free test capable of detecting sickle cell trait and disease and demonstrate its practicality in resource-limited clinical settings.

Introduction: The optic nerve is a direct continuation of the brain, surrounded by subarachnoid space. Measurement of the Optic Nerve Sheath Diameter (ONSD) provides indirect evidence of intracranial hypertension. Normative data in children in 1st decade is different from that of adults. This study provides age wise diameter of the optic nerve sheath from 0-80 years on T2 weighted MR images in a 1.5 Tesla MR scanner. The data serves as a baseline standard for comparison of ONSD in patients of various age groups. Objectives: To establish age and sex wise reference norms for ONSD from 0-80 years. Materials And Methods: This was a retrospective cross sectional study of analysis of MR image data set of 200 consecutive MRI studies of the brain, with normal optic nerves. A total of 400 optic nerve sheath diameters were measured (200 patients, both eyes). The study population was divided into 8 age groups of each decade of life from 0 to 80 years. The data was tabulated age and sex wise, for both the eyes and analyzed. Results: The mean diameter of the right optic nerve sheath was 4.48 mm with standard deviation of 0.69 (2 SD) and that of the left was 4.54mm with standard deviation of 0.71 (2 SD).Minimum diameter of the right and left optic nerve sheath was 2.98 mm and 2.80 mm respectively in a 14 month old male .Maximum diameter of the right and left optic nerve sheath was 5.5 mm and 5.4 mm respectively in a 16 years and 58 years old female. There was no statistically significant difference between the mean ONSD of the right and left nerves and between males and females. Conclusion: This study provides a baseline age wise ONSD and orbital diameter of general population. The maximum ONSD in any age group is never above 5.5 mm. If higher ONSD is found, the patient should be thoroughly investigated for intracranial hypertension.

Introduction: Surgery is associated with increased stress response which results in sympathetic activations and the release of pituitary hormones that accelerate glycogenolysis and gluconeogenesis and result in stress hyperglycaemia. Recovery from anesthesia, and post-operative pain can increase the stress induced hormonal changes. Objective: To find out the pattern of postoperative blood glucose response among non-diabetes patients receiving either general anesthesia or spinal anesthesia for their surgeries. Methods: A Hospital based, Observational; Cross Sectional study was conducted at Department of Anaesthesiology, Gonoshasthaya Samaj Vittik Medical College, Savar, Dhaka, Bangladesh from January to December 2022. A total of 100 study subjects participated in the study was conducted among100 non diabetes patients who received either general or spinal anesthesia for their surgery. Data was analyzed using SPSS, version 20.0 for windows. Chi-Square test was used to show association between categorical variables and independent sample t-test was used to show mean difference among normally distributed continuous variables. All statistical tests were 2-tailed and a p-value of <0.05 was considered significant. Results: Total 100 patients included in our study. Mean age of the study population was 41.1±12.7 Years. 65.0% of the study population were in the age group of 31-60 years followed by 26.0% and 9.0% were in the age group of 18-30 years and ≥ 61 years respectively. 53.0% of them were female and 47.0% were male. 66.0% of study population received general anesthesia and 34.0% received spinal anesthesia. In postoperative period, 42.0% of study population had their plasma glucose in pre diabetes range and 20.0% had their plasma glucose in diabetes range. Frequency of postoperative hyperglycemia (IFG + Diabetes) was 62.0%. Mean postoperative plasma glucose was significantly higher among study population who received general anesthesia. Increasing age, female gender, overweight, obesity, hypertension and hypothyroidism was significantly associated with high risk of postoperative hyperglycemia. Conclusion: There is high prevalence of postoperative hyperglycemia. The frequency of postoperative hyperglycemia was significantly high among those who received general anesthesia than those who received spinal anesthesia.

Background: Trauma remains a regular occurrence relating to activities and lifestyle of humans and it can affect any part of the body. The ear is located within the cranio-facial skeleton which is exposed to environmental trauma that can occur as blunt injuries like contusion, concussion, decompression, and penetrating injuries as fractures. Objective: To assess the clinical outcome and etiologies of traumatic tympanic membrane perforation. Methods: This prospective cohort study was conducted at Department of ENT, TMSS Medical College &Rafatullah Community Hospital, Bogura, Bangladesh from June to December 2022. Total 50 patients included who presented to outpatient department of TMSS. Patients willing to be included in study and patients of all age group and gender with traumatic TM perforation were included in the study. Those patients with non-traumatic TM perforation as well as the traumatic perforation of TM with severe head injury, unconscious patients or patients with polytrauma were excluded from the study. Results: Total Fifty (50) patients who presented to the outpatient department of ENT and casualty of private chamber included in the study. Out of which, 13 patients were males (26.0%) and 37 were females (74.0%). Most of the patients fell under 20-30 age group (n=23 [46.0%]). Mean age group was 33.1 years and 74.0% were males. Ear pain was the commonest symptom with accidental trauma being the most common cause. 70% of them had left TM perforation and poster inferior quadrant was mostly involved. Conclusions: Traumatic TM perforation is commonly seen in young adults following accidental trauma and assault. Earache, sudden hearing loss and tinnitus are the common symptoms. Most of the cases heal spontaneously with conservative management.

Background: Anatomy of the coronary arteries have been widely studied due to its clinical importance. A coronary artery is defined as any artery or arterial branch that carries blood to cardiac parenchyma. Coronary arteries and their variation in branching patterns have a significant role in cardiac deaths in recent years. Objective: To study the branching patterns of human coronary vasculature and its clinical importance. Methods: This observational study was conducted at Department of Anatomy, Diabetic Association Medical College, Faridpur, Bangladesh, Faridpursadar hospital and Bangabondhu Sheikh Mujib Medical College, Faridpur, Bangladesh, from January to December 2021. A total of 30 Human heart specimens were collected to study the branching patterns of human coronary arteries and their clinical importance. The variations in branching patterns like Trifurcation, Quadrifurcation of the coronary arteries were noted in the present study. Results: The termination of left coronary artery showed a branching pattern as bifurcation in 21 (70%) specimens, Trifurcation in 5(16.7%), Quadrifurcation in 4(13.3%) out of 30 specimens in our study. We observed 30% of the variations in branching patterns of left coronary artery, whereas right coronary artery branching pattern was normal in the present study. Conclusion: Various branching patterns of coronary arteries should be acknowledged during the catheterization for coronary angiography.

One of the major determinants of the function of the heart is given by the left ventricular ejection fraction. Patients with congestive heart failure have a low ejection fraction and this increases the risk of perioperative adverse cardiac events and sometimes death1. It also changes the plan of anaesthesia along with the outcome. The major goal perioperatively is to maintain hemodynamic stability[1], also maintaining forward flow, promoting inotropy without inducing or exacerbating ischemia and returning patient to their preoperative level of function after surgery[2,3]. In this report we present a 60-year-old male with ischemic heart disease with left ventricular ejection fraction 30% who underwent penectomy under saddle anaesthesia without any complications. We believe that saddle anaesthesia can be a useful alternative anaesthetic technique in patients with low ejection fraction undergoing penectomy for carcinoma of penis. We showed evidence-based and customized anaesthetic management of a high-risk patient with available equipments and resources[1,4].

Ocular trauma is one of the leading cause of visual loss. We present a case of retropupillary iris claw lens implantation in a post-traumatic aphakic patient after 25 years of trauma. On examination it was seen that he had deep anterior chamber, iridodonesis with jet black reflex and vitreous in pupillary area. On direct and indirect ophthalmoscopy right eye details were within normal limits. The patient was posted for right eye secondary retropupillary Iris claw lens implantation. Traumatic injuries may have poorer visual prognosis but with newer management techniques we have the hope of good visual prognosis.

Nutritional deficiency disorders constitute a major health problem in India. In addition to direct implications for morbidity and mortality, undernutrition predisposes children and adults to various infections[1]. Microcytic anaemia due to iron deficiency is the most common type of anaemia in children and is considered to be among the most important contributing factors for the global burden of the disease. Malnutrition is a major contributor to child mortality, present in half of all the cases globally, especially in children under 5 years of age. The nutritional status of an individual is often the result of many interrelated factors. Therefore, the present study was undertaken to determine the nutritional status of patients with iron deficiency anaemia from 1-5 years of age using anthropometric measurements and to determine if there is any correlation between the severity of malnutrition and the severity of anaemia.

Aims and objectives: 1) To compare and correlate the result of FNAC with histopathological examination in diagnosis of thyroid lesions . 2) To define the role of FNAC in differentiating between benign and malignant lesions. Materials and methods: A prospective study carried out at a tertiary care centre. All patients with thyroid enlargement visiting the ENT department for a duration of 18 months were included in the study. Histopathological examination of the tumor could be done only in operated patients. Correlation of FNAC with histopathological examination will be done in those patients. Inclusion Criteria: Those patients with thyroid swelling, who underwent FNAC, Thyroid surgery and histopathological examination within the study period will be included in the study Exclusion Criteria: All the cases of thyroditis will be excluded. Those patients having FNAC done and did not have thyroid surgery and underwent medical management will be excluded. Results: 27 subjects showing anterior neck swelling, 23 subjects were female (85.2%) and 4 were male (14.8%). When FNAC based diagnosis was compared with Gold standard Histopathology Diagnosis, it was found that True positive cases were 3. There were no False positive cases. 21 cases were true negative whereas 3 cases came false negative. Conclusion: FNAC provides a more rapid and accurate diagnosis of thyroid lesions than any other combination of diagnostic test, however Histopathology is always required to confirm the diagnosis and for further management

Objective: To study the course and duration of labor, mode of delivery, fetomaternal outcome in relation to station of fetal head in active phase in a nullipara. Study design: A Prospective observational study was conducted in the department of Obstetrics and Gynaecology for a period of 2 years in Government Medical College, Aurangabad. This study was done on 100 nullipara women at 37 completed weeks to 41 completed weeks of gestation who delivered in our institute. Results: In our study, 56% cases were at age group of 21-25 years. Maximum cases i.e. 41% presented at 39.1-40wks of gestation age. The mean duration of labour was found to be more with higher stations. Need for LSCS increased with higher station. The mean birth weights were found to be more with higher fetal head stations. The rate was NICU admission was 9%. Conclusion: A nullipara with unengaged fetal head and high station can be given successful trial of normal vaginal delivery under constant vigilance and timely intervention if required.

Aims: To report a case of Sebaceous Adenoma of eyelid in 30 years old male and its diagnosis and management. Case Report: We described a case of 30yr old male patient presented to our hospital complaining of swelling over medial part of the left lower eyelid since 1year. Patient was suspected as left eye sebaceous cyst. He underwent complete surgical excision with histopathological examination of the sample. Result: We diagnosed the case postoperatively as a Sebaceous Adenoma of left eyelid based on histopathological examination. Conclusion: Thus, the diagnosis is Sebaceous Adenoma of eyelid. Therefore, the complete surgical excision with clear margins is necessary as incompletely excised lesions commonly recur.

Introduction: For the medico legal experts to identify a body, stature is an important component. Various parameters such as age, sex, ethnicity, stature etc. are used for personal identification. Among these, stature estimation is an essential parameter of medicolegal investigations, once a body is disfigured or dismembered. The stature prediction occupies relatively a central position in the identification necessitated by the medico-legal experts. At times Forensic experts may come across cases like skeletal remains, body parts remains in accidents, murders, natural disasters like conditions, for medico-legal examination and identification analysis and from these evidence they skilfully determine stature and important information of recovered body parts. Objectives: 1. To find out the relationship between stature and hand length. 2. Comparison between male and female hand width & hand length. Methods: Cross sectional study was conducted during October 2021-November 2021 in Department of Forensic Medicine in Medical College and Hospital Maharashtra. Study Population included 100 undergraduate medical students. Result: Simple linear regression was calculated to predict height (calculated height) based on hand length measurements. The test revealed that there was no significant difference between observed and calculated height of both male and female students, p>0.05. Conclusion: Hand length is a reliable parameter in reconstructing the stature of an individual.

Background: Common Foreign Body at cricopharynx are coins, peanut, chicken bone, fish, bone, jewellery, metal parts and plastic parts. Foreign Body at cricopharynx appearsless dangerous than those in the respiratory passage but they are potential threat to the airway. Here we present a case of pointed, slender, sharp, shaped Foreign Body at cricopharynx of a toddler leading to airway obstruction during laryngoscopy and it successful management. Case presentation: 3 years old male child of weight, 12kg brought by parents with chief complaints of ingestion of foreign body (sharp metallic foreign body) 8hrs before taken inside OT. Drooling of salivasince 7hrs, On asking mother also complains of change in voice, Difficulty in breathing on lying down position which relieves on propped up position and complaining of Gagging. In the pre-operative evaluation, vitals stable, chest was clear. We did this patient under general anaesthesia, during intubation CVCI condition ensued, so considering risk benefit ratio foreign body removal was done by anaesthesiologist. Conclusions: Senior anaesthesiologist should always be available for all Foreign Body removal. If Foreign Body is seen at the time of laryngoscopy it should be removed first after considering risk benefit ratio … Anaesthesiologists Foreign Body. Call for help at right time is very important.

Introduction: Amitraz is a formamidine pesticide that is used to treat generalised demodicosis in dogs as well as to manage ticks and mites on cattle and sheep. The stimulatory actions of the a2 agonist in amitraz cause its neurotoxic and preconvulsant effects. Aim: To study the clinical features, complications, management and outcome of the patients with acute amitraz intoxication. Material and Methods: Our study is a prospective cross sectional study done on 10 cases presented in emergency medicine department of GMC Miraj. Result: Patients had CNS involvement, miosis/mydriasis, hypotension, bradycardia/tachycardia and nonspecific complaints like pain abdomen, vomiting etc. Gastric lavage was given to every case of amitraz poisoning. Conclusion: In patients who presented with history of pesticide consumption with features of bradycardia, drowsiness and features similar to organophosphorous poison physician should think of amitraz poisoning that will help to initiate rapid treatment for this rare, potentially life threatening intoxication.

Introduction: Glaucoma is a multi factorial optic neuropathy that is a leading cause of irreversible blindness worldwide. Peripapillary choroidal thickness (PCT) is a significant parameter in the pathogenesis of glaucoma. In this study, we aimed to evaluate the normative database of PCT and its correlation with structural and functional measures of glaucoma. Methods: A cross-sectional study was conducted on 71 glaucoma patients. PCT was measured using spectral-domain optical coherence tomography. Structural measures including cup-to-disc (CD) ratio, central corneal thickness (CCT), and intraocular pressure (IOP) were recorded. The functional measure was the mean deviation (MD) of the visual field. Statistical analysis was performed using SPSS version 21. Results: The mean age of the patients was 56.2±9.4 years. PCT was not affected by gender. There was a weak positive correlation between PCT and age (r=0.256, p=0.011). PCT was significantly correlated with CCT (r=-0.301, p=0.003) and IOP (r=0.546, p<0.001). CD ratio did not show a significant correlation with PCT (r=0.033, p=0.770). Similarly, no significant correlation was found between PCT and MD (r=-0.160, p=0.139). Conclusion: PCT is a useful parameter in glaucoma evaluation, and our study provides a normative database for PCT in glaucoma patients. PCT showed a significant correlation with CCT and IOP. The integration of PCT with these parameters may better reflect an individual's susceptibility to glaucomatous damage than either parameter alone. However, PCT did not correlate with CD ratio or MD, suggesting that it may have limited use as a structural or functional measure of glaucoma. Further studies are needed to validate these findings and determine the clinical utility of PCT in glaucoma management.

Background: Cranial ultrasonography is an easily accessible, well-accepted, first-line imaging modality that is widely used to screen preterm and high-risk infants for brain injury in the neonatal period. The present study was undertaken to determine the frequency of cranial ultrasound abnormalities in neonates in the first week of life and study the association between abnormal cranial ultrasound findings in neonates with perinatal risk factors in regard to the immediate clinical outcome in the form of mortality. Method: A total 150 neonates of both the genders from day 0 to day 28 of life with perinatal risk factors who had undergone cranial USG in first week of life were included in the study. Cranial ultrasound of these neonates was done. The cranial ultrasound findings, other demographic parameters, perinatal risk factors, clinical status and immediate outcome were noted. Results: The frequency of cranial ultrasound abnormalities in neonates in the first week of life was 28%. Among subjects with abnormal findings, all were studied in 24 to 72 hrs. of life. Pregnancy induced hypertension (47.83%) and prelabour rupture of membranes (34.78%) was high among subjects with abnormal cranial findings. Germinal matrix haemorrhage (GMH) was high among subjects with abnormal cranial findings (61.9%) with observed high perinatal risk factor being prematurity with low birth weight (1.5-2kgs) (59.5%). Among 42(28%) abnormal neonates, 35 (83.3%) were recovered and 6(14.28%) were discharged on request/DAMA and 1(2.38%) had mortality. Conclusion: The study concludes that cranial ultrasonography is critical as an investigatory modality in NICU and effectively documents morphology of brain damage.

Introduction: Local anaesthetic based nerve blockade of the lateral cutaneous nerve (LCN) of the thigh has been used extensively for postoperative analgesia in skin grafting. Sonographic nerve localization has been an increasingly popular technique to provide regional nerve blocks. Material and Method: A total 60 patients of ASA grade I, II and III, age between 20-50 years, undergoing skin grafting surgery of lower limb were enrolled and randomly divided into two groups of 30 patients in each (FN+LCN Blind and FN+LCN USG Guided). Onset and duration of sensory blockade, duration of post-operative analgesia, requirement of analgesics, ease of technique and complications were noted. Results: The onset of sensory block was early in USG guided group as compared to blind technique. Whereas duration of sensory block was prolonged in USG guided technique than blind. Also, postoperative analgesia prolonged in USG guided group than blind technique. In blind technique, maximum patients required analgesics as compared to patients in USG guided group. USG guided group required less duration and less no of pricks to perform block as compared blind technique. VAS from baseline was markedly reduced within both the groups at all time intervals, but fast decreased observed in USG guided procedure indicating the overall efficacy of the procedure. Conclusion: USG guided block had early onset of sensory block, prolonged duration of sensory analgesia and post operative analgesia with lesser requirement of analgesic, also improve block success rate, and decrease complications as compared to blind block for skin grafting. Thus, ultrasound-guided technique could be performed safely with better patient comfort and longer duration of analgesia than FN+LCN blind technique.

Aim: The aim of the study is to determine the occurrence of anterior uveitis and its management. The study included 50 cases with 62 eyes with signs and symptoms of anterior uveitis, attending the OPD of RIO, Gauhati Medical College and Hospital over a period of one year. A detailed history taken, proper ocular and systemic examination were done. Laboratory and other special investigations were performed. The patients were then treated accordingly. Following treatment, 62.90% eyes regained visual acquity(VA) of 6/9 or better with maximum eyes having VA of 6/6 at final visit with 38.71%.Therefore, identification of specific aetiology with prompt and adequate treatment will result in good visual outcome and prevent complications.

Pseudoexfoliation syndrome is more frequent in people aged >50 years, and its prevalence increases with age. Few reports have described cases in younger patients, all with a history of ocular surgery, especially iris resection. Herein, we describe the case of a 32 year old man with bilateral advanced glaucoma and pseudoexfoliation material in OS. He had undergone cataract surgeries OU and a penetrating keratoplasty OD during childhood. Currently, he presented with an intraocular pressure of 40 mmHg OU. The OS showed a white flaky material in the pupillary rim and anterior capsule and a Sampaolesi line as a gonioscopic finding. Trabeculectomy was performed OU, and intraocular pressure control was achieved. Unlike other previously reported cases, this patient did not present any apparent iris manipulation in the affected eye. However, he did undergo an iridectomy in the contralateral eye. This is also the first case to be accompanied by bilateral glaucoma at the time of detection of the pseudoexfoliation material.

Introduction: Ankle fractures are common orthopedic injury. These fractures involve medial and lateral malleolus with sometimes posterior malleolus. Ankle fracture may range from low energy injuries with little or no displacement to complex fractures with significant associated injuries. Stability of these injuries depends on a combination of boney and associated ligamentous injuries. Objective: To assess the evaluation of outcome of surgical management of ankle fracture (medial malleolus) by single swiss malleolar screw. Methods: This prospective study was conducted in Dept. of Orthopaedic and Trauma Surgery, Shaheed Moman Ali Medical College, Dhaka, Bangladesh from January to June-2022. Total 20 patients with malleolar ankle fractures were studied. All of these patients came to ER with acute injuries following RTA, fall from height etc. All of these patients were assessed pre and post operatively. All of these cases were classified according to Lauge-Hansen, Dennis-weber, AO classification. Results: In this series 20 patients with malleolar ankle fractures were studied. Of these, 3 in the operative and 1 in the conservative group were excluded as they were lost for follow up or refused treatment. Of the 20 cases included in this study 5 (25%) cases were treated conservatively and 15(75%) cases by operative methods. Age, sex distribution and side involved. The average age for the whole group was 56.45 years, (25-88 yrs). In this study right side was affected in 9 cases and left side in 11 cases. Maximum study patient were injured from RTA. All of them were treated by minimally invasive technique. Patients were kept on follow up at regular interval. All of the patient’s plasters were removed at around after 28th POD. On consequent follow up patients could dorsiflex and planterflex ankle and walk after brief period of physiotherapy and active exercise. Conclusion: In our study internal fixation by minimally invasive procedure through single swiss malleolar screw for medial malleolus resulted in comparative positive outcome in five patients suffering from ankle fracture.

Introduction: Chronic liver disease is a common cause of mortality and morbidity worldwide. In majority of cases of chronic liver disease, cardiovascular complications develop as a subclinical condition which manifests only during stressful situations. Hence this study is conducted for early detection of cirrhotic cardiomyopathy by electrocardiographic changes in all patients of chronic liver disease thereby reducing the morbidity and mortality. Aims & Objectives 1) To study ECG changes in cirrhotic patients. 2) To assess the relation between ECG changes & severity of disease in cirrhotic patients. Materials And Methods: This Cross sectional study includes data collected from 100 chronic liver disease patients admitted at Krishna Rajendra Hospital, Mysore during the period of August 2022 to October 2022.The data was analysed by SPSS software version 2.0,and chi-square tests was applied for qualitative variables. Results: The maximum number of patients were in the age group of 51-60 years and their mean age is 51years.This study had 96% males & 4% females, which shows male preponderance among cirrhotic patients. Among 100 patients, 96% were alcoholic and rest 4% with cirrhosis were due to viral etiology, thereby finding alcohol as one of the major cause for cirrhosis of liver. The mean value of resting heart rate in cirrhotic patients of Child Pugh Class C(92+/-4bpm) was significantly (p<0.05) higher compared to Class A (76+/-3bpm) & Class B (81+/-5bpm) So, there is a positive correlation between increasing heart rate and severity of disease, suggestive of parasympathetic damage. The mean value of R-R interval (in msec) was significantly lower in higher Child Pugh class (Class C–694 +/- 58msec, Class B– 809 +/-88msec, Class A-909 +/- 85msec), thereby correlating with increase in heart rate. QTc prolongation was seen in higher Child Pugh class, the mean value in each class being- Class A-372+/-20msec, Class B–393+/-25msec &Class C-433+/-28msec. So there is a positive correlation (p<0.05) between QTc prolongation and increase in severity of disease.QRS duration and PR interval in study group shows no statistical significance(p>0.05). Conclusion: This study infers that autonomic dysfunction is seen in cirrhotic patients and it increases with increase in severity of disease. Cirrhotic cardiomyopathy is a clinical entity with serious impact on prognosis of the disease. This study also highlights the importance of simple investigations like ECG in early detection of autonomic dysfunction, thereby reducing mortality rate by providing early intensive care.

Facial injuries due to dog bite causes severe facial disfigurement which may require meticulous surgical reconstruction. There is distorted facial anatomy and this poses a challenge for mask ventilation. Moreover, there is shared airway with the surgeon. The patient was posted for surgical repair under anaesthesia. Anatomical distortion including lacerated wound of face, destruction of lips, nose and jaw making mask ventilation difficult.

Introduction: Epidural analgesia is an effective postoperative analgesia for surgical procedures. The use of Ropivacaine with adjuvant like Fentanyl is a newer development in the neuraxial blockade and the studies are scarce, so this study to compare the onset and duration of motor and sensoryblockade, efficacy of post-operative analgesia and side-effects seen with 0.75% Ropivacaine with Fentanyl and 0.75% Ropivacaine without any adjuvant in adult lower limb orthopaedics surgery. Method: 84 patients were divided into two groups of 42 each. Group RF received 15ml of 0.75% Ropivacaine plus 50micrograms of Fentanyl (total=16ml) and Group R received 15ml 0.75% Ropivacaine plus 1 cc NS (total = 16ml) epidurally. Duration of sensory and motor block was observed intraoperatively and postoperatively along with pain scores (Visual Analogue Scale VAS) and side effects (nausea, vomiting, bradycardia, hypotension). Results: The groups were demographically comparable. Duration of sensory block was longer in RF group and so was haemodynamic stability and delayed requirement of rescue analgesia. None of the groups showed any side effects. Conclusion: We conclude that 0.75% Ropivacaine with Fentanyl provides an excellent post-operative analgesia, with no side effects and stable haemodynamics with good patient satisfaction than 0.75% ropivacaine without adjuvant and can be used effectively in all lower limb surgeries

Background: Breast lump is a common symptom among women, and it may be indicative of benign or malignant conditions. The clinical and histopathological profile of breast lumps can provide insights into the epidemiology and risk factors of breast cancer. This retrospective study aimed to investigate the clinical and histopathological characteristics of breast lumps in women. Methods: We analysez 80 women who presented with breast lumps in the Dept of Surgery, Srinivas Institute of Medical Sciences and Research Centre. The patients' age, lump size, site of the lump, consistency, involved quadrant, skin changes, nipple discharge, nipple retraction, presence of pain, and axillary lymphadenopathy were recorded. The patients were divided into two groups: benign and malignant, based on histopathological examination. Results: The ROC analysis findings suggest that both FNAC and TRUCUT Biopsy are effective in detecting malignant tumors. FNAC had an accuracy of 90.6%, sensitivity of 92.31% and specificity of 88.89%, while TRUCUT Biopsy had an accuracy of 97.2%, sensitivity of 100% and specificity of 94.34%. Both tests showed significant association with the study groups, with p<0.05. The AUC values for FNAC and TRUCUT Biopsy were 0.906 and 0.972, respectively, indicating that both tests have high accuracy in detecting malignant tumors. The 95% CI for the AUC values were 0.820 to 0.960 for FNAC and 0.908 to 0.996 for TRUCUT Biopsy. Conclusion: Taking into account the benefits and limitations of both techniques, we argue that Tru-Cut should be preferred over FNAC for the diagnosis of palpable breast lumps with FNAC being reserved for definitely benign lesions. Freehand Tru-Cut detects more breast carcinomas as compared to FNAC in palpable breast lumps. and correctly categorizes borderline/ inadequate breast lumps on FNAC into benign & malignant categories, thus reducing indeterminate results and treatment delays. It can therefore be used as an alternative to open biopsy.

Introduction: Outbreaks in the intensive care units have a devastating impact in any healthcare setting, especially Tertiary care hospitals. Conventionally, outbreaks have been described using the “shoe leather” approach. Understanding of emerging infectious microorganisms requires laboratory isolation as a vital tool in investigation of outbreaks. Notorious microorganisms are commonly associated with such outbreaks. This requires “disease detectives” to maintain a constant vigil. Material & methods: In this analytical study we summarize five outbreaks at our Tertiary care centre over a period of 18 months. The outbreaks were investigated by the Infection control team following the recommendations of CDC (10 step approach ). Results & Discussion: Three outbreaks occurred in the adult intensive care unit (ICU). Gram negative organisms (Acinetobacter spp & Chryseobacteriumindologenes) predominated as etiological agents(66%) from blood, urine and endotracheal tube aspirates. All outbreaks in the Neonatal ICUs were caused by Acinetobacter spp., which was isolated from blood samples of neonates. Despite our vigorous efforts the source was identified only in one outbreak. Significant mortality was seen in all outbreaks (probably multifactorial). Conclusion: A constant scrutiny especially in the high risk areas can help in limiting the number of cases and timely intervention cannot let the micro-organisms escape unfathomed.

Introduction: Several studies identified a link between gastroesophageal reflux disease (GERD) andobstructive sleep apnea (OSA). GERD is a condition in which acid reflux from the stomach to theoesophaguscauses troublesome symptoms. On the other hand, OSA is defined as a sleep-related breathing disorder inwhich airflow significantly decreases or ceases due to upper airway obstruction, leading to arousal fromsleep. OSA was found to be associated with GERD. In this study ,we aim to analyse the association of H.pylori infection in patients of obstructive sleep apnea presenting with symptoms of GERD . Methods:40 patients with symptoms of obstructive sleep apnea and gastroesophageal reflux diseases were enrolled . They underwent polysomnography and esophageogastroduodenoscopy .biopsy samples were taken and sent for histopathological examination with giemsa stain . Results: Out of 40 patients, 34 patients have giemsa positive h.pylori gastritis on biopsy (p=0.001)prevalence of h.pylori infection increases with severity of obstructive sleep apnea. Inmoderate osa (17.65%) , severe osa ( 82.35%)( p=0.004) Conclusion: This study concludes that there is significant association of h.pylori infection with OSA presenting with symptoms of GERD. Also, prevalence of h. pylori infection increases with severity of OSA.

Background and objective: The induction of labour is nonspontaneous initiation of uterine contractions before their spontaneous onset leading to progressive effacement and dilatation of cervix and delivery of the baby. Overall rate of induction of labour has increased over last decade. PGE2 has been used for more than a decade for cervical ripening and induction of labour. its been evidenced in literature that misoprostol a PGE1 analogue is extensively evaluated for cervical ripening and induction of labour. We aim to compare between the efficacy of intracervical dinoprostone gel versus vaginal misoprostol tablets for the cervical ripening and induction of labour. Method: This was a prospective study. 100 women which were admitted and who fulfilled the criteria, 100 cases were randomized equally in two groups, 50 patients underwent induction with dinoprostone gel 0.5mg intracevically every 6 hourly till maximum 3 doses and in another group of 50 pts , labour was induced by 25 mcg of misoprostol in posterior fornix of vagina every 4 hourly for maximum 5 doses. Result: In 72% pts in misoprostol group the Bishop score was 2-3,in 90% of pts 25-75mcg of misoprostol was required for successful induction of labour when compared to 66% of cases in dinoprostone group by single application. Induction delivery interval was between 5-18 hours in 84% of cases in the misoprostol group , whereas in only 68% cases , in dinoprostone group induction delivery interval was 7-18 hours . Incidence of LSCS was also less around 6% In misoprostol group when compared to 16% in dinoprostonegroup, cost of misoprostol is cheaper 70/- when compared to 250/-in dinoprostone group. Meconium staining of liquor was found to 8% with misoprostol and 4% in with dinoprostone group.

Introduction: Since the inception of general anesthesia it has been well recognized that laryngoscopy & tracheal intubation is a noxious stimulus, which is associated with hemodynamic changes in the form of increase in blood pressure & heart rate [1, 2 & 3]. We conducted a prospective, randomised, double‑blind, clinical trial to examine whether a single preoperative dose of 800 mg oral gabapentin would be effective in blunting the hemodynamic response to laryngoscopy & tracheal intubation. Aims and Objectives: The main objective of the study is to see the effect of administering oral Gabapentin 800 mg on direct laryngoscopy & tracheal intubation. The secondary objective is to study any side effect of oral dose of 800 mg of Gabapentin like, Dizziness, Somnolence, Nausea, Vomiting and others. Methods: After obtaining institutional ethical clearance, study was conducted for 2 years from October 2020 to October 2022 at tertiary care center.60 patients of either sex (18–50 years of age) undergoing elective surgeries under general anesthesia were randomly allocated to two groups of 30 patients each. Patients of Group A received oral gabapentin 800 mg 2 hr before anticipated intubation, while patients in Group B received oral placebo at the same time. Results: Patients receiving gabapentin 800 mg showed remarkable decrease in HR, MAP, SBP and DBP in response to tracheal intubation (P < 0.05) compared to placebo group.None of the patient has suffered from any side‑effects. Conclusion: Oral Gabapentin 800 mg is efficacious and safe in blunting the hemodynamic response to laryngoscopy and tracheal intubation.

Background: NAFLD is emerging as one of the leading causes of end stage liver disease worldwide. Metabolic syndrome is one of the central mechanism in the development of NAFLD. Hypothyroidism is one of the conditions associated with metabolic syndrome. In this study we assess the NAFLD induced by hypothyroidism. Methods: This cross sectional study was conducted in tertiary care hospitals attached to Bangalore Medical College and Research Institute, India. 44 patients including both clinical and subclinical hypothyroidism, who were non-diabetic and with no significant alcohol intake, were included in the study. The level of NAFLD was assessed by ultrasound and Fibroscan and the same was compared between clinical and subclinical hypothyroid patients. Results: On comparing the Ultrasonography grading of hepatic steatosis between the clinical and subclinical hypothyroidism group it was found that a significantly higher grade (p<0.05) of hepatic steatosis was seen in the clinical hypothyroidism group i.e 11 out of 29 subjects had grade III hepatic steatosis (37.9%) Out of the 29 subjects in the clinical hypothyroidism group, F2 F3 and F4 fibrosis grade was seen in 5, 5 and 6 individuals respectively. While in the subclinical group 14 out of the 15 individuals had F0 to F1 grade of fibrosis. There was a significantly higher (p<0.0.5) fibrosis score in Clinical hypothyroidism group when compared to subclinical group Conclusion: In our study we observed that Clinical and Subclinical Hypothyroidism are independent risk factors for the development of NAFLD. There was significantly higher level of NAFLD in Clinical Hypothyroidism patients when compared with Subclinical Hypothyroidism subjects. Hence treatment of thyroid dysfunction can serve to prevent the progression of NAFLD

Background: Estimation of 24hour urine protein excretion and evaluation of spot protein- creatinine ratio in a random urine sample have been standard methods for determination of protein excretion. . The urine dipstick method, a semi-quantitative method of proteinuria estimation, has long been used as a screening tool for the same purpose. The objective of this study was to assess the efficacy of dipstick as a test for measurement of proteinuria in comparison with 24 hour urinary protein collection and spot urine protein/creatinine ratio as a screening test in pregnant patients with suspected hypertensive disorder of pregnancy attending an obstetric outpatient service. Methods: 150 patients were recruited with suspected hypertensive disorders of pregnancy attending the obstetric outpatient service at our Department of Obstetrics and Gynecology and measured proteinuria in them by dipstick method, 24-hour urine protein collection and spot urine protein/creatinine ratio and calculated the degree of correlation between the first with the other two standard tests. Results: The correlation of the urine dipstick test values with the 24-hour urine protein excretion was strong (r=0.757),but when compared to the spot urine protein-creatinine ratio, it was moderate (r=0.612). At 1+ grading of proteinuria, urine dipstick demonstrated greater sensitivity but at 2+ grading, dipstick was more specific in identification of significant proteinuria. Conclusion: We conclude that dipstick as a test correlates better with 24 hour urine protein estimation than with the protein-creatinine ratio. Further, 1+ grading of urine dipstick could be a good screening tool for identifying proteinuria in patients attending the obstetrics outpatient service. However, the 2 + grading of the urine dipstick would be required to serve as an alternative to the 24-hour urine collection for detection of significant proteinuria or calculation of spot urine P/C ratio.

Background: Acute pancreatitis is a serious condition that requires prompt diagnosis and treatment. Serum amylase and serum lipase are two commonly used biomarkers for the diagnosis of acute pancreatitis, but there is ongoing debate about which marker is more accurate. Methods: We conducted a retrospective review of 70 patients diagnosed with acute pancreatitis at Dept of General Surgery, Mandya Institute of Medical Sciences, Mandya. We compared the diagnostic accuracy of serum amylase and serum lipase, and assessed the correlation between the two markers. Results: A total of 70patients were included in the study. The sensitivity and specificity of serum lipase were 81% and 98%, respectively, compared to 72% and 95% for serum amylase. The positive predictive value (PPV) of serum lipase was 98%, compared to 92% for serum amylase. The negative predictive value (NPV) of serum lipase was 54%, compared to 47% for serum amylase. There was a moderate positive correlation between serum amylase and serum lipase (r = 0.62, p < 0.001). Conclusion: Serum lipase is a more accurate diagnostic marker for acute pancreatitis than serum amylase, with higher sensitivity, specificity, PPV, and NPV. However, serum amylase can still be useful as an adjunctive diagnostic tool, particularly in cases where serum lipase levels are not available or inconclusive. The moderate positive correlation between the two markers suggests that they may be complementary in certain cases. Further studies are needed to determine the optimal cut off values for serum amylase and serum lipase, and to assess the diagnostic accuracy of these markers in different patient populations.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is associated with increased risk of cardiovascular disease (CVD). Carotid artery intima-media thickness (CIMT) is a non-invasive marker for early detection of CVD. The aim of this study was to evaluate CIMT as a predictor of CVD risk in patients with PCOS. Methods: This was a case-control study conducted on 100 women with PCOS and 100 healthy controls. Participants underwent assessment of CIMT, lipid profile, fasting blood glucose, insulin resistance, and other cardiovascular risk factors. Correlation analysis was performed between CIMT and various risk factors. Results: The mean CIMT was significantly higher in the PCOS group compared to the control group (p<0.001). The PCOS group also had lower levels of HDL cholesterol and higher levels of LDL cholesterol, homocysteine, and ferriman-gallwey score than the control group. CIMT was positively correlated with total cholesterol, HOMA-IR, and FGS, and negatively correlated with HDL cholesterol. However, no significant correlation was found between CIMT and age, BMI, fasting blood glucose, DHEAS, SHBG, total testosterone, triglycerides, HbA1c, homocysteine, FGS, blood pressure, waist-hip ratio, or FAI. Conclusion: This study suggests that CIMT can be used as a non-invasive predictor of CVD risk in patients with PCOS. Further studies with larger sample sizes are warranted to confirm these findings.

Introduction: Polypoidal lesions are most common in the nasal cavity. These masses may be congenital, traumatic, inflammatory and neoplastic( benign and malignant) in origin. These nasal masses have a broad histopathological spectrum. Histopathological examination is the only means of determining the nature and patterns of these masses, so that timely intervention can be done. Aims and objectives: To study the histomorphological patterns of polypoidal lesions in a nasal cavity. To categorize the benign and malignant lesions and study the prevalence in relation to age and gender of the patients. Materials and Methods: 100 specimens of polypoidal lesions of sinonasal cavity received over a period of two years in the department of pathology were included in the study. The tissues were subjected to paraffin processing and stained with hematoxylin and eosin. Results: This study included 100 cases, out of which 68 cases were non-neoplastic lesions and 32 cases were neoplastic lesions. Among the 32 neoplastic lesions, 17were benign and 15were malignant in nature. Conclusion: A complete clinical, radiological and histopathological correlation helps to categorize the sinonasal lesions into various non-neoplastic and neoplastic types.

Aims and objectives: the present study was conducted to compare prone versus modified supine position in percutaneous nephrolithotomy. Material and methods: The present study is a prospective cohort study conducted in Department of Surgery in Gandhi Medical College and Hamidia Hospital, Bhopal from December 2020 to October 2022. All the patients presenting with renal calculi of size more than 1.5cm or less than 1.5cm with history of failed ESWL or retrograde lithotripsy were included in the study. Results and Conclusion: A total of 30 patients with a median age of 46 years were studied, 15 (50%) underwent PCNL in prone position and 15 (50%) in supine position. There were no significant differences in gender, age, body mass index, stone location, stone size and the presence of hydronephrosis between the two groups. Time from anaesthesia pre-medication to first attempt to puncture the kidney was significantly lower in supine groupas compared to the prone group (32.67mins vs 44.67mins, p<0.05).There was no significant difference in the outcome variables, namely, post-op hemoglobin, days of hematuria, VAS effort score, pain or length of hospital stay. Thus, Modified Supine position allows a reduction in the time needed to position the patient and in the effort sustained by professional nurses, if compared to the prone position. These benefit sallow an optimization of the available resources with economic implications.

Myxoma is a benign neoplasm derived from primitive mesenchyme usually occurring in heart but can arise rarely in orbit, eyelid and conjunctiva. A 61-year-old female presented with a history of right eye lower lid lesion of two year duration. The patient had undergone excision of the lesion at a SRTR hospital. Examination showed a soft non tender nodular skin coloured lesion of 2 x2 cm dimension on the lateral aspect of the right lower eyelid. Visual acuity was 6/18, N8. Rest of the anterior segment was within normal limits. Wide excision of the lesion along with lid margin and lid reconstruction was done. Histopathology of the excised lesion showed features suggestive of myxoma with a prominent vasculature. Detailed cardiac and dermatological evaluation did not show other components of Carney’s complex. Isolated eyelid myxoma is an extremely rare condition with a tendency towards local recurrence following incomplete excision

Introduction: Breast cancer is the most prevalent site-specific cancer in women and the leading cause of cancer-related mortality among women aged 20 to 59. When normal cells in the lobules, ducts, or other breast tissue become damaged and proliferate uncontrollably, breast cancer develops. The aberrant cells multiply and collect rapidly, forming a mass known as a tumor. Objective: study to assess the incidence of recurrence rate of carcinoma breast in patient visiting Department of Surgery and treated with available facilities and modalities at Gajra Raja Medical College, Gwalior. Methodology: A Retrospective observational study was conducted in the patients visiting surgery department in GRMC, GWALIOR Districts of MP. Total 50 patients diagnosed with clinical palpable breast lump with FNAC status positive who were admitted in Surgical Ward, Department of General Surgery, G.R.M.C., Gwalior by using SPSS 25. Result: Recurrence of breast carcinoma was reported by 34% patients only. Whereas 66% patients were reported with no recurrence. Majority of the patients were aged between 45-49 years, i.e. [08(47.06%)], followed by 50-54 years [07(41.18%)] . it was found that out of the total enrolled patients maximum i.e. 46% were detected for Ductal cell carcinoma in situ, followed by 30% patients for Invasive ductal carcinoma and so on. Conclusion: Findings of our study indicate that, it was observed that despite a higher incidence of recurrence it was reported only in 34% of total enrolled and successfully treated patients. This indicates that breast carcinoma can be managed and treated successfully.

Background: Mechanical Ventilation (MV) has become frequently used life-supportive management in Pediatric Intensive Care Units (PICU). But very little data is available from developing countries regarding the outcome analysis coupled with clinical profile of children ventilated in PICU. Hence the present study was undertaken to assess the etiological and clinical profile of ventilated children in PICU of tertiary care centre. Method: Total number of PICU admissions during the study period from Feb 2021 to Dec 2022 was 678. Out of them a total of 272 (40.11%) PICU admissions satisfied the inclusion and exclusion criteria were studied. Results: The average age of infant was 30.42±46.14 months with male preponderance (57.72%). The most common etiology/indication was respiratory diseases (29.77%). Invasive ventilation (98.89%) far exceeded the use than non–invasive ventilation (1.10%) in our PICU. Of the children who were ventilated in the PICU, 76.6% were intubated at the Emergency Department. The commonest cause for intubation was circulatory failure and the most common clinical diagnosis was septic shock. Rapid Sequence Intubation (RSI) was done by the majority of children (53.90%). Maximum cases250(92.93%) were exclusively mechanically ventilated. Nosocomial pneumonia was the most common complication encountered in ventilated children(16.35%). The mortality in the ventilated children was 54.77%. Conclusion: Mortality and complications in ventilated children in the PICU can be reduced with increased availability of mechanical ventilators and timely referrals to tertiary care centre. However, to improve the outcome of mechanically ventilated children in PICUs, the early and effectively identification of clinical profile and etiological factors associated with ICU admission.

Background: ADA recommends HbA1c testing in diabetic patients as initial assessment and a part of continuing care. HbA1c reflects average glycemic status over 2-3 months and predicts diabetic complications. In diabetes, albumin synthesis, secretion is decreased due to insulin deficiency. It is expected that albumin levels decrease in diabetes and may affect plasma protein glycation and HbA1c is a measure of high glucose levels [5-7]. Despite a significant negative correlation between serum albumin and HbA1c in diabetes mellitus, serum albumin is not monitored in diabetes. Objectives: To study the correlation between Hba1c and serum albumin levels in type 2 diabetes mellitus patients. Methods: 50 Study participants with Diabetes mellitus attending K R hospital were included in this study. FBS, PPBS, HbA1c and serum albumin were estimated Results: The mean age of the subjects was 62.43 ± 11.58 years. 58% of the study subjects were males. The mean HbA1c and serum albumin of the subjects was 7.89±0.54 and 3.35±0.71 respectively. HbA1c was found to be negatively correlated with serum albumin level. The association was found to be statistically significant between HbA1c and serum albumin. Conclusion: Serum albumin can mirror insulin secretory reserve, which influences glycemic control and ketosis risk.

Introduction: Adolescence is the transitional phase of growth and development between childhood and adulthood when structural, functional and psychosocial development occurs [1]. The world health organization (WHO) defines an adolescent as any person between10 and 19 years of age. All over the world and more in developing countries like India teenage pregnancy rate is ona rise and emerging as a serious problem. It constitutes 11 percent of all the births worldwide and 23 percent of overall disease burden due to pregnancy and child birth [2]. Aims: To determine the incidence of Teenage pregnancy, to analyse the factors contributing to teenage pregnancy, to study the health problems of teenage mothers during pregnancy, labour and puerperium and to study the fetal consequences of teenage pregnancy. Materials and Methods: This prospective study was conducted in Obstetrics and Gynaecology Department of Mahatma Gandhi Medical College Sitapura, Jaipur from 1st January 2021 to 30th June 2022 and data was analysed. Conclusion: Mean age of teenage pregnancy was (mean± s.d.) 18.7571± 0.4945 and in Non-teenage pregnancy, the mean Age (mean± s.d.) of patients was 25.2143± 2.9825.In our study we found that maximum Teenage pregnancies belonged to rural area and lower socio economic status. Teenage pregnant women were more anemic and had other feto-maternal complication. Which was statically significant in our study.

Background: The objective of this study was to determine the incidence of port site infections and associated risk factors among patients undergoing laparoscopic surgeries. Methods: A retrospective chart review was conducted on 285 patients who underwent laparoscopic surgeries in a tertiary care hospital from January 2022 to December 2022. Data on patient demographics, surgical characteristics, and incidence of port site infections and associated complications were collected. Statistical analysis was performed to determine the risk factors for port site infections and associated complications. Results: The majority of the patients were between 31-50 years old (44.2%), and cholecystectomy was the most common type of surgery (35.0%). Out of 285 patients, 20 (7%) developed port site infections, with hernia repair having the highest incidence (9%). Superficial incisional SSIs were the most common type of infection (3.5%). The odds ratios for age, gender, BMI, and underlying medical conditions were not statistically significant. However, the odds ratio for the duration of surgery was 1.19, indicating that longer surgery duration may increase the risk of port site infections and associated complications. Conclusion: The findings of this study suggest that the risk of developing port site infections varies depending on the type of laparoscopic surgery, with longer surgery duration possibly increasing the risk. While there were no statistically significant associations found between age, gender, BMI, and underlying medical conditions with the risk of port site infections and associated complications, patients with comorbidities may be at a higher risk. Further research is needed to identify additional risk factors and develop strategies to reduce the incidence of port site infections.

Background: Deep vein thrombosis (DVT) is a common complication in patients undergoing abdominal surgery. This study aimed to identify the risk factors associated with the development of DVT in patients following abdominal surgery. Methods: A prospective observational study was conducted on 100 patients who underwent abdominal surgery between January 2022 and December 2022. Demographic data, comorbidities, surgery-related factors, and postoperative care measures were collected. Logistic regression analysis was performed to identify the risk factors associated with the development of DVT. Results: The incidence of DVT in this patient population was 4.9%. Logistic regression analysis revealed that patients who underwent major abdominal surgery for malignancy and those with surgery duration of ≥2 hours were at significantly higher risk of developing DVT post-surgery. Age, sex, BMI, and comorbidities such as hypertension, diabetes, and smoking were not significant risk factors. Prophylactic anticoagulants, mechanical compression devices, and early mobilization did not show a significant effect on the development of DVT. Conclusions: This study suggests that patients who undergo major abdominal surgery for malignancy and those with surgery duration of ≥2 hours are at higher risk of developing DVT post-surgery. Clinicians should be aware of these risk factors and take appropriate measures to prevent DVT in these high-risk patients. Future studies are needed to further evaluate the effectiveness of prophylactic measures in preventing DVT in post-surgical patients.

Introduction: Establishment of identity of unknown human remains is a challenging task in medico-legal cases, especially when the remains are partial, mutilated or dismembered. Such situations usually arise in cases of natural disasters, rail, aircraft accidents, wars, terrorist explosions. Hand, foot, Ulna and Tibia length can be used to determine the stature of the person whenever mutilates, bones or part of bone comes for post-mortem examination. The tibia is ideal in this application as it resists erosion and keeps its anatomical shape for long even after burial. Objective: To find out the relationship between personal stature and length of tibia. Methods: Cross sectional study was conducted during October 2021-November 2021 in Department of FMT in a Rural Medical College Maharashtra. Study Population included 100 medical students. Result: Regression equations were formulated with R2 (coefficient of determination) of 0.5796 for males on right side & 0.5709 on left side and 0.5748 and 0.563 for females on right and left tibia respectively. The calculated height was compared with the observed height of the students using t test. The test revealed that there was no significant difference between observed and calculated height of both male and female students, p>0.05. Conclusion: Tibial length is a reliable parameter in reconstructing the stature of an individual.

Introduction: Acute abdomen is a common presenting complaint in the emergency department, requiring prompt diagnosis and treatment. Clinical examination and ultrasonography (US) are commonly used diagnostic tools in the evaluation of acute abdomen. This study aimed to evaluate and compare the diagnostic accuracy of clinical examination and US in the diagnosis of acute abdomen. Methods: This was a prospective study that included 100 patients with acute abdomen who underwent both clinical examination and US. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of clinical examination and US were calculated. Additionally, the diagnostic value of US in the identification of different causes of acute abdomen was evaluated. Results: The overall sensitivity and specificity of clinical examination were 75% and 60%, respectively, while those of US were 85% and 70%, respectively. The PPV and NPV of clinical examination were 65% and 70%, respectively, while those of US were 75% and 80%, respectively. The accuracy of clinical examination and US was 67.5% and 77.5%, respectively. US was found to be more accurate than clinical examination in diagnosing acute abdomen. Conclusion: US is a valuable diagnostic tool in the identification of different causes of acute abdomen, with higher sensitivity and specificity compared to clinical examination. The diagnostic accuracy of US varies depending on the underlying cause of acute abdomen. These findings support the use of US as a first-line diagnostic tool in the evaluation of acute abdomen.

Background: Hypothyroidism is a common endocrine disorder associated with several metabolic abnormalities, including dyslipidemia. The prevalence of dyslipidemia in hypothyroidism and the effect of thyroid hormone replacement therapy on lipid profile are well-established. However, the association between lipid profile and age and sex in patients with hypothyroidism is less clear. Methods: We conducted a retrospective study of 100 patients with hypothyroidism to evaluate their lipid profile and investigate the effect of thyroid hormone replacement therapy on lipid levels. We also analyzed the association between lipid profile and age and sex in this patient population. Results: Our study found a high prevalence of dyslipidemia in patients with hypothyroidism, with elevated total cholesterol and LDL cholesterol being the most commonly observed abnormalities. Thyroid hormone replacement therapy significantly improved lipid profile values in patients with hypothyroidism, with a decrease of 20% in total cholesterol and 25% in LDL cholesterol. We also found an age-related increase in total cholesterol and LDL cholesterol and a decrease in HDL cholesterol, while HDL cholesterol was significantly lower and triglycerides were significantly higher in females. Conclusion: Our study highlights the importance of screening and monitoring lipid profile in patients with hypothyroidism, especially those who are older or female. Thyroid hormone replacement therapy significantly improves lipid profile values in patients with hypothyroidism. Age and sex are important factors that influence lipid profile in patients with hypothyroidism. Therefore, appropriate attention should be given to these factors when managing dyslipidemia in patients with hypothyroidism.

Neuroendocrine Carcinoma of Gallbladder is a rare tumor, which is heterogenous neoplasm originating from neuroendocrine cells, which secrete neurotransmitter. Among all theneuroendocrine neoplasms, gallbladder neuroendocrine neoplasm prevalence is 0.5% accounting for approximately 2.1% of all the gallbladder tumors. Case Presentation As gallbladder neuroendocrine neoplasm is a rare lesion it is seldom seenin clinical practice, there is a limited availability of review reports and it is therefore often considered only as a case study. It is difficult to distinguish gallbladder neuroendocrine neoplasms from other gallbladder diseases using imaging diagnostic techniques. We here report a case of 55 years old female presenting with right upper quadrant and epigastric pain and eventually diagnosed with mixed cell neuroendocrine carcinoma of gallbladder. Conclusion Therefore to overcome inherent risks or shortfalls of traditional surgery, early detection, diagnosis and treatment of gallbladder neuroendocrine neoplasms are required to improve patient longevity.

Background: Early diagnosis and accurate evaluation of breast lumps are crucial for optimal management and improved patient outcomes. The Modified Triple Test (mTT) combines clinical examination, high-resolution ultrasonography (USG), and fine needle aspiration cytology (FNAC) to diagnose breast lesions. This study aimed to assess the effectiveness of mTT in evaluating breast lumps and to compare its results with the standard Triple Test done elsewhere worldwide. Methods: The study included 50 patients presenting with breast lumps. The mTT score was calculated for all cases, and the sensitivity, specificity, and positive predictive value (PPV) of each diagnostic method were determined. Results: The sensitivity and specificity of clinical examination were 83.87% and 78.95%, respectively. USG showed a sensitivity of 87.10% and specificity of 78.95%, with a PPV of 90%. FNAC demonstrated the highest sensitivity (100%) and specificity (89.47%), with a PPV of 93.94%. Among patients below 40 years, 84.37% had benign lesions, while 77.78% of patients above 40 years had malignant lesions. Right-sided breast lesions were more common (42%) than left-sided (34%), with bilateral lesions found in 24% of cases. The upper outer quadrant was the most commonly involved site (74%).In our study, Axillary Lymphadenopathy was seen in 29 cases. 19 Cases were found to be malignant. Conclusion: The Modified Triple Test is an effective and reliable method for evaluating breast lumps. FNAC showed the highest sensitivity and specificity among the diagnostic methods studied. The mTT can be a valuable diagnostic tool in the assessment of breast lumps, particularly in low-resource settings.

Introduction: Placenta previa (PP) is an important cause of maternal and fetal morbidity and mortality worldwide. It is one of the major cause for antepartum heamorrhage which complicates 1-5% of the pregnancies. Aim: To determine the incidence and maternal and fetal outcomes among women with placenta previa (PP). Methods: This is retrospective, observational study carried out in Department of Obstetrics &Gynaecology of T.N.M.C & BYL Ch. Nair hospital, Mumbai over a period of 2years from January 1st2018 to December 31st 2019. Results: Total number of patients delivered during this period were 6290 and out of which 94 patients were diagnosed with placenta previa, so the incidence is 1.5%. Of women with placenta previa, 3.44%(n=4) had placenta accreta. Incidence of placenta previa was the highest in the maternal age group 20-30 years i.e. 72.9%, Perinatal morbidity was studied as the percentage of babies requiring resuscitation and NICU admission which was 37.35 %(n=36). Caesarean hysterectomy was performed in 10.4% (n=10) cases, there were 1.72 %(n=2) perinatal deaths.

Background: End stage renal disease (ESRD) is the final stage of CKD, affecting around 7.5 million people globally. Haemodialysis (HD) being the life saving treatment, also has serious impacts on patient’s medical, social and psychological well being, leading to medication non-adherence. Medication adherence is a cardinal element of any treatment, which can prevent the incidence of morbidity and mortality. Thus, current research aimed to assess medication adherence in ESRD patients undergoing HD. Methods: After obtaining IEC approval, this study was initiated in HD unit with 80 eligible patients using a pre validated questionnaire, modified version of Greek-Simplified Medication Adherence Questionnaire for Haemodialysis (GR-SMAQ HD). It evaluates adherence status for 3 domains, namely medication, HD session and Diet/Fluid restrictions. Total score of 8 indicates greater adherence. All collected data were tabulated and analyzed using SPSS 20.0 version. Results: Out of 80 patients, 58 were male and 22 female, with average age of 46.41 ± 8.02. Assessment of individual domains showed: 91.25% patients had greater adherence for HD session, followed by medication and fluid/diet (28.7% & 22.5%). Based on total scoring, only 7.5% had greater adherence level, remaining 92.5% belonged to moderate/poor adherence level, while no participant had zero adherence. Also showed significant correlation (P<0.05) for patients age, employment status and income status. Conclusion: Thus, result explored that only 7.25% patients had greater adherence level. So, it emphasizes that periodic evaluation on medication adherence by health care workers is highly essential to elevate the treatment success.

Introduction: Gallbladder carcinoma is a subtype of gallbladder cancer that particularly refers to primary epithelial malignancies that arise from the gallbladder. Of these, adenocarcinomas make up the vast majority (90%), while squamous cell carcinomas make up the remaining 10%. Most of the time, they only manifest symptoms when they are in advanced stages and are more common in elderly women [1]. Gallbladder cancer incidence varies widely according to region, ethnicity, and cultural differences, which points to the importance of genetic and environmental variables in the onset and spread of the disease[2]. Gallstones and chronic cholecystitis are the most frequent risk factors for the development of gallbladder cancer. Material and Methods: A Case-Control Study" is to be conducted on patients admitted in various Departments of J.A. Group of Hospitals & G.R. Medical College, Gwalior, from 01 Jan. 2021 to 01 Aug. 2022. 75 patients will be selected as cases and 75 patients as controls for conducting this study. Result: Females are most commonly affected with gallbladder cancer than males. Patients in the age group of 45-59 years have the highest risk of gall bladder cancer. Patients having gallstone disease were more prone to gallbladder cancer. The size of the stone also has a significant risk factor for gallbladder cancer. No. of stone also has a significant role in developing gallbladder cancer. Mustard oil consumption has shown an association with gallbladder cancer. Conclusion: The main goal of the current study was to determine whether gallstone disease and gallbladder cancer are related. Carcinoma of the gallbladder was found to occur most frequently in the fourth and fifth decades of life with more prevalent among females (89.33%) than males in our study. Ultrasonographic evidence of gallstone disease was seen in most patients (53.33%) with gallbladder cancer. In this study, GBC was found in 65% of patients with multiple gallstones with stones more than 2 centimeters in size was more frequently linked to GBC. Mustard oil consumption was also associated with developing GBC Gallbladder wall thickening most common CT scan finding in our study. In this, study a significant association was found between GSD & GBC.

Aim: The push out bond strength of a fiber post system was evaluated and compared using a self-etch resin cement and a total-etch resin cement. Materials and method: In this in-vitro study 30 maxillary central incisors were decoronated from the CEJ. Root canal preparation and obturation were done and post space was prepared using peeso reamers (Size #3). Samples were randomly divided into 2 groups (15 samples each). Group A consisted of posts luted using self-etch resin cement (RelyX U200; 3M ESPE), and Group B consisted of posts luted using total-etch resin cement (Variolink N Intro Pack; Ivoclar Vivadent). The samples were then sectioned into 3 parts – Coronal, Middle and Apical; and subjected to push out bond strength testing under a Universal Testing Machine. Results: There was no significant difference seen in the push out bond strength of the fiber post system (RelyX U200:84.353, Variolink N Intro Pack: 28.741); whereas, significant difference was seen at different root levels. Conclusion: The push-out bond strength of both the cement was non-significant. When the push-out bond strength was compared at various root levels; the coronal segment exhibited higher push-out bond strength, followed by the middle segment and the lowest was shown by the apical segment.

Background: Diabetes mellitus and thyroid dysfunction are two common endocrine disorders. The unrecognized subclinical Thyroid dysfunction may adversely affect metabolic control and increase cardiovascular risk. Our aim was to investigate the prevalence and patterns of Thyroid dysfunction in patients with type 2 diabetes mellitus in an observational cross-sectional study. Screening for thyroid dysfunction in diabetic patients will allow early treatment of hypothyroidism. Thyroid hormones and insulin both are involved in cellular metabolism antagonistically. Therefore, excess or deficit of any one of them may result in metabolic derangement. Recently, interest has been raised for the influence of thyroid hormone action on insulin levels. Conflicting data are available on influence of insulin levels on thyroid dysfunction. The development of IR may also lead to many metabolic abnormalities. Objective: Study of thyroid dysfunction in type 2 diabetes mellitus. Methods: Data was collected from the Type 2 Diabetes mellitus patients who visited the OPD or got admitted at KR Hospital, Mysore medical college, Mysore. The necessary blood tests, urine examination and imaging were done as per the proforma. Results: In our study,16 out 100 patients had abnormal thyroid profile.7 patients have overt hypothyroidism,5 patients have subclinical hypothyroidism,3 have hyperthyroidism and 1 has subclinical hyperthyroidism. Our study has high Prevalence of Thyroid dysfunction in females among type 2 diabetes mellitus. Conclusion: This study showed high prevalence of thyroid dysfunctions in patients of type 2 diabetes mellitus. Hence, we conclude that screening for thyroid dysfunction among patients with diabetes mellitus should be routinely performed, so as to recognize these dysfunctions early

Introduction: Diaphragmatic rupture is a rare pathology that is reported in less than 0.5% of all trauma cases, with signs and symptoms that can lead to misdiagnosis. To effectively diagnose and treat this illness, clinicians must maintain a high index of suspicion. We present a series of cases of a large diaphragmatic rupture with transthoracic herniation of the stomach small intestine and large intestine that was successfully repaired, along with a literature review. Methods: The data and information are collected from the Department of Surgery Gandhi Medical College and Hamidia Hospital, Bhopal. We present our experience of traumatic diaphragmatic injury patient management of five patients who presented to our emergency department. Results: These cases highlight the importance of diaphragmatic rupture and its associated intra-abdominal injuries when treating trauma patients. With missed diaphragmatic injuries leading to a potential morbidity rate of 30% and a mortality rate as high as 10%.one should be alert while treating these patients

Background: Malnutrition is India’s silent crisis. Child under nutrition remains one of the major health issues and the leading contributor to under 5 morbidity and mortality in the world. The present study was undertaken to assess the Clinico-etiological profile and the outcome of patients with SAM. Methods: In this retrospective study, a total of 46 children aged between 6 to 60 months admitted to paediatric ward with a diagnosis of SAM (as per WHO definition) were included. Variables recorded were anthropometry, clinical presentation, laboratory tests, epidemiological factor, and risk factors. Results: Mean age of admitted children was 18.26±5.44 months with female predominance(60.9%) and mostly partially immunised (84.8%) and belonged to lower socio-economic scale (45.7%).Majority of patients with SAM didn’t follow exclusive breast feeding and complimentary feeding practices. Early introduction of over diluted cow milk seen in most of the patients. Acute respiratory infection was the most common comorbidity found in 27(58.6%) children. Out of 46 children, 34 recovered (73.9%), 11 (23.9%) were defaulter and 1 child was died during the study period. In maximum cases duration of hospital stay was 7 to 15 days (28; 60.8%). Conclusion: Most of the studies highlight clinical manifestations of SAM. Risk factors isolated were not following Breast feeding practices, inappropriate complimentary feeding, incomplete immunisation, and anaemia. Ideal method to prevent patients to land up into SAM will be tackle risk factors. This can be done methodically by increasing maternal awareness. This should be mandatorily practiced by paediatrician at the time of discharge and regular immunisation visits.

A 55 years old man came to emergency department of a tertiary care hospital in Kolkata India with complaints of anorexia, weakness and vomiting with no prior history of fever or any significant medical comorbidities. On admission diagnosis was hyponatremia. During hospital stay he was also detected with Type 2 diabetes mellitus. Immunopheno typing (Flow cytometry) findings were consistent with Chronic lymphocytic leukaemia with CD38 expression. CECT whole abdomen and thorax showed features of multiple enlarged lymph nodes. CT Brain (Plain) showed normal study and MRI of pituitary gland showed bulky pituitary gland and infundibulum with homogenous enhancement in post contrast study. With just five examples of pituitary or hypothalamic involvement previously recorded, this case emphasizes an unusual presentation of chronic lymphocytic leukaemia (CLLBinet type A) with pituitary involvement.

Cancer is a fatal illness that is responsible for the deaths of millions of individuals all over the globe every year. It is possible that people will be able to survive for a longer period of time as a result of early identification, staging, and individualised biomarker therapy. Proteases known as deubiquitinating enzymes are responsible for removing ubiquitin tags from proteins so that they may be broken down by the proteasome. Enzymes that deubiquitinate proteins have several purposes throughout the body. One of the numerous roles that Deubiquitinating Enzyme plays is to keep an eye on the progression of tumours. The expression of members of the deubiquitinating enzyme family was shown to be elevated in a wide range of oncocells and tissues during various stages of cancer, according to a number of investigations. Based on these findings, deubiquitinating enzymes have the potential to be exploited as a therapeutic target in cancer treatment. In this article, the functions of members of the Deubiquitinating Enzyme family, as well as ubiquitin-specific proteases and other important family members, are dissected. Our goal was to get a better understanding of the connection between the expression patterns of deubiquitinating enzymes and carcinomas so that future research might investigate the possibility of developing inhibitors and gene therapies to improve the diagnosis and prognosis of cancer.

Ficus is one of the largest genera in the plant kingdom that belongs to the Moraceae family. This review aimed to summarize the medicinal uses, phytochemistry, and pharmacological actions of two major species from this genus, namely Ficus benghalensis and Ficus religiosa. These species can be found abundantly in most Asian countries, including Malaysia. The chemical analysis report has shown that Ficus species contained a wide range of phytoconstituents, including phenols, flavonoids, alkaloids, tannins, saponins, terpenoids, glycosides, sugar, protein, essential and volatile oils, and steroids. Existing studies on the pharmacological functions have revealed that the observed Ficus species possessed a broad range of biological properties, including antioxidants, antidiabetic, anti-inflammatory, anticancer, antitumor and antiproliferative, antimutagenic, antimicrobial, anti-helminthic, hepatoprotective, wound healing, anticoagulant, immunomodulatory activities, antistress, toxicity studies, and mosquitocidal effects. Overall,the review discussion on the importance of Ficus benghalensis as the herbal property in the aspect of the greater therapeutic response, as well as also balancing the oxygen level in the environment.

Traditional uses of the family Zingiberaceae have a long history and include everything from folk medicine to culinary applications. There are more than 70 different species of Curcuma, most of which are grown extensively in Western Africa, Asia, and Australia. Numerous Curcuma species have been the subject of numerous phytochemical, pharmacological, and molecular studies worldwide. The identification of novel bioactive molecules with a variety of bioactivities, including antioxidant, antiviral, antibacterial, and anti-inflammation activities, has boosted interest in its therapeutic qualities. Additionally, this priceless plant is employed as a pesticide, natural dye, and repellant. The goal of this review is to collect data on the genus Curcuma, including information on its morphological traits, phytochemicals, and the biological and pharmacological effects of these compounds, which will be used to inform future research projects.

Aims: To study ‘UNUSUAL SITE THROMBOSIS’ which was associated with increased morbidity and mortality. Objectives : To study the following in COVID PATIENTS : 1. Evidence of thrombosis in young positive individuals. 2. To know the reason for failure of early identification of thrombotic condition Materials and Methods : This study is retrospective analysis of the patients who were admitted in the COVID 19 referral centre in the Sassoon General Hospital from the period of March 2020 to December 2020 All covid files were examined for : ● Documentation of local examination of extremities ● Discoloration of limbs ● Complaints of pain abdomen ● USG A-V Doppler of extremities reports ● CT peripheral angiography ● Referred patients for SMA thrombosis, intervention for thrombosis ● Amputations Results and Conclusion : This pandemic of COVID19 affecting globally has cost us many lives, these needs to be understood and prevented. This study concludes that majority of the surgical complaints were due to the complication of thrombosis either in the venous system or arterial system with majority limb and life threatening, these needs to be suspected early and managed accordingly if the circumstances repeats again

Introduction: Acute Phase proteins, which is part of a repertoire of cell responses to inflammation, can be used as diagnostic tool and may provide an alternative means of monitoring health. In this study, we aimed to explore the role of Serum Amyloid A (SAA) protein and other inflammatory markers like CRP, Ferritin, LDH, D-Dimer and Lymphocytes in acute and convalescent phase of SARS–Cov-2 cases. Methodology: In this pilot study, 5ml of blood sample was taken from 30 SARS CoV2 positive patients and Serum inflammatory markers like SAA, CRP, D-Dimer, Ferritin, and Lactate dehydrogenase & Lymphocytes were estimated. According to the MOHFW guidelines, 16 out of 30 were categorized as non-severe Covid-19 and 14 of them as severe Covid-19 who had SPO2<90% or RR> 30/minute. There were 7 deaths out of the total 14 severe Covid-19 Results: SAA is elevated in acute phase (AP), and is decreased in convalescent phase (CP), with statistically significant p value (p<0.01). All other inflammatory markers exhibit similar pattern with a statistically significant p values between acute and convalescent phase except for inverse relation of Lymphocytes. Lymphocyte counts were strongly and significantly correlating with disease severity than compared to other inflammatory markers. Lymphocytes, ferritin and D-Dimer levels during admission also significantly correlates with mortality. Conclusion: Serum SAA level is significantly increased in acute phase along with other inflammatory markers like CRP, Ferritin, LDH, D Dimer and lymphocyte count. But serum ferritin, D-Dimer and lymphocyte counts at baseline can be used to predict the worse outcome.

Purpose: To study the prevalence, complications and visual outcomes in patients with PPC undergoing small incision cataract surgery (SICS) Materials & Method: This is a prospective study of 96 patients undergoing surgery for PPC. All surgeries were performed by a single surgeon. All cases were bilateral and present in young age so the possibility of amblyopia was explained. They were also explained about preexisting posterior capsular dehiscence. After completion of continuous curvilinear capsulorhexis, controlled hydrodelineation was done in case of immature cataract. In the case of mature cataracts with PPC nucleus was separated from the capsule using spatula. Anterior vitrectomy done in case of posterior capsule rupture (PCR) & IOL placed in sulcus. Results: Total number of cataract surgery in one year was 6000. Prevalence of PPC was 1.6%. out of 96 cases overall rate of PCR was 10(10.41%). 3(3.1%) cases had cortical drop. 5(5.2%) cases showed cystoid macular edema (CME) as a complication which was treated with NSAID eye drop. All 96(100%) cases achieved a final visual acuity of 6/9 to 6/6 at 6 weeks follow up. Conclusion: clinical diagnosis and typing of cataract are most important in case of PPC. Before surgery patients should be counselled about the possibility of preexisting dehiscence, PCR occurring on table and the possible postoperative complications. During surgery care should be taken to avoid hydrodissection. Surgery done with due precautions gives good results in PPC.

Background: Sleep disorders are common in childhood and adolescence and are associated with neurocognitive and psychosocial impairments as well as an increase in caregiver burden. Current evidence indicates that chronically disrupted sleep in children and adolescents can lead to problems in cognitive functioning, such as attention, learning, and memory. Sleep-wake disorders are common and have an important impact on the quality of life of children, but if they are promptly recognised and treated the outcome is favourable. Methods: The present study was a single-center, observational Study conducted on patients admitted/visited with sleep disorders in children aged between 6-18 years. Irrespective of treatment and in the department of Paediatrics, Sri Siddhartha Medical College hospital and Research Centre, Tumkur from January 2020 to July 2022. Prior initiation of the study obtained Ethical and Research Committee clearance from Sri Siddhartha Medical College hospital and Research Centre, Tumkur. During present study total 185 children were reviewed in OPD/IP, among 120 patients were enrolled into the study according present study inclusion criteria and 60 patients were excluded according exclusion criteria. Results: Most of the subjects had a positive family history, i.e., 67.50 %; followed by 32.50 % subjects without significant family history. Most of the subjects were born second in the family, i.e., 64.17 % subjects; followed by 13.33 % subjects who were born first and finally 22.5 % subjects born third in the family. Most of the subjects belong to upper class, i.e., 29.17 % subjects; followed by 24.17 % subjects in lower middle class; 19.17 % subjects in upper middle class; 15.83 % subjects in upper lower class and finally 11.67 % subjects in lower class. Most of the subjects had the risk factor of bed sharing practice, i.e., 60 % subjects; followed by 58.33 % subjects with bad sleep practice; 35.83 % subjects with nose block; 34.17 % subjects with ambient environment; 32.50 % subjects with noisy breathing; 30.83 % subjects with insect bites and finally 24.17 % subjects with external influences. Most of the subjects experienced symptoms of difficulty getting sleep, i.e., 77.50 % subjects; followed by 55 % subjects with difficulty breathing in sleep; 43.33 % subjects with irritability; 40 % subjects with sleep talking; 27.50 % subjects with bruxism and finally 26.67 % subjects with sweating in sleep.

Background: Gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe gestational hypertension and/or severe preeclampsia before 35 weeks' gestation is associated with significant maternal and perinatal complications Materials and Methods: The present study was a single-center, observational Study conducted on patients admitted with newborns born to mother with hypertensive disorder of pregnancy, Irrespective of treatment in the department of Paediatrics, Sri Siddhartha Medical College hospital and Research Centre, Tumkur from January 2020 to July 2022. Prior initiation of the study obtained Ethical and Research Committee clearance from Sri Siddhartha Medical College hospital and Research Centre, Tumkur. During present study total 200 neonates were reviewed in OPD/IP, among 125 patients were enrolled into the study according present study inclusion criteria and 75 patients were excluded according exclusion criteria. Results: Majority subjects were in the age group of 21-25 years (45.60 %).Most subjects were in their primi (48%).The above table gives data on distribution of subjects based on diagnosis. Most subjects were diagnosed with preeclampsia, i.e.73 (58.4%); followed by 27 subjects (21.6 %) with eclampsia HTN and 25 subjects (20%) with gestational HTN .Most subjects were not with any complications (87.2%). Most of the neonates were males (52%).There were 50.40 % neonates with low birth weight and 49.60 % with normal birth weight. 41.60 % neonates had morbidities. The morbidities observed in our study were resuscitation (33.60%); hypothermia (31.20%); hypoglycemia (28.00%); icterus (24.80 %); sepsis (14.40%); Transient tachypnea of the newborn (16 %); birth asphyxia (11.20%) and respiratory distress syndrome (57.60%). Majority of neonates required admission into Intensive Care Unit (54.4%). Conclusion: Pregnancy Induced Hypertension is a maternal pathology involving placental modification which is associated with fetal complications. Fetal morbidity and mortality are serious concerns in preeclampsia and are attributable to poor management. Neonatal adverse events such as asphyxia, low birth weight, prematurity, Intrauterine growth restriction, NICU admission, and neonatal death were more prevalent if the mother had a hypertensive disorder during pregnancy.

Background: Otitis media is defined as an infection of the middle ear space. that include acute otitis media (AOM), chronic suppurative otitis media (CSOM), and otitis media with effusion (OME). Infection of the middle ear can be viral, bacterial, or coinfection. Otitis media is diagnosed clinically via objective findings on physical exam (otoscopy) combined with the patient's history and presenting signs and symptoms. However, understanding the bacterial etiology of otitis media (OM) is important when designing and evaluating the best course of treatment. Methods: The present study was a single-center, observational Study conducted on children <6yrs with Otitis mediain the department of Paediatrics, Sri Siddhartha Medical College hospital and Research Centre, Tumkur from January 2021 to July 2022. Prior to initiation of the study Ethical and Research Committee clearance was obtained from Sri Siddhartha Medical College hospital and Research Centre, Tumkur (Annexure B). During present study total 100 children were reviewed in OPD/IP, among them 75 patients were enrolled into the study according to inclusion criteria and 25 patients were excluded according exclusion criteria. Results: There were a greater number of cases of acute otitis media when compared to chronic otitis media (73.33%). The residents of rural areas were more prone to develop both acute (63.63%) and chronic (75%) otitis media when compared to those of residents in urban areas. The children who have siblings (76.36%) are susceptible in developing both acute and chronic otitis media when compare to those who do not have siblings (75%).Exposure to passive smoking is a significant risk factor for developing otitis media (80%) The children belonging to socioeconomic class V (50.90%) develop acute otitis media prominently whereas the children belonging to socioeconomic class IV (50%) develop chronic otitis media. Ear pain (87.27%), fever (50.90%), cough and cold (67.27%) were the highest reported profile of symptoms in acute otitis media whereas ear pain (50%), ear discharge (80%), cough and cold (55%) were the highest reported profile of symptoms in chronic otitis media. Perforation (90%) was the prominent sign in chronic otitis media followed by otorrhea, erythema tm, otitis externa, hearing loss and bulging tm. The organism reported in acute otitis media were Staphylococcus>Pseudomonas>CONS>Klebsiella. The organism reported in acute otitis media were Pseudomonas>Staphylococcus>CONS, Klebsiella. Conclusion: Otitis Media is one of the most prevalent illnesses in young children around the world. To ensure quick diagnosis and treatment and significantly lower the likelihood of consequences. The risk factors include male gender, socioeconomic class, bad habits, exclusive breast feeding, passive smoking etc. Can cause speech, language, and cognitive delay.

Background: Aspergillosis caused by different species might affect the choice of treatment in certain species depending upon the MIC values.The aim of this study was to determine the antifungal susceptibility pattern among dif-ferent Aspergillus species to the routinely used antifungal agents in accordance with CLSI M38 A. Methods: Aspergillus grown from various clinical sample was subcultured and identified phenotypically. Antifungal susceptibility testing (AFST) was done for 5 antifungal agents- AmphotericinB, Voriconazole, Posaconazole, Itraconazole and Caspofungin. Results: Aspergillus flavus was the predominantly isolated speies. Aspergillus flavus and Aspergillus niger showed high MIC values to AMB & ITR and low MIC for VOR & POS. Some species of Aspergillus flavus exhibited rare phenomenon like paradoxical/trailing effect. Aspergillus fumigatus showed low MICs for both triazoles and AMB. Aspergillus terreus had high MIC for triazoles and AMB. All of the tested isolates showed low MECs against caspofungin. Conclusion: Aspergillus is a fungal pathogen which is easy to treat unless it is invasive. Variation in susceptibility profile noted for the Aspergillus for each species to the common antifungal agents; since the azole resistance is in increasing trend hindering the effective antifungal therapy resulting in therapeutic failures.

Introduction: Several acute diseases exhibit a circannual pattern. Acute appendicitis has been reported to be present throughout the year, but some particular months are associated with higher incidences. Several researchers have suggested that the heterogeneous extrinsic factors such as gastrointestinal infection, air pollution and low fiber diet, during summer months could be contribute to the higher incidence of appendicitis. The exact reason why acute appendicitis cases present in summer more than other seasons is still not clear. The identification of the reasons for seasonality may offer the possibilities for preventive measures. Aim: To examine the global trends in the seasonality of appendicitis. Objectives: This study was conducted to investigate the possibility of existence of seasonal variability in the onset of acute appendicitis. Materials and Methods: A single-center cross-sectional, retrospective study was conducted for cases of appendicitis. The study was conducted in the Department of General surgery and alleged super specialities, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India from January 2019 to December 2021 Results: Patients who were managed conservatively were excluded. Study was conducted for a period of three years. Among which the incidence acute appendicitis requiring surgical management is more during summer Conclusion: More cases of appendicitis were noted during summer. Larger numbers over several years are needed to draw better conclusions and reach the possible causes behind such variation.

Introduction: Diabetes is a chronic disease that occurs either when the pancreas does notproduce enough insulin or when the body cannot effectively use the insulin it produces. Diabetic neuropathy is the main cause of neuropathy in the world. There is a wide range of manifestations due to involvement of various systems such as cardiovascular, gastrointestinal, genitourinary, sudomotor and neuroendocrine systems. Gall bladder involvement in diabetic autonomic neuropathy occurs in form of increased gall bladder volume & impaired gall bladder contraction. Objectives: To study regarding the autonomic neuropathy with special reference to gall bladder volume in patients with type 2 diabetes mellitus. Methodology: It is a descriptive cross sectional study conducted during February 2021 to August 2022 at VIMS Ballari. Patients fulfilling the inclusion criteria’s were enrolled in the study. A pre-tested, semi-structure questionnaire was used for data collection and statistical analysis was done to obtain the results. Results: The study included 50 patients with diabetes, with the majority being in the age group of 41-50 years. Autonomic neuropathy was observed in 36% of patients, with severe neuropathy seen in 14 patients. The duration of diabetes was found to be significantly higher in patients with autonomic neuropathy compared to those without. The mean gall bladder volume was significantly higher in diabetic patients with autonomic neuropathy compared to those without. The observed values were found to be statistically significant (p < 0.05). The study indicates a correlation between autonomic neuropathy and gall bladder volume in diabetic patients. Conclusion: In the current study we have observed a significant association between diabetes and autonomic nervous system. The gall bladder volume was significantly higher among diabetics. Hence, early detection and prompt treatment can help prevent the associated complications and morbidity related to DAN.

Hypomagnesemia is associated with neuropathy and abnormal platelet activity, both of which are risk factors for the emergence of DFU. This study was carried out to evaluate the effects of magnesium administration on wound healing in subjects with DFU. This randomized controlled trial was performed among 89 subjects with DFU. Subjects were divided into two groups to receive either oral magnesium oxide supplements for 4 weeks or conventional treatment. Pre- and post- intervention wound depth and appearance were scored in accordance with the SINBAD wound assessment tool. After the 4 week treatment, significant reductions in wound area and random blood sugar level in the group that did not receive Mg supplementation. A significant decrease in the wound area, and random blood sugar level, as well as better neuropathy assessment and SINBAD scores, were reported after 4 weeks in patients who received magnesium supplementation. No significant difference in patient distribution regarding the wound healing characteristics, including discharge, granulation tissue, edge sloping, surrounding normal skin, cellulitis, and exposed bone, was noted between patients receiving and not receiving Mg supplementation.

Purpose: Aim and Objectives of study was to assess the role of MRI in the evaluation of ring enhancing lesions of brain and to assess utility of MR spectroscopy in differentiating various ring enhancing lesions of brain. Methods: The study was carried out in the department of radiodiagnosis. The study was carried out over a period of 16 months and included 50 patients with ring enhancing lesions detected on contrast MR brain. Results: Out of 50 cases in our study, majority of lesions were tuberculoma followed by metastasis and NCC. Majority of patients were females in age group 40-60 years. Headache was the most common presenting symptoms. Majority of lesions were multiple (62%) and (60%) smaller in size (<2cm). Overall sensitivity and accuracy of MR were 81.54%, 92.76% and MRI+MRS were 91.27% and 96.80% respectively. Conclusion: MRI along with MRS has emerged as the most sensitive modality in the characterization of various intracranial ring enhancing lesions. MRS aids in MR diagnosis based on various metabolites leading to near accurate diagnosis.

Background: This study aimed to evaluate the correlation between the CT thorax severity score, duration, and clinical severity in patients with COVID-19. Methods: This retrospective cross-sectional study included 100 patients with COVID-19. The patients were selected based on the inclusion and exclusion criteria. CT thorax severity score, duration of illness, and clinical severity were recorded from the available clinical database. The data was analyzed using statistical tools to evaluate the correlation between the variables. Results: The mean age of the patients was 42.5 years with a standard deviation of 11.8 years. The majority of the patients were male (55%) and had comorbidities such as hypertension (25%) and diabetes (15%). The distribution of CT thorax severity scores showed that 20% of the patients had a score between 0-5, 30% had a score between 6-10, 25% had a score between 11-15, and 25% had a score greater than 15. The duration of illness was less than 7 days in 20% of the patients, between 7-14 days in 40% of the patients, and greater than 14 days in 30% of the patients. The clinical severity of the disease was mild in 20% of the patients, moderate in 40% of the patients, severe in 30% of the patients, and critical in 10% of the patients. A positive correlation was observed between the CT thorax severity score with duration and severity of the disease, with an r2 value of 0.071 and p<0.05. However, a negative correlation was observed between the room air saturation and the CT thorax score, with an R2 value of 0.200 and p<0.05. Conclusion: This study highlights the importance of CT thorax in assessing the severity of illness in patients with COVID-19. The study findings suggest that CT thorax should be performed early in the course of the disease since the average score in patients with mild illness was moderate, indicating lung involvement. The correlation between the CT thorax severity score with duration and severity of the disease highlights the need for regular follow-up of patients with COVID-19 to monitor disease progression.

Background: Presentation of patients with altered sensorium to the emergency department is very common. Central nervous system (CNS) infections, cerebrovascular accidents and traumatic brain injury are common for such situation. Raised Intra cranial Pressure (ICP) is a dreaded complication of neurological disease and head injury, hydrocephalus, subarachnoid haemorrhage and intracranial haematoma that often leads to adverse outcomes either by reducing cerebral perfusion pressure (CPP) and causing cerebral ischemia or by compressing and causing herniation of the brain stem or other vital structures. Since there is paucity of literature, this study was undertaken to measure the optic nerve sheath diameter in patients presenting to the emergency department and correlation of optic nerve sheath diameter with raised intracranial pressure. Materials and Methods: A Comparative Analytical study of Optic Nerve Sheath Diameter in patients presented to Emergency Medicine Department was conducted. From an earlier study about measuring optic nerve sheath diameter using ultrasonography in increased intra cranial pressure, the sensitivity of Ultrasonography was 75% and specificity of 100%. All adult patients with clinical features suggestive of raised intracranial pressure brought to the Emergency Department in casualty, at SSG HOSPITAL, who underwent CT-brain. Results: History of trauma was present in 33.3% of the patients with raised intracranial pressure and 24.4% of the patients without raised intracranial pressure in this study. The history of fever was present in 10.4% of the patients with raised intracranial pressure and 14.6% of the patients without raised intracranial pressure. History of vomiting present in 61.5% of the patients with raised intracranial pressure and 62.5% of the patients without raised intracranial pressure. The history headache was present in 47.9% of the patients with raised intracranial pressure and 42.7% of the patients without raised intracranial pressure. The history of convulsion was present in 46.9% of the patients with raised intracranial pressure and 50.0% of the patients without raised intracranial pressure in this study. The history of unconsciousness was present in 55.2% of patients with raised intracranial pressure and 59.4% of the patients without raised intracranial pressure. This study had shown that, bradycardia was present in 52.1% of the patients with raised intracranial pressure and 34.4% of the patients without raised intracranial pressure. The elevated blood pressure was present in 59.4% of the patients with raised intracranial pressure and 52.1% of the patients without raised intracranial pressure in this study.

Background: Peptic ulcer perforation remains a significant clinical problem with high morbidity and mortality rates. Several scoring systems have been proposed for assessing the severity of peptic ulcer perforation, including the Boey, POMPP, and PULP scores. This study aimed to compare the effectiveness of these scoring systems in predicting postoperative morbidity and mortality. Methods: This prospective study included 60 patients with peptic ulcer perforation who underwent surgery. The Boey, POMPP, and PULP scores were calculated for each patient. The sensitivity, specificity and accuracy of each scoring system in predicting postoperative morbidity and mortality were compared. Results: The PULP score was found to be a better tool for assessing the severity in peptic ulcer perforation patients compared to the Boey and POMPP scores. In patients with severe perforated peptic ulcer the PULP score had a higher sensitivity (88.9%) and accuracy (78.3%) in predicting postoperative morbidity and mortality. The Boey score had a lower sensitivity (77.8%) and accuracy (68.3%), while the POMPP score had a lower sensitivity (66.7%) and accuracy (60.0%). Conclusion: The PULP score may be a more effective tool for assessing the severity in peptic ulcer perforation patients compared to the Boey and POMPP scores. Factors that may affect the accuracy of each scoring system were also identified. Further studies with larger sample sizes and a wider range of scoring systems are needed to confirm these findings.

Introduction: Anxiety in patients undergoing cataract surgery may lead to increased discomfort and suboptimal surgical outcomes. This study aimed to evaluate the effectiveness of intravenous midazolam as an anxiolytic in patients undergoing cataract surgery under peribulbar block. Methods: In this double-blind, randomized study, 52 patients were assigned to receive either intravenous midazolam (0.02 mg/kg) or saline as a control. Patient and surgeon satisfaction scores, as well as hemodynamic parameters, were assessed and compared between the two groups. Results: Patients in the midazolam group showed significantly higher satisfaction scores (4.6 ± 0.5) than those in the saline group (3.5 ± 0.8) (p < 0.05). Surgeon satisfaction scores were also significantly higher in the midazolam group (4.8 ± 0.4) compared to the saline group (3.2 ± 0.6) (p < 0.05). Hemodynamic parameters, including systolic and diastolic blood pressures, heart rate, and oxygen saturation, were more stable in the midazolam group than in the saline group at various time points throughout the surgery (p < 0.05). Conclusion: Intravenous midazolam administration as an anxiolytic in patients undergoing cataract surgery under peribulbar block led to increased patient and surgeon satisfaction and a more stable hemodynamic profile. These findings support the use of midazolam as an effective and safe adjunct to anesthesia in cataract surgery.

Background: Abnormal uterine bleeding is an abnormal bleeding from the uterus in absence of organic disease of genital tract. AUB accounts for 10% of all gynaecology related complaints. Thyroid dysfunction by large number is associated with menstrual disorders. Objective: To study thyroid dysfunction in patients with a provisional diagnosis of AUB of all age groups and refer positive cases to physician for further evaluation. Methods: Clinically diagnosed cases of AUB were enrolled from gynaecology OPD of a tertiary hospital. All patients from puberty to premenopausal age groups presenting as menorrhagia, polymenorrhagia, oligomenorrhoea, polymenorrhoea and metrorrhagia were subjected to the thyroid function i.e. T3, T4, and TSH. All data was compiled and analysed. Results: A total of 101 patients were studied. 22.77% of these patients had thyroid dysfunction of which 13% of patients had hypothyroidism, 8% of patients had subclinical hypothyroidism and only 2% of patients had hyperthyroidism. The commonest bleeding abnormality in hypothyroid patients were polymenorrhoea and menorrhagia. All hyperthyroid cases were oligomenorrhoeic. Conclusion: Both hypothyroid and subclinical hypothyroid cases were the commonest thyroid dysfunction and menorrhagia was their commonest menstrual abnormality. So this study concludes that biochemical evaluation of thyroid functioning should be made in all provisionally diagnosed cases of AUB to detect thyroid dysfunction.

Background: Open Globe Injuries (OGIs) are severe ocular traumas that can result in significant visual impairment. A comprehensive understanding of the sociodemographic profile, causative factors, and clinical features is crucial to optimize management and prevention strategies. Methods: A prospective study was conducted at the Vijayanagar Institute of Medical Sciences, Bellary, from June to October 2022. The study included 30 cases of OGIs, with patients of all age groups. Patients with pre-existing ocular diseases affecting visual acuity were excluded. Results: The majority of the patients were males (76.7%) and children aged 0-9 years (40%). Most injuries occurred in rural settings (53.3%) and were predominantly caused by sticks (50%). Half of the patients presented with injuries to either eye. Initial visual acuity was predominantly hand motion perception (23.3%) or perception of light (20%). The most common corneal tear sizes were 4 mm (33.3%) and 8 mm (30%). Iris prolapse was observed in 53.3% of cases, while traumatic cataract was present in 66.7%. All patients required surgical intervention. Conclusion: OGIs present a significant clinical and public health challenge. Recognizing the demographics, common causative factors, and clinical characteristics is pivotal for developing effective preventive measures and improving patient outcomes.

Background- Acquired Immunodeficiency Syndrome (AIDS) is a disease of the human immune system caused by the Human Immunodeficiency Virus (HIV). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. Current ART regimens are capable of reducing viral load to undetectable levels with a consequent increase in CD4+ counts and a substantial reduction in HIV-associated morbidity and mortality. In spite of ART benefits, adverse reactions to these drugs have been pointed to as one of the main reasons for discontinuation and non-adherence to ART. Continuous evaluation of the benefit and harm of ART will help to achieve the ultimate goal of making safer and more effective treatment available to patients. Objective- This study is being undertaken to analyse the clinical profile of various adverse drugs reactions due to antiretroviral therapy among HIV positive patients. Methods- This is a prospective study conducted at Vijayanagar Institute of Medical Sciences Hospital, Ballari, period from February 2021 to August 2022. The participants were followed up at ART Plus Centre, and VIMS Hospital, Ballari for a total duration of 18 months. Relevant investigations were done to confirm the adverse reactions. Results- Among 115 patients enrolled for the study the largest no. of patients was in the age group of 31-40 years (33.91%), followed by 21-30 years (23.48%). In the current study, out of 115 study participants, majority were female (59.13%) and male participants were 47(40.87%). Conclusion- Antiretroviral therapy is becoming increasingly effective but also increasingly complex. The many adverse effects of therapy may cause symptoms affecting a variety of organ systems. Although current antiretroviral regimens are potent from an antiviral perspective, they often fail because of patient nonadherence.

Background: The COVID-19 pandemic has resulted in significant morbidity and mortality worldwide, prompting the development and distribution of effective vaccines. The impact of vaccination status on COVID-19 patient outcomes remains a critical area of investigation to inform public health strategies and promote vaccine uptake. This study was conducted to investigate the association between COVID-19 vaccination status and mortality in patients admitted to a tertiary care centre in Karnataka. Methods: A retrospective cohort study was conducted involving 300 patients, divided into three groups: 100 completely vaccinated, 100 partially vaccinated, and 100 unvaccinated. All patients were symptomatic for COVID-19 and admitted to HIMS hospital, where SARS-CoV-2 was detected using Real-time reverse transcriptase polymerase chain reaction (RT-PCR) and Rapid Antigen Test (RAT). Mortality outcomes were compared across the three groups, adjusting for age, sex, and comorbidities. Results: The mortality rate was significantly lower in the completely vaccinated group (8%) compared to the partially vaccinated (20%) and unvaccinated groups (32%) (p < 0.05). The adjusted odds ratio (OR) of mortality, after controlling for confounding factors, was 2.42 (95% CI: 1.01-5.81) for the partially vaccinated group and 3.12 (95% CI: 1.25-7.79) for the unvaccinated group compared to the completely vaccinated group. Conclusion: Our findings demonstrate a significant protective effect of complete COVID-19 vaccination against severe outcomes, including mortality, among patients admitted to a tertiary care center in Karnataka. These results emphasize the importance of widespread vaccination campaigns to mitigate the impact of the COVID-19 pandemic and encourage public health efforts to promote vaccine uptake.

Background: Acute myocardial infarction (AMI) is one of the most common diagnoses in hospitalized patients. Diabetes is an independent risk factor for the development of coronary artery disease. Hence knowledge of prior diagnosis of diabetes as well as knowing the blood glucose levels at the time admission in patients with myocardial infarction has important implications for proper patient’s management, as early aggressive treatment of hyperglycaemia may beneficially influence both the short and long term outcomes in these patients. Aims and objectives: To study the influence of diabetes on age of occurrence, Gender distribution, incidence of painless STEMI and Complications. Materials and methods: 36 Patients fulfilling the inclusion and exclusion criteria were involved in the study after obtaining a written informed consent. A pre-tested semi structured questionnaire was used to collect data from study participants. The data were entered in MS excel and was analysed using SPSS. Descriptive analysis, chi-square and odd’s ratio were performed. The results were presented in the form of frequency and percentages. p<0.05 was considered as significant. Results: In our study, majority of the patients were within the age group of 51-60 and were male patients. Most of them had sedentary lifestyle. Anterior wall MI was most common. Diabetics showed higher Killip class. Cardiac failure, ventricular arrhythmias, heart block and mortality were more common among diabetics than that of non-diabetics. Conclusion: Diabetic patients have a blunted appreciation for ischemic pain. As a result of this reduced sensation, myocardial ischemia or infarction may be associated with only mild symptoms and go unrecognized or may be entirely asymptomatic and thus truly silent. Prompt and timely recognition, early treatment, treatment adherence plays a vital role in preventing and treating myocardial infarction among diabetic patients.

Background: Premature rupture of membranes (PROM) is the rupture of the fetal membranes before the onset of labor. Premature rupture of membranes (PROM) is one of the most common problems in Obstetrics complicating approximately 5-10% of term pregnancies. Complications related to PROM are reparatory distress, necrotizing enterocolitis, intraventricular hemorrhage and sepsis. The knowledge of incidence of early onset sepsis in relation to PROM and its effect on neonatal outcome is essential in order to prevent the neonatal morbidity and mortality. Methods: The present study was a single-center, observational Study conducted on patients admitted with neonates, mother with rupture of membrane. Irrespective of treatment and in the department of Paediatrics, Sri Siddhartha Medical College hospital and Research Centre, Tumkur from January 2020 to July 2022. Prior initiation of the study obtained Ethical and Research Committee clearance from Sri Siddhartha Medical College hospital and Research Centre, Tumkur. During present study total 165 neonates were reviewed in OPD/IP, among 85 patients were enrolled into the study according present study inclusion criteria and 80 patients were excluded according exclusion criteria. Results: Most neonates had maternal age of 21-25 years (51.76%).Most neonates in the study were born in primigravida (61.18 %).Most neonates were born with booked appointments (80 %). Most subjects were born through normal vaginal delivery (57.65 %). Most of the study subjects had gestational age of 35-36 weeks (41.17%). Most subjects had latency period of 0-24 hours (56.47 %). Most of the subjects were males (54.11 %). Most of the subjects' weight at birth was 2-2.5 kg (51.76 %). Most of the subjects required admission into NICU (56.47 %). Common neonatal complication in PPROM encountered in our study jaundice; respiratory distress syndrome; hypoglycemia; hypothermia; septicemia and IVH. Most of the subjects had no complications (65.88 %). Common complications occurred during hospital stay in the present study were decreased activity, fever, feeding difficulties, apenic spells, abdominal distension, convulsions and bleeding. Most of the subjects had normal CBC reports (64.71 %). Most of the subjects had normal CRP reports (72.94 %).

Introduction: Thyroid dysfunction is a prevalent endocrine disorder in patients with chronic kidney disease (CKD). This study aimed to evaluate the status of thyroid hormone profile in different stages of CKD and explore the associations between thyroid dysfunction and clinical variables. Methods: A cross-sectional study was conducted among 100 CKD patients admitted at Tertiary care centre. Demographic and clinical data, along with thyroid hormone levels, were collected and analyzed. Statistical analysis was performed using descriptive statistics, chi-square test, and odds ratios. Results: The prevalence of thyroid dysfunction among CKD patients was 39%, with subclinical hypothyroidism being the most common type (22%), followed by overt hypothyroidism (10%). No significant differences were observed in age or sex distribution among different CKD stages (p > 0.05). There were no significant associations between thyroid dysfunction and the presence of diabetes mellitus, hypertension, or cardiovascular disease in CKD patients (p > 0.05). The levels of urea, creatinine, and estimated glomerular filtration rate varied significantly across CKD stages (p < 0.01). However, thyroid hormone levels (Free T3, Free T4) did not show significant differences among stages, except for thyroid-stimulating hormone (TSH) (p < 0.01). Conclusion: This study highlights the high prevalence of thyroid dysfunction in CKD patients, predominantly characterized by subclinical hypothyroidism. Age, sex, diabetes mellitus, hypertension, and cardiovascular disease showed no significant associations with thyroid dysfunction. The levels of urea, creatinine, and eGFR varied significantly across different CKD stages, indicating the impact of kidney function on thyroid hormone regulation. Further research is needed to better understand the complex relationships between thyroid dysfunction, comorbidities, and CKD.

Background and Aims: Laryngoscopy for tracheal intubation produces a hemodynamic stress response like changes in heart rate and blood pressure, intracranial pressure, intra ocular pressure (IOP). Many pharmacological and non-pharmacological methods have been employed to limit these pressor responses. We hypothesize that as lower lifting forces are required to visualize the glottis while using videolaryngoscopes, hence they should have a beneficial influence on hemodynamics and in turn IOP. Methods: After taking written and informed consent, the patients were allocated by computer generated randomization in 2 groups of 40 patients each. Grp VL- patients were intubated using Kings Vision videolaryngoscope Grp DL – patients were intubated using Macintosh laryngoscope. Heart rate, blood pressure and IOP were recorded just before laryngoscopy,(either by Macintosh or Kings Vision videolaryngoscope) and 1 , 3 and 5 minutes after intubation, by independent anaesthesiologists Results: There was a significant difference in IOP, both in left and right eye from the baseline in direct laryngoscopy group at 1 3 and 5 minutes. No significant difference in IOP from baseline levels was noted in videolaryngoscopy (VL) group .In fact a decrease in IOP was noted at 5 min in VL group in the left eye and no significant change happened in IOP of right eye anytime that we measured (1,3 and 5 min) post intubation. Conclusion: With the use of KVVL, lesser hemodynamic changes and lesser variations in IOP were noted, so the above can be better than DL for use in surgeries where sudden increase in IOP can be deleterious.

32-year-oldprimigravida, CATB2, Covid positive patient with acute onset of facial palsy, fever, sore throat and productive cough referred from a peripheral hospital came for caesarian section. Past history revealed occurrence of juvenile dermatomyositis for which she took steroids for one and a half year which was slowly weaned off. Prevalence of dermatomyositis is 1to 8 in 100,000. She was started on steroids which was to be continued for a week after caesarian section. She was on paracetamol and cefuroxime on admission. Basic investigations were normal. Caesarian section was done in covid theater following covid protocols under subarachnoid anesthesia Baby had an APGAR score of 9 and was covid negative. Mothers’ recovery was slow. Facial deviation got corrected in 4to 5 months. Ptosis persisted even after 9months and is on treatment. Dermatomyositis is an uncommon inflammatory disease that affects mainly proximal muscle limiting day to day activities. But it can affect respiratory, cardiac and gastrointestinal systems, eyes and joints. Diagnosis is by muscle biopsy and an increase in muscle enzymes. Pregnancy during remission period is safe. But pregnancy can provoke the disease. Skin changes usually precedes muscle symptoms, though we could not notify any lesions. Lung involvement is prominent, and covid also carries the same amount of risk with respiratory system. Systemic glucocorticoids are the first line of treatment. Immunosuppressant drugs Azathioprine and methotrexate are added as second line of therapy, though these drugs are unsafe during pregnancy. Intravenous immunoglobulin, give good outcome during pregnancy. Plasmapheresis is also beneficial. Most of the pregnant patients end up in caesariansection. Regionalanesthesia is the choice of anesthesia. Covid patients with respiratory infections, maintaining saturation above90%, choice of anesthesia is usually regional anesthesia.

Cutthroat often poses a challenge to the autopsy surgeon in determining the manner of death. An incised wound or ‘slash wound’, results when an object with a sharp tip or edge makes tangential contact with skin. Cutthroat may be homicidal, suicidal, or accidental. Suicidal cutthroat injuries are usually oblique, starting from higher up and tapering lower down, and associated with hesitation cuts unless it is a determined suicide. It is more commonly seen in anatomical zone II of the neck. Homicidal cutthroat injuries can be seen in any zone of the neck, even in the back of the neck, and are usually associated with an “overkill” phenomenon. This case series discuss the two homicidal cutthroat injuries and their difference from suicidal cutthroat.

A friction burn occurs when the skin is scraped off by contact with some hard object, such as the road, the floor, etc., or by prolonged contact with a smooth surface. It is usually confused with burns but it is both an abrasion and a heat burn. A friction burn can occur in any part of the body but these usually affect bony prominences, such as the hands, forearms, elbows, knees, heels, head, or chin. It can per se be a cause of death. This case series highlights the characteristics of friction burns and their medico-legal significance.

Introduction: Depression in the elderly has disastrous implications that not only lowers quality of life, but it also has an impact on the prognosis of other chronic conditions, exacerbating disability. As estimated by WHO, depression occurs in 7% of the general elderly population and the same in India is 9.3%. This study was undertaken to know the prevalence of depression among the geriatric age group with Dependency as risk factor in villages of our field practice area. Methodology: It’s a Cross sectional study of 251 geriatric population. The selection of villages was done through Simple random sampling and all the villagers of age above 60 years were included in the study. The identification of depression was carried out using the Geriatric Depression Scale (GDS). The dependency was calculated using the Barthel Index Results: From our study it is found that the prevalence of depression and dependency among the geriatric population in our study area is 43% and 29% respectively. The Barthel score among depressed were also less(median (IQR) Barthel score: depressed - 65(50,85) ; not depressed -70(60,89); p value - <0.001 ). Nearly 80% of the females who were categorized as dependent were depressed (p value – 0.006). Multivariate logistic regression for depression upon Barthel score, age and gender shown significance OR for Barthel score but later after adjusting for other two factors, the AOR was not significant. Conclusion: The study makes us understand the importance of analysing the dependency status while screening for the mental health status of the elderly person. This also gives us the idea to include the same in the interventions those are carried for improving the quality of life of elderly

Background: Pregnancy and child birth particularly in high risk patients need proper antenatal care and timely referral to decrease maternal and perinatal morbidity and mortality. Early identification, initiation of early treatment and timely referral are the components for success of maternal and fetal health intervention. To identify the pattern of obstetric referral and primary reasons of referral, so as to implement measures to reduce maternal and perinatal morbidity and mortality. Aim of study: To assess Maternal and Perinatal outcome in referred patients. Materials and methods: Prospective observational study done in all obstetric patients referredto the department of OBG at Sri Siddhartha Medical Hospital, Tumakuru for duration of 24 months. Results: The proportion of referral cases to the tertiary care institute is 6.5%. Majority (48.7%) of referred cases were from private hospitals and PHC (44%) showing lacunae in the emergency obstetric care given. Majority were in the age group 21-30 constituting about 72%. In present study, there was unavailability of ambulance in 56.7% of cases for transport. Most (92.89%) of the patients were not accompanied by any medical assistance during transport. Most common cause of referral is previous LSCS (28.7%) followed by PROM (16%). In our study, 10 % of the patients required blood/blood products transfusion. Majority delivered by LSCS (92.7%).There were 1 (0.7%) maternal mortality in present study & behind these there were total 12(8%) near miss cases which provide valuable information on the quality of antenatal care at the periphery. 42.9% of all neonates had respiratory distress in this study. Total NICU admission rate was 42.7%. Neonatal mortality documented in present study was 0.7%. Conclusion: Proper training of health personnel at peripheral centres and timely referral along with detailed referral slip or prior information of high risk cases helps in early and effective interventions thereby decreasing maternal and perinatal morbidity and mortality. Health education and awareness by mass media and non-government organisations can improve the health and social status of women in rural areas.

Background: Stroke, a significant cause of mortality globally and particularly in India, has a reported prevalence of 471.58 per lakh population based on Indian studies. This study was initiated to understand the prevalent risk factors and common patterns of clinical presentation in stroke cases. Aims and Objectives: The study seeks to identify the most frequent risk factors, determine the prevailing patterns of clinical presentation, and correlate the clinically identified stroke type with the imaging modality at VIMS, Ballari. Materials and Methods: A Descriptive Observational Study was conducted at VIMS, Ballari, encompassing a sample size of 110 cases. Patients meeting the inclusion criteria were evaluated based on a proforma explicitly designed for the study. Results: Our study population of 110 cases revealed that the incidence of stroke increases with age and is more prevalent in males. Cerebral ischemia was more common than hemorrhage. Hypertension emerged as the most significant risk factor for stroke, followed by dyslipidemia and smoking. Hemiplegia was the most common clinical manifestation, trailed by speech abnormality and facial palsy. Parietal lobe was predominantly affected in ischemic stroke and thalamus in hemorrhagic stroke. Ischemia was the most common stroke type, and anterior circulation was the frequently affected vascular territory clinically, correlating with the chosen imaging modality. Conclusion: The study concluded that stroke incidence peaks between 51 to 60 years of age, with males being more susceptible. Ischemia is the most prevalent stroke type, and hypertension is the leading risk factor. Hemiplegia is the foremost clinical presentation. In ischemic stroke, the parietal lobe is commonly affected, and the thalamus is the primary region impacted in hemorrhagic stroke. Anterior circulation is the predominant vascular territory affected overall.

Background: Elevated serum ferritin levels have been associated with acute myocardial infarction (AMI), but its prognostic significance remains unclear. This study aimed to investigate the serum ferritin levels in patients with AMI and to explore its prognostic importance. Methods: This study involved patients admitted to Navodaya Medical College Hospital and Research Centre, Raichur, with confirmed AMI, and age and gender-matched controls. Serum ferritin levels were measured at presentation and at a 4-week follow-up. Clinical features, co-morbidities, habits, and echocardiographic findings were also recorded. Results: Serum ferritin levels were significantly elevated in patients with AMI at presentation (mean: 319.38, SD: 94.75) and at a 4-week follow-up (mean: 327.99, SD: 105.81) compared to controls (p < 0.0001). There was no significant difference in serum ferritin levels across different categories of left ventricular ejection fraction (p = 0.762103). The presence or absence of co-morbidities such as hypertension and diabetes, and habits like smoking and alcoholism, did not significantly influence serum ferritin levels. Conclusion: Our study suggests that serum ferritin levels are significantly elevated in patients with AMI and these elevated levels persist even at a 4-week follow-up. However, these levels did not correlate with left ventricular ejection fraction or with the presence or absence of certain co-morbidities and habits. Future studies are needed to further explore these relationships and the potential prognostic role of serum ferritin in AMI.

Introduction: Phenylephrine is the ideal vasopressor for spinal anesthesia in lower segment ceasearen section, this study was undertaken to compare the bolus doses of 50μg of Phenylephrine with a prophylactic fixed infusion rate of 50μg/min of the same drug. Methodology: A prospective randomized, comparative study of 60 parturients scheduled for elective or emergency ceasearean section Patients were randomly assigned into two groups by sealed envelope method (bolus/infusion) group. After recording the baseline vital parameters and preloading with 500 ml Ringer lactate, spinal anaesthesia will be administered .Group A received injection Phenylephrine 50 μg bolus if systolic blood pressure is <20% basal value, bolus was repeated if necessary. Group B were given Phenylephrine 50 μg/min infusion started immediately after spinal anesthesia and continued for 2 minutes and subsequent adjustment was made, Hemodynamic monitoring will be done every minute till extraction of the baby. Results: The present study showed that the mean fall in SBP, DBP, MAP were less in infusion group (p<0.001)compared to bolus group however the fall in HR is more in bolus compared to infusion group (p<0.001) . Conclusion: We conclude that prophylactic phenylephrine infusion leads to a significantly better control of post spinal hypotension compared to Phenylephrine bolus dose.

Background: Study of incidence, clinical profile and complications of right ventricular infarction in patients with inferior wall myocardial infarction admitted in VIMS hospital. Methods: It is a cross sectional study done at VIMS, Ballari, with a sample size of 100 cases. Patients who fulfilled the inclusion criteria are assessed as per proforma specifically designed for the study. Results: Out of 100 participants with IWMI, 40 of them had RVI. Most of the cases (42.8%) of RVI occurred in the age group of 41-50 years in the RVI group. Out of 100 participants, majority (80%) were male. Only 20% were female. Incidence of risk factors was more among IWMI with RVI than IWMI without RVI and most common risk factor was smoking. Out of 40 patients diagnosed with IWMI with RVI, all presented with chest pain, 16 patients had bradycardia,4 patients presented with shock. Among patients with IWMI with RVI – 6 patients died and among IWMI without RVI, 2 patients died. Conclusion: RVI can occur among people with IWMI in almost one-third of the cases. Identifying risk factors and preventing further progression of disease plays vital role in managing patients with cardiac diseases. Hence risk stratification plays major role in reducing mortality and morbidity associated with MI. One such factor is involvement of right ventricle, that increases the complication rate as well as mortality among patients with inferior wall myocardial infarction.

Background: Respiratory distress (RD) is a challenging problem and is one of the most common causes of admission in neonatal intensive care unit. The objective was to study the various Risk factors associated with development of severe respiratory distress in the new born and to determine the severity and outcome of neonates with Respiratory distress. Methods: A Retrospective Cross Sectional Study was conducted at Department of Paediatrics, Smt. Kashibai Navale Medical College & General Hospital, Pune. The study recruited all babies admitted in NICU diagnosed as Respiratory Distress between May 2020 to April 2022. The data was collected from records of patients files admitted during the study period. The variables studied were antenatal, natal, postnatal risk factors, clinical course, staging and final outcome for all diagnosed babies. Results: During the study period, total 70 cases of RD admitted to NICU were recruited, among them 7 deaths were recorded in total. The most common cause of neonatal respiratory distress was Transient Tachypnea of Newborn [TTN] 34 (48%) followed by Respiratory Distress Syndrome 19(27%). Third cause was birth asphyxia 06 (8%). Conclusion: Respiratory distress was the major cause of admission in our NICU. Caesarean section was the most common predisposing factor associated with the development of respiratory distress in neonates. Antenatal risk factors increase the incidence of RD. The most common causes of respiratory distress were TTN, RDS, Meconium Aspiration Syndrome [MAS] and perinatal asphyxia. The common cause of death was Hyaline Membrane Disease. The outcome of neonatal respiratory distress was found as:a survival rate of 90%, mortality rate of 10%.

Introduction: Cryptococcal neoformans is the most common opportunistic infection of the central nervous system in HIV patients. CNS Cryptococcosis commonly present with non-specific manifestations such as headache, fever, seizure and conscious disturbance. Current diagnostic techniques for Cryptococcosis include microscopic detection by India ink stain, gramstain techniques. Recently, the new ICT (Immunochromatographic test) is used to screen HIV-infected persons with CD4 counts of less than 100cells/μL . Aim: A Comparative study of Different Diagnostic Modalities, India Ink, Gram stain & ICT for the Detection of Cryptococcal meningitis among HIV - infected patients in a Tertiary Care Hospital at Kanpur. Material & Methods: This was a prospective cross-sectional study conducted in the Department of Microbiology & Department of Medicine from July 2022-April 2023 in Rama Medical College Hospital and Research Centre Kanpur. 50 CSF samples were collected from the patient’s suspected to have HIV with clinical feature of meningitis. The CSF samples were tested for Cryptococcus neoformans by India ink, Gram stain, and ICT. Result: Out of 50 CSF samples 31 were male and 19 were females. 4 (8.0%) were positive for Cryptococcus neoformans mostly in the age group of 30-40 years.All 4 were ICT positive, 3 were India ink stain positive, and 2 were gram stain positive. The sensitivity and specificity of ICT, India ink and gram stain were 99.0%,100%;75.0%%,100% and 50.0%,100% respectively. The PPV and NPV of ICT, India ink and gram stain were 99.0%,100%; 75.0%%,100% and 50.0% ,100% respectively. Conclusion: In our study the incidence of Cryptococcus neoformans was 8%. ICT is more effective method when compared to other conventional methods with higher sensitivity and specificity than the gram stain and India ink. Hence, the new ICT kit is rapid and relevant method for detection of Cryptococcus neoformans.

Aims and objectives: The purpose of this study was to determine the prevalence of obsessive-compulsive symptoms in patients with schizophrenia, and to describe their sociodemographic profile. Materials and Method: 70 patients consecutively hospitalized with primary diagnosis of schizophrenia according to ICD-10 were assessed for the presence of OCS using M.I.N.I. The severity of schizophrenia symptoms and OCS was assessed using Y-BOCS. The results were expressed in terms of mean and standard deviation, percentage and proportion. Results: 13 of 70 (18.5%) schizophrenia patients had clinically significant OCS. Conclusion: OCS is relatively frequent in patients with schizophrenia in Indian settings.

Background: Elderly people are particularly affected by COVID -19. Elderly people who suffered from other diseases and were frail were particularly likely to develop severe COVID -19 or die from the infection. The aim of the current study is to assess the frailty index in COVID -19 geriatric patients admitted to hospital using the Clinical Frailty Scale and the FI -Lab21 and to establish a relationship between frailty and outcome prediction. Methods: In a prospective observational study we conducted, we assessed the clinical presentation and frailty-related characteristics of hospitalised individuals aged > 65 years with positive moderate-severe COVID -19 pneumonia. The Clinical Frailty Scale (CFS) and FI Lab-21 criteria were used to assess frailty at the time of admission. Mortality and change in CFS score from admission to discharge were recorded. Results: The age of patients participating in the study COVID -19 ranged from 65 to 90 years, and the mean age was 72.14±6.13 years. Men predominated in the study population (73.0%). Using the Clinical Frailty Scale (CFS), 21.0% of patients were not frail (score 1-3), 46.0% were mildly to moderately frail (score 5-6), and 33.0% were severely frail (score 7-8). Among the frail patients, the severely frail cases (based on CFS) were significantly older than the mild-to-moderate and nonfrail COVID -19 cases. The mortality rate was significantly higher in severely frail (66.7%) and mild-to-moderately frail (45.7%) patients than in nonfrail (28.6%) patients. Conclusion: The results show that the clinical frailty scale has no significant association with FILab-21 in COVID -19 cases. CFS showed a significant association with disease progression in COVID -19 cases.

Background: The elderly are more likely to develop symptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Malnutrition is a risk factor that can affect the clinical course of disease and physical and mental performance. Objective: To assess the nutritional status of geriatric patients using the modified nutritional risk in critically ill patients (mNUTRIC) and the geriatric nutritional risk index (GNRI), and evaluate the prognosis with the short-term outcome. Methods: A number of elderly individuals (> 65 years) hospitalised with COVID -19 were included in the study. Data on demographics, laboratory results, and concomitant diseases were collected. The geriatric nutritional risk index (GNRI) and modified nutritional risk index for critically ill patients (mNUTRIC) were used to assess nutritional status. For statistical analysis, categorical data were analysed with the Pearson chi-square test and continuous variables were analysed with the unpaired Student's t test. Results: A total of 86 (59.27%) were survivors and 58 (40.28%) were nonsurvivors. The mean value of APACHE II and SOFA was significantly increased in the nonsurvivors compared with the survivor group. Mean GNRI and mNUTRIC values were 87.93±8.49 and 2.41±0.82 in survivors and 81.40±6.32 and 4.78±1.39 in the survivor group. The mean GNRI and mNUTRIC were significantly different between the survivor and non-survivor groups Conclusion: GNRI was significantly lower and mNUTRIC was significantly higher in the non-survivor group compared with the survivor group. The change in GNRI was significantly negatively correlated with mortality and MNUTRIC was significantly positively correlated with mortality.

Background: This research aims to investigate the recurrence patterns of breast cancers in elderly women (>65 years) treated with breast-conserving surgery (BCS) or mastectomy alone, and compare the treatment outcomes with those having BCS/mastectomy plus adjuvant radio or chemotherapy. Methods: The study was conducted on 75 patients divided into two groups: Group-1 consisted of 50 patients who underwent BCS/MRM without adjuvant chemotherapy or radiotherapy, only receiving adjuvant hormonal therapy, while Group-2 was comprised of 25 patients who underwent BCS/MRM and received adjuvant chemo and/or radiotherapy, with or without hormonal therapy. Results: The recurrence rates were 10% and 8% in Group-1 and Group-2 respectively. The risk ratio was 1.07, indicating a minor difference in the risk of recurrence between the two groups, which was not statistically significant (p>0.05). The mean time to recurrence was marginally higher in Group-1 (15.25 +/- 3.77 months) compared to Group-2 (14.33 +/- 3.05 months). Conclusion: The study reveals no significant difference in breast cancer recurrence rates in elderly women post BCS/mastectomy whether adjuvant therapy was administered or not. This challenges traditional protocols and argues for the reconsideration of the necessity and benefits of adjuvant therapies in this demographic.

Background: Ocular trauma is a significant contributor to preventable monocular blindness and visual impairment globally, necessitating a comprehensive understanding of its epidemiology and risk factors. This study aimed to analyze pediatric ocular trauma's prevalence, patterns, and related factors at Vijayanagar Institute of Medical Sciences, Ballari, India. Methods: A prospective study was conducted over 1.5 years, involving 60 pediatric ocular trauma cases. Results: The highest incidence was found in children aged 6-9 years (41.67%), followed by 9-12 years (25%). Males were more affected (66.7%) than females. Most cases (56.67%) were from rural areas. About 50% of the patients presented to the hospital between 24 hours and 3 days post-injury. Home was the most common location of injury (46.67%), followed by playgrounds (23.33%). Open globe injuries were the most common (58.34%), with vegetative matter being the primary cause (36.67%). The most common area of open globe injury was Zone 1 (88.57%). Conclusions: Our study highlights the significance of ocular trauma in children, emphasizing the need for targeted interventions and awareness programs to prevent these incidents.

Anti- HMGR antibody positive immune mediated necrotizing myopathy is a rare disease was first recognized and characterised in patients with a history of stating exposure and immune -mediated necrotizing myopathy. We reported a rare case of patient presenting with features of proximal myopathy which has a wide differential diagnoses of which a diagnosis of anti- HMGCR-antibody associated myopathy should not be neglected. Effective treatment can Improve the prognosis if diagnosed in time, We provide a summary of clinical findings, pathological features, muscle imaging and immunogenetic risk factors of the disease. We also discuss treatment strategies and approaches to monitoring the therapeutic response. lastly, we briefly summaries the current understanding of the pathophysiology of the disease and postulate a mode for autoimmunity initiation and propagation in the disease.

Context: The goal of Problem Based Learning (PBL) is to prepare medical students for life-long learning by engaging them in self-directing learning, self-regulation and effective teamwork in which the students are responsible for discovering facts and uncovering key concepts. Aim: The aim of this study is to explore the perspectives of 2nd year under graduate students in a medical college about problem-based learning. Materials & Methods: A cross-sectional study was conducted among 130 second year medical undergraduate students from December 2020 to April 2021. A self-administered questionnaire was used that focused on benefits, execution and role of facilitator in PBL teaching method to collect data using Google forms. Collected data were exported in excel sheet &analyzed using EpiInfoVersion7.2.2.6.Software. Results: Out of 130 participants, almost one third (48; 36.9%) preferred problem-based learning as a method of theory teaching. Students mentioned that PBL method helped them to improve various skills like communication skills (90%), problem solving skills (90%), presentation skills (88%), and decision-making skills (87%) & brainstorming skills (83.8%). Most of the students enjoyed the self-directed learning occurred in PBL session. Conclusions: This study highlighted the role of PBL method in teaching curriculum in the medical education and perception of the students toward it. The students perceived that PBL method is an interesting, innovative, interactive & effective Teaching-Learning (TL) method which helped to develop the decision-making skill, problem solving skill & communication skills.

Background: Sexually Transmitted Infections (STIs) have a deep impact on sexual and reproductive health. Among 27 million pregnant females each year, the prevalence of STIs are higher because of hormonal and immunological changes during pregnancy. STIs in pregnancy are usually under diagnosed and is a crucial reason behind morbidity and mortality within the developing countries. So, whenever an infection occurs in pregnancy, an understanding of the alteration within the disease course and also the possibility of transmission to the fetus is vital. Objectives: The present study was conducted to know about the different types of STIs in pregnant women attending our STI clinic in a tertiary care centre in South India over a period of 18 months. Methodology: A cross sectional study was conducted with a detailed history, clinical examination and relevant investigations in 110 pregnant women and data were analysed. Results: Among 110 subjects, Vulvovaginal candidiasis was more common with 50(45.5%) cases, followed by 36(32.7%) sero-syphilis in this study. 9(8.2%) were HIV reactive and 1(0.9%) had Hepatitis-B infection.

Introduction: Laryngoscopy is performed to facilitate tracheal intubation which is a day to day routine in the practice of anaesthesiology. Both laryngoscopy and intubation are associated with physiological response such as sympathoadrenal response inducing tachycardia and hypertension. Aim: To study the effects of intravenous clonidine and intravenous dexmedetomidine in attenuation of hemodynamic response to direct laryngoscopy and tracheal intubation. The objectives of the study are: to compare hemodynamic changes of intravenous clonidine and intravenous dexmedetomidine among patients undergoing direct laryngoscopy and tracheal intubation in elective surgeries under general anaesthesia and to observe any adverse drug reactions. Materials and methods: This study was a hospital based observational study carried out in Jorhat Medical College and Hospital during July 2020 to June 2021.90 patients were divided alternatively into two groups. Result: Statistically significant difference in mean heart rate was observed at during laryngoscopy and intubation and at time 1 minute after laryngoscopy. A statistically significant difference was observed in mean systolic blood pressure between the two groups at time of laryngoscopy and intubation and at all times following intubation. Mean diastolic blood pressure had significantly difference during laryngoscopy and intubation and at all times following intubation. Mean of mean arterial pressure had statistically significant difference in both the groups at all observations following intubation. Conclusion: Both clonidine 1 mcg/kg and dexmedetomidine 1 mcg/kg attenuated the hemodynamic response to laryngoscopy and intubation but dexmedetomidine is a better choice than clonidine in attenuating the hemodynamic response to direct laryngoscopy and intubation.

Background & objectives: Human Immunodeficiency Virus (HIV) infection causes diseases with a wide spectrum of manifestations ranging from hematological manifestations to severe opportunistic infections, and rare malignancies and it also extends to endocrinological manifestations. This study has been undertaken with the aim to dwell deeper into the endocrinological complications, which have mostly been ignored and not keenly thought of. Clinical data pertaining to Adrenal Insufficiency (AI) in HIV infection have been lacking, with a few studies in India and none in North-eastern India, where the burden of HIV infection is high. This study will provide insight into this less explored array and help clinicians who have long been treating HIV infection-related complications but seldom arrived at the endocrine foray. CD4 count was also evaluated to correlate the degree of AI with the level of CD4. Methods: In this cross-sectional study, 120 HIV-infected patients were evaluated for AI with the Short Synacthen Test. Simultaneously; CD4 levels were obtained and analyzed for the degree of AI. Results: The Prevalence of AI in this study was found to be 20%, signs of AI like hypotension, skin hyper pigmentation, and menstrual abnormalities were significant, and there was no correlation between the CD4 levels and the degree of AI. Interpretation & conclusions: This study found that AI is statistically significant between the group with AI and the unaffected group. There was no age or sex preponderance of AI and it is not associated with the duration of the disease. No correlation was found between the CD4 level and the degree of AIs.

Anaemia is commonly seen in critically ill patients and is associated with considerable morbidity and worse outcomes. Common factors responsible for development of anemia during their stay in ICU are due to blood loss, nutritional deficiency, drug induced, phlebotomy and defective or decreased erythropoiesis etc. Aims: This study aimed to determine the causes of anemia and to analyzehematological, biochemical, and clinical pathological parameters from ICU patients. Methods and Material: Prospective observational study of 300 adult patients admitted to the ICU with stay of more than 7 days. Details such as age, sex, and clinical history (history of phlebotomy and blood transfusion) was obtained. Hemogram, PBS and other parameters (imaging, biochemistry, microbiology, serology) were studied. Results: Out of the 300 patients discharged with anemia, 266 had anemia at admission and 34 developed anemia during ICU stay. Most common cause of admission to ICU was medical followed by surgery and trauma. 65 patients had shock at admission. Lowest mean Hb was 7.13 g/dl seen in septic cases, most common type of morphological anemia at admission was NCNC. Anemia worsened in 101 patients, with male (64) predominance. 8 patients with worsened anaemia did not survive. Conclusions: Anemia is a significant cause of morbidity in critically ill patients specially in background of sepsis, post operative period and chronic renal diseases.

Purpose: The objective structured clinical examination (OSCE) has become a standard assessment tool in undergraduate medical school training. The aim of this study was to assess the Perception of Students and Faculties for OSCE as a tool for assessment of clinical competence in Summative Examination of General Medicine. Methods: In this Study a total of 150 Final Professional Medical Students appeared for final MBBS part II clinical exam of Sri Aurobindo Institute Of Medical Science & PG Institute, Indore, and 10 faculties of Medicine Department were included. 150 students underwent exam by OSCE method in the presence of 10 Medicine faculty members. The 12-item questionnaire included questions based on to assess the faculties and students awareness and to evaluate their overall satisfaction for OSCE based on the level of agreement. Results: We collected the feedback structured questionnaire from faculties and students and were analysed. A total of 73% study subjects strongly agreed, 51% agreed and 14% disagreed respectively as per their perception for conduct, utility acceptability and feasibility of OSCE as an assessment tool in subject of medicine. Conclusions: An overall positive perception of OSCE by students and examiners was seen. The OSCE was rated strongly in favor as clinical assessment tool in present study and yields dependable information about the performance capabilities of competencies of Final Professional MBBS students.

Background: Metabolic syndrome is a cluster of risk factors associated with increased cardiovascular morbidity and mortality. Left ventricular diastolic dysfunction (LVDD) is an early manifestation of metabolic disease-related cardiomyopathy. This study aimed to investigate the association between metabolic syndrome and LVDD, as well as potential sex differences and specific risk factors. Methods: A cross-sectional study was conducted, including [insert number] participants with metabolic syndrome. Demographic data, clinical measurements, and echocardiographic findings were recorded. Statistical analysis was performed to assess associations and correlations. Results: Among the study population, [insert percentage] % were found to have LVDD. Metabolic syndrome showed a dose-dependent association with the risk of LVDD, with a stronger association observed in men compared to women. Waist circumference and triglyceride levels were identified as independent risk factors for LVDD in men. However, no significant correlations were found between LVDD and blood pressure, fasting blood sugar, waist measurement, triglycerides, or high-density lipoprotein levels. Conclusion: This study provides evidence of an association between metabolic syndrome and the risk of LVDD, emphasizing the importance of early detection to prevent disease progression and cardiac failure. Sex differences were observed, with men showing a stronger association between metabolic syndrome and LVDD. Waist circumference and triglyceride levels were identified as significant risk factors for LVDD in men. These findings highlight the need for comprehensive risk assessment and targeted interventions in individuals with metabolic syndrome to mitigate the risk of LVDD.

Background: In 2019, diabetes was the direct cause of 1.5 million deaths. DM (DM), long considered a disease of minor significance to world health, is taking its place as one of the main threats to human health in the 21st century [1]. It is the most common non-communicable disease worldwide and the fifth leading cause of death in developed countries. It has been estimated that by the year 2025, India will have the largest number of diabetic subjects in the world. Objectives: To study the prevalence of macrovascular and microvascular complications in newly diagnosed T2DM patients. Methods: The study is a clinical, cross-sectional study of 180 newly detected type 2 diabetics attending medicine department outpatient/ inpatient, Dr. B. R. Ambedkar Medical College, Kadugondanahalli, and Bangalore from November 2020 to May 2022(18 months) who matched the inclusion criteria. Results: In this, 84 were males and 66 were females. The prevalence of macrovascular complications CAD, and PVD was 17.0% and 8.0% respectively and microvascular complications of retinopathy, nephropathy, and neuropathy were 21.0%, 17.0%, and 22.0% respectively. Conclusion: There is a high prevalence of neuropathy and retinopathy at the time of diagnosis. HbA1c levels predict the prevalence of complications. Screening for neuropathy, retinopathy, and nephropathy at diagnosis is statistically significant. Screening with simple tests at diagnosis for all cases of diabetes is essential to identify the complications at an early reversible stage.

Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first month of life. Neonatal sepsis encompasses systemic infection of the new born including septicemia, meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infection of newborn [AIIMS] [1]. A prospective nonrandomised study was conducted in neonatal intensive care unit. At risk babies were further evaluated and investigations like complete blood count, C reactive protein, chest xray, body fluid examination( cerebrospinal fluid and urine ) and blood culture was sent. Then according to the clinical presentation and the investigations reports, antibiotic pattern was decided. Majority of the neonates had hypothermia as the presenting clinical feature followed by respiratory distress and poor perfussion. Hypothermia was the most common clinical feature steps can be taken to minimise hypothermia by proper maintenance of warm chain and early initiation of breast feeding .Higher incidence of septicemia is seen in male patients as compared to female patients. Early identification of the presenting feature and early initiation of antibiotics can play a major contributing role in reducing mortality and complications of early onset septicemia. Practicing and maintain aspetic precautions from the place of delivery and in the neonatal intensive care unit can also reduce the incidence of early onset septicemia.[Nelson][2]

Introduction: The disorders of gastrointestinal tract are responsible for a great deal of morbidity and mortality. Endoscopy in combination with biopsy plays an important role in the exact diagnosis of gastrointestinal tract disorders for further management. Objectives: The aim of the study was to highlight the utility of colonoscopy biopsies in diagnosis of conditions affecting the lower gastrointestinal tract ranging from inflammatory to neoplastic. Material and Method: This was a retrospective observational study done in the histopathology department of this medical college of North India over a 1 year period. This comprises a spectrum of a total of 65 cases of lower gastrointestinal tract lesion in form of colonoscopies biopsies. A detailed demographic and clinical details regarding imaging and other biochemical investigations documented from the departmental records. Hematoxylin and Eosin-stained endoscopic biopsies of adequate size and representative areas were studied retrospectively. Results: Chronic nonspecific colitis was the predominant non-neoplastic lesion seen among 43% cases. Adenocarcinoma was the commonest malignant lesion contributing for 80 % of malignant lesions of lower GIT. Conclusion: The incidence of the non-neoplastic lesion is higher than the neoplastic lesion. The most common non-neoplastic lesion is chronic colitis. GIT endoscopy along with biopsy is an established procedure for investigating a wide range of gastrointestinal conditions.

Background & Objective This comparative observational trial was carried out to establish the benefits of the 'Mandakini' dressing in comparison with conventional wet gauze dressings, in patients with neuropathic plantar ulcers. The objective of this study is: • To compare the effect of mandakini offloading technique over normal saline in diabetic foot ulcer. • To show the improvement in quality of ulcer healing using mandakini offloading technique. Methods Study Design - Hospital based Comparative Observational study. Period of study – 9 months from September 2021 to May 2022 Place of study: A. J. Institute of Medical Science and research Centre, Mangalore Sample size- Total of 50 patients are taken divided into two groups of 25 each. The treatment group received ‘Mandakini’ dressing which was changed every week. Control group received conventional normal saline dressings. Size of the ulcer, grade of the ulcer and wound surface area was assessed at the end of every week up to 6 weeks in both groups. The percentage of wound covered with granulation tissue, the percentage of wound covered with non-viable tissue and the time taken for healing of the ulcer were compared between the two groups Results: A total of 50 patients were randomized into treatment and control group with 25 patients in each. The ‘Mandakini’ dressing group had a significant reduction in the wound size compared to the control group). Time taken for healing of the ulcer was significantly less in ‘Mandakini’ dressing group Interpretation & Conclusion: Mandakini dressing significantly reduces the wound size and time taken for the healing of plantar ulcer compared to conventional normal saline dressing. Patient acceptability, patient satisfaction, quality of life and cost of the total treatment were better in Mandakini dressing group.

Introduction: Corona virus is a family single stranded RNA virus. Covid 19 the disease spectrum varies from asymptomatic infections to severe disease requiring mechanical ventilation. Chest X-ray and computed tomography are primary imaging tests for diagnosis, follow up and complications in this pandemic era. This study was intended to correlate the clinical severity, radiological features, and vaccination status with the outcome of hospitalized COVID 19 patients. Materials And Methods: This retrospective study included 757 admitted covid-19 patients in a dedicated tertiary care hospital. The patient’s data concerning medical history, vaccination history, laboratory findings, radiological features, severity and outcome were extracted from medical records for subsequent evaluation, interpretation and correlation. Results: A total of 757 patients included in the study, the mean agewas52 years with male preponderance. Majority of them had mild disease (52.8%), moderate and severe disease were (31%) and (13.5%) respectively. In this study 74.5% of people were vaccinated and 25.5% unvaccinated. To assess the severity of the disease chest X-rays were done. In that 32.5% were normal, 66.05% had consolidation. Bilateral involvement was seen in 45.18%.it was observed that involvement of left lung was more than the right. Upper zone involvement was associated with severe disease (67.6%).When compared with vaccination status patients, unvaccinated had more severe disease correlating with chest X-ray features in severity. Conclusion: This present study emphasizes the importance of covid vaccination; patients who didn’t receive vaccination had more severe disease and was evidenced by involvement of the lung showing severity of radiological features in chest X-ray.

Background: Hyponatremia, characterized by low serum sodium levels, has been identified as a potential prognostic marker in acute coronary syndrome (ACS). However, its precise relationship with ACS prognosis remains unclear, necessitating further investigation. Aim: This study aims to determine the incidence of hyponatremia in ACS patients and assess its role as a prognostic indicator. Additionally, the correlation between hyponatremia levels and left ventricular dysfunction (LVD) on 2D echocardiography will be evaluated. Results: The study included 40 ACS patients, predominantly middle-aged males with evidence of cardiac muscle damage and moderate LVD. The prevalence of hyponatremia varied among different ACS types, with higher rates observed in ST-elevation myocardial infarction (STEMI) subtypes. Significant associations were found between LVD and the presence of hyponatremia, as well as between hyponatremia and mortality in ACS patients. Conclusion: Hyponatremia appears to be prevalent in ACS patients and may serve as a poor prognostic indicator. Its association with LVD and increased mortality highlights the importance of monitoring and managing sodium levels in ACS patients. Further research is needed to explore potential interventions and strategies for improving outcomes in ACS patients with hyponatremia.

Introduction: Surgery for acetabular fractures is challenging due to challenging surgical access, challenging fracture anatomy, challenging anatomic reduction, challenging surgical complications, challenging functional outcomes, and challenging chondral damage. Acetabular fractures have a significant mortality and morbidity rate. Internal fixation is a fast developing method of treating these fractures with results that are comparable to those of conservative treatment. Displaced fractures are now typically treated with surgery. Perfect reduction is the aim of open reduction and internal fixation of an acetabular fracture. Our study compares the outcomes of non-operative and operative care for displaced acetabular fractures in the Indian population. Methods: We chose 50 patients for this retrospective investigation, of whom 25 received surgery and 25 did not, and who were all diagnosed with a displaced acetabular fracture. Since all patients underwent surgery more than a year after the fracture, we compared their functional results at the end of the year. We used the Merle D'Aubigne and Postel scoring system to evaluate the functional result at one year. These results were then compared between the two groups using a paired t-test. Results: In the operated group, we had 56% (14 patients) great results, 24% (6 patients) very good results, 4% (1 patient) decent results, 8% (2 patients) mediocre results, and 8% (2 patients) poor results. The non-operated group had outcomes of 16% (4 patients) that were excellent, 20% (5 patients) that were very good, 4% (1 patient) that were good, 16% (4 patients) that were moderate, and 44% (11 patients) that were poor. We split the outcomes of patients who underwent surgery and those who did not into two groups. Patients in the first group were those who had good or better results, and patients in the second group were those who had subpar results. With an odd ratio of 9.036 and a 95% coefficient interval between 3.966 and 20.588, the Fisher's exact test was employed to compare the two groups, and the results showed a statistically significant difference between the outcomes of the operated and non-operated groups. Conclusion: Compared to conservative care, displaced acetabular fractures treated with surgery fixation perform better in terms of functional outcome and post-treatment side effects.

High flow nasal cannula is an emerging treatment option in paediatric intensive care units for paediatric patients In acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiology. It can avoid invasive method of mechanical ventilation and offers a safe practical approach to oxygen delivery and support. Aim is to describe 9 cases with acute respiratory distress with differing underlying pathophysiology and their response to high flow nasal Cannula oxygen therapy. Patients admitted in PICU with acute respiratory distress with acute encephalitis, congenital heart disease, laryngomalacia etc and treated with HFNC oxygen therapy were chosen to review. 4 infants and 6 children were reviewed. All were commenced on high flow nasal cannula therapy in PICU and all demonstrated an improvement in their work of breathing. 2 patients were referred to higher Centre in view of CHD with improvement on HFNO. There was also a substantial improvement in their haemodynamic status. HFNO Therapy is an viable treatment option for a range of patients presenting to PICU With acute respiratory distress. More invasive method of respiratory support may be avoided by use of HFNC oxygen therapy.

Background: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease that affects children and adults. It requires continuous insulin administration for glucose control. T1DM significantly impacts children's quality of life (QOL), affecting their daily activities and causing emotional and social challenges. Aim: The current study aims to assess the effect of Type 1 DM on the quality of life of children who seek treatment for the disease. Methodology: This cross-sectional study included 60 children with Type 1 Diabetes Mellitus (T1DM) divided into two age groups. The Pediatric Quality of Life Inventory (PedsQL) questionnaire assessed their quality of life from Physical, Emotional, Social and Schooling dimensions. Results: The study on children with Type 1 Diabetes Mellitus (T1DM) aimed to examine the differences in quality of life based on age and gender. The participants were divided into two age groups: 8-12 years and 13-18 years, with most children falling into the 8-12 years category. Male children constituted a higher proportion compared to females. Significant differences were found between the age groups across various dimensions of quality of life, with the 8-12 years group generally reporting higher scores. However, no significant gender differences were observed. Children with T1DM face physical, emotional, social, and schooling challenges, indicating the condition's impact on their lives. Conclusion: This study emphasizes the multidimensional impact of T1DM on children's quality of life and suggests targeted interventions. By addressing these multidimensional factors, we can better meet the needs of children with T1DM and improve their overall well- being.

Background: Mucormycosis is a severe fungal infection that has seen a significant increase in cases, particularly among COVID-19 patients, posing a major challenge to healthcare systems in India. Understanding the clinical and epidemiological profile of mucormycosis patients is crucial for effective management and resource allocation a study was conducted to analyse the clinico-epidemiological profile of mucormycosis patients. Objective: The objective of this retrospective study was to examine the clinical and epidemiological profile of patients with mucormycosis admitted to RIMS Teaching Hospital. Materials & Methods: A retrospective study design was employed, utilizing existing records and documents from patients admitted to RIMS Teaching Hospital with a diagnosis of mucormycosis. Relevant data, including demographic information, medical history, treatment details, and outcomes, were extracted and analyzed. Data cleaning and quality assurance measures were implemented to ensure accuracy and reliability. Results: The study included 55 patients diagnosed with mucormycosis. The clinical and epidemiological profile of these patients was assessed, revealing important findings. Corticosteroid therapy was found to be commonly administered in the management of mucormycosis; however, the study highlighted the need for careful evaluation of the potential risks and uncertainties associated with its use. The prevalence rates of comorbidities differed from previous studies, emphasizing the association between COVID-19, diabetes mellitus, and mucormycosis, underscoring the importance of comprehensive strategies targeting these interconnected conditions. The distribution of affected anatomical sites reflected potential routes of fungal invasion, with notable variations observed. Furthermore, a significantly higher survival rate was observed among the patients, suggesting the potential effectiveness of the management approach employed. Conclusion: This retrospective study provides valuable insights into the clinical and epidemiological profile of patients with mucormycosis admitted to RIMS Teaching Hospital. Careful evaluation of corticosteroid therapy, comprehensive strategies addressing comorbidities, and understanding the distribution of affected anatomical sites are crucial for effective management and prevention. These findings contribute to our understanding of mucormycosis and provide a basis for future investigations and interventions.

Background: Heart failure is a prevalent and chronic condition with a rising incidence globally, including in India. Red cell distribution width (RDW), a measure of erythrocyte size variation, has been proposed as an indicator of inflammation and oxidative stress in cardiovascular diseases, including heart failure. However, limited data exist on the relationship between RDW and heart failure severity in Indian patients. This study aimed to investigate the correlation between RDW and the severity of heart failure in Indian patients. Result: The study included patients across various age groups, with the majority falling in the 51-60 years range, and most of the patients were male. Hypertension was the most common risk factor for heart failure, followed by dyslipidemia and obesity. Ischemic heart disease emerged as the primary cause of heart failure in the studied population. Distribution of patients based on NYHA classes revealed a higher percentage in the more severe classes (III and IV). The mean RDW was significantly higher in patients with advanced heart failure compared to those with milder forms. Conclusion: The study findings indicate a correlation between elevated RDW and increased severity of heart failure in Indian patients. RDW shows potential as a biomarker for risk stratification and monitoring disease progression in this population. Further research is needed to explore the clinical utility of RDW in the early detection and management of heart failure, along with its implications for developing new therapeutic approaches specific to the Indian context.

Background: Cervical and breast cancers are the leading malignancies in females in India, early detection through regular screening plays a vital role in its prevention and management. The incidence of abnormal cervical cytologic findings during pregnancy is 0.72 to 1.67%.Pap smear testing is simple, cost effective and is safe in pregnancy. In low resource countries like ours, this may be the only opportunity when the woman comes to a health centre. Objective of the study is to determine the prevalence of abnormal cervical smears and genital infections among pregnant women and is to determine the awareness of pap smear as a cervical cancer screening test in pregnant women Methods: A prospective study was conducted among 100 women attending the outpatient unit of the Department of Obstetrics and Gynaecology for antenatal check-ups. Conventional pap smear was used in this study. The cytological results were reported as per the Bethesda classification system 2014. Descriptive statistics were used to analyse the data, including frequencies and percentages. Results: In this study, among 100 antenatal women mean age was 23.70 years. Mean age at marriage was 19.72years.58% were multigravida and 42% were primigravida Among the 100 Pap smear reports, 72% were NILM, 22% nonspecific inflammatory changes, 5% bacterial vaginosis and 1% ASCUS. The findings revealed a lack of awareness among the study participants, with 73% reported no awareness of cervical cancer. Similarly, 82% of women were unaware of screening methods for cervical cancer. Furthermore, only 2% of the participants had undergone previous screening. These results highlight the significant gap in knowledge and the low prevalence of screening among the study population. Conclusion: The antenatal period should be utilized as a valuable opportunity to screen them for cancer cervix. The study underscores the need to improve awareness and knowledge about cervical cancer and screening among women. Enhancing awareness can contribute to early detection, timely interventions, and improved outcomes for women.

CKD one of the non-communicable diseases was forecasted to be raised in the cases, in which there is rise in uraemic toxins which may leads to secondary complication, hence we intended to study the inflammation due to uraemic toxicity. The study subjects were picked randomly. The basic information, the patient history was collected and blood samples were drawn after obtaining a written consent form. The patients were grouped into four different groups as, Group I (controls) contain normal healthy individuals free from all the systemic ailments (n=50). Group II contains individuals with CKD stage 1 &2 (n=50) Group III contains individuals with CKD stage 3, 4 & 5 (n=50). Group IV contains individuals with Hemodialysis (n=50). The study protocol was approved by the Institutional Ethics Committee. Biochemical parameters like fasting blood glucose, RFT, uric acid and inflammatory biomarkers were analyzed. Although inflammation may have protective, but in hemodialysis the inflammation does persist which can lead to development of CV events. In this regard we suggest to estimate the CRP levels along with YKL-40 to decide the doses of dialysis to reduce the inflammation as a conceptive therapy to reduce the CV events.

Introduction: Dental anxiety and pain acts as a barrier in accessing oral health care. Pedodontists face uncooperative children whose behaviour may hinder the effective treatment delivery and may cause possible harm to themselves and the pedodontist. Local anesthetic injection is one of the most anxiety inducing stimuli in pediatric dentistry.

Aim: This study aims to compare the efficacy of pre-cooling with ice, vibration+distraction, laser bio-stimulation and local anaesthetic (LA) gel with conventional method on reduction of pain, anxiety and behaviour of children aged 5-9 years.

Methodology: This study included 100 children requiring inferior alveolar nerve block. The children were equally divided into four groups: Group I ice group, Group II vibration+distraction group, Group III laser bio stimulation group, Group IV LA Gel group. After proper drying of the mucosa, one of the four techniques was applied for one minute followed by administration of Local Anesthesia. The pain response was assessed by Wong Baker Faces Pain Rating scale and Sound Eyes Motor Scale (SEM). The anxiety was assessed by measuring pulse rate before and after LA administration by pulse oximeter. Behaviour was assessed using Faces, Legs, Activity, Cry, Consolability Scale (FLACC)

Results: The children in vibration+distraction group had lower pulse rate, FLACC Score, and pain rating scores followed by ice, LA Gel and Laser Bio stimulation than the conventional procedure.

Conclusion: Pain management during LA injection is integral step in gaining initial trust and during subsequent visits. The present study suggests that simple methods like ice cooling and vibration+ distraction can be used as effective non pharmacological techniques to reduce injection pain.

Background: Unengaged fetal head during Caesarean section often complicates the delivery process. This study aimed to compare the Vectis method versus the manual method in terms of operative and neonatal outcomes, maternal experiences, and professional preferences.

Methods: We conducted a comparative study involving 80 women undergoing Caesarean section with unengaged fetal heads. The study population was divided into two groups: the Vectis group and the manual extraction group, with 40 participants in each group.

Results: The use of the Vectis method resulted in significantly reduced mean uterine incision to extraction time (64.60±36.86 seconds) as opposed to the manual method (83.08±35.32 seconds, p=0.025). The maternal experience was significantly better in the Vectis group, with all participants (100%) reporting no discomfort during extraction, unlike the manual group where all participants reported discomfort (p<0.001). Surgeons found extraction easier in 77.5% of cases with the Vectis method, in contrast to 55% in the manual method (p=0.639). Most anaesthetists (80%) expressed a preference for the Vectis method (p=0.963). Neonatal outcomes were similar between the groups, with comparable APGAR scores at 1 minute (Vectis: 7.30±0.72; Manual: 6.73±0.55; p=0.001) and 5 minutes (Vectis: 8.83±0.55; Manual: 8.65±0.48; p=0.496), and no neonatal injuries reported in either group.

Conclusion: The Vectis method of fetal head extraction during Caesarean section offers potential advantages over the manual method, including shorter extraction times, improved maternal experience, and professional preference, without impacting neonatal outcomes.

Introduction: Scoring systems objectively guide towards providing quality of care as well as plays a significant role as far as outcomes of a particular procedure. In the present study a comparison is made between two well established scoring systems i.e, POSSUM & P- POSSUM and also importance is given to highlight synergistic usage of well established scoring systems to effectively gauge in anticipating the outcomes post laparotomy. Objectives of the Study: To compare the accuracy of mortality prediction between the two scoring systems. To highlight the importance of synergistic use of scoring system in predicting morbidity and mortality. Usage of Clavien-Dindo scoring system to attain comparative objectivity of a surgical procedure. Materials and Methods: It is the prospective observational study conducted for the period of 1 year. The data is collected from the inpatients after obtaining the written informed consent, undergoing laparotomy admitted under the Department of General Surgery, Ramaiah Hospitals, Bengaluru during the period of study. Results: Among the 96 cases studied 60(62.5%) were males and 36(37.5%) were females. Emergency resuscitation, operation done within less than 24 hours is 49%. Elective cases were 47.9% and emergency immediate operation done within less than 2 hours is 3.1%. Mean physiological score calculated using POSSUM and P-POSSUM is 21.92% and 22.98% and the difference is not statistically significant. Mean operative score calculated using POSSUM and PPOSSUM is 15.13% and 17.16% and the mean difference is significant statistically. Mean mortality calculated using POSSUM and P-POSSUM is 20.44 and 12.46% and the difference is statistically significant. Mortality prediction was noted to be better with P-POSSUM scoring system, while POSSUM over predicted mortality by 1.5 times even in low risk cases. Complication following a procedure were graded using universally accepted CLAVEIN DINDO grading system so that comparative objectivity is maintained. Conclusion: It was noted from the study that POSSUM scoring over predicted mortality in low-risk cases by 1.5 times, against other studies wherein the overestimation was noted to be between two to eight folds. P-POSSUM accurately predicted the operative severity and expectant management and was statistically significant parameter. It was noted from the study that morbidity estimation is as important as precise mortality estimation of a particular operative procedure. Hence we conclude highlighting the fact that synchronous usage of POSSUM and P-POSSUM is an essential guiding which will aid in expectant post procedural outcomes.

Background: Depression is a significant concern in adolescents, especially in hospitalized patients. Efficient screening tools are critical to detect and manage depression in this population. This study aimed to compare the predictive value of PHQ2 and PHQ9 scores in detecting depression in adolescents in a tertiary care hospital setting.

Methods: A prospective cohort study was conducted involving 70 adolescent patients (aged 10-19 years) admitted in Bangalore Medical College and Research Institute hospitals from March to April 2023. Patients were assessed using PHQ2 and PHQ9 questionnaires during their hospital stay.

Results: Results demonstrated a strong positive correlation between PHQ2 and PHQ9 scores (r=0.852, p<0.01). Out of the total patients, 25.7% scored ≥3 on PHQ2, indicating a risk for depression. PHQ9 categories ranged from Minimal to Severe Depression, with 60.0% of participants falling under Minimal Depression and 14.3% under Mild to Severe Depression categories.

Conclusion: The study confirms the efficacy of both PHQ2 and PHQ9 as reliable screening tools for depression among adolescents in a tertiary care setting. Both tools are advantageous, with PHQ2 offering a rapid initial assessment and PHQ9 providing a detailed evaluation of depression severity. These findings underscore the importance of routine mental health screenings in hospitals.

Aim: To assess and contrast the efficacy of thaumaturgic techniques with that of conventional techniques.

Materials and Methods: Three hundred and sixty children aged 2-13 years, identified as manifesting strong-willed behaviour were selected for the study. The children were randomly allocated to one of the thaumaturgic distraction techniques groups. Anxiety was assessed before and after the operative procedure using the facial anxiety scale.

Results: There has been a significant decrease in anxiety on usage of thaumaturgic techniques. The thumb and light trick and book trick significantly reduced anxiety in children aged 2-7 years, the book trick and item prediction trick significantly reduced anxiety in the children aged 7-11 and only the item prediction trick in children aged 11-13 years.

Conclusion: Thaumaturgic methods have been useful in controlling children's conduct throughout a range of age groups. The method of treatment, however, is crucial to its success.

Critical value reporting is one of the requirements for laboratory accreditation and is an important aspect of quality assurance regarding reporting of results. This reporting of patient results specially critical values should be clear, accurate and rapidly communicated to clinicians.

Methods: Biochemical parameter results of one year (January 2020 to December 2020) were retrospectively evaluated in terms of identification of critical values generated from the testing of samples on siemenes analyser and their association with entries in the call back register in a biochemistry lab situated in a tertiary care hospital. Statistical analysis was conducted using Microsoft Excel 2016 program.

Result: A data of 79773 tests were analysed, and 2658(3.3%) critical alerts were generated by the Siemens auto analyzer. of these only 1649(2%) were recorded in the call back register of critical alert.

Introduction: A spectrum of hematological manifestations are seen at every stage of human immunodeficiency virus (HIV) infection, and they often pose a great challenge in the Diagnosis and management.

Out of all complications, Hematological abnormalities, Anemia is the most common abnormality seen in HIV s patients and its incidence is strongly associated with the progression of the disease.

Objectives: The present study aims to study the hematological manifestation in newly detected HIV patients & to study the relationship between various haematological manifestation with WHO clinical staging.

Methodology: It is a observational and descriptive study done at ART CENTRE VIMS, BALLARI, with a sample size of 108 cases. Patients who filled the inclusion criteria are assessed as per proforma specially designed for study.

Conclusion: The study concluded that anaemia was the most common haematological abnormality followed by elevated ESR, thrombocytopenia, leucopenia. CD4 count is the best predictor of WHO staging.

Background: This study aimed to compare changes in central corneal thickness (CCT) and endothelial cell count following small incision cataract surgery between immature and mature cataracts.

Methods: A hospital-based observational study was conducted on 60 patients (51.7% male, 48.3% female) who underwent manual small incision cataract surgery. The study population comprised 30 immature and 30 mature cataract patients. The patients were evaluated preoperatively and on days 1, 1 week, 6 weeks, and 12 weeks postoperatively.

Results: Postoperative CCT increased on day 1 (immature: 544.33µm, mature: 555.43µm) and then gradually decreased to near preoperative levels by the 6th week (immature: 494.9µm, mature: 495.83µm). The immature cataract group exhibited a higher mean preoperative endothelial cell count (2574.03 cells/mm²) than the mature group (2447.46 cells/mm²). Although both groups experienced a decrease in endothelial cell count, the immature group maintained a higher count throughout the postoperative period, reaching 2276.23 cells/mm² by the 3rd month, compared to 2072.43 cells/mm² in the mature group. Visual acuity showed significant improvement postoperatively, with 96.7% of immature and 90% of mature cataract patients achieving a visual acuity of 6/6 to 6/18 at the 6th week.

Conclusion: Small incision cataract surgery has a minimal long-term impact on corneal thickness and results in a manageable decrease in endothelial cell count in both immature and mature cataracts.

Background: To study the preoperative, intraoperative and postoperative complications and to study postoperative visual outcome in these patients.

Methods: This is a prospective observational study conducted on a study population of 43 patients who were diagnosed with IHD (ejection fraction >40%). Complete ophthalmic examination with slit lamp, fundus examination, intraocular pressure, biometry was performed. All patients underwent thorough cardiac evaluation and fitness for cataract surgery under local anaesthesia was obtained.Lignocaine2% without adrenaline was used for local anaesthesia. Systemic medications like aspirin and other blood thinners were stopped 5-7 days before surgery. These patients were subjected to the same protocol of Manual small incision cataract surgery like all other patients. Final visual acuity was accessed at the end of 6weeks.

Results: Of the 43 patients with IHD,15 patients (34.89%) were in age group of 45-60 yr,23 patients (53.48%) were in age group of 60-70yr,5 patients (11.62%) were above 70years. 8 patients (18.6%) had intraoperative bleeding from sclero corneal tunnel,4 patients (9.3%) had postoperative subconjunctival haemorrhage. All 43 patients (100%) achieved 6/9 to 6/6 postoperative vision at 6 week follow up. None of the patients had any systemic complications like decrease of saturation, variation in heart rate during surgery.

Conclusion: In patients with IHD who undergo cataract surgery, complications can be minimized by proper preoperative evaluation and intraoperative care. Surgery done with precaution will reduce intraoperative complications and gives good visual outcome

Introduction: Sleep is defined as unconsciousness from which a person can be aroused. It affects the physiology of the body and is affected by other systems and external environment sociocultural practices. There are various methods to detect and diagnose sleep disorders and one of them is child sleep habits questionnaire which is a retrospective 45 item parent questionnaire. CSHQ includes questions about various domains that include major presenting clinical sleep complains in children. This study is planned to study sleep problems and its association with socio demographic factors among children between 3 to 9 year of age.

Objectives: To estimate the prevalence of sleep problems in children age 3 to 9 years andits association with socio–demographic factors

Methods: The observational study included 400 healthy children from 3 to 9 year of age, who were healthy siblings accompanying children in opd and wards. CSHQ was explained to the parents in hindi and their response was recorded and data was analysed.

Results: Sleep problems arevery prevalent (49%) among 3 to 9 year of age which was influenced by several factors like maternal education, overcrowding in the house, socioeconomic status. Most common sleep problem was sleep anxiety (17%) followed by Bedtime Resistance (5.8%), Sleep-related breathing disorders (5.5%), Night Wakings (3.8%), Sleep duration (3.3%), Daytime sleepiness (2.3%) and Parasomnia (1.3%). Sleep onset delay was the least common sleep problem (0.8%).

Conclusions: This study concludes that sleep problems are very prevalent in children that is also influenced by several factors like lower socioeconomic status, lack of maternal education, overcrowded homes and (CSHQ) is a very effective screening tool for detecting and diagnosing sleep problems.

Central venous access is a common and essential procedure performed in many clinical settings for a variety of indications. Like any other procedure Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed manner and vary based on type of central venous access. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. This research article  discusses about the  number of patient who had various complications of central line which has been observed in age group of 12 to 30yrs, 30 to 50 yrs, and 50 and above yrs in past one year in Hamidia Hospital Bhopal.

Burkholderia (previously Pseudomonas) isa Gram negative bacilli commonly found in soil and moist environments [1]. Small hospital outbreaks due to a single contaminated source suchas a disinfectant, intravenous solutions, nebulizer solutions, mouthwash and medical devices including respiratory-therapy equipment [1]. In our hospital, we had 3 reported cases of hospital acquired bloodstream infections caused by Burkholderia species from the pediatric ward. An outbreak investigation was conducted by the Hospital Infection Controlcommittee. The source was identified as distilled water used for nebulization in the pediatric ward.

Background: Preoperational anxiety is a universal reaction experienced by patients who are admitted in the hospital for surgery. Preoperative anxiety can be defined as- ‟unpleasant state of uneasiness or tension that is secondary to a patient being concerned about disease, hospitalization, anaesthesia and surgery. This study aims to compare the effects of oral melatonin and oral alprazolam alone and with Combination of both melatonin and alprazolam on perioperative anxiety and sedation.

Aims & Objectives: The objectives of our study were to compare anxiety and sedation, using Hospital anxiety and depression scale and Modified Ramsay Sedation Score.

Material and methods: A total of 90 adult patients were randomly allocated into three groups. Group 1received oral alprazolam0.5 mg, Group 2 received oral melatonin 3 mg, Group 3 received alprazolam 0.5 mg and melatonin 3 mg tablet as premedication.

Results: Three groups were comparable with respect to demographic profile including mean age, sex, weight, and ASA physical status, sedation, and anxiety levels. Sedation was better in Melatonin than Alprazolam and it was further improved on adding Alprazolam and Melatonin (p value<0.5). Anxiety was decrease in Melatonin and slightly decrease in Alprazolam, Adding melatonin to alprazolam reduced anxiety levels more than either of the two drugs given alone (P value 0.0004).

Conclusion: Combination of alprazolam 0.5mg and melatonin 3mg significantly reduced the patient’s level of anxiety with sedative effect, which helped in smoother induction of anaesthesia.

Study Objective: To compare the post-operative analgesic efficacy, pre-operative sedation and perioperative anxiety reduction of oral Gabapentin and oral Clonidine in abdomino-pelvic and lower limb surgeries done under spinal anaesthesia.

Design: Prospective randomized comparative study.

Materials and Methods: 60 patients belonging to ASA physical status I and II of both sexes (each group 30 patients) were randomly selected for the study.Group G patients received 300 mg Gabapentin orally and Group C patients received 100 microgram Clonidine orally 120 minutes before surgery. Preoperative sedation, post operative analgesia, perioperative anxiety and adverse effects were compared in both the groups.

Results: Group G showed better VAS readings of 2.33±0.92 in comparison to 5.7±1.29 of Group C at the 6th hour postoperatively. The p value was 0.0001 which is considered significant. Rescue analgesia was more associated with Group C (2.16±0.91) when compared to Group G (1.4±0.49) showing a p value of 0.0002, which is considered significant. The Ramsay sedation score which was used in this study showed a better sedative effect by Gabapentin than Clonidine in the preoperative period. Gabapentin group showed significant sedation at 120 minutes with a p value of 0.0001.

Hospital anxiety and depression score which was used in this study was significantly less in group G patients than group C patients. And remained less upto 24 hours post surgery with a value of 0.0001

Side effects like nausea and vomiting were more associated to Group C as compared to Group G but dizziness was more associated with patients receiving Gabapentin than Clonidine.

Conclusion: Our study shows that Gabapentin is a better adjuvant for providing preemptive analgesia than Clonidine. Gabapentin also showed lesser incidence of side effects.

Background: Platelet rich plasma (PRP) and human umbilical cord blood (HUCB) are two cheap and easily accessible newer modalities used to improve wound healing. The aim of our study is to analyze the effect of these two new modalities and compare it with conventional dressings.

Method: Patients with chronic wounds were divided randomly into three different groups. Group A received a topical application of PRP to their wounds; group B received a topical application of HUCB, while group C were treated with conventional dressings. Wounds were observed weekly and results analyzed at the end of 6 weeks.

Results: Significantly better improvement in wound healing was observed in group A (PRP) and group B (HUCB) patients as compared to group C (Conventional dressing) with a reduction in surface area, improvement in the wound bed, reduction in exudates amount and healthy granulation.

Conclusion: Both PRP and HUCB are cost effective, easy to extract and prepare, and are better and convincing agents used in chronic wounds.

Introduction: Anemia is a  major  global  health  problem,  especially  in developing countries like India, despite the fact that this problem is largely preventable & easily treatable. It is responsible for  morbidity  and  mortality  among  general population. The present study analysed the  type  of  anemia,  various  causative  risk  factors associated   with   anemia   and clinico-pathological manifestations  of  anemia  among  patients under department of general medicine, Hassan institute of medical sciences and srichamaranjendra teaching hospital, hassan, karnataka. Methods: A total of78 cases aging 18 to 80 years diagnosed as severe anemia based on WHO criteria of hemoglobin concentration were analysed for epidemiological, clinical and hematological parameters. A prospective observational study was conducted at HIMS, Hassan. Result: During the study period, a total of 78 severe anemia cases were included in the study. Of these 37.17%males, 62.8%females. Most prevalent in the age group of 41-50 years. Rural population 50%, urban 50%. Occupation more common in farmers 44.8%.The most common presentation was fatigue (73.08%). The common hematological finding was microcytic hypochromic blood picture (61.5%) with Iron deficiency anemia in 80.7% and nutritional cause being the most common etiology (47.43%). Conclusion: Severe anemia is more prevalent in rural areas and middle age groups with nutritional cause being most common etiology, measures to be taken by the government to ensure proper nutritional achievments and to prevent mild anemia progressing to severe anemia.

Introduction: Clavicle fracture account for approximately 2.6% of all fractures and for 44 % to 66% fractures about the shoulder. Middle third fractures account for 80% of all clavicle fractures whereas fractures of lateral and medial third of the clavicle account for 15% and 5 % respectively. Most minimally displaced clavicle fractures can be successfully treated non-operatively with some forms of immobilization.

Materials and methods: Plain radiograph of clavicle with shoulder in antero-posterior view was taken to assess the site of fracture and the fracture type (displacement and comminution). The fractures were classified according to Robinson’s classification. Patients were then allotted randomly into two groups. Patients selected for conservative treatment with figure of eight Clavicle Brace and arm sling/pouch were treated with the brace immediately. Patients selected for surgery were operated as early as possible once the general condition of the patients were stable and the patients were fit for surgery as assessed by the physician. All patients were followed up every week for 2 weeks post treatment and thereafter every 6th week, 3rd month and 6th month.

Radiographs are taken at immediate post treatment period, 6 weeks, 3 months and 6 months. Features of healing and functional outcome were looked for with help of Constant and Murleys scoring system at the time of injury, 6 weeks, 3 months and 6 months. Also, evidence of implant breakage, non-union, infection was also looked for.

Result: The patient’s functional outcome was measured using Constant and Murley scoring system and it was found that patient treated surgically had significantly better functional outcome at 6 weeks, 3 months and 6 months respectively when compared to conservative group. The complications we faced in surgical group were 2 cases of infection, 3 cases with implant failure and 1 case of non-union. In conservative group 4 cases of non-union, 3 cases of delayed union and 4 cases of shoulder stiffness. There was also two case of superficial skin infection in surgical group.

Conclusion: It was observed that patients who underwent surgical treatment had better functional outcome in terms of early ROM and so return to work was earlier compared to conservative group. According to present study, surgery can be recommended over conservative treatment in patients with displaced

mid-third fracture clavicle

Unicameral bone cyst (UBC) is a benign cystic lesion most commonly diagnosed in the proximal aspects of the humerus and femur of growing children. Medullary venous obstruction is the leading pathogenesis theory, resulting in fluid accumulation, bone resorption, and cortical thinning. Most UBCs are asymptomatic and likely go undiagnosed, while the most common presentation is a pathologic fracture. UBC of the proximal femur exhibits unique characters and complications. Post-excision stabilization of the cyst is recommended to avoid malunion and facilitate post-operative rehabilitation and an earlier return to normal activities. In the present case report, surgical treatment of a pathological neck of the femur fracture following a unicameral bone cyst was managed with internal fixation of the proximal femoral plate with bone grafting, which showed a good clinical and radiological outcome.

Background: Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia. Complex combinations between environmental and genetic factors cause various types of diabetes mellitus. Complications from diabetes mellitus, such as cardiac autonomic neuropathy, are common. Unbalanced autonomic function, which manifests as cardiac autonomic neuropathy, is a significant predictor of cardiovascular events in the diabetic patients.

Objectives: To study the prevalence of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus with peripheral neuropathy in a tertiary care teaching hospital.

Methodology: Observational Cross-sectional hospital-based study done in 131 type 2 diabetes mellitus patients who presented to the General Medicine outpatient and inpatient departments of a tertiary care teaching hospital of central Kerala from December 2020 to April 2022. The data was entered in MS excel sheet and was analyzed using SPSS software.

Results: In the present study the mean age was 62.24 years. Among participants, 96.2% had HbA1c levels above 6.5%. Mean duration of living with diabetes is13.40 years. We observed that 65.6% of the patients in our study population had Cardiac autonomic neuropathy. Despite having peripheral neuropathy, 34.4% of participants exhibited normal cardiac sympathetic and parasympathetic function.

Background: Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. Accurate prediction of mortality is crucial for guiding clinical decisions and optimizing patient outcomes. The Pneumonia Severity Index (PSI) and CURB-65 scores are commonly used scoring systems for mortality prediction in CAP. This study aimed to compare the predictive accuracy of the PSI and CURB-65 scores in hospitalised patients with CAP.

Methods: A prospective observational study was conducted in the General Medicine Department of a tertiary care hospital. A total of 100 patients diagnosed with CAP were included. Demographic and clinical data were collected upon admission, and the PSI and CURB-65 scores were calculated. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive accuracy of both scores.

Results: The in-hospital mortality rate was 23% for patients with CAP. The PSI score exhibited an area under the ROC curve of 0.88, indicating a high level of accuracy in predicting mortality. The CURB-65 score demonstrated an AUC of 0.81, suggesting moderate accuracy. Comparison with existing literature showed consistent findings regarding the PSI score's superior performance.

Conclusion: Both the PSI and CURB-65 scores have value in predicting mortality in hospitalised patients with CAP. However, the PSI score demonstrated slightly higher discriminatory power. These scoring systems, along with clinical judgment and additional diagnostic tests, can aid in risk stratification and guide decision-making. Further multicenter studies with larger sample sizes are needed to validate these findings and explore other scoring systems for improved risk stratification in CAP.

Introduction: Sciatica, a common presenting complaint in routine clinical practice, is often caused by the herniation of the nucleus pulposus within an intervertebral disc. Lumbar intervertebral disc prolapse has traditionally been treated most effectively through surgical interventions. The study aims to investigate the clinical manifestations of lumbosacral intervertebral disc prolapse in patients, evaluate the outcomes of open lumbar discectomy for such cases, and examine the impact of this surgical procedure on pain, vertebral tenderness, and SLRT (Straight Leg Raising Test).

Methodology: This is a prospective observational type of study done from December 2020 till June 2022 and post-operatively all the patients were followed up till September 2022. Sample size was 30 cases were included in the study. This study was conducted in DR. B.R.AMBEDKAR MEDICAL COLLEGE AND HOSPITAL on patients who were diagnosed with lumbosacral intervertebral disc prolapse aged between 30 to 80years of age .After obtaining their written informed consent, data was collected regarding basic demographic details. Pain, Tenderness and Straight leg rising test (SLRT) was used to assess the outcome measures at 1week, 6week and 3months intervals.

Results: Majority of the patients were Male patients (63.33%) female patients (36.67%) in incidence. The mean age of patients was 47.53 years (18 to 60 year), L4 - L5 was the most common disc to herniated. 28 patients (93.33%) out of 30 patients showed significant improvement It was found to be statistically significant with respect to MACNAB score and JOAS score during their Post –op 0weeks, 1week, 3week, 12week.Complications after the surgery were found to be superficial infection in 2 (6.67%) cases, CSF Leak in 1 case (3.3%), post op blood loss (>100 ml) in 20 cases (66.67%).

Conclusion: Hence, Open lumbar discectomy always remains as a gold standard as it has the better visualization of the bulged disc, allows complete removal of the bulged disc and better after removal of the disc material, freeness of the nerve roots can be better visualized.

Background and Objectives: Fracture of the proximal humerus is associated with severe morbidity to the patient condition. The incidence of this fracture is anticipated to rise as population longevity with the same causing osteoporosis of bones increasing the susceptibility to fractures. From a practical and aesthetic perspective, achieving effective fracture realignment is crucial. There is a lot of confusion about the best way to treat different types of fractures due to the wide range of treatment options available for these injuries. Open reduction with Proximal Humerus Interlocking System is presently the gold standard. The goal of this study was to evaluate the outcome of PHILOS plating for proximal humerus fractures

Methods: The current study was a prospective analysis of 20 proximal humerus fracture cases that were admitted to Dr. B. R. Ambedkar Medical College between September 2020 and August 2021. Patients with proximal humerus fractures over the age of 18 were included as cases, and cases were chosen in accordance with inclusion and exclusion criteria. Patients who were medically unfit, unwilling for surgery, or who had open fractures when they arrived were excluded from the study.

Results: This  study  comprises  the  sample  of  20  patients,  in  which  12 were females  and  8 were  males.  The  age distribution  was  varied  from 18 years  to  74  years  with  an  average  age  of  51  years.

Out  of  20  patients, 6  patients  were  victim  of  road  traffic  accident  in  which  one  associated with  fracture  neck  of femur  on  ipsilateral  hip, 10 patients  had  self  fall,  4 patients were fell from height (minimum 10 feet)  and one was victim of an  epileptic  attack.

Longest duration of follow up was 21 months with a mean follow up of 12 months. final follow up assessment with ‘The Constant Criteria’ Of the 20 cases,7(35%) patients had excellent result, 10(50%) good , 2(10%) moderate , 1 (5%) poor

Conclusion: Open reduction and PHILOS plating for proximal humerus fractures has shown to achieve good anatomical and functional outcome. The complications arising from the procedure were within acceptable limits. The surgical procedure continues to be at the forefront of the management of Proximal Humerus Fractures.

Background: Depression is a significant concern among individuals with Type 2 diabetes, impacting both their mental well-being and disease management. This study aimed to determine the prevalence and severity of depression and assess medication adherence in a sample of Type 2 diabetic patients.

Methods: A cross-sectional study was conducted at a tertiary care center, involving 200 Type 2 diabetic patients aged 25-55 years. The Beck Depression Inventory (BDI) was used to assess depression severity, and medication adherence was self-reported. Demographic information and diabetes-related characteristics were collected. Descriptive statistics and chi-square tests were used for data analysis.

Results: The prevalence of depression in the study sample was high, with approximately 45.5% of patients exhibiting some degree of depression. The severity of depression varied, with 10.5% experiencing borderline clinical depression, 13% experiencing moderate depression, and 5% experiencing severe depression. Medication adherence decreased significantly with increasing depression severity, ranging from 90% adherence in patients with normal BDI scores to 20% in those with severe depression. There was a significant association between the duration of diabetes and depression severity, indicating a potential cumulative effect over time. Gender differences in medication adherence were observed but did not reach statistical significance.

Conclusion: This study highlights the high prevalence of depression among individuals with Type 2 diabetes and its impact on medication adherence. It emphasizes the importance of comprehensive care that integrates mental health screening and psychosocial support into diabetes management. Targeted interventions are needed to enhance medication adherence and mental health support for this vulnerable population. Future research should focus on developing and evaluating such interventions to improve outcomes for individuals with Type 2 diabetes.

Objectives: The present research was conducted to evaluate the antimicrobial efficacy of herbal root canal irrigants (neem, garlic extract, Tridax procumbens) and sodium hypochlorite against Enterococcus faecalis.

Materials and Methods: Before being inoculated onto Mueller-Hinton agar plates, the E. faecalis bacterial culture was grown overnight in the brain heart infusion (BHI) broth. Antibacterial inhibition was measured using agar well diffusion. The appropriate wells in agar plates were filled with a solution of sodium hypochlorite and herbal irrigants (neem, garlic extract, T. procumbens, and A. marmelos extracts), which were then incubated for 24 hours at 37°C. The bacterial inhibition zone in each well was measured and noted. The results were tabulated and analysed using statistics.

Results: Sodium hypochlorite indicated the maximum inhibitory zone against E. faecalis, subsequently neem, garlic extract and the lowest by Tridax procumbens.

Conclusion: Neem, garlic extract, and Tridax procumbens were tested herbal remedies that demonstrated an inhibitory zone against E. faecalis. These irrigants are therefore suitable for use as root canal irrigating solutions.

Background: Tuberculosis, the disease caused by Mycobacterium tuberculosis, is recognized as a global public health problem. Post Tuberculosis sequelae are the anatomical and pathophysiological changes in the respiratory system which occurs secondary to complications of pulmonary TB, whether primary or secondary, even after completion of treatment and complete bacteriological cure. Accurate estimates of the frequency and the extent of the pulmonary impairment from tuberculosis are important to patients and clinicians. Hence, it is necessary to assess the extent of the pulmonary function abnormalities among patient who have successfully completed the treatment for pulmonary tuberculosis.

Objectives: To assess the type and grade of airway obstruction in patients who are successfully treated for pulmonary tuberculosis attending Respiratory Medicine department.

Methodology: Cross-sectional hospital based observational study was conducted for a period of one and a half years between February 2021 to July2022 in a tertiary care at Agartala Tripura. All the patients with past history of treated tuberculosis attending in the Department of Respiratory Medicine (OPD & IPD), Agartala Govt. Medical College & G.B.P. Hospital from February 2021 to July 2022 were included in the study fulfilling inclusion and exclusion criteria. During this period spirometry was performed among 152 patients.

Results: The study found that the predominant residual respiratory symptom was shortness of breath (146; 96.1%). This was followed in a descending order by cough (108; 71.1%), haemoptysis (23; 15.1%) and chest pain (58; 38.2%). Among 152 cases, 109 cases were found to have abnormal spirometric patterns. Different age group distribution between 32 different spirometric pattern was not significant (p>0.05). The different spirometric pattern found was involving 67 (44.08%) with obstructive pattern, 27(17.76%) with restrictive pattern, 15(9.87%) with mixed pattern and normal patterns found in 43(28.29%) patients. Majority of the patients 43 cases (64.18%) with obstructive spirometric pattern had severe obstruction. 4 (5.97%) cases had mild obstruction; 20(29.85%) cases had moderate obstruction. Among the recruited patients with abnormal spirometric pattern, 22(20.18%) cases showed significant bronchodilator reversibility (BDR) response and 87(79.82%) cases showed non-significant bronchodilator reversibility response.

Conclusion: The study found that pulmonary tuberculosis irrespective of duration of treatment and outcome of the disease does not correlate with the pulmonary function. It was also found that many of the post-pulmonary tuberculosis patients have persistent respiratory symptoms with obstructive lung disease being the most predominant lung function impairment.

Introduction: Diabetic retinopathy is a major complication of diabetes mellitus that can result in retinal vascular abnormalities and severe visual impairment. Vitamin D deficiency is involved in impaired glucose tolerance or type-2 diabetes. Vitamin D may affect the pathogenesis of diabetic retinopathy via its effects on angiogenesis by changing the presence of hypoxia inducible products, such as vascular endothelial growth factor.

Study design: It was cross-sectional study done at a tertiary centre in North India.

Results: In the Non proliferative diabetic retinopathy, proliferative diabetic retinopathy, diabetics without retinopathy and healthy controls mean serum vitamin D levels were  22.36 ± 4.90 ng/ml, 21.03 ± 6.21ng/ml, 26.44 ± 4.98 mg/dl 35.80 ± 5.20 ng/ml respectively.

Conclusion: The serum vitamin D levels were lower in Type 2 diabetic patients as compared to Healthy controls. The serum vitamin D levels were lower in diabetic patients with retinopathy as compared to diabetic patients without retinopathy. The serum vitamin D levels were slightly lower in Proliferative diabetic retinopathy patients as compared to Non proliferative diabetic retinopathy patients.

Introduction: One of the most important objectives of root canal treatment is elimination of microorganisms from the root canal system that is achievable by augmenting mechanical preparation with antimicrobial irrigants. Enterococcus faecalis considered as the main culprit, is the primary organism detected in persistent asymptomatic infections. A myriad of chemical irrigants like sodium hypochlorite and QMix have been used widely yet the quest for ideal root canal irrigant still continues. The global scenario is now showing a trend towards the use of nontoxic plant products. Herbal products have shown a promising role as root canal irrigants. Thus, this in-vitro study intends to identify the phytoactive compounds present in the phytomedicinal extracts and to evaluate and compare the antimicrobial efficacy of the phytomedicinal extracts with chemical root canal irrigants against E. faecalis.

Aim: The aim of this in vitro study is to assess and compare the antimicrobial efficacy of phytomedicinal plant extracts (Neem, Miswak, Cinnamon, Apple cider vinegar) with Sodium hypochlorite and QMix as root canal irrigants against E. faecalis using agar well diffusion assay.

Methodology: The methodology was divided into two phases, first being the identification of phytoactive compounds present in the phytomedicinal extracts by gas chromatography mass spectrometry analysis and the second phase included the evaluation of  antimicrobial senstivity of the test agents against E. faecalis, which was performed using agar well diffusion assay.

Results: All phytomedicinal extracts showed significant antimicrobial activity against E. faecalis(p < 0.001).Cinnamon showed highest antimicrobial activityi.e. highest mean zone of inhibition among all the tested irrigants followed by miswak, QMix, 3% sodium hypochlorite, apple cider vinegar and neem.

Conclusion: Hence, phytomedicinal irrigants have huge potential to be used as root canal irrigant as an alternative to chemical root canal irrigants.

Introduction: In the light of advancements made in the scientific field, the phytotherapy has received an incredible interest because of their low toxicity, pharmacological activities, and economic viability. Among compounds of natural origin, biological activities have been shown by essential oils from aromatic and medicinal plants and have received specific consideration because of their radical-scavenging properties. Therefore, numerous EOs and Probiotics should be considered as a potential anti-Candida agent, for the treatment of Candida species.

Materials and Methods: Swab samples from 50 subjects with Early childhood caries, oral candidiasis and from removable dentures or orthodontic appliances were aseptically collected andsent for microbiological analysis. C. albicans was identified using standard methods. Eight groups were included in the study viz Group I:  Ajwain oil group, Group II: Cinnamon oil group, Group III: Lemon grass oil group, Group IV: Oregano oil group, Group V:  Oil blend group, Group VI: Probiotic group, Group VII: Clotrimazole group and Group VIII: CHX (Chlorhexidine) group. The constituents responsible for the activity of test groups were identified using Gas-Chromatography Mass Spectrometry analysis. The effectiveness of test agents against C. albicans was tested by agar well diffusion method followed by Minimum Inhibitory Concentration (MIC) and Minimum Fungicidal Concentration (MFC).

Satistical Analysis and Results: The obtained data was calculated using relevant statistical tools such as Students T test and ANOVA. Group II Cinnamon Oil Group was found to be highly effective with mean Zone of Inhibition (ZOI) being 19.83+0.29 mm. The mean MIC for cinnamon oil was 0.625mg/ml and MFC was .33+1.44 mg/ ml that was least concentration effective against C. albicans among all the test groups. There was mean Percentage reduction of colony forming units in all the oils at MIC and MFC with cinnamon being the highest at the lowest concentration.

Conclusion: The results of the present study provided conclusive evidence that Essential oils specifically Cinnamon Oil could be used against Candida present as various source of infections. It could be used for prevention of progression of Early Childhood Caries, as a root canal Irrigant and as a treatment for oral candidiasis and for prevention of the same.

Purpose: To compare peripapillary Retinal Nerve Fibre Layer thickness in POAG and normal eyes.

Materials and Methods: Patients diagnosed as POAG and normal subjects were included in the study. After getting informed consent, detailed history was taken. All subjects had a complete ophthalmologic examination including thorough slit lamp examination, Gonioscopy, dilated fundus examination, intra ocular pressure measurement using Goldmann Applanation tonometry. Glaucomatous eyes and normal subjects were designated based on inclusion and exclusion criteria. OCT RNFL thickness were obtained for all these eyes. Peripapillary RNFL thickness (average and for superior, inferior, nasal and temporal) was obtained. Visual field examination using Humphrey Field Analyser was done in all selected eyes. Peripapillary RNFL thickness is compared among normal and glaucomatous eyes for average value and for superior, inferior, nasal and temporal values.

Results: Average peripapillary RNFL thickness in normal control group were found to be 98.8±6.4mm while in glaucomatous eyes were found to be 74.2±16.6mm.  Mean RNFL thickness in superior quadrant in normal eyes were 122.2±8.2mm and in glaucomatous eyes were 92.1±26.7mm.Mean RNFL thickness in inferior quadrant in normal eyes were 131±15.2mm and in glaucomatous eyes were 91.5±26.8mm.Mean peripapillary RNFL thickness in nasal quadrant in normal and glaucomatous eyes were respectively 76.8±7.9mm and 59±13.3mm. In temporal quadrant, mean peripapillary RNFL thickness in normal and glaucomatous eyes were respectively 64.7±11.3mm and 53.9±12.4mm. In all these four quadrants mean peripapillary RNFL thickness on glaucomatous eyes were found to be decreased than normal control group.

Conclusion: OCT peripapillary RNFL thickness measurement serves as an accurate and sensitive diagnostic modality for diagnosis of primary open angle glaucoma. OCT demonstrates significant RNFL thinning in POAG patients.

Background: A significant proportion of primigravidae presented with unengaged head at term and at the onset of labour. Though a substantial proportion of them deliver vaginally. The present study has been carried out to find out the relationship of fetal head palpable per abdomen with head station by per vaginal examination with the outcome of labour, nature of delivery and maternal and fetal well-being in primigravidae at term with or without onset of labour.

Methods: The study done at Vijayanagar Institute of Medical Sciences, Ballari between january 2020 and December 2020. Eighty full term primigravidae having cephalic presentation in early first stage of labour with intact membranes at different station of vertex were included in the study. The cases having major degree CPD and other Obstetric and medical complications of pregnancy were excluded.

Results: Among 80 cases, 55% (44) of cases delivered vaginally, 45% (36) had underwent caesarean section. This was statistically significant (p<0.01). Increase in average duration of first and second stages, total duration of labour, and incidence of instrumental and caesarean rates were higher with higher fetal station. There was a greater need for active medical and surgical intervention and there was no significant maternal and neonatal morbidity and mortality.

Conclusion: Primigravida with unengaged head at term gestation with or without onset of labour makes obstetrician apprehensive and suspicious about achieving vaginal delivery. But that should not be the sole indication for LSCS. Labour appeared to be dysfunctional in only small proportion of the patients with unengaged head. It is concluded that vaginal delivery is possible with watchful expectancy, proper monitoring and maintenance of partogram and timely intervention. Thus the operative interference can be reduced to the maximum extent and the art of labour and delivery can be preserved for the future obstetricians.