A B S T R A C T

Introduction: Proximal humerus fractures are common and debilitating injuries and its incidence is increasing especially in elderly. Fractures of the Proximal Humerus constitute 5% of all fractures. These are third most common fractures in elderly population after hip & distal radius fractures.

Aim: To find out the functional outcome of proximal humerus fractures in patients treated by internal fixation with PHILOS plate by using Neer's score.

Material and Methods: This was a prospective study conducted at department of Orthopaedics in a government hospital in Jaipur, Rajasthan. Sample size calculated was 30 patients.

Results: In the present study mean age of study subjects was 48.57 ± 14.95 years. Most of the patients with proximal humerus fracture undergoing PHILOS plating were males (60%) while 12 (40%) were females. In the present study most of the fracture humerus were of 3 part Neer type (50%), followed by 2 part type (30%) and 4 part type (16.7%), while only 1 (3.3%) patient had Fracture dislocation. All patients aged <30 years showed excellent outcome (100%). Among patients aged 30-49 years, most patients (70.6%) had satisfactory outcome and 17.6% patients had unsatisfactory outcome, only 2 (11.8%) patients had excellent outcome.

Conclusion: The incidence of complications and subsequent re-operation is relatively high. Based on our observations, inadequate positioning of the implant resulted in reduced functional outcome. Hence, to improve functional results, we consider plate positioning to be of utmost importance when using PHILOS plate fixation. Adequate surgical skills and surgeon’s experiences with the surgical technique are necessary to achieve correct implant fixation and avoid these intraoperative errors.

Background: Blood stream infection is a potentially life threatening infection with high mortality, which is predominantly caused by Staphylococcus aureus In the India. Methicillin classified MRSA is rising constantly in comparison of MSSA which makes Blood Stream infection more difficult to treat. On the other side BSI also classified on the basis of their transmission source, inside and outside of the hospital known as hospital acquired and community acquired BSI.  Objective: The aim of our study was to determine, is the sensitivity testing if sufficient for treating BSI caused by S. aureus by understanding the difference between community associated and healthcare associated S. aureus infection in terms of methicillin resistance, biofilm producing ability and antimicrobial resistance pattern. As previous study says hospital acquired BSI is more resistant and having more ability to form biofilm on implants which makes them more difficult to handle. As there is a lack of next level treatment possibilities we need to find out all relative information to fill the gap between testing and treatment. Methods: This is a prospective study carried out on Staphylococcus aureus isolated from the Blood culture through outpatient and inpatient departments during period “between” January 2017 to December 2017. A total of 58 Staphylococcus aureus isolates were recovered from blood culture. All strains classified as MRSA and MSSA based on cefoxitin resistance. ViteK and Micro broth dilution method were used for antimicrobial resistance pattern and biofilm production respectively. Results: Out of 58 non-duplicate Staphylococcus aureus isolates, 21(36.20%) were community associated and 37(63.79%) were hospital associated, out of which 10(47.62%) and 22(59.46%) were Methicillin resistant and 11(52.38%) and 15(40.54%) isolates were Methicillin sensitive respectively. The biofilm producing ability was recorded as high biofilm producer, low biofilm producer and non-biofilm producer. On the basis of particular classification both community acquired and hospital acquired based MRSA (10, 22) was fund 4(40%), 13(59.09%) High biofilm producers, 1(10%), 4(18.18%) low biofilm producers and 5(50%), 5(22.73%) non biofilm producers. On a same hand Out of all 11 and 15 MSSA isolates of community acquired infection and hospital acquired infection were found as 2(18.18%), 4(26.67%) high biofilm producer, 2(18.18%), 4(26.67%) low biofilm producers and 5(50%), 7(46.67%) non biofilm producers. The antimicrobial resistance pattern difference been reported between hospital acquired and community acquired infection. The impact of biofilm producing ability been found on resistance pattern of all isolates. Conclusion: In our study most isolates were hospital associated. The presence of high resistance in IPD isolated MRSA isolates represent the impact of some other factors in hospital on antimicrobial resistance pattern, and  after understanding the impact of biofilm production on resistance pattern helping somehow to fill the gap in between testing and treatment.

Background: Peripheral Arterial Disease (PAD) is a significant complication in patients with diabetes mellitus, often leading to increased morbidity. This study aimed to evaluate the effectiveness of the Ankle-Brachial Pressure Index (ABPI) as a diagnostic tool for PAD in this patient population.

Methods: This prospective study included 150 diabetic patients. The ABPI was measured and correlated with clinical parameters, including age, duration of diabetes, BMI, smoking status, and glycemic control. The sensitivity, specificity, and AUC of ABPI for PAD detection were calculated.

Results: The study found that abnormal ABPI readings were significantly associated with older age (p < 0.001), longer duration of diabetes (p < 0.001), higher BMI (p < 0.001), and smoking (p = 0.012). Poor glycemic control was also linked to abnormal ABPI readings (p < 0.001). The ABPI showed a sensitivity of 85% and a specificity of 80% for diagnosing PAD, with an AUC of 0.83. Patients with hypertension and dyslipidemia had a higher prevalence of abnormal ABPI readings.

Conclusion: ABPI is a reliable diagnostic tool for detecting PAD in patients with Diabetes Mellitus. Its effectiveness is influenced by several patient-related factors, including the duration of diabetes, BMI, and glycemic control. Regular ABPI screening is recommended in diabetic patients, especially those with additional cardiovascular risk factors.

Background: Dengue fever, a significant public health concern, is known for its systemic and potentially severe complications. This study aimed to investigate the incidence and nature of pulmonary complications in dengue patients.

Methods: In this prospective study, 100 patients with confirmed dengue infection were evaluated for the development of pulmonary complications. Data on demographic characteristics, clinical presentation, laboratory findings, radiological results, treatment, and outcomes were collected and analyzed.

Results: Pulmonary complications were observed in 43% of the patients. The most common complication was pleural effusion (20%), followed by pulmonary edema (10%), acute respiratory distress syndrome (ARDS) (8%), and pneumothorax (5%). The study highlighted a significant association between older age (>40 years) and increased risk of pulmonary complications (OR 2.5, p = 0.005). Patients with pulmonary complications had a longer hospital stay (mean 7 days, SD ± 2) compared to those without (mean 4 days, SD ± 1, p < 0.01) and were more likely to require ICU admission (23.25% vs. 3.51%, p < 0.001).

Conclusion: The study demonstrates a high incidence of pulmonary complications in dengue patients, with age being a significant risk factor. These findings underscore the need for vigilant monitoring and early intervention in managing dengue, particularly in older patients

Background: Hypertension is a complex cardiovascular disorder with multifactorial etiology. This study aimed to investigate the association between serum calcium and magnesium levels and hypertension.

Methods: A prospective observational study was conducted with 100 newly diagnosed hypertensive patients and 100 normotensive controls. Serum calcium and magnesium levels were measured, and their correlation with blood pressure was analyzed.

Results: Hypertensive patients exhibited significantly higher serum calcium levels (9.8 ± 0.6 mg/dL) compared to normotensive controls (9.4 ± 0.5 mg/dL, p < 0.001). Conversely, serum magnesium levels were lower in hypertensive patients (1.9 ± 0.2 mg/dL) than in controls (2.1 ± 0.2 mg/dL, p = 0.003). A positive correlation was found between serum calcium levels and blood pressure severity (systolic: r = 0.28, p = 0.004; diastolic: r = 0.19, p = 0.03), while an inverse correlation was observed for magnesium (systolic: r = -0.31, p = 0.002; diastolic: r = -0.25, p = 0.01).

Conclusion: The study highlights the significant association of serum calcium and magnesium levels with hypertension. These findings suggest the potential of serum mineral levels as predictive markers and therapeutic targets in hypertension management.

Background: Acute ischemic stroke (AIS) is a major cause of morbidity and mortality worldwide. Identifying reliable prognostic biomarkers is crucial for managing AIS effectively.

Methods: This prospective observational study included 125 AIS patients. Serum albumin and CRP levels were measured at admission, 48 hours, 72 hours, and at discharge. Patients were followed up for six months, focusing on mortality, functional recovery, and post-stroke complications.

Results: Lower serum albumin and higher CRP levels at admission were significantly associated with increased stroke severity and poorer outcomes. The mortality rate at 6-month follow-up was 12%. Each g/dL decrease in albumin increased the odds of adverse outcomes by 25% (Odds Ratio 0.75, 95% CI 0.62 - 0.91, p < 0.05), and each unit increase in CRP was associated with a 5% increase in the odds of adverse outcomes (Odds Ratio 1.05, 95% CI 1.01 - 1.09, p < 0.05). A significant negative correlation was observed between serum albumin and CRP levels (correlation coefficient -0.52, p < 0.01 at 72 hours).

Conclusion: Serum albumin and CRP levels are significant prognostic biomarkers in AIS, associated with stroke severity and outcomes. Their routine assessment could aid in risk stratification and management of AIS patients.

Background: Acne vulgaris is a prevalent skin condition requiring effective treatment strategies. This study compares the efficacy and tolerability of topical Clindamycin alone versus a combination with Benzoyl Peroxide in treating mild to moderate acne.

Methods: A randomized study involving 200 participants compared Clindamycin alone (n=100) and Clindamycin combined with Benzoyl Peroxide (n=100). The primary outcome measures were total lesion count and Investigator Global Assessment (IGA) scores over 8 weeks. Adverse events and patient compliance were also evaluated.

Results: The combination therapy group showed a greater reduction in total lesion count (64.7% reduction) compared to the Clindamycin group (48.6% reduction) with a significant difference (p<0.001). IGA score improvement was also more substantial in the combination group (52.9% improvement) compared to the Clindamycin group (44.4% improvement, p=0.046). Adverse events were more frequent in the combination group but did not significantly affect compliance.

Conclusion: The combination of Clindamycin and Benzoyl Peroxide demonstrated superior effectiveness in treating mild to moderate acne compared to Clindamycin alone, with a higher but manageable rate of adverse events. These findings suggest that combination therapy can be a more effective option for acne management, balancing efficacy and tolerability.

Background: With the rampant rise in globalization and urbanization, there is an alarming escalation in the burden of common Non-communicable diseases which are the prime causes of mortality and morbidity especially in a country like India, a country in rapid demographic transition.

Objectives: This study was conducted to estimate the burden of Hypertension and Diabetes along with 10 year fatal and nonfatal cardiovascular risk estimation.

Methods: A cross-sectional population-based study was conducted among adults aged 18 and above in Manipur. The study outcome was to estimate the prevalence of hypertension and diabetes using a validated questionnaire adapted from WHO PEN along with 10 year fatal and non-fatal cardiovascular risk using the WHO/ISH chart. Statistical analyses like mean, chi-square, and logistic regression tests were conducted. P value <0.05 was considered statistically significant.

Results: Of the 560 participants, 27.5% were hypertensive and 10.7% were diabetic. One in three of them had one of the NCDs and 5.7% had NCD multimorbidity. Higher age group [odds ratio (AOR): 5.2], inadequate physical activity [AOR: 2] and overweight [AOR:2] were significantly associated with the burden of hypertension whereas diabetes was significantly associated with higher age group [AOR: 9.5] and abdominal obesity. [AOR: 3]. A quarter of them had 10-19% risk of CVD and 10.7% of the individuals had 20-30% risk of developing CVD in the next 10 years.

Conclusion: A quarter of respondents were hypertensive which mirrors the rule of halves for hypertension, one in 10 of respondents were diabetic and a quarter of them had a CVD risk of 10-19%. Despite the high burden of these diseases, a majority of them were under diagnosed mandating the need for cost-effective, high-quality interventions in low-resource settings.

Rheumatoid Arthritis is a chronic inflammatory multi systemic disorder. In our tertiary care hospital in eastern India, we observed all the patients in both Indoor and Outdoor patients department presenting with Early Rheumatoid Arthritis. We assessed the severity of the disease via DAS 28 score among the patients. It was found that all the patients had moderate to high disease activity during presentation. On further evaluation, it was found that some patients were seronegative. Although seropositive patients have higher disease activity with more progressive disease and multi systemic involvement, DAS 28 score had poor positive correlation with both RA factor and Anti CCP in our study.

Background: Preterm neonates face significant health challenges, with outcomes influenced by various maternal, neonatal and clinical factors. As the formation and maturation of central nervous system of preterm neonates is incomplete, they are more vulnerable to brain injury. In this study we have assessed the role of Neurosonography in early diagnosis of intracranial pathologies in preterm neonates.

Methods: This study involved a retrospective analysis of 100 preterm neonates admitted to Quaternary care hospital's NICU. We assessed demographic data, maternal and neonatal risk factors, clinical presentations, and neurosonography findings.

Results: The gender distribution was nearly equal (51% female, 49% male). Most neonates had a birth weight >1.5 kg (77%) and were ≤34.0 weeks gestation (54%). High prevalence of abnormal maternal risk factors was noted, including PPROM (28%), GDM (14%), and eclampsia (10%). Mechanical ventilation was required in 47% of cases. Common co-morbidities were RDS (37%), TTN (33%), and Neonatal Hyperbilirubinemia (27%). Neurosonography showed a high incidence of abnormalities (55%), with Germinal Matrix Hemorrhage (36%) and Cystic-Periventricular Leukomalacia (18%) being significant. A strong correlation was observed between lower birth weight, earlier gestation, and abnormal neurosonography findings (P values 0.038* and 0.033*).

Conclusion: There was moderately significant association between abnormal NSG and gestational age and birth weight. Most common intracranial abnormality detected through NSG was Germinal matrix haemorrhage and it carried the highest mortality. RDS, Severe RDS, TTN, Neonatal Sepsis, Neonatal hyperbilirubinemia had significant with abnormal NSG. This study concludes that early neurosonography in preterm neonates’ aids in predicting abnormal neurological outcome and preventing long term sequelae.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a complex respiratory condition characterized by airflow limitation and systemic inflammation. The COPD Assessment Test (CAT) is an established tool for evaluating the impact of COPD on patient health status. Recent studies have suggested that the Neutrophil Lymphocyte Ratio (NLR) may reflect systemic inflammation and predict exacerbations in COPD.

Objective: To establish the correlation between NLR and CAT scores in COPD patients and to evaluate the potential of NLR as a biomarker for disease severity.

Methods: This cross-sectional observational study included 45 COPD patients. NLR was calculated from complete blood counts, and CAT scores were obtained. Pearson’s correlation coefficient was used to analyze the relationship between NLR and CAT scores.

Results: The mean NLR was 3.5 ± 1.3, and the mean CAT score was 18.2 ± 5.6. A significant positive correlation was found between NLR and CAT scores (r=0.68, p<0.001). Higher NLR values were associated with higher CAT scores, particularly in the highest CAT score category (>20), which had a mean NLR of 4.2 ± 1.1 (p<0.001).

Conclusion: The study provided evidence for a significant positive correlation between NLR and CAT scores, suggesting that NLR could be a valuable biomarker for COPD severity and patient health status impact. These findings reinforce the role of systemic inflammation in COPD and support the potential use of NLR in routine clinical assessment.

Pleomorphic adenoma is the most common benign salivary gland tumor which commonly affects the parotid gland. Minor salivary glands of the palate can be involved, which is the most common intraoral site affected. Pleomorphic adenoma contains both epithelial and myoepithelial cells hence they are referred to as benign mixed tumors. Here we report a case of a female who presented with swelling in the hard palate, which was diagnosed as pleomorphic adenoma.

Introduction :  Association  between  TB  and  malnutrition  is  bidirectional.  Under nutrition  increases  the  risk  of  progression  of  TB  infection  to  active  TB  and  further increases  metabolism  leading  to  weight  loss.  Hence  the  current  study  was  taken  up

Methodology :  Descriptive  cross  sectional  study  was  done  among  65  TB  patients who  were  started  on  anti  tuberculosis  treatment  in  April- June,2022  for  the  first  time. Sample  size  was  calculated  based  on  prevalence  of  malnutrition  among  TB  patients  that is  21%  (n= 4pq/L2).  Study  population  was  selected  by  simple  random  sampling. The  data was  collected  by  interviewing  the  patients  with  pretested  semi structured  questionnaire.

The  data was  entered  and  analyzed  using  SPSS  Software

RESULTS : 65  participants  were  taken  into  study  mean  age  was  48.31± 15.9 years; 70.77% were  men;  mean  BMI  was  18.8±  0.39 kg/m2;  70.8%  were  pulmonary  TB  and  29.2%  were  extra  pulmonary  TB;  9.23%  were  diabetics;  6.15%  were  reactive  to  HIV  ;prevalence of  malnutrition  among  study  subjects  was  46.2%  with  BMI<18.5 kg/m2

Discussion :The study revealed that 46.2% of study population are malnourished and was comparable to the study done by Berhanu Elfu Et Al where 57.17% were malnourished

Conclusions :  High  proportions(46.2%)  of  TB  patients  were  malnourished  so  high priority  to  be  given  to  improve  nutrition  among  TB  patients  in  NTEP

SUMMARY : Malnutrition  is  a  serious  problem  among  TB  patients , and  high  priority should  be  given  to  improve  nutrition  among  TB  patients , thus contributing  to  treatment success rate

Background: Enterococci are nosocomial pathogen. Their pathogenic potential has been attributed to their ability to resist antimicrobial drugs intrinsically, acquire and distribute antibiotic resistance determinants and adapt to changing environments. Linezolid resistance occurs by the mutations in the domain V of 23S rRNA, the presence of the cfr gene or mutations in the L3 and L4 ribosomal proteins. Erythromycin resistance is mainly due to target-site modification by the rRNAmethylating enzyme encoded by the erm gene or mediated by efflux pump mechanisms. This study aimed to detect and characterize the antimicrobial resistance mechanism to oxazolidinone (linezolid) and macrolide (erythromycin) among clinical isolates of Enterococci. Studies describing theresistance to erythromycin and linezolid are limited.

Objective: This study aimed to detect and characterize the antimicrobial resistance mechanismto oxazolidinone (linezolid) and macrolide (erythromycin) among clinical isolates of Enterococci.

Materials and Methods: A total number of 150 clinical isolates were included in this study. Susceptibility to various antibiotics was determined by disc diffusion. Minimum Inhibitory Concentration (MIC) was ascertained by agar dilution method for linezolid and erythromycin. Polymerase chain reaction was done to detect the genes, ermB and cfr that encode for erythromycin and linezolid respectively.

Results: Among 150 isolates, predominant were Enterococcus faecalis 116 (77%)  followed by  Enterococcus faecium 34 (23%). Of the 150 study isolates, the susceptibility to ampicillin was 64.6% (97/150), high level gentamicin 47% (70/150), linezolid (100%) and vancomycin (100%). Of the 90 exudative enterococcal isolates, only 13 were susceptible to erythromycin. Of the 77 erythromycin resistant isolates, ermB gene was detected in 42 and exhibited a high levelresistance with >32 mg/ml. The gene encoding for linezolid resistance, cfr was not detected in any of the study isolates.

Conclusion: High level resistance to erythromycin is mediated by ermB. Vancomycin and linezolid resistance were not encountered in the study. However, continuous monitoring of antimicrobial resistance of Enterococcus species is necessary to provide a guide for the appropriate selection of antibiotics for treatment and to implement preventive measures. 

Background: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a critical drug-induced hypersensitivity, often associated with antiepileptic drugs.

Case Report: A 21-year-old male with epilepsy developed DRESS syndrome after 8 weeks of phenytoin treatment. Symptoms included fever, widespread erythematous rashes, lymphadenopathy, and gastrointestinal discomfort. Laboratory findings showed leukocytosis, eosinophilia, and elevated liver enzymes, with high serum phenytoin levels. The Regi SCAR score was 7, confirming the diagnosis. Management involved discontinuing phenytoin, starting alternative antiepileptics, and administering corticosteroids and immunosuppressants, leading to patient improvement.

Discussion: This case emphasizes the necessity of early recognition and management of DRESS syndrome in patients on antiepileptic medication. It highlights the importance of the RegiSCAR criteria for diagnosis and the need for vigilant drug level monitoring. The variable presentation of DRESS syndrome, often leading to misdiagnosis, is also discussed.

Conclusion: DRESS syndrome is a life-threatening condition requiring prompt diagnosis and treatment. Awareness among clinicians is essential for early intervention and improved patient outcomes

Background: Type 2 diabetes mellitus (T2DM) patients with uncontrolled sugar are at increased risk of atherosclerosis as compared to diabetic patients with controlled sugar. Detecting atherosclerosis in its subclinical stages can potentially impede or mitigate the development of complications such as coronary artery diseases, stroke, and peripheral vascular diseases. Early identification offers the opportunity to implement interventions that may slow down the progression of the disease and reduce the risk of atherosclerotic-related complications.

Objective: Identification of subclinical atherosclerosis in controlled and uncontrolled diabetic patients and explore various factors [highly sensitive C-reactive protein (hs-CRP) and triglyceride (TG)] that can be associated with a high risk of subclinical atherosclerosis.

Patients and methods: We recruited 60 known case of T2DM patients without any clinically manifested disease and without any past history of a vascular disease. Those patients were divided into two equal groups, well controlled and uncontrolled based on their HbA1c. After complete history and physical examination, investigations including serum triglyceride (TG), hs-CRP, fasting and 2 hours postprandial blood glucose were obtained. All participants underwent for measurement of carotid intima media thickness (CIMT),marker of subclinical atherosclerosis by duplex ultrasonography.

Results: Uncontrolled diabetic patients have increased CIMT (6.9394mm) as compared to controlled diabetic patients (.8181mm). There was highly significant positive correlation between CIMT and hs-CRP in uncontrolled diabetic group (p value .001, r value .469) but no association within controlled diabetic group ( p value .074 and r value was .244) . While significant positive correlation with CIMT and TG level in controlled diabetic group (p value <.001 and r value was .689) and no correlation between CIMT and TG level in uncontrolled diabetic group (p = .195 , r = .175).

Conclusion: The risk of subclinical atherosclerosis is more in uncontrolled diabetics as compared to controlled diabetics. In uncontrolled diabetics subclinical atherosclerosis was associated with elevated hs-CRP level and in controlled diabetic CIMT was associated with elevated serum TG levels

Background and Objective: Parallel opportunistic infections have been identified as an additional illness spectrum since the COVID-19 pandemic began. One of these opportunistic diseases that needs attention is mucormycosis, which has seen a sharp rise in cases and rapid dissemination when compared to the pre- COVID-19 era. Following COVID-19, there have been instances of immune suppression. in addition to the presence of comorbid illnesses, which raises the possibility that mucormycosis will be deadly. Early detection and prompt diagnosis can save lives. Magnetic resonance imaging (MRI) imaging is the cornerstone of care for individuals with ROCM. The use of MRI imaging in ROCM was reviewed in this review, with particular attention paid to the optimal MRI protocol in a ROCM case, the routes by which infection spreads, the conventional diagnostic features, MRI for disease staging, MRI for prognostication, MRI for follow-up, and imaging characteristics of common differentials in ROCM.

Materials and Methods: This hospital-based prospective study was conducted on 20 people who tested positive for COVID-19 RTPCR over the course of six months, from March 2021 to August 2021, at the Department of Radiodiagnosis, Alluri Sitarama Raju Academy of Medical Sciences, Eluru. Patients had PNS, orbits, and brain MRIs, which were then analyzed. The statistical analysis employed descriptive statistics.

Image reconstruction: Volume rendering approaches for all axial, coronal, and sagittal reformats have been applied. For vascular assessment, projection images with the maximum and average intensities are used. As noted, clinical and radiological follow-up was done on the cases.

Results: 20 patients were discovered to have rhino orbital cerebral mucor mycosis out of 50 COVID 19 RTPCR positive cases; follow-up biopsies confirmed this diagnosis. Out of 20 individuals with mucor, 11 patients had involvement in the nasal cavity and paranasal sinuses, 6 patients had orbital involvement, and 4 patients had central nervous system involvement.

Conclusion: Imaging is essential for guiding surgical treatments even before clinical symptoms appear and for assessing the severity of the disease, which facilitates a timely diagnosis. When mucor spreads into the orbits and neck regions early in the disease, fat stranding may be the only imaging indicator of extra-sinus dissemination. Therefore, it is critical to thoroughly assess fat-suppressed sequences on MRI when making a diagnosis.MRI is used as a screening method to assess mucormycosis even in the absence of clinical symptoms. Therefore, MRI is essential for determining the severity, stage, and prognosis of a disease, information that is useful for therapy planning.

Background: Total knee arthroplasty (TKA) is a common orthopedic procedure aimed at alleviating pain and restoring function in patients with knee osteoarthritis. The choice of surgical approach can significantly impact postoperative outcomes, particularly in terms of recovery speed and pain management.

Methods: This summary synthesizes findings from multiple studies comparing the subvastus (SV) and medial parapatellar (MPP) approaches in TKA. The focus is on early functional outcomes, including quadriceps strength recovery and pain reduction.

Results: Patients undergoing TKA via the SV approach demonstrated a quicker return of quadriceps strength and slightly better pain scores in the immediate postoperative period. Specifically, a 0.8-point improvement in pain scores (95% CI 0.22 to 1.35) was noted in favor of the SV approach compared to the MPP approach.

Conclusion: The SV approach to TKA offers advantages in terms of faster postoperative recovery, particularly with regard to quadriceps strength and pain management. These benefits highlight the role of tissue-sparing surgical techniques in enhancing patient outcomes after knee arthroplasty

Background: Peripheral neuropathy is a prevalent and debilitating complication of Type 2 Diabetes Mellitus (T2DM), significantly affecting patients' quality of life. This study aimed to assess the prevalence and correlates of peripheral neuropathy among T2DM patients.

Methods: A cross-sectional study was conducted on 400 T2DM patients, assessing the presence of peripheral neuropathy and analyzing its association with demographic, clinical, and lifestyle factors.

Results: The prevalence of peripheral neuropathy was found to be 40%. Significant correlates of peripheral neuropathy included BMI ≥30 kg/m² (adjusted Odds Ratio [aOR]=1.8, p=0.02), duration of diabetes >10 years (aOR=2.3, p<0.01), and HbA1c >9% (aOR=2.9, p<0.01). Smoking showed a trend towards increased risk but was not statistically significant in the adjusted model.

Conclusion: Peripheral neuropathy affects a significant proportion of T2DM patients, with obesity, long duration of diabetes, and poor glycemic control being key associated factors. These findings highlight the critical need for integrated diabetes management strategies focusing on weight and glycemic control to prevent or delay the onset of peripheral neuropathy.

A 103-year-old female, with a history of hypertension, presented with a 6-month history of a progressive, ulcerative growth on her left thumb following trauma and subsequent nail excision. The lesion, originating from the nail bed, exhibited no discharge, bleeding, or pain but was associated with a foul smell and restricted thumb movement. Despite the absence of systemic symptoms, the growth's insidious nature and physical examination findings prompted urgent surgical intervention. The patient underwent a successful excision of the affected thumb, including metacarpal bone removal under local anesthesia. Histopathological examination confirmed well-differentiated squamous cell carcinoma (SCC). Postoperative recovery was uneventful, with the patient being discharged on postoperative day 1 and showing no signs of infection or complications at a 10-day follow-up. This case underscores the importance of considering SCC in persistent, non-healing wounds of the nail bed in geriatric patients, highlighting the challenges in diagnosis and the necessity for prompt surgical management to prevent disease progression.

This retrospective cohort study aimed to assess the clinical and radiological outcomes of utilizing a suprapatellar approach for intramedullary tibial nailing in the semi-extended knee position to manage proximal tibia fractures in patients with diabetes. Proximal tibia fractures, common in the knee joint, can significantly impact the quality of life, occurring frequently in women as they age and resulting from high-energy trauma in younger patients or low-energy fractures in the elderly. Diabetes, a known cause of delayed bone healing and soft tissue repair, can lead to diabetic dermopathy, reducing blood flow and sensation in the skin, making wound healing challenging. Additionally, high blood sugar levels in diabetes impair the immune response, increasing infection risk and further delaying healing. The study, conducted at the Department of Orthopedics in RGMC & CSMH Kalwa Thane over 18 months, included 30 patients with proximal 1/3rd Tibial fractures and mean HbA1c of 7.1, while excluding those with pathological fractures, periprosthetic fractures, deformities in the same limb, severe knee osteoarthritis, Gustilo Grade 3C open Tibial fractures, or severe soft tissue lacerations, contamination, and suprapatellar area infection. The suprapatellar approach in the semi-extended knee position offered an alternative to traditional methods, facilitating fracture reduction, especially for proximal third tibial and diaphyseal fractures, and yielding excellent functional outcomes with early radiological recovery and no postoperative anterior knee pain or malalignment. This approach appears safe, with minimal complications compared to conventional methods, making it a valuable option for managing proximal tibia fractures in diabetic patients, potentially improving fracture management and patient outcomes

Background: ketamine is unique in the sense that it produces dissociative anaesthesia rather than generalized depression of the CNS.  Aim: The aim of this study was to evaluate the effect of administration of ketamine as the only anesthetic drug utilized to induce the patients, maintain intraoperative hemodynamics, postoperative analgesia, and analgesia during certain operations like appendectomy, Hernia, Hydrocele and circumcision at a district hospital in Assam. Settings and Design: This prospective, observational study was conducted from January2023 to December2023, over a period of 12 months in a District hospital in Assam. Materials and Methods: Fifty individuals aged 15 to 40 who were scheduled for various procedures were enlisted. Before surgery, ketamine was administered at a dose of2 to 3 mg/kg. During the procedure, this dose was repeated every ten to fifteen minutes at a rate of .5 to 1 mg/kg. For the first five hours, hemodynamic parameters, the duration until the first rescue analgesia, and complications were noted.  Results: Within the first five hours following surgery, 90% of the patients did not require any postoperative rescue analgesics. 10% of the patients experienced mild postoperative problems, and none of the patients reported pain right away after finishing of procedure.  Conclusion: Ketamine with inducing doses have been shown to be effective analgesics, especially during procedures like conventional appendicectomy, operations for Hernia, Hydrocele and Circumcisions.

Background: The efficacy of Nalbuphine and Fentanyl as adjuvants to Bupivacaine in supraclavicular brachial plexus blocks remains a significant point of study in anesthesia, particularly for upper extremity surgeries.

Methods: This randomized study compared Nalbuphine and Fentanyl added to Bupivacaine in 60 patients undergoing upper extremity surgeries. The onset and duration of sensory and motor blocks, as well as hemodynamic parameters, were evaluated.

Results: Nalbuphine demonstrated a significantly faster onset of sensory (5.03 ± 0.88 minutes) and motor blocks (7.1 ± 0.84 minutes) compared to Fentanyl (sensory: 7.5 ± 0.5 minutes, motor: 8.9 ± 0.831 minutes), with p < 0.001. The duration of sensory and motor blocks was also significantly prolonged in the Nalbuphine group (sensory: 360.87 ± 8.64 minutes, motor: 348.17 ± 12.54 minutes) compared to the Fentanyl group (sensory: 344.9 ± 12.24 minutes, motor: 324.1 ± 14.04 minutes), p < 0.001. Hemodynamic parameters were stable and comparable between the groups.

Conclusion: Nalbuphine, as an adjuvant to Bupivacaine, offers a faster onset and longer duration of both sensory and motor blocks in supraclavicular brachial plexus blocks compared to Fentanyl, with maintained hemodynamic stability.

Ashwagandha (Withania Somnifera) is widely used as an adaptogenic medicinal herbin Ayurveda, the Indian system of Medicine. This study assessedpotential toxic effects associated with repeated oral administration of Ashwagandha root extract (ARE) for two weeks in Wistar rats. Twenty male and female Wistar rats were assigned to four groups viz., control, ARE (500/1000/2000 mg/kg body weight per day). Animals were observed for mortality/morbidity, clinical signs of toxicity (daily cage side observation), clinical examination (gait, mobility, arousal level, respiration, clonic/tonic movement, stereotype, bizarre behaviour, defecation, urine pools, vocalization, and rearing) prior to dosing and before necropsy day, body weight (weekly), and feed consumption. After 14 days, the animals were euthanized (CO2) and subjected to detailed gross necropsy (examination of external orifices, cranial, thoracic, and abdominal cavities, and their contents). Organs (liver, kidney, heart, spleen, brain, adrenal, thymus, ovaries, uterus with cervix, testes, and epididymis) were removed and weighed. No clinical signs of toxicity were observed with Ashwagandhatreated groups, and it had nosignificant (p>0.05) effect on body weight and feed consumption by animals compared to control. No differences (p>0.05) were observed between ARE treated animals and control with respect to the absolute and relative organ weightand gross pathological findings. Ashwagandha root extract was found to be well tolerated in doses up to 2000 mg/kg body weight administered orally for 14 days in Wistar rats.

Aims and objectives: To determine the diagnostic accuracy of Magnetic Resonance Imaging (MRI) in the detection of sellar region tumors and to study the correlation between MRI and histopatological findings in their evaluation.

Materials and methods: An analytical cross-sectional study was performed in the department of Radiology and imaging in collaboration with department of Neurosurgery and Pathology, ASRAM Medical college and Hospital, Eluru, during the period of May 2022 to March 2023. MRI of brain was performed using 1.5 Tesla MRI scanner, Seimens Magnetom Avento Syngo (MR D- 13) 16 channel machine on 35 patients referred for evaluation of sellar region tumors and the findings were correlated with histopathological results post-operatively.

Results: The mean age group of sellar region tumors was 32.4 (±1.85) years. Most common sellar region lesion diagnosed on MRI was pituitary macroadenoma comprising 37% of the total cases. Among the total MRI diagnosed 35 cases, 28 (80%) cases were confirmed histopathologically. The accuracy, sensitivity, specificity, and negative predictive value (NPV) of MRI in diagnosing sellar region tumors were in the range of 88.9- 94.3%, 80- 91.7%, 89.7-96.7%, and 95.5- 96.7%, respectively.

Conclusion: The sensitivity and specificity of MRI in diagnosing various types of sellar region tumors almost paralleled histopathological results (gold standard) and was found in between 82% to 91%. This research concludes that MRI is a useful imaging technique for the diagnosis of malignancies in the sellarregions and pituitary adenoma

The symptoms of obesity hypoventilation syndrome (OHS), often called "Pickwickian syndrome," include hypercapnia during the day, sleep-disordered breathing, and obesity overall. An exclusionary diagnosis. A worsening of or a persistent condition of increasing dyspnea might be observed in patients. This case study details the symptoms and management of a 61-year-old female patient who arrived with shortness of breath with physical exercise and was diagnosed with severe obesity (BMI: 51.9 kg/m2). Very high levels of carbon monoxide were detected in the arterial blood gas (ABG) study. Hypertension, diabetes, obesity, dyslipidemia, and hypothyroidism were all present in this patient. After the patient was stabilised, they were quickly treated with non-invasive ventilatory (NIV) support and supportive care. The patient was prescribed NIV to use overnight and was discharged.