Background: The evaluation of male anterior urethral lesions has traditionally relied on retrograde urethrography, a technique that has served as the gold standard for many years. However, with the advent of sonourethrography, there arises a potential for a more efficient and possibly safer method of assessment. This study aims to explore the utility of sonourethrography in this domain and to benchmark its diagnostic performance parameters, such as sensitivity, specificity, and predictive values, against the established retrograde urethrography.

Methods: Ethical clearance was acquired for 49 male patients referred from the Department of Urology and General Surgery due to complaints related to anterior urethral abnormalities. Each patient underwent a sonourethrogram procedure using the Philips HD 15/Philips Affiniti 50G machines, followed by the conventional retrograde urethrography.

Results & Interpretation: When compared to the gold standard retrograde method, sonourethrography boasted a sensitivity of 83%, specificity of 94%, positive predictive value of 96%, and a negative predictive value of 78%. Notably, sonourethrography is quicker and simpler to administer than retrograde urethrography, eliminates the need for iodinated contrast material, and removes radiation risks. Given its three-dimensional nature and its safety for repeated use, incorporating sonourethrogram into daily medical practice offers a convenient and side-effect-free solution.

Conclusion: Sonourethrography emerges as a highly efficient, safe, and faster alternative to the conventional retrograde urethrography for assessing anterior urethral lesions. With its high sensitivity, specificity, and predictive values, coupled with its advantages such as no radiation exposure and the elimination of iodinated contrast materials, sonourethrography is poised to become a preferred choice in clinical settings. Its three-dimensional capabilities and the absence of side effects further accentuate its value, making a compelling case for its broader adoption in everyday medical practice.

Background:Neoadjuvant chemotherapy (NAC) is frequently employed in the treatment of early and locally advanced breast carcinomas. Evaluating the response of the tumor to such treatment is crucial for deciding subsequent therapeutic steps. Ultrasound and Doppler indices present as a non-invasive and cost-effective approach for this assessment. This study aims to elucidate the role of ultrasound and color doppler indices in assessing the response of breast malignancies to NAC.

 

Methods:Patients diagnosed with early breast carcinoma and locally advanced breast carcinoma underwent ultrasound and Color Doppler imaging to characterize the lesions. The parameters assessed included tumor size, echogenicity, tumor margins, number of flow signals, resistivity index, pulsatility index, and lymph node size. These assessments were repeated post-NAC and then compared with histopathology findings post-surgery.

 

Results:At diagnosis, the lesions were predominantly hypoechoic or heteroechoic with irregular margins. The mean tumor size at diagnosis was 17.05 square centimeters. Post-chemotherapy, the mean lesion size reduced to 5.92 square centimeters. There was a notable reduction in the number of flow signals, peak systolic velocity (PSV), resistivity index (RI), and pulsatility index (PI) post-NAC, especially in patients who responded well to the treatment. Using histopathology as the gold standard, ultrasound's sensitivity in gauging tumor response to NAC was 86%, while its specificity was 71%.

 

Conclusion:Ultrasonography, being a non-invasive, cost-effective modality without radiation exposure, proves to be a reliable tool for assessing breast carcinoma response to NAC. Such assessment is pivotal in strategizing further therapeutic plans.

Introduction: Postoperative sore throat (POST) is one of the most common complications in patients undergoing endotracheal intubation for general anaesthesia. Magnesium sulphate nebulization helps in providing equal and effective distribution of the drug throughout the pharynx and upper respiratory tract. In this study, we have compared three different strengths of magnesium sulphate (125 mg,250 mg and 500 mg) pre-operatively to prevent POST.

Methodology: A prospective randomized, comparative study of 90 physical status ASA Class I and II patients scheduled for surgeries under general anaesthesia requiring endotracheal intubation was conducted at a tertiary care hospital.

After institutional ethical committee clearance, informed written consent was obtained from all patients who met the inclusion criteria. Patients were randomized into group A (125mg MgSO4), group B (250 mg MgSO4) and group C (500mg MgSO4) according to sealed envelope method.

Patients included in the study were nebulized with respective doses of magnesium sulphate for 15 minutes before induction of anaesthesia. After the completion of surgery, patients were shifted to post operative anaesthesia care unit and incidence of postoperative sore throat at rest and on swallowing was assessed at 0, 2, 4 ,12 and 24 hours postoperatively.

Results: Incidence of POST at rest and swallowing was high in group A(125mg) at all time points. There was a statistically significant difference at rest between group A(125mg) and group C(500mg) at 0 hours (p= 0.015), 2 hours (p= 0.013), 4hrs (p=0.006),12hrs(p=0.005) & 24hrs(p=0.023).

No incidence of POST at rest was observed at 24hrs with Group C (500mg).

Incidence of POST at swallowing observed was statistically significant between group A(150mg) and group C(500mg) at all time points.

No significant difference was observed at both rest and swallowing between group B(250mg) and C(500mg) at all time points.

Conclusion: We conclude that 500mg MgSO4 nebulization administered pre-operatively is superior in attenuating the incidence of POST when compared to 250mg and 125mg.

Introduction: Stroke is the third leading condition with the highest mortality and death and is a major cause of disability. The estimated number of deaths due to stroke is about 5.71 million people as per the WHO data, and is estimated to peak at 7.8 million in 2030. Citicoline is believed to exert neuroprotection and neurorestoration intracellularly by supporting cellular phospholipid synthesis. Citicoline is used in Acute Ischemic Stroke patients, however, there is not enough statistical evidence available for the benefits of the same. Hence, this calls for a meta-analysis of RCTs on a larger scale to generate highest level of scientific evidence regarding the controversial negative studies of Citicoline when tested against placebo.

Objectives: To review and analyze statistical evidence from existing randomized controlled trials, the therapeutic efficacy of Citicoline in acute ischemic stroke (AIS) patients.

Materials & Methods: A total of 17 studies, involving 5127 patients were included. The studies were double-blind, randomized, and placebo-controlled clinical trials studying the effect of Citicoline on patients with Acute Ischemic Stroke. The included patients suffered from an Acute Ischemic Stroke with a minimum therapeutic window of 6 hours. The treatments tested were either Citicoline, with doses ranging from 250 to 4000 mg daily, or placebo. The duration of the treatment ranged from 10 days to 9 weeks. The principal summary measures were the Odd’s Ratio(OR) and Relative Risk (RR). For the measurement of treatment effect Rev Man 5.4.1 version software by Cochrane Database will be utilized to calculate Odd’s ratio and Relative Risk(RR).

Results: The RR(for 5127 participants) was 1.301(random effect model) and 1.163(fixed effect model)[95% confidence interval (CI) 1.081 to 1.2521 (fixed effect model), p<0.001] and the overall OR(for 5127 participants) was 1.769(random effect model) and 1.281(fixed effect model)[95% confidence interval (CI) 1.137 to 1.443 (fixed effect model), p<0.001], indicating a slight advantage of Citicoline over placebo treatment. Citicoline was also found to be associated with a less number of adverse events and deaths compared to placebo.

Conclusion: Citicoline is proven to be slightly more efficacious than placebo, with lesser adverse events and deaths. However the margin of benefit is narrow. Future trials comparing the same, on higher number of patients is necessary to draw a final conclusion on it.

The prospective comparative study compared the operative complications of laparoscopic total extraperitoneal hernioplasty with drain and total extraperitoneal hernioplasty without drain for inguinal hernia which was carried out in our rural tertiary health care centre of central India in department of surgery. Both groups were evaluated and compared for complications seroma, hematoma, urinary retention, scrotal oedema, mesh infection, drain site infection, post-operative pain at 24 hours, 7 days and 1 month after surgery and recurrence.

A total of 106 cases of inguinal hernia repair were studied between the period of January 2020 to June 2021 of which 57 were operated for laparoscopic total extraperitoneal hernia repair without drain placement and 49 were operated for laparoscopic total extraperitoneal hernia repair with drain placement.

Our finding were seroma formation was more in laparoscopic total extraperitoneal inguinal hernia repair without drain placement than laparoscopic total extraperitoneal inguinal hernia repair with drain placement and the difference was statistically significant. Mean VAS score for postoperative groin pain at 24 hours, 7 days and 1 month were more in laparoscopic total extraperitoneal inguinal hernia repair with drain placement than in laparoscopic total extraperitoneal inguinal hernia repair without drain placement hence, we can say that laparoscopic total extraperitoneal inguinal hernia repair without drain placement was less painful in terms of postoperative pain.

The P-value for other parameters like urinary retention, hematoma, scrotal oedema, mesh infection, drain site infection was >0.005 which was statistically not significant (P>0.005).

Thus, from present study we concluded that, the laparoscopic total extraperitoneal inguinal hernia repair with drain placement was safer but slightly more painful and having lesser complications than the laparoscopic total extraperitoneal inguinal hernia repair if a trained surgeon with optimum experience in laparoscopic surgery was available.

Background: Erectile dysfunction (ED) is a widespread health issue affecting men across different age groups. Its complexity arises from the interaction of arterial, venous, sinusoidal, and nervous systems, with dysfunctions leading to ED. Various factors, such as cardiovascular diseases, diabetes, and lifestyle habits, influence ED. Penile Doppler sonography, a non-invasive method, is instrumental in evaluating ED, offering insights into penile anatomy and vascular flow patterns.

Objectives: To assess the diverse causes of Erectile Dysfunction using Colour Doppler in a tertiary care center.

Materials and Methods: In a prospective observational study from March 2021 to August 2022, 45 patients clinically diagnosed with ED were referred from various departments to the Department of Radio-Diagnosis, Vydehi Institute of Medical Sciences and Research Centre. Evaluation involved an intracavernosal injection of papaverine, followed by peak systolic and EDV measurements in the right cavernosal artery at 5-minute intervals for 30 minutes.

Results: Colour Doppler ultrasound effectively diagnosed ED by showcasing arterial and venous insufficiencies. Systolic velocities below 25cm/s indicated arterial insufficiency, while an EDV over 5cm/s denoted venous incompetence. The method is likely to undergo further refinement in the diagnostic criteria.

Conclusion: Penile Doppler ultrasound emerges as a secure, minimally invasive, and efficient method for evaluating ED. It offers a fast and straightforward assessment, making it a preferred choice in clinical settings.

Objectives: The purpose of this study was to evaluate the safety and effectiveness of bipolar transurethral enucleation and resection of the prostate (TUEP) compared to bipolar transurethral resection of the prostate (TURP) in the treatment of enlarged prostate, with a focus on long-term results.

Materials and Methods: The present study conducted in patients admitted in Gandhi medical college associated Hamidia Hospital, Bhopal and carried out in Department of General Surgery. The study included 40 patients who admitted with the diagnosis of benign prostatic enlargement and underwent surgical treatment either by TEUP (n=20) or TURP (n=20) between the time periods of Jan 2021 to Sept. 2022. Patient characteristic and laboratory data were recorded and were examined pre and post operatively in terms of safety and efficacy.

Results: There were no significant differences in the preoperative parameters between groups. Comparing with TURP, TUEP had shorter time taken for surgery (33.5±3.28 and 46.75±7.99), more amount of tissue resected (33±8.74 and 26.5±9.45), minimal Post-OP-IPSS score (1.05±1.05 and 4.7±1.38) and fall in HB level (1.17±1.13 and 2.03±1.00) with statistically significant difference. In TUEP group significantly fewer reoperation and complications occurs with minimal Clavien-Dindo Grading(p-value-0.0003)as compared to TURP group. The statically significant lower mean hospital stay observed in TUEP and TURP groups (3.05±0.22 and 3.95±0.82, p-value-0.0298).

Conclusion: It is recommended that TUEP be chosen as the primary method for larger prostate sizes, as it has fewer complications, a shorter hospital stay, and greater safety and efficacy compared to TURP.

Background: Understanding the anatomical variations of the abdominal aorta and its branches is vital for clinicians. Such knowledge aids in averting complications and injuries during surgical procedures and radiological interventions. This study aims to assess these variations and compare the findings with existing literature.

Methods: The study was conducted in the Department of Radio diagnosis at VIMS & RC, Bangalore using a Siemens Somatom Definition AS 128 slice Multi-detector CT scanner with 5 mm collimation. All patients, regardless of age, undergoing CECT and CT angiography referred from all departments at VIMS & RC, Bangalore, were eligible for inclusion. However, patients with prior major abdominal surgeries or known cases of chronic renal disease were excluded. For the imaging procedure, triphasic CT scans were executed. The analysis incorporated axial cuts of 5 mm thickness and thin section reconstructions of 1 mm. Additionally, multiplanar reformats were utilized, and maximum intensity projections (MIP) were employed specifically for vessel analysis.

Results: Our study offered a vivid demographic distribution. Males dominated the sample size at 64.3%, while females were at 35.7%. When observed age-wise, the participants had an average age of 45.41 ± 15.67, the youngest being 10 years old and the eldest at 81 years. The age bracket of 51-60 years showed the most significant representation, whereas a meager 4.8% fell below 20 years. Shifting focus to the crux of the study - the radiological outcomes - a sizable 73.6% of participants showcased standard results. However, variations were not amiss. Bilateral Accessory Renal Arteries manifested in 8.7%, while both Accessory Right Renal Arteries and Trifurcation of Celiac Trunks each made their presence in 7.1%. Accessory Left Renal Arteries were seen in 3.2% of the participants. A rare sighting was that of the Right Hepatic Artery taking its origin from the superior mesenteric artery, seen in a scanty 0.3%. Encouragingly, no anomalies cropped up in the inferior mesenteric artery branching.

Conclusion: With the increasing use of Multidetector CT (MDCT) over DSA for vascular structure evaluation, the clarity and quality of imaging have improved substantially. Recognizing anomalies of the abdominal aorta preoperatively, especially in procedures like organ transplants and chemoembolization, is paramount to minimize post-operative complications.

Background: This study aimed to investigate the morphology of the Median Nerve in Carpal Tunnel Syndrome (CTS) through ultrasound and establish a correlation with findings from the nerve conduction velocity study.

Methods: After receiving ethical clearance and informed consent, 42 patients were enrolled from the Department of Neurology and underwent assessment in the Department of Radiodiagnosis. These patients underwent laboratory examinations to rule out secondary causes of CTS. Each underwent an ultrasound, with examiners blind to the Nerve Conduction Study (NCS) outcomes. Using NCS as the benchmark, we calculated the sensitivity and specificity of the ultrasound, focusing on the cross-sectional area (CSA) of the Median nerve. Statistical analysis using paired t-tests and the Wilcoxon Sign rank test compared the ultrasound and NCS findings.

Results: 42 CTS patients were studied. When benchmarked against NCS, the ultrasound showed concurrence in diagnosing Median Nerve entrapment neuropathy. There was significant variation between the ultrasound diagnosis and NCS parameters, as evidenced by a significance level of 0.000. Furthermore, the unaffected nerve's CSA proximal to the tunnel inlet displayed minimal variance between the two methods.

Conclusion: Variations in ultrasound metrics exist between CTS patients with moderate NCS irregularities and those with normal NCS. This indicates ultrasound's potential as an additional diagnostic tool, especially for early CTS cases without evident nerve conduction anomalies

Human immuno deficiency virus is RNA retro virus. HIV infection can be transmitted by four ways, It can be transmitted from infected mother to her fetus during pregnancy, during delivery and through breastfeeding.

Transmission of Treponema pallidum infection from syphilitic mother to her fetus through Placenta occurs at any stage of pregnancy. Transmission of Hepatitis B virus by vertical transmission to fetus occurs mostly in first trimester. Transmission of Hepatitis C infection occurs mainly by post transfusion in prenatal period. AIM: the aim of the study is to assess the sero prevalence of HIV, HBV, HCV and Syphilis among pregnant women attending antenatal OP and Labor ward in GGH, Rajamahendravaram. Methods: This study was conducted by using standard guidelines of NACO And CLSI. The data was statistically analysed. Results: A total number of 2400 antenatal women are screened for HIV, HBV, HCV and Syphilis infection. Among those second gravida was higher with 50%, Most of the women from rural area, Seroprevalence of HIV is 0.66% HBV is 1.75% HCV is 0.041% and Syphilis is 0.04%.

Intrathoracic lesions, encompassing pulmonary, pleural, and mediastinal masses, necessitate histopathological assessment for precise diagnosis. Image-guided percutaneous biopsy has emerged as a technique to attain this. This study evaluates its utility, reasons for inconclusive results, and associated complications.

Methods: 120 patients, who had prior imaging indicating an intrathoracic lesion, were enrolled post-ethical committee clearance and obtaining informed consent. The biopsy was conducted using Siemens 128 slice CT scanner or GE 16 slice CT scanner. Feasibility for image-guided biopsy was determined and procedures were executed. A follow-up evaluation comprised:

a) Histopathology outcomes.

b) Reasons for inconclusive results.

c) Complications, their management, and effect on the patient's clinical outcome.

Results: Conclusive histopathological results were received in 89.1% of cases, aligning with existing literature standards. The findings were significantly valuable for the attending physician. Factors leading to inconclusive results included small lesion size, intraprocedural complications, necrotic core biopsies, and the need for additional samples for IHC examination. Complications, primarily pneumothorax and hemorrhage, were observed in 22% of participants. This rate is consistent with prevailing literature. Most complications were conservatively managed, with only 4.1% requiring further intervention. Monitoring the patients' clinical status revealed symptomatic improvements, affirming the safety and reliability of the biopsy method for intrathoracic lesions.

Conclusion: Image-guided percutaneous biopsy of intrathoracic lesions stands as a safe and dependable technique, offering low complication rates and significant diagnostic insight into pulmonary, pleural, and mediastinal masses

Background: This study was conducted to  delineate a standard nomogram for fetal adrenal gland dimensions in an Indian cohort and to examine the relationship between fetal adrenal gland and kidney lengths.

Methods: Prior to the commencement of the study, approval was sought from the ethical committee, and informed consent was acquired from 123 expectant mothers attending the VIMS & RC's Radio-diagnosis department between 18 and 37 weeks of gestation. These participants underwent ultrasonography using a curvilinear transducer 2-6 MHz on a Philips Affiniti 50G machine. Sagittal and coronal views were used to record the maximum dimensions of both adrenal glands. Thereby, a reference range for the adrenal gland size during the second and third trimesters was deduced.

Results: During 18-24 weeks, measurements for the right adrenal gland were: medial limb (1.01 * 0.51), body (0.16 * 0.35), lateral limb (1.02 * 0.51), with a concurrent kidney size of 19.16± 1.95 mm. For the left adrenal gland: medial limb (1.01 * 0.49), body (0.16 * 0.34), lateral limb (1.01 * 0.5), and kidney size 19.8± 1.52 mm.For 25-30 weeks, right adrenal gland measurements were: medial limb (1.08 * 0.5cm), body (1.34 * 0.65cm), lateral limb (1.79 * 0.8cm), with kidney size being 25.83± 1.64 mm. The left adrenal gland revealed medial limb (1.08 * 0.81cm), body (1.34 * 0.65cm), lateral limb (1.8 * 0.8cm), and kidney size at 26.07± 1.46 mm.From 31-35 weeks, the right adrenal gland dimensions were: medial limb (2.34 * 1.13cm), body (1.75 * 0.85cm), lateral limb (2.29 * 1.1cm), and kidney size at 31.57± 0.67 mm. The left adrenal gland showed medial limb (2.3 * 1.04cm), body (1.8 * 0.86cm), lateral limb (2.34 * 1.19cm), and kidney size at 32.03± 2.45 mm. Lastly, between 36-40 weeks, the right adrenal gland measurements were: medial limb (2.61 * 1.31cm), body (2.32 * 1.06cm), lateral limb (2.58 * 1.27cm), and kidney size was 35.36± 1.61 mm. The left adrenal gland had medial limb (2.6 * 1.3cm), body (2.33 * 1.07cm), lateral limb (2.6 * 1.32cm), with a kidney size of 35.33± 1.51 mm.

Conclusion: he study, a cross-sectional analysis conducted in the Radio-diagnosis department at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, successfully established a standard nomogram for fetal adrenal gland dimensions in an Indian cohort during the second and third trimesters. Additionally, the established fetal renal to adrenal ratio validated and enriched the derived data.

Background: Musculoskeletal tumors pose significant diagnostic and treatment challenges. Accurate assessment of these tumors is critical for therapeutic decision-making, especially concerning limb salvage surgeries. Magnetic Resonance Imaging (MRI) offers detailed visualization, making it an invaluable tool in the evaluation of the extent and nature of such tumors.

Aims and Objectives: To assess the involvement patterns of bone, periosteal, and soft tissue in musculoskeletal tumors through MRI.

To correlate the findings of operable MRI cases with the results observed during intraoperative procedures.

Methods: After securing ethical committee clearance and informed consent, 60 patients with musculoskeletal tumors were referred to our department for an MRI study. Based on these MRI findings, plans for limb salvage surgeries were coordinated by both surgical oncology and orthopedics teams.

Results: Our cohort study's diagnostic accuracy, sensitivity, and specificity are detailed for each study variable. The mean age of participants was found to be 27.75 +/-14.97 years, with a notable male dominance (Male: Female ratio of 2.5:1). Separate sections elucidate the skeletal distribution, tumor nature, periosteal reactions, articular surface, soft tissue, neurovascular bundles, and intra-medullary involvements observed in our study. The sensitivity, specificity, and diagnostic accuracy of MRI stand at 97.6%, 94.4%, and 70% respectively.

Conclusion: This highlights MRI's pivotal role as the preferred modality in delineating the scope of musculoskeletal tumors, stressing its utility in ascertaining tumor invasion extents and its importance in preoperative evaluations and treatment assessments.

Background: The characterization of renal and ureteric calculi composition has been explored using various imaging techniques. The study aimed to assess the correlation of ultrasound twinkling artifacts with Dual Energy Computed Tomography (DECT) in this context.

 

Aims and Objectives: Establish the association between the composition of renal stones and the presence and grading of twinkling artifacts using color Doppler, in comparison with Dual Energy CT.

Determine the sensitivity and specificity of ultrasound twinkling artifact vis-à-vis Dual Energy CT.

 

Methods: A total of 50 patients with a history of flank pain, haematuria, difficulty in micturition, or known renal and ureteric calculi were included after receiving ethical committee clearance and informed consent. These patients underwent an ultrasound KUB, followed by DECT KUB. The ultrasound, performed using Philips Affiniti 50 & Philips HD 15 machines, utilized a curvilinear probe of 2-5 MHz. The DECT KUB was conducted with a Siemens 128-slice CT scanner. Findings from the ultrasound were then compared to DECT KUB results regarding stone composition.

 

Results: The study identified 67 stones of four different compositions: 32 calcium oxalate, 10 calcium hydroxyapatite, 20 uric acid, and 5 cystine. Twinkling artifact grading on ultrasound color doppler was as follows: grade 0 (23 stones with no artifact), grade 1 (17 stones with less than half the surface showing the artifact), and grade 2 (27 stones fully exhibiting the artifact). When cross-referenced with DECT KUB results, no substantial correlation was found between twinkling artifact grades and renal stone morphology.

 

Conclusion: The in vivo study involving 50 patients found no significant correlation between the grades of twinkling artifacts on ultrasonography and the results of DECT KUB in characterizing renal stone morphology. The ultrasound twinkling artifact, although not definitive for morphology determination, exhibited a correlation showing 95.8% sensitivity and 87% specificity statistically.

Introduction: The individuals with diabetes have at least a 10-fold greater risk for soft tissue and bone infections of the foot than individuals without diabetes. The Indian diabetic population is expected to increase up to 57 million by the year 2025.

Aims and Objectives: To evaluate the bacteriological profile and antibiogram of diabetic foot ulcer.

Material and Methods: 150 Samples of diabetic foot ulcers were collected over a period of six months by using sterile swabs and they were processed as per the standard protocol. Pathogenic organisms were isolated, identified by biochemical tests. Antibiotic susceptibility testing was done by Kirby -Bauer disk diffusion method on Mueller Hinton Agar and results were interpreted as per Clinical and Laboratory Standards Institute guidelines.

Results: Bacterial etiology could be identified among 74 cases out of 150 (49.3%), among which Pseudomonas aeruginosa was the commonest (in 25 cases), followed by Klebsiella spp. (in 20 cases), Escherichia coli (in 13 cases), Proteus mirabilis (in 12 cases), Staphylococcus aureus (in 3 cases) and Enterococcus in 1 case.

Conclusion: Gram negative bacilli were more prevalent 70 out of 74 cases (94.5%) than gram positive cocci, 4 out of 74 cases (5.5%). In our study the commonest isolate was Pseudomonas aeruginosa (33.7%), followed by Klebsiella spp. (27.02%) and Escherichia coli (17.56%). Meropenem and Piperacillin/tazobactam are drug of choice in such cases.

Background: Acne is a chronic multifactorial inflammatory disorder of pilosebaceous unit. It is frequently seen in adolescents and young adults. Acne leads to significant psychological distress, social anxiety and impairs quality of life in patients

Aim: To assess demographic variables and Quality of life in patients with Acne vulgaris.

Method: This was a hospital-based, observational, pre-structured, questionnaire-based study done in 1015 patients who attended the Skin and VD, OPD of Mahatma Gandhi Medical College and Hospital, from January 2021 to June 2022.

Results: A total of 1015 patients were included in the study with a female to male ratio of 1.2:1. The age of the patients ranged from 14-35 years. Majority of the study participants were students (51.4%). Most common site affected was face (68%). Dermatology life quality index (DLQI) score ranged from from 1 to 20 with mean score of 8.18 ± 4.45. Overall quality of life assessment showed moderate to very large effect in patients with Acne Vulgaris depending on the severity of the disease.

Conclusion: Acne Vulgaris negatively impacts quality of life. This effect is more pronounced in female patients and young adults with severe acne. Proper counselling and psycho-social support should be provided to improve the Quality of life in these patients.

Introduction: Developmental anomalies of female genital tract are not very common, incidence reported in the literature is0.2%–3.8% [1] Depending on the specific defect, a woman’s obstetric and gynaecologic health may be adversely affected.

Aims and Objectives: Through the present study we aim to evaluate the various clinical presentations of congenital anomalies of female genital tract, appropriate management used for the respective cases to improve both obstetric and gynaecological outcome.

Methods: A prospective observational study was conducted at the Maharajah‘s Institute of Medical sciences, Obstetrics and Gynaecology department for a period of 3 years. Among more than 3000 patients reporting in the outpatient department within the above mentioned time period, 13 cases of  female genital tract developmental defects were diagnosed through clinical history, physical examination, hormonal study, imaging-studies and  hysterolaparoscopy. The optimum mode of management for each case was individualised and assessed in terms of the final outcome and is being followed-up.

Results: Present study shows prevalence of mullerian anomalies is 0.4 % at our tertiary care center. Main presenting symptoms were primary amenorrhoea and infertility. Most of the patients belonged to the adolescent age group.

Conclusion: Female genital tract anomalies are a morphological diverse group of developmental disorders. The surgical approach for correction is specific to the type of malformation. Due to the frequent association between müllerian and urinary anomalies, the finding of any of the types should lead to the investigation of the other [2].

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common inherited hemolytic disorders occurring among humans.

Aim: In this study, the aim was to find out the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in a group of students studying MBBS in a tertiary care hospital in North India.

Material & Methods: Student’s history information was collected in questionnaires and blood samples data were collected and reported.

Results: In this study, the results showed that the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among a group of 600 students studying MBBS, evaluated at NCMCH in North India was nil (0%). The two-tailed P value was less than 0.0001***, in the Chi-square test. By conventional criteria, this difference was considered to be extremely statistically significant.

Conclusion: It is concluded that the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in a group of 600 students studying MBBS in NCMCH in North India was nil in our study

A lipomais benign soft tissue tumour of adipose tissue which is mostly covered with a sheath of fibrous capsule and found mostly in subcutaneous tissue plane. A lipoma can be found anywhere where fat is located in the body. Rarely, they can occur deep to subcutaneous tissue and very rarely deep to submuscular plane. Deep submuscularlipomas are large by the time they present clinically and are liable to cause compression of neurovascular structure in the vicinity. In proximal forearm, they can compress theradial nervewhere it divides into posterior interosseous nerve (PIN) and superficial radial nerve which may result in weakness of extensor group of muscles of fingers and sensory loss over the dorsoradial aspect of hand. I am presenting a case of large submuscularlipoma, in a 44 years old female, deep to supinator muscle compressing the radial nerve at its division into PIN and superficial radial nerve.

Background: Acute poisoning is a significant health concern in developing countries like India. This study aimed to understand the current trends of acute poisoning in a tertiary care center in Karnataka, India.

Methods: A retrospective observational study was conducted over three months in 2022, including all inpatients admitted with a history of acute poisoning.

Results: Of the 190 patients, 57% were males, with a mean age of 34 years. The majority were laborers (45%) or housewives (39%), illiterate (36%), and from rural areas (64%). The most common mode of poisoning was oral (80%), predominantly with pesticides (43%). The primary reason for poisoning was suicidal intent (76%). Clinically, most patients had mild to moderate severity, with 44% requiring ICU admission, and a mortality rate of 15%.

Conclusion: The study underscores the influence of socio-demographic factors in acute poisoning and the critical need for prompt management. The findings can guide healthcare providers in creating targeted strategies for prevention, early detection, and management of acute poisoning cases.

Objective: To measure cranio-vertebral parameters in asymptomatic individual in CT head and to study the deviation from the normal range in Indian population with their MRI correlation.

Materials & Methods: The present study was carried out as a prospective cross-sectional comparative study at Department of Radiodiagnosis, Gandhi Medical College & associated Hamidia Hospital Bhopal during the study period of one year. Data collection was done & information was recorded on a proforma. The patients then underwent NCCT head. Parameters such as Welcher basalangle, Clivus canal angle, Boogards angle, Foramen magnum (Anteroposteriorand transverse diameter), Length of clivus, Distance between tip of dens & Mcrae’sline, clivus canal line tangential/transecting the dens and cord abnormality were assessed. Any deviation from the normal values were noted normal being the mean value under one standard deviation of the population assessed. The subjects with abnormal parameters underwent MRI which were then correlated with the CT findings.

Results: This study was conducted on a total of 3822 participants of them, 42 had CVJ anomaly on CT scan. Among the patients with incidentally detected CVJ anomalies, majority (69%) of patients reported BI followed by AOA (42.9%), PTB (21.4%), OSD (4.8%) and OT (2.4%). Combination of anomalies are also found. Among the patients with abnormal CVJ parameters, 11.9% of subjects reported presence of cord signal in MRI, 69% of subjects found clivus canal line transecting dens and remaining 31% found tangential to dens in both MRI and CT scan.

Conclusions: Basilar invagination (BI) was the most common CVJ anomaly found in our study. The most common combination were (BI)+ (AOA). Comparison of CT and MRI findings with respect to Dens in relation to McRae’s line and association of CT and MRI findings with respect to Wackenheims clivus canal line (TTT) was found significant. Spinal cord signals could be pickedup by MRI.

Background: There are not much information available about benign breast problems like duct ectasia (DE) and periductal mastitis (PDM) even among surgeons and general physicians. The current study aimed to analyse clinical features, procedures as well as surgical modalities associated with these benign breast problems for better understanding of the disease progression and treatment

Methodology: This is a prospective study with sample size of 42 patients conducted in M S Ramaiah teaching hospital, Bangalore conducted between October 2020 to September 2022.

Results: In this study, patients  presented with nipple discharge, breast lump, itching over nipple areolar complex, nipple retraction and breast pain were included. Based upon the symptoms, appropriate investigations like USG, Mammography, FNAC, Cytology of nipple discharge and MRI breast was done. Patients were diagnosed with, Duct ectasia, Duct papilloma, Periductal mastitis and Pituitary adenoma. Appropriate treatment like wide local excision, Microdochectomy, Hadfield’s procedure, conservative treatment were given. A correlation between symptoms, diagnosis and management was done to analyse BBDDs.

Conclusion: Ductal diseases are considered as benign breast problems with unknown etiology. Nipple discharge, breast lump and breast abscess are some of the most common symptoms associated with these problems. In most of these BBDDs conservative management has been proved as the appropriate modality of treatment. With an appropriate guide to diagnosis and management, most ductal diseases can be treated accurately.

Objectives: Benign Biliary Stricture (BBS) often cause a significant amount of morbidity in patients due to its relatively painless course of progression and subtle clinical manifestations. This hospital-based study primarily focuses on BBS in Indian patients intending to find out its different etiologies and clinical manifestations; to observe clinical progression and response to the different treatments.

Materials and methods: Patients with age ≥18 years and diagnosed with benign biliary stricture were included in the study. Routine blood testing and special tests for tumor markers were done. Ultrasonography (USG), Contrast Enhanced Computed Tomography (CECT) abdomen, Magnetic Resonance Cholangio-pancreatography (MRCP), Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangio-pancreatography (ERCP) were performed for evaluation of BBS. The total number of stents used, stents exchanged and duration of use till the resolution of symptoms were noted.

Results: Out of 100 recruited patients, 56 were females and 44 were males with a mean age of 48.5 ± 14.96 years. Abdominal pain (90%), jaundice (42%) and fever (25%) were the most common clinical manifestations. Most of the BBS were of indeterminate cause (56%). Laparoscopic Cholecystectomy (LC) was the most common etiology in the remaining patients. The mean number of stent exchanges and mean number of stents used were 2.68±0.69 and 4.16±1.52 respectively. The average mean duration of stent use was found to be 8.77±2.02 months.

Conclusions:ERCP for the treatment of BBS should be preferred over surgery and the percutaneous approach due to its low invasiveness, because it is more patient friendly, safer and repeatable.

Background: Anaemia is a condition in which oxygen carrying capacity of blood is reduced to meet the various physiological demands. Medical students are at high risk of anaemia due to long duration of study, stress and strain of vast curriculum, inappropriate and inadequate diet. So they are the most vulnerable group for development of nutritional anaemia.

Objective: This study is aimed to evaluate the knowledge and awareness about anaemia and its complications among undergraduate medical students.

Methodology: A cross sectional questionnaire based study was conducted for 2 months among undergraduate medical students of all professional years of medical colleges in Vidarbha region. A total of 300 students were included in the study. A questionnaire was designed to assess their awareness and basic knowledge regarding the signs and symptoms, investigations, diagnostic and treatment modalities of anaemia.

Results: Majority of students (99.3%) were aware about what is anaemia and had the basic knowledge regarding it. Vast majority of the participants were aware about the various complications associated with long standing anaemia affecting their cognitive functions, physical capacity, work performance and immunity.

Conclusion: Mild anaemia is highly prevalent among medical students regardless of gender. Presence of anaemia has shown to significantly affect their academic performance, personal as well as professional life. Awareness and knowledge about anaemia is very important in medical students to prevent further complications

Introduction : Non traumatic Acute abdominal pain is caused due to a number of causes like acute appendicitis, diverticulitis, cholecystitis, renal calculus etc. The diagnosis of nontraumatic acute abdomen is a team work of radiologist and clinician. Nontraumatic acute abdominal conditions require precise radiological diagnosis to achieve excellent results to reduce morbidity and mortality.In the earlier part of the twentieth century, plain x-ray of abdomen was the only such investigation which was introduced as a diagnostic tool in clinical practice,s there is tremendous advancement in scientific fields, more and more diagnostic facilities like ultrasonography, endoscopy, MRI, CT scan, radionuclide scan and other sophisticated investigations have developed which can give more information than the plain x-ray. As air is a bad conductor of sound waves, the pathology can be missed in such conditions, which can still be picked up by a plain x-ray abdomen where ultrasound has failed to detect the lesion. So with this view a study was planned to analyze the findings of plain x-ray and ultrasound in non traumatic acute abdomen, to evaluate the acute abdominal conditions by using plain x-ray and ultrasound.

Aims and Objectives:

1) To study the various plain radiographic findings associated with nontraumatic acute abdomen.

2) To study the various ultrasonographic findings associated with nontraumatic acute abdomen.

3) To analyze the efficacy of plain x-ray and ultrasonography in the diagnosis of nontraumatic acute abdomen and to compare their individual merits and their superiority in the diagnosis. Both plain x-ray and ultrasonographic findings were correlated with final diagnosis which was done either by other mode of investigation, clinical correlations or laparotomy.

4) To reduce the investigation time and to facilitate early management of the patient to reduce the morbidity and mortality associated with nontraumatic acute abdominal conditions.

Materials and Methods: The study conducted was a non-randomized, prospective study. for a period of 12 months patients clinically having acute onset of pain abdomen attending the department of Radio-diagnosis Andhra medical College, Visakhapatnam Sample size of 50 cases who presented to us with nontraumatic acute abdomen were admitted to the hospital in the above-mentioned period and were subjected to plain x-ray of abdomen and ultrasonography of abdomen. Patients were admitted in various wards like general wards, special wards.

Result: Based on clinical history and clinical examination provisional clinical diagnosis was made. According to clinical diagnosis there were cases (32%) of renal and ureteric pathology, 13 cases (26%) of Intestinal obstruction, 7 cases (14%) hepatobiliary pathology, 5 cases[10%] of intestinal perforation, 4 cases[8%]of acute appendicitis,2 cases[4%]of acute gastritis,3 cases(6%)of other causes [1 case of acute pancreatitis, splenic pathology and appendicular mass.

Background: Frozen section helps in rapid intra-operative diagnosis. It is performed to confirm malignancy, to know the organ of origin, to determine adequacy of margins, to detect lymphnode metastasis. Modification of surgery can be decided at the time of surgery on the table on the basis of frozen section findings.

Aims and Objectives: To assess the accuracy of frozen section findings in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of frozen section with histopathological report.

Methodology: This was a cross-sectional study of 81 frozen section samples done in the department of pathology of a tertiary care hospital from January 2022 to May 2023. All frozen section samples with their permanent tissue samples sent for final histopathological evaluation were included in the study.

Result: A total of 81 speciemens were analyzed, of which 79 specimens diagnosis were concordant and 2 specimens were discordant.

Conclusion: The accuracy of frozen section diagnosis at this tertiary care hospital can be interpretated as comparable with most international quality control statistics for frozen sections. The overall error rate and deferral rates are within the range of previously published studies. The results suggest specific measures should be taken to reduce the number of discrepancies.

Background: ASV is adaptive mode of ventilation where a target ventilator pattern is automatically chosen. This study was undertaken to compare the clinical parameters between ASV and ACMV mode of ventilation.

Material and Methods: A prospective study was undertaken in 60 critically ill patients who were randomly divided in to two equal groups i.e., ASV and ACMV modes of mechanical ventilation. Group A patients were ventilated by using ASV mode of ventilation and 30 patients of Group B were ventilated by using ACMV mode of ventilation. The patients particulars including number of days of ventilation, number of days of in ICU and number deaths were entered. APACHE and SOFA scores were calculated and compared.

Results: About 40.0% of the cases in ACMV group and 33.3% in ASV group were aged more than 60 years. Males were higher in ACMV group and females in ASV group. Mean number of days of ventilation in ACMV group was 6.8 days in ASV group was 5.53 days. Mean number of days of stay in ICU was 9.53 days in ACMV group and 8.53 days in ASV group which was statistically significant. About 10.0% of the cases in ACMV group and 6.7% of the cases in ASV group died during follow up. Mean APACHE score was 22.13 in ACMV group and 18.0 in ASV group and it was statistically significant between the two groups. SOFA score was 5.8 ACMV group and 4.57 in ASV group which was statistically significant.

Conclusion: This study concludes that, ASV mode of ventilation in reduction of ICU stay, duration of ventilation, low APACHE & SOFA scores.

Background: Poor infection control practices during childbirth are recognized as a critical factor leading to maternal and neonatal morbidity and mortality. Therefore, this study intends to assess the effectiveness of safe delivery and surgical kits supplied by Government of Andhra Pradesh to ensure a safe birthing environment. This study shows impact of safe delivery and surgical kits supplied by the Government of Andhra Pradesh on maternal and neonatal morbidity and mortality. However, the current evidence is limited and further studies are required.

Materials and Methods: It was a retrospective observational study done at a tertiary care hospital attached to medical college admitting patients from all over the district. On an average, 3500 women deliver every year at our institute. This study is conducted on 200 Pregnant women with period of gestation above 37 weeks, giving normal vaginal birth at GGH SRIKAKULAM and Health personnel using  safe delivery and surgical kits were included regardless of women’s obstetric or medical complications, parity, education or socio-economic status.

Study Period: JULY 1ST 2021 TO AUGUST 31ST 2021

Results: This study proved that universal and uniform usage of safe sterile practices during intrapartum care by health care professionals reduced maternal post partum sepsis, duration of hospital stay and improved patients and health care person satisfaction scores. Similarly the neonatal sepsis rates and admission to NICU was also almost nil in those cases delivered using the safe delivery kits. Usage of safe delivery and surgical kits appears to be a promising strategy to achieve the country targets of SGD reducing maternal and neonatal morbidity and mortality.

Conclusion: All health care delivery points of intrapartum maternity care should practice safe birthing techniques and use the kits supplied to achieve zero sepsis for both mother and neonate.

Background: Klebsiella pneumoniae can cause a number of diseases, such as pneumonia, bloodstream infections, meningitis, and urinary tract infections. Depending on the infection site, the symptoms of Klebsiell apneumoniae infection vary. The purpose of this study is to determine the prevalence of the ESBL enzymes in Klebsiella pneumoniae isolates using phenotypic techniques from various hospital wards and the identification of ESBL resistance genes such as CTX, TEM and SHV.

Method: Different clinical samples from a tertiary care hospital were used to obtain Klebsiella pneumoniae isolates, which were then identified using a conventional disc diffusion technique and Combined double disc method, ESBLs were screened. The CTX, TEM, and SHV genes were genotypically detected using Multiplex PCR in accordance with the recommended procedure.

Result: The pattern of Antimicrobial susceptibility testing revealed that the most resistant antibiotics include, CAZ (76.67%), CTX(74.07%), CXM(72.67%), followed by TOB(72%), and PIT (67%). Out of 150 Klebsiella pneumoniae isolates, ESBL Combined double disc method positive are ceftazidime+clavulinicacid115 (74.7%) and, cefotaxime+clavulinic acid positive, 112 (74.7%). By using the Multiplex PCR technique, the CTX and SHV and TEM genes were 65.3% 51.3% and41.3% recorded respectively.

Conclusion: Most Klebsiella pneumoniae isolates that produced ESBLs have the CTX gene.

Objectives:

• To evaluate different radiological signs / findings of Normal pressure hydrocephalus (NPH) in MRI, in patients with atleast 2 symptoms of hakim triad.
• The role of different radiological signs in differentiating patients with NPH and patients without NPH
• To rule out other closely related differential diagnosis for NPH.

Materials & Methods: This study was performed using 1.5 Tesla Philips D stream MRI machine. Imaging and clinical data of 50 patients with atleast 2 symptoms from Hakim triad from 2022-2018 were reviewed retrospectively and different radiological signs are evaluated for NPH.

Results & Conclusion: Out of 50 cases in our study, Small Callosal angle, Disproportionately enlarged subarachnoid space hydrocephalus, Wider temporal horns and idiopathic NPH RAD scale helps to differentiate, patients with NPH from patients without NPH. Out of all D/D, Alzheimer’s being most closely related D/D.

Background: Diabetes is a non communicable disease and today the world is experiencing a silent pandemic. Its complications negatively impact the patient’s quality of life, caregivers and society.  Evidence based medicine suggests good Glycaemic control is required to restrict the complications of diabetes. Many factors play a significant role in poor glycaemic control. This study aims to identify the factors affecting glycemic control in patients with type 2 diabetes.

Methods: A prospective observational study was conducted on 175 patients with diabetes mellitus having HbA1c more than 7g% from April 2022 to September 2022. A pre-tested, semi-structured questionnaire was used to collect the socio-demographic details, history and reasons for not taking insulin after obtaining informed consent.

Results: 56% were between 41-60 years. The mean Hba1c was 11.3% with no significant differences between genders, socio-economic status and place of residence. 82.9% did not take insulin due to a patient related factor. Fear of injection being the most important (37.7%) which was seen more in male (32%) than females (23%). 13.1 % were not advised by their doctor.

Conclusion: Proper adherence to treatment plays a pivotal role in preventing complications. Patient factors which are major cause of non adherence to insulin usage and doctors inertia to advice insulin therapy at appropriate time, need to be addressed. Patients and caregivers have to be counselled on the need for insulin therapy in management of the condition and preventing complications

Introduction: Epidural anesthesia is a versatile technique for providing anesthesia andpostoperative analgesia. Contributes to maintenance of hemodynamic stability and reduces postoperative stress, improving the patient outcome.

Objectives: Levobupivacaine with clonidine and ropivacaine and clonidine were used in lower abdomen and lower limb procedures during epidural anesthesia to compare the onset and duration of sensory and motor blocking.

Materials and method: The present study was prospective observational analytical study. This study was conducted from January 2021 to June 2021, the study was done in the R.G. Kar Medical College's Obstetrics and Gynecology, Orthopaedics, and Surgery operation operation theatre. Total 70 patients were included in this study.

Result: In our study, out of 70 patients, mean Duration of Surgery was higher in Group-A [97.91428571± 18.35815483] compared to Group-B [95.85714286±21.57359887 (min)] which was not statistically significant (p=0.66). We found that, mean Onset of sensory block was higher in Group-A [18.65714286± 1.433688315] compared to Group-B [16.34285714±0.998317913 (min)] though it was not statistically significant (p=0.989). It was found that, mean Onset of motor block was lower in Group-B [18.91429± 2.019651] compared to Group-A [22.45714±0.781079 (min)] but this was not statistically significant (p=0.622). We found that, mean Duration of Sensory Block was higher in Group-A [186.9428571± 6.949155078] compared to Group-B [163±7.970534 (min)] though it was not statistically significant (p=4.39). Our study showed that, mean Duration of Motor Block was higher in Group-A [203.5714286± 6.92092188] compared to Group-B [179.4286±7.252933 (min)] though it was not statistically significant (p=2.31). Our study showed that, slightly higher number of patients had ASA1 in Group-B [24 (23.5)] compared to Group-B [23 (23.5)] but this was notstatistically significant (p=.799133). In our study. Majority number of patients had MPG 1 in GROUP A [28] compared to GROUP B [27] which was notstatistically significant (p=.419316).

Conclusion: we conclude that, the onset and duration of sensory and motor blockade higher in levobupivacaine with clonidine compared to ropivacaine with clonidine for Epidural anaesthesia in lower abdominal and lower limb surgeries.

Background: Individuals with MDD differ from non-depressed individuals upon measures of dimensional personality traits. It is found that there has been a complex and variable association between personality and depression. We can decide treatment plan, course of treatment, and prognosis based on this knowledge. Aims: To study the Big Five Personality Traits in Patients of Major Depressive Disorder. Methods: A cross-sectional study was conducted at a tertiary care hospital at the Department of Psychiatry. 100 patients were taken. Personality traits were assessed using the Big Five Inventory focused on domains like Neuroticism, Extraversion, Openness to experience, Agreeableness, and Conscientiousness. The severity of depression was assessed using Hamilton Depression Rating Scale. Other appropriate variables were obtained using semi-structured proforma. Data was analyzed with SPSS Epi Info™ v7.2.5. Linear correlation between two continuous variables was explored using Pearson’s correlation (if the data were normally distributed) and Spearman’s correlation (for non-normally distributed data). Statistical significance was kept atp < 0.05. Results: Correlation of Big Five personality traits was studied with respect to various socio-demographic and clinical variables. Conclusion: Personality trait Neuroticism may be a risk factor in developing major depression. Extraversion, Openness to experience, Agreeableness and Conscientiousness may be associated with some protective effect. An individual-tailored approach to management is advisable for better long-term outcomes based on personality traits.

Introduction: The prevalence of hypertension in the elderly is increasing worldwide. Non adherence to medication in elderly is a major concern which is associated with adverse outcomes. Non adherence to medications is a complex issue hence this study is undertaken to study factors affecting for non adherence to medications in elderly hypertensive patients. Materials And Methods: This retrospective study included 270 elderly patients i.e. (>60 years) after screening among out patients visiting general medicine and geriatric departments of BMCRI, Bangalore. Complete physical examination, BP measurement and the reasons for non adherence were assessed from patients. Results: Total of 270 patients, majority were in the age group of 60-70 years (63.3%). Males and females were 60% and 40%.The duration of hypertension was more in the range of 10-15 years (36%), followed by 15-20 years in (33.3%).The common reasons for non adherence was“ the high cost” in 22% and “too many tablets to consume” in 18.7% of patients. Remaining 16% “did not understand the importance” in taking medication, about 13% of due to its “side effects” around 9% due to “forget fullness” and 6% stopped medications as they were “asymptomatic”.Conclusion: The problem of non-adherence to medications is universal in patients with hypertension. The main reasons are poly pharmacy and increased cost in our study. Others include poor consultation, forgetfulness in elderly patients. Regular and repeated consultation especially establishment of “hypertensive clinics” will go a long way to improve the adherence to treatment protocol in hypertension patients.

Sodium Glucose co-transporter – 2 (SGLT-2) inhibitors are class of oral antidiabetic drugs used in the treatment of Type II diabetes Mellitus. They act on the SGLT- 2 protein expressed in the renal proximal convoluted tubules to reduce the absorption of filtered glucose, decrease the renal threshold of glucose and promote glucose excretion. They have gained popularity due to their beneficial effects on heart and kidneys. However their use is associated with increased risk of Euglycemic ketoacidosis. Here we present a case where SGLT – 2 inhibitor used in combination with Insulin in a patient of LADA was associated with D.K.A where severe Metabolic acidosis persisted even after correction of hyperglycemia and dehydration which did not respond to continuous infusion of Dextrose, insulin and Sodium bicarbonate, ultimately requiring Hemodialysis.

Background: Chronic kidney disease (CKD) is known to have significant repercussions on bone mineral density (BMD) and body composition. We aimed to evaluate BMD and body composition alterations across different stages of CKD.

Methods: A hospital based Observational study was carried out in 120 patients in the Department of Medicine, Assam Medical College & Hospital, Dibrugarh for a period of one year from 1st July, 2021 to 30th June, 2022.  BMD at the femur neck and lumbar spine was evaluated using Z-scores. Body composition was assessed focusing on sarcopenia prevalence and body fat percentage across CKD stages.

Results: In our study, based on the Z-score at the femur neck, 45% of participants had osteopenia, with a slightly higher prevalence in females (23.33%) compared to males (21.67%). Osteoporosis was identified in 31.67% of the cases, with females (16.67%) again slightly outnumbering males (15%). About 23.33% of the cases had a normal Z-score, with males (15.83%) being more than females (7.50%).When assessing the Z-score at the lumbar spine, results showed a different distribution. Osteopenia was present in 43.34% of the cases, with females (24.17%) being more affected than males (19.17%). Osteoporosis was seen in 17.5% of the participants, with a nearly equal distribution between males (8.33%) and females (9.17%).From the total cohort of 120 patients, 54% were diagnosed with sarcopenia. Additionally, the mean fat mass varied slightly across stages 3, 4, and 5 of CKD but remained relatively consistent, with readings of 17.13±4.24, 16.71±3.49, and 16.95±4.83 respectively.

Conclusion: CKD exerts a substantial impact on bone health, with increasing prevalence of osteopenia and osteoporosis in advanced CKD stages. Additionally, a high prevalence of sarcopenia across CKD stages was observed, underscoring the necessity for comprehensive musculoskeletal management in CKD patients.

Introduction: Uncommon tumor, that accounts for 3-5% of all gynecological malignancies. Most commonly seen in postmenopausal women. 90% accounts to SCC. Although external in location, hesitancy results in delayed diagnosis.

Case report: 64 year old P4L3 postmenopausal woman with no known comorbidities, was admitted with multiple episodes of vomiting, irrelevant talk, generalised weakness. Incidentally, a swelling was noted over external genitalia. of size 4x3cm over left labia majora. Vulval biopsy showed Squamous Cell Carcinoma of Vulva. She underwent Total Abdominal Hysterectomy + B/L Salpingo ophorectomy + Appendicectomy + left inguinal lymphnode dissection followed by Modified Radical Vulvectomy. Lymphatics both superficial and deep femoral were dissected. HPE of the specimen showed SCC of vulva-moderately differentiated, SCC insitu of cervix, superficial spreading type extending up to endometrium, following which Adjuvant chemoradiation of dose 54 Gy in 27 fraction along with 5 cycles of weekly Injection Cysplatin was given starting from 1 month post surgery.

Conclusion: Synchronous primary genital cancer is an uncommon occurrence. In this case, additional association with Empty Sella Syndrome makes the management even more complex.

 

Background: Intussusception is a common cause of intestinal obstruction in children, which requires prompt diagnosis and treatment in order to prevent, loss of bowel segment due to necrosis. Non operative management of intussusception is the treatment of choice. The aim of the study was to evaluate the efficiency of ultrasound guided hydrostatic reduction in treating intussusception.

Objective: The purpose of this study was to evaluate the clinical picture of cases undergoing USG guided hydrostatic reduction and to assess its outcome.

Materials and Methods: We conducted a retrospective study of intussusception cases who underwent USG guided hydrostatic reduction in our department of paediatric surgery, Tirunelveli medical college during the period of September 2021 to August 2023. A total 88 cases were included in the study.

Results: Mean age of the study participants was found to be 15.3±10.5 months with notable male predominance. Most common symptoms reported in this study was abdominal pain (76.1%) followed by vomiting (65.9%), abdominal distension (44.3%), blood in stools (35.2%), constipation (43.2%) and diarrhea (34.1%). All the cases underwent USG hydrostatic reduction however the success rate was reported as 85.2% and the rest of the cases underwent open manual reduction or resection anastomosis. Mean duration of stay in hospital was reported as 5.3±2.6 days and notably there were no mortality reported.

Conclusion: Ultrasound guided hydrostatic reduction is effective treatment modality option for intussusception, with high success rate & less morbidity.

INTRODUCTION: Haemoglobinopathy is a major genetic public health problems in India, responsible for significant  morbidity and mortality.Individuals with trait (carriers) are healthy and unaware of their carrier status unless specifically screened.If a couple carry a  significant haemoglobinopathy trait there is a 1 in 4 chance with each pregnancy that their child will inherit a major haemoglobinopathy.The most effective approach to reduce the burden in the society is to reduce the incidence by implementation of a carrier screening programme.This study is done to know the prevalence of haemoglobinopthies and variant of haemoglobin using cation exchange HPLC.

AIMS AND OBJECTIVES:

• To identify the pregnant woman at risk of having homozygous or heterozygous  child with a severe haemoglobinopathies in  tertiary level hospital of south Gujarat.

MATERIALS AND METHODS:

• The present study was carried out in a tertiary care hospital for a period of 1 month . 100 Antenatal patients attending Obstetric-out patient department for routine check-up were included in the study.
• 2 ml EDTA venous blood from pregnant mothers after informed consent .This blood is subjected for complete haemogram, peripheral blood smear and HPLC using Biorad  testing system.Descriptive analysis is done and data is presented innumbers and  in %.

RESULT: Out of a total of 100 pregnant women 20% were having haemoglobinopathies, whereas 80% had normal haemoglobin. Out of 20 cases, maximum number of cases i.e. Sickle cell trait cases i.e. 10 % followed byβ –Thalassemia trait7 % followed by Other haemoglobinopathies are also found i.e. sickle cell disease 2% HbE homozygous 1%.

CONCLUSION: This study shows a high prevalence of haemoglobinopathies in antenatal mothers necessitating  an appropriate screening stratergy for antenatal mothers.We should concluded that HPLC is a sensitive technique for studying haemoglobinopathies during pregnancy.

Introduction: Mupirocin is used to decolonize methicillin resistant Staphylococcus aureus (MRSA). It acts by inhibiting protein synthesis. Resistance to mupirocin is mediated by the mupA gene. MRSA have a highpropensity of acquiring resistance to mupirocin. Coagulase negative Staphylococci (CONS) are thought to be reservoirs for several resistance genes including mupA. Hence, this study was undertaken the mechanism of mupirocin resistance among clinical isolates of Staphylococci.

Materials and Methods: A total of 336 clinical isolates of Staphylococci were included in this study. Methicillin was detected by phenotypic and genotypic methods. Low and High mupirocin resistance was detected using 5µg and 200µg disc. Presence of mupA was detected by polymerase chain reaction (PCR).

Results: Among the 336 Staphylococci of the current study, 133 were Staphylococcus aureus and 203 were CONS. A total of 85 isolates which included 29 low level and 56 high level mupirocin resistant isolates. Only 53 isolates harbored the mupA gene.

Conclusion: Mupirocin resistance in Staphylococcus aureus and CONS, should be monitored vigilantly. Prudent use of mupirocin and strengthening execution of infection control measures should be mandated to curtail the spread of resistance.

Background: Patient’s expression is an important source of information in screening for problems and developing an effective plan of action for quality improvement in health care organization. The aim of the study was to assess the level of patient satisfaction among patients, attending outpatient department of M.B Multi Speciality Hospitals, Visakhapatnam.

Methodology: Cross-sectional observational study was done among patients attending Outpatient Department of M.B Multi Speciality Hospitals during 1-4-22 to 30-6-22 using a Bilingual structured questionnaire. Data was collected and analysis was done.

Results: Sample size - 419 outpatients were evaluated.  Overall patient satisfaction towards Outpatient services was above 90%. 410 patients opined that Physician care, careful listening and easy access of care were the major satisfaction indices contributing to 98%. Major dissatisfaction mentioned by outpatients was the waiting time at registration counter, waiting time for the consultant’s appointment, delay in availability of laboratory reports. 

Conclusion: The present study was an attempt to assess the level of satisfaction of Out Patient towards OPD services, Appropriate and ongoing data collection and analysis could help in optimizing utilization of outpatient services to achieve better outcomes Keywords: Health care, Satisfaction, Outpatient Department and Questionnaire.

Background & Aim: Frailty is a major prognostic factor in cirrhosis. Its assessment and intervention towards performance enhancement is important in the management of cirrhosis. Our study aimed to assess the prevalence of frailty in patients with cirrhosis and comparison of frailty by different indices.

Methods: One hundred and twenty cirrhotic patients were included. Frailty assessment was done using compares Fried frailty index (FFI), Clinical frailty index (CFI), Short physical performance battery (SPPB), Edmonton frail scale (EFS), Liver Frailty Index (LFI), ECOG, Karnofsky performance scale (KPS), and Instrumental activity of daily living (IADL). Risk factors of frailty analysis were made based on LFI.

Results: Mean age of presentation was 43.57±10.16years, and 80% were males. Most common etiology was alcohol (50.1%). Prevalence of frailty based on LFI, FFI, CFI, SPPB, EFS, ECOG, KPS, and IADL was 45%, 38.3%, 39.2%, 46.7%, 45%, 36.7%, 36.7%, and 29.2%. There was a significant positive association of frailty based on the LFI score with other scores (P<0.0001). Risk factors for frailty were being underweight (50% vs. 15%; P<0.0001), severity of ascites (P<0.0001), CTP score (P<0.0001), Mean MELD score (18.33±4.33 vs. 14.37±3.49; P<0.001) and MELD Na (20.43±4.62 vs. 15.50±3.95; P<0.001) was significantly higher among frails compared to non-frail patients.

Conclusions: Frailty is quite prevalent in liver cirrhosis. Frailty assessment should be routinely carried out. Frailty assessment by any score can be used to prevent further complications in these patients.

Introduction: Horse shoe kidney (HSK) is considered as the most common fusion anomaly with an incidence of 1 in 400-666 births. According to AUA and EAU guidelines, PCNL is the surgical modality of choice for renal calculi more than 2 cms even in case of HSK. In this case series, we describe our experience with prone PCNL in the management of nephrolithiasis in HSK over the last 10 years.

Methods: Retrospective analysis of hospital records yielded data of 22 patients who underwent prone PCNL for HSK calculi between June 2012 and May 2022. Patient characteristics and stone characteristics were recorded. Procedure related outcomes like number of tracts established, total procedural time, need for auxiliary procedures, stone free rate and postoperative complications according to modified Clavien Dindo classification were tabulated and analyzed.

Results: Mean age of patients in this study was 44.2 years ranging from 9 to 70 years. Mean stone surface area was 376.54 mm2. Single subcostal upper pole calyceal puncture and tract was able to clear the calculi in 18 cases. Supracostal punctures were required for 4 patients. Auxiliary procedures like redo-PCNL and ESWL were needed in 1 and 2 patients respectively. Blood transfusion was done in 2 patients. Primary stone free rate of82.7% and final stone free rate of 95.5% was achieved.

Conclusion: Prone PCNL is equally safe and efficient management strategy for the treatment of calculi in horse shoe kidneys comparable to PCNL in normal kidneys.

Background: In India, type 2 diabetes mellitus(DM) is an epidemic disorder because of social impact and changes in way of life. According to the WHO, 72 million people were affected by DM in India in the year 2017, a figure expected to almost double to 134 million by 2025, the largest number in any country in the world. Aims and Objectives: The aim is to investigate the Lipid Peroxidation, Oxidative stress and its correlation with Glycated Hb in Type2 Diabetes of North West Punjabi population. Material and Methods: This cross- sectional study included 200 subjects, 100 were type 2 diabetic patients and 100 were healthy non-diabetic individuals. The data were analyzed using a t test. Results; The results showed positive correlation between HbA1c and fasting blood Glucose (r = 0.417, p= 0.000) with MDA(r=0.340,p=0.000), Triglycerides (r = 0.214, p= 0.003), Total cholesterol(r= 0.306,p=<0.002), Non HDL(r=0.322,p=0.001), LDL(r=0.327,p=0.001), VLDL(r=0.318,p=<0.001), with glycated Hb in patients of type 2 diabetes mellitus. Similarly, with HbA1c and with BMI (r= 0.422,p=0.000) with glycated Hb in patients of type 2 diabetes mellitus, Whereas negative correlation was observed between HbA1c and other parameters like HDL (r=0.197, p=0.050), HDL to LDL ratio(r=0.144,p=0.152), SOD (r=0.025,p=0.803). Conclusion; As glycemic control of diabetic patient decreases, this increase of glycated Hb leads to atherogenic lipid profile along with increased lipid peroxidation, thus making the individual susceptible to various complications, both macrovascular and microvascular.

BACKGROUND: Thrombocytopenia is a prevalent problem for physicians of many specialties in tropical areas such as India. In many etiological disorders, thrombocytopenia manifests as an asymptomatic condition that might progress to a life-threatening condition requiring blood transfusion. Malaria and dengue fever infections are generally linked with thrombocytopenia, with variable clinical patterns. The most prevalent cause of thrombocytopenia is infection. The aim of present study the clinical profile and outcome of patients presenting with severe thrombocytopenia.

METHODOLOGY: A prospective study was conducted in patients presented with severe thrombocytopenia in Dayanand Medical College and Hospital, Ludhiana from 1/03/2021 to 28/02/2022.The patients were followed up during their hospital stay and further followed up on OPD basis for 6 weeks or till the response was achieved..

RESULTS: Tropical fever was the most common cause of severe thrombocytopenia with 61 cases followed by sepsis with 23 cases. Bleeding manifestations were seen in 43.08% patients. Complete response was seen in 80% of the tropical fever, 43% of sepsis and 66% of ITP patients. Mortality was maximum in patients with sepsis induced thrombocytopenia.

CONCLUSION: Tropical fever is the commonest diagnosis made in patients who are detected to have severe thrombocytopenia. Treatment of the patients varied with the underlying etiology. Mortality was maximum in sepsis induced thrombocytopenia.

Background: Premenstrual syndrome (PMS) shows a wide variety of cyclic and recurrent physical, emotional, and behavioral symptoms occurring during the late luteal phase of the menstrual cycle and abating shortly following the beginning of menses. The present study assesses whether the activity of the autonomic nervous system is altered during the menstrual cycle of women with different degrees of premenstrual symptomatology

Material & Methods: Twenty PMS cases with their mean age 20±1.5 with regular menstrual cycles participated in this study. The autonomic nervous system activity was noninvasively measured by HRV power spectral analysis & menstrual distress questionnaire was compared among normal controls & PMS cases.

Results: has shown significant change in VHF (P=0.00), VLF (P=0.02), Sympathetic vagal balance (P=0.05) in PMS cases as compared to control. Significant increase in VHF (P=0.03) & VLF (P=0.00) is seen in leuteal phase as compared to follicular phase in PMS cases. SDNN & RR interval was also compared it was found to be significantly decreased in leuteal phase of PMS cases as compared to controls.

Conclusion: we can say that there is sympathetic over activity in Late leuteal phase  of menstrual cycle in females of age group 20-25.This sympathetic over activity hampers in day to day routines of the subjects as dysphoric symptoms are increased markedly during late luteal phase in PMS cases as compared to controls.

The incidence of cardiac disease in pregnancy is around 1%. Pregnancy complicated with cardiac disease is associated with increased risk of maternal morbidity & mortality. This study was conducted at Department of Obstetrics & Gynaecology, Government Medical College, Kottayam from September 2020 for one year. It was a prospective observational study done in 97 women who satisfied the inclusion criteria. Patients were classified as per modified WHO (World Health Organisation) pregnancy risk scoring.84.5% belonged to the age group of 20-34 years. Valvular heart disease(VHD) constituted 52.6% and congenital heart disease(CHD) 41.2%. Among VHD, mitral stenosis was most common, 23.5%.WHO class I,II,III&IV constituted 37.1%, 37.1%, 15.5% &10.3% respectively. Among 97 patients, 10 (10.3%) had to undergo MTP,31 (31.9%) underwent LSCS &56 (57.7%) underwent normal labour. The incidence of preterm labour was 5.7%, hypertension 11.5% and IUGR 8% which were more in WHO class IV. Congestive cardiac failure was the common complication which was observed in 4.1% of cases again observed in WHO risk IV cases.18 babies had birth weight less than 2500 g(20.7%). Low APGAR score<7 was observed in 5.7% of newborn and 5.7% of required NICU admission which was found to have significant association to modified WHO risk classification.1 case of stillbirth was observed (1.1%). There was no neonatal death. The incidence of congenital heart disease in neonate among patients with CHD was 5%.There was one case of maternal death.

Background: Extract from the roots of Ashwagandha plant has been used through generations for its positive effect as an anti-stress, anti-tumor, anti-arthritic, and neuro-regenerative agent. The compounds have shown considerable effect as a thyroid disrupting agent also. Extremely contradictory findings have been shown in both animal and human studies regarding the effect of Ashwagandha on thyroid levels, and hence it is important to monitor the safety and efficacy in pre- clinical models before we shift to clinical trials for the same. Objective: To evaluate the thyroid disrupting potential of the Ashwagandha root extract (ARE) on Zebra Fish (Danio rerio) model. Methodology: A total of 105 (7 groups of 15 each) transgenic Zebra fish embryos (tg: mCherry) at 2 days post-fertilization stage were included to study the effect of ARE on the developing thyroid gland. Potassium perchlorate (KOCl), a known thyrotoxic substance was used as a positive control and dimethyl sulfoxide (DMSO) was the vehicle control. The effect on thyroid glands was assessed using a thyroglobulin reporter gene fluorescence assay. Five serial concentrations from 1 mcg/ml to 50 mcg/ml of ARE were used. On day 5 post-fertilization, images were analyzed under a fluorescence microscope for intensity variations. Result: The result from this study showed no differences in the expression of thyroglobulin reporter gene with Ashwagandha root extract. Conclusion: The Ashwagandha root extract did not show any effect on thyroid gland in developing zebra fish embryos and can be considered safe with respect to its effects on thyroid gland.

Introduction: Diagnosis of Extrapulmonary TB (EPTB) remains a challenge as the number of Mycobacterium tuberculosis (MTB) bacilli present in tissues and pus samples from various sites of disease are often low & non-uniformly distributed. Molecular diagnostic methods like GeneXpert or Cartridge-based nucleic acid amplification test (CBNAAT) seems to hold the key to future of better and efficient diagnosis of Extrapulmonary Tuberculosis (EPTB) in pus and tissue samples as it simultaneously detects M. tuberculosis and Rifampicin resistance in samples.

Material & Methods : A Retrospective cross sectional study was carried out in the Department of Microbiology. This study includes pus and tissue samples from November 2021 to December 2022 – 14 months. All pus and tissue samples were subjected to aerobic culture, simultaneously Gram stain, ZN stain, Modified ZN stain, KOH mount were performed among them. All samples that met the inclusion criteria which were sterile and smear negative (Gram stain, ZN stain, Modified ZN, KOH mount) were subjected to clinical evaluation. In these cases, detailed clinical history for TB were taken and samples were subjected to GeneXpert. Later on data were analysed on the basis of clinically suspected and clinically not suspected for TB.

Inclusion criteria: Frank Pus sample > 3 ml, Tissue minimum 1 gm

Exclusion criteria: Blood-stained Pus, Pus samples < 3 ml, Pus swab, Tissue received in Formalin, Clinical history not available

Results: Total 387 samples (360 pus, 27 tissue) received for aerobic culture. Among them 198 samples (181 pus, 17 tissue) were aerobically sterile and smear negative (Gram stain, Zn stain, Modified ZN, KOH mount). Out of 181 pus samples, 47 samples (13.05%) met the inclusion criteria and were subjected to Gene-Xpert. Among these 15 positive samples, 11 samples (23.40%) were clinically suspected & 4 samples (8.51%) clinically not suspected were detected of M. Tuberculosis. Among 27 tissue samples, 17 sterile and smear negative samples were subjected to Gene-Xpert, among them only 2(11.76%) clinically not suspected samples of Tissue were detected for M. Tuberculosis.

Conclusion: Diagnosis of EPTB is very important as pus and tissue are regarded as precious samples which cannot be repeatedly retrieved. Our data suggest use of GeneXpert for diagnosis of EPTB in smear negative, aerobically sterile pus & tissue samples.

BACKGROUND: Although Broad ligament fibroids are rare, their surgical management includes nuances of anatomical awareness, traction and counter-traction techniques, and proper hemostasis. AIMS AND OBJECTIVES-To provide an overview of the  background, clinical presentation, and imaging related to broad ligament fibroid .;to discuss pertinent anatomical landmarks and demonstrating laparascopic myomectomy techniques in cases of  broad ligament myomectomy technique. MATERIALS AND METHODS: Five cases of true broad ligament fibroids and 10 cases of false broad ligament fibroids were operated.3 of them misdiagnosed as intramural fibroids on USG and subserosal on CT SCAN. RESULTS: All were removed laparoscopically, with very minimal blood loss and without a need for blood transfusion. We traced the course of the ureters in all cases. No complications were encountered. CONCLUSION: The broad ligament fibroid even though being the rarest of extra-uterine tumours can grow to a large size as exemplified in these cases. Early diagnosis and laparascopy in experienced hands  can decrease the peri and post-operative complications in such cases.

Introduction: There are various attitudes which are associated with the COVID-19 pandemic. Stress was a common consequence of pandemic, As stress in females is proven to be having direct effect on menstrual cycle. In present study we had estimated onset of

menstrual irregularities in married females of reproductive age living in vicinity of RHTC Jawan, Aligarh UP.

Methodology; This study was conducted on 200 females of reproductive age without any chronic illness. We asked for their enstrual history. Only those females were included who had no prior menstrual disorder before pandemic. Then we calculated the percentage of females who complained of onset of menstrual disturbance during pandemic. We also tried to assess the mental stress among females with irregular menses.

Results and Conclusion: 21% females have given the history of irregular periods. Among these 42 females 36 have history of emotional and social stress.

Background:Low Birth Weight (LBW) is a significant determinant of infant mortalityand childhood morbidity.It is amultifaceted medico-social and a major public health problem globally. Numerousfetal as well as maternal predictors attribute LBW. Aims: The present study was conducted among the newborns in Bankura Sammilani Medical College and Hospital to estimate the prevalence of low birth weight as well as to determine its predictors. Settings, Design, Methods and Material: This  hospital based descriptive cross sectional study was conducted from June - September 2022among 268 newborns in the Post Natal Ward of Bankura Sammilani Medical College and Hospitalwith the help of a predesigned pretested semi-structured schedule. Statistical Analysis Used: Trial version of Statistical Package for the Social Sciences was used to analyze the data. Chi square test was applied when necessary. Results: 32.1% of the newborns were low birth weight. Age of the mothers, spacing of birth, morbidities present in the mother during pregnancy and anaemia in pregnancy were the factors which were significantly associated with the occurrence of low birth weight. Conclusions: Low birth weight is a quite prevalent in Bankura. Strategies may be planned to prevent the modifiable maternal factors like teenage pregnancy, comorbidity, spacing of birth, anaemia in pregnancy etc.

Background : Acute kidney injury (AKI) in tropical and subtropical countries differ from their temperate counterparts in their modes of origin and clinical presentation. The aetiology of tropical AKI is varied and the volume of literature on this issue is meagre in eastern part of India .The current study explored the prevalence of different causes of tropical AKI, along with its early and late outcomes  among patients admitted to a tertiary care hospital in Kolkata of Eastern India.

Methods : This is an observational study with prospective nature, conducted in the inpatient wards of a tertiary care teaching hospital in Kolkata at the eastern part of India for a duration of one and half year from February 2020 to July 2021. A sample of 50adult population, aged between 18-90 years comprising both male and female presenting with acute kidney injury undergone the current study.

Results : The mean age of the patients was 30.86 ( with standard deviation+/- 6.56 ) years, most were men, hailing from rural areas. Majority developed AKI following an infection, commonly Malaria and Scrub typhus. Of the non-infectious causes snake bite envenomation was important. Oliguria were the most important complications and 32% patients required haemodialysis. The mean duration of hospital stay was 15.18 (SD +/- 6.64)days. Among the study population8% died when undergoing inpatient treatment in hospital.

Conclusion: Tropical AKI in eastern region of India was mostly caused by infections of which Malaria and Scrub Typhus are common followed  by snakebite envenomation among rural young men. The disease is associated with a long hospital stay but relatively less mortality.

Background: Ashwagandha (Withania somnifera also known as Indian Ginseng or Winter Cherry) is a prominent herb in Ayurveda medicine, commonly used to promote youthful vigor, longevity, and overall wellbeing. This paper focuses on ashwagandha as an ergogenic aid and presents the results of a randomized, double-blind, placebo-controlled clinical study on the effects of ashwagandha administered as an adjuvant to a resistance training program, on serum testosterone and inflammatory markers in healthy adults.

Aim: To investigate the effects of Ashwagandha root extract on serum testosterone and inflammatory markers in healthy adults following resistance training.

Methods: This was a prospective, randomized, double-blind, placebo-controlled study in 80 healthy male and female adults between 18–45yearsof age after obtaining informed consent. Enrolled participants were randomly allocated to receive capsule Ashwagandha root extract 300 mg, or an identical placebo capsule containing starch. Both treatments were given twice daily for with milk or water for 8 weeks. Study assessments included serum testosterone (total and free), CD4 cell counts, and serum levels of inflammatory markers (IL-6, TNF-Alpha), done at baseline and after 8 weeks.

Results: Four participants in the placebo and 3 from ashwagandha group did not complete the study, and analyses were done on 73 (36 ashwagandha, 37 placebo) participants data. The free serum testosterone levels increased (p<0.0001) in males receiving Ashwagandha compared to placebo. The levels of IL-6 and TNF-alpha were less in the Ashwagandha group, but these were statistically insignificant (p>0.05).

Conclusion: Ashwagandha root extract supplementation in combination with resistance training is effective in improving free testosterone levels in men but not in women.

Introduction: Parathyroid adenoma is part of a spectrum of parathyroid proliferative disorder that includes parathyroid hyperplasia, parathyroid adenoma, and parathyroid carcinoma. Patients typically present with evidence of primary hyperparathyroidism with elevated serum calcium levels and elevated serum parathyroid hormone levels. 8 patients with parathyroid adenoma are presented in this study describing their presentations, clinical profiles, and management.

Materials and Methods: It is a case series retrospective review of 8 cases of parathyroid adenoma conducted at MS Ramaiah Medical College Hospital, Bangalore from october 2020 to june 2022.

Results: Eight cases of operated parathyroid adenoma were included in the study, out of which, 2 were male and 6 were female. 4 patients had an incidentally detected parathyroid adenoma while rest of the patients presented with generalised weakness, bony pain and abdominal pain. Serum calcium ranged from 9.6 mg/dl - 13.2 mg/dl (Mean ± SD - 11.26 ± 1.09 mg/dl). Serum PTH ranged from 427 pg/ml - 2161 pg/ml (Mean ± SD - 840.5 ± 559.11 mg/dl). Technetium-99m methoxyisobutylisonitrile (99mTc MIBI) scintigraphy picked up a single parathyroid adenoma wherein 6 of these cases, right-sided parathyroid was involved and left parathyroid adenoma was seen in 2 patients. All the patients underwent parathyroid adenoma excision under GA. Decrease in more than 50% of baseline PTH confirmed the excision of parathyroid adenoma. Intra operative PTH ranged from 57.6 pg/ml - 287.2 pg/ml (197.01 pg/ml). The postoperative period for all these patients was uneventful. There was definitive symptomatic improvement after parathyroidectomy.

Conclusion: The study showed association of diabetes in 4 cases and 4 cases of asymptomatic parathyroid adenoma were incidental findings. In the remaining cases, there was strong clinical suspicion, supported by biochemical evidence, which was then confirmed by 99mTc MIBI scintigraphy. The diagnosis of a parathyroid adenoma was strengthened by 99mTc MIBI scintigraphy and later supported by histological analysis. In each of these cases, there was a clear indication for surgery, and following the procedure, symptoms began to improve.

Background: This study was conducted to evaluate the cardiovascular effects of DEXMED (dexmedetomidine) and MgSO4 (magnesium sulfate) in a clinical setting.

Methods: A total of 126 patients were equally distributed between two groups: DEXMED and MgSO4. Vital parameters, including heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were assessed at various time points before and after drug administration.

Results: The DEXMED group consistently exhibited lower heart rates post-drug administration, with statistically significant differences at all measured time points (p<0.001). In terms of blood pressure, the DEXMED cohort revealed lower SBP, DBP, and MAP across all time intervals, with p-values ranging from 0.040 to 0.000. The mean age of the DEXMED group was 39.13 ± 9.48 years, while the MgSO4 group had a mean age of 37.30 ± 8.14 years (p=0.63).

Conclusion: DEXMED administration resulted in consistently lower heart rates and blood pressures compared to MgSO4. Given the cardiovascular implications, meticulous patient monitoring is paramount, especially in those with cardiovascular comorbidities. Personalized medical approaches in selecting anesthetic agents are advised.

Parkinson's Disease (PD) is an age-related progressive neurodegenerative disease that poses significant challenges for both patients and healthcare providers. One of the crucial challenges in PD diagnosis and management is the absence of reliable diagnostic biomarkers and variability in PD symptoms, leading to potential misdiagnoses. Artificial Intelligence (AI) solutions and quantum computing techniques can be utilized to enhance PD diagnosis, monitoring, and treatment. Several AI-based tools and systems have been developed that facilitate early diagnosis, continuous monitoring, data integration, and medication optimization. Quantum computing algorithms can further be developed to analyze medical data and make predictions regarding PD presence and progression. The accurate diagnosis of Parkinson's disease can be achieved through AI, and there is need for a strong collaboration between Artificial Intelligence (AI) and healthcare systems that can adapt to evolving needs. This will lead to a significant contribution to advancing AI in healthcare and improving patient well-being.

Introduction: Any bleeding coming out from uterus other than menstruation is abnormal uterine bleeding. It is major gynaecological problem leading to gross ill health especially in peri-menopausal and meno-pausal age group. It becomes mandatory to find the endometrial pattern in such cases to analyse the pattern of abnormal uterine bleeding.

Material & Methods: 450 patients reported with dysfunctional uterine bleeding during a period of one year (2019) in the department of Obstetrics & Gynaecology in a tertiary care hospital. Out of which 100 patients satisfied our inclusion and exclusion criteria. This was prospective study & was done to determine the types and frequencies of endometrial pathologies in women presenting with abnormal uterine bleeding who underwent endometrial sampling by Dilatation & Curettage. The data was presented in frequency and percentage. Correlation was found between the age & endometrial findings and between type of clinical symptom presentation & endometrial findings.

Results: 100 patients were included in the study according to the chosen inclusion and exclusion criteria. The majority of cases (38%) belong to the age group of 31-40 years followed by 32% in the age group of 41-50 years. DUB was more common in multiparous women (61%) followed by grand multiparous (19%) and nulliparous (20%). 67% of patients were of normal weight, 13% underweight and 20% were overweight.

Conclusion: Evaluation of women presenting with dysfunctional uterine bleeding is absolute necessity to detect underlying pathologies. The endometrial sampling is an important diagnostic tool in the management of abnormal uterine bleeding. The cause of DUB is strongly related to patient age, type of menstrual cycle and menopausal status.

This article explores the clinical features and  diagnostic utility of bronchoalveolar lavage associated with tuberculosis.Early diagnosis of pulmonary tuberculosis (PTB) is essential to reduce the spread, morbidity, mortality, and escalating costs associated with advanced disease.In this article 45 cases of tuberculosis are presented, highlighting the role of bronchoalveolar lavage . Mycobacterial culture is considered gold standard but time taken for results is 2-6 weeks. Bronchoalveolar lavage (BAL) is a safe, minimally invasive and inexpensive diagnostic technique commonly used to obtain cells, infectious agents and noncellular elements from the lower respiratory tract in patients with bilateral diffuse lung diseases.Bal fluid sample is also being used for applying Gene Xpert for MTB in our hospital sectors. Evaluation FOB/BAL is a useful diagnostic tool, and seems to have changed the course of therapy in more than half of patients, by initiation or cessation of treatment.

Eclampsia is defined as women with pre-eclampsia and a convulsion that cannot be attributed to other causes1. Eclampsia is one of the obstetric emergencies where resuscitation plays an important role and requires regular drills to optimise management. Hypertensive disorders of pregnancy has been one of the most important causes of morbidity and mortality worldwide in recent years2, 3. However in majority of the cases eclampsia is preceded by features of pre-eclampsia, imminent eclampsia and found to be more in rural population, young age, unbooked cases and primigravida2,3,4.

The need of the hour is to educate the women and health care workers regarding regular antenatal checkups, frequent BP monitoring, a good knowledge about high-risk symptoms and signs for good pregnancy outcome and to avoid maternal and foetal complications. This can be done with the help of flipcharts, pictures, information reflex and educational videos. The strengthening of existing health care facilities, timely referral system and transportation facilities helps in reducing morbidity and mortality. Appropriate anti-hypertensive management, administration of MgSO4 before referral at any health care facility, timely delivery, fluid management will ensure a good outcome in eclampsia.

Introduction: The liver is one of the most frequently damaged organs and remains the most common cause of death following blunt abdominal trauma. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability..

Aim and Objective: We aimed to analyze the effectiveness and morbi-mortality of both conservative and surgical treatment options.

Material and Methods: This prospective study was conducted at the Dept. of Traumatology and Surgery, MGM Hospital, Jaipur, Rajasthan, from April 2023 to July 2023. The study used non-probability consecutive sampling to select 80 liver trauma patients. The patients included were at least 18 years old and of both genders, and they were trauma patients who were hemodynamically stable at the time of presentation and voluntarily agreed to participate in the study.

Results: The study included patients with a mean age of 40.32 ± 11.5 years. The most prevalent types of extra-abdominal injuries among the patients were pancreas injuries (17.5%), CNS (Central Nervous System) injuries (57.5%), chest injuries (15%), diaphragm injuries (15%), spleen injuries (16.2%), and kidney injuries (10%). There was a significant variation (p=0.000) observed in the ICU stay and hospital stay between both study groups. We found 3.3% mortality in conservative group and 25% in operative group.

Conclusion: Conservative treatment is an adequate treatment in mild to moderate liver injury patients. Failure of conservative treatment did not show a higher incidence of complications or mortality but it should be performed in centres with experienced surgeons.

BACKGROUND: Gamma-glutamyl transferase (GGT) plays an important role of an enzyme responsible for breaking down glutathione, a vital antioxidant within mammalian cells.Coronary artery disease (CAD) stands as the primary reason of global mortality. Atherosclerosis stands as the primary factor behind Acute Coronary Syndrome (ACS)The pro-oxidant reactions facilitated by GGT subsequently accelerate LDL cholesterol oxidation, leading to peroxidation of lipids mainly LDL. This oxidative-stress brought about by GGT could potentially assume an important role in the formation of atheroma leading to atherosclerosis.

METHODOLOGY: The goal of this research is to measure the correlation amongst serum GGT levels in patients diagnosed with Acute Myocardial Infarction &amp; to analyse how these levels relate to their medical outcomes.

RESULTS: In our analysis, a serum GGT level equal to or exceeding 52.5 U/L was identified as a predictor factor for coronary atherosclerosis with a significance level of P&lt;0.022. The sensitivity of this predictor was found to be 72%, while the specificity was 71.4%.

CONCLUSION: GGT serves as a convenient, rapid, and effective marker of atherosclerosis. It provides insight into the extent of atherosclerosis among patients with myocardial infarction. Therefore, GGT can be employed as a supplementary marker for predicting atherosclerosis in individuals at risk