Introduction: Postpartum urinary retention (PUR) is defined as being unable to void completely after delivery .The covert PUR is described as “a post void residual bladder volume (PVRV) of ≥ 150 ml after spontaneous micturition, verified by ultrasound or catheterization”.Aims & Objectives:The aim was to identify high risk factors for covert postpartum urinary retention after vaginal delivery by ultrasonography and objectivesare to study theprevalence of covert PUR and to assess the associated obstetric variables.Material & Methods: In this prospective observational descriptive study 250 postpartum women were taken who delivered vaginally without urinary symptoms.. The post void residual volume (PVRV) wasmeasured by ultrasonography urinary bladder region at the time of discharge. PVRV < 150 ml was considered as normal and treated asCONTROL GROUP; PVRV ≥ 150 ml was considered as STUDY GROUP.For all participants, maternalcharacteristics such as age and parity; gestational age at onset of labor; induction of labor, duration of second stage of labor; and episiotomy; were collected and statistically analysed.Results: The characteristics of the patients with or without covert PUR were compared gestational weeks (p = 0.043),induction of labour (p=0.003), duration of second stage of labor (p value <0.001); and need for episiotomy (p=0.003) werefound to be statistically significant between patients with PVRV under 150 mL and ≥150 mL. Age and parity were not foundto be statistically significant.Conclusion: In this study gestational weeks, induction of labour , duration of second stage of labor and need for episiotomy were identified as risk factors for covert post partum urinary retention. This study may help us to identify a high risk group for postpartum covert urinary retention.

Background: Sickle cell anemia (SCA) is amongst the most common genetic condition. It is the mutation of beta globin chain and has been acknowledged to have a global public health impact. This disease is common among many tribal and backward populations in India. In the central India its prevalence varies from 10-40%. It can be classified as two types of homozygous sickle cell disease and heterozygous sickle cell trait. Hand-foot syndrome (swelling), pain and anemia are some of the very common complications of the disease. In Sickle cell anemia, the number of healthy RBCs decrease which results in reduction of Oxygen in the tissues.Objectives: Currently available drugs do not seem to improve hemoglobin level of patients of Sickle cell anemia to considerable extent. Our experience with Hemoxin R Plus, an Ayurvedic medicine was very encouraging in improving quality of Life of SCA patients. Our aim of this analysis of the data available with us was to compare safety and efficacy of Hemoxin R Plus, with the standard of care in improving hemoglobin, RBC and Quality of life and in patients having SCA.Materials and Methods: This was a retrospective analysis. Hospital records of the patients were used and reviewed for the analysis. Data was collected by the doctors from the medical records department, who treated the patients. Data analysis was done by applying Levene's Test for Equality of Variances. Results: Hemoxin R Plus was found to be better than the standard of care (hydroxyurea and folic acid) for every parameter considered for analysis, viz. Hemoglobin, RBCs and Sr. Creatinine. Hemoxin R Plus was found to be safe in the dose administered, as there were no adverse events reported, and liver markers and Sr. Creatinine did not go higher for any patient.Conclusion: Capsule Hemoxin R Plus can be used for of the management of sickle cell anemia in improving hemoglobin, RBCs and in reducing pain and inimproving the quality of life.

Background: Hypertrophic scarring presents a significant therapeutic challenge in dermatologic practice. Fractional CO₂ laser therapy has emerged as a promising treatment modality, yet comprehensive clinical data remains limited. Objective: To evaluate the efficacy and safety of fractional CO₂ laser therapy in the management of hypertrophic scars through objective and subjective parameters. Methods: Forty-five patients with hypertrophic scars underwent three sessions of fractional CO₂ laser treatment at 6-week intervals. Outcomes were assessed using Vancouver Scar Scale (VSS), digital caliper measurements, standardized photographs, patient-reported outcomes, and independent observer evaluation. Results: Mean scar thickness decreased from 3.8 ± 0.9 mm to 2.0 ± 0.5 mm (47.4% reduction, p<0.001), as measured by digital caliper with high inter-observer reliability (ICC: 0.91-0.94). Total VSS scores improved from 9.8 ± 2.1 to 4.5 ± 1.1 (p<0.001). Patient-reported pain and pruritus showed significant reduction (mean change: -4.4 points, p<0.001). Independent observer assessment demonstrated 51-75% improvement in 46.7% of cases (Kappa=0.84). Younger scars (≤1 year) showed superior response compared to older scars (VSS improvement: 5.8 ± 1.2 vs 4.9 ± 1.1, p=0.023). Transient adverse events included erythema (100%) and edema (93.3%), with mean recovery time of 5.8 ± 1.4 days. Conclusion: Fractional CO₂ laser therapy provides significant improvement in hypertrophic scars with a favorable safety profile and minimal downtime. Early intervention yields superior outcomes, suggesting optimal timing as an important consideration in treatment planning.

Trauma are the leading cause of death in the first four decades of life. Nevertheless, thoracic traumas only seldom require invasive procedures. In particular, chest drain placement is required in case of pleural disruption causing haemothorax, pneumothorax or haemopneumothorax. Although large-bore chest drains have been traditionally used in case of haemothorax, recent evidences seem to question this routine, showing good performances of small-bore and pig tail drains. Although it is a common procedures, experience and training is needed to avoid complications which might be even lethal. Surgical exploration after thoracic trauma is rare, accounting for less than 3% of traumas. Penetrating traumas more likely requiresurgical exploration compared to blunt trauma. Anterolateral thoracotomy is usually performed in this setting, but also clamshell or hemi-clamshell approach can be used. In selected patients, minimally invasive techniques can be performed. Large randomized trials are still needed to assess and standardized the role of new tools and procedures in the thoracic trauma setting.

Background: Vitamin D deficiency has emerged as a potential contributor to insulin resistance in type 2 diabetes mellitus (T2DM). This study investigated the relationship between vitamin D status and insulin resistance among patients with T2DM.Methods: A prospective cross-sectional study was conducted at a tertiary care center involving 328 T2DM patients. Serum 25-hydroxyvitamin D levels, glycemic parameters, and insulin resistance (HOMA-IR) were measured. Multiple linear regression analysis was performed to identify independent predictors of insulin resistance. Results: The prevalence of vitamin D deficiency (<20 ng/mL) was 54.6%, with a mean serum level of 20.8 ± 8.4 ng/mL in the study population. A strong inverse correlation was observed between vitamin D levels and HOMA-IR (r=-0.642, p<0.001). Vitamin D deficient patients demonstrated significantly higher HOMA-IR values (6.48 ± 2.82) compared to those with sufficient levels (3.69 ± 1.46, p<0.001). Multiple regression analysis identified vitamin D levels (β=-0.284, p<0.001) as an independent predictor of insulin resistance, along with BMI (β=0.308, p<0.001) and physical activity (β=-0.242, p=0.002). HbA1c levels were significantly higher in vitamin D deficient patients (8.2 ± 1.4%) compared to those with sufficient levels (7.1 ± 0.9%, p=0.002).Conclusion: A significant inverse association exists between vitamin D levels and insulin resistance in T2DM patients. The high prevalence of vitamin D deficiency and its independent association with insulin resistance suggests the potential therapeutic importance of maintaining adequate vitamin D status in T2DM management.

Objective: This study aims to evaluate the diagnostic efficacy of Magnetic Resonance Imaging (MRI) in assessing scrotal lesions, with a focus on differentiating between benign and malignant conditions. The limitations of ultrasound in some scrotal pathologies underscore the need for an advanced modality like MRI to improve diagnostic accuracy.Methods: A prospective cross-sectional study was conducted on 102 male patients presenting with symptoms of scrotal lesions. All participants underwent both ultrasound and MRI evaluations, with results compared against histopathological findings. Imaging sequences included T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI). Statistical analyses included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROC curves to assess MRI's diagnostic accuracy.Results: MRI showed higher diagnostic accuracy (96.1%) compared to ultrasound (91.2%) in identifying scrotal lesions. Specifically, MRI demonstrated sensitivity and specificity rates of 94.1% and 96.5%, respectively, while ultrasound showed 88.2% and 91.8%. ROC analysis further established MRI’s superior diagnostic performance in distinguishing between torsion, epididymo-orchitis, and malignancies.Conclusion: MRI is a valuable diagnostic tool for scrotal lesions, particularly in cases where ultrasound results are inconclusive. Its high sensitivity and specificity make MRI a recommended modality for comprehensive scrotal lesion evaluation

Background: Heart failure poses a significant global health burden, necessitating reliable prognostic markers. This study evaluated the utility of soluble ST2 in predicting adverse outcomes in heart failure patients.Methods: A prospective observational study was conducted on 86 heart failure patients. Soluble ST2 levels were measured at admission, and patients were followed for adverse outcomes. Demographic characteristics, clinical parameters, and comorbidities were analyzed.Results: The study population comprised predominantly females (58.1%) with a mean age >60 years (54.7%). Breathlessness was the primary presenting symptom (96.5%), with 43.0% patients in NYHA Class IV. Patients with adverse outcomes demonstrated significantly higher ST2 levels (56.1 ± 22.5 ng/mL vs 26.7 ± 12.2 ng/mL, p<0.001). ROC analysis yielded an AUC of 0.86 (95% CI: 0.78-0.95). Using a 36 ng/mL cutoff, ST2 showed 82.4% sensitivity and 76.9% specificity for predicting adverse outcomes, with an 87% negative predictive value.Conclusion: Soluble ST2 demonstrated significant prognostic value in heart failure, particularly in identifying low-risk patients. The biomarker's high diagnostic accuracy supports its integration into routine clinical assessment for improved risk stratification.

Leprosy, or Hansen’s disease (HD), is a bacterial disease caused by Mycobacterium leprae [1,2] that continues to be a significant health problem in many parts of the world. It produces a chronic infection in humans that affects mainly peripheral nerves and skin but may also affect sites such as eyes, mucous membranes, bones, and testes.2,4 According to National Leprosy Eradication Program India has prevalence of less than 1 case of leprosy per 10,000 population and has reported 1,63,672 new cases in 2021-2023 [5].In the present study, we analyzed the differenthistomorphological patterns of leprosy among patients at Era’s Lucknow Medical College and Hospital. Data were collected from the medical records in the Department of Pathology, focusing on 121 clinically diagnosed cases of leprosy from January 2021 to June 2023.By analyzing these different types, the study aims to enhance understanding of leprosy's manifestations in this region, which may aid in improving diagnosis, treatment, and public health strategies for managing the disease.

Background: Closed reduction and percutaneous pin fixation techniques have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. Commonly lateral pinning and cross pinning techniques are utilised for fixation. However, controversy exists regarding the selection of the appropriate procedure. Methods: A prospective study with 15 cases of displaced fracture supracondylar humerus, treated by lateral pinning and cross pinning, was conducted between August 2020 and May 2022. Patients were treated with either the lateral entry pin alone or the cross pinning with a combination of lateral entry pin and medial entry pin. Age, gender, fractured side, duration of surgery, postoperative complications, surgical approach, direction of pin application (lateral or cross), and Modified Flynn grading system grade was noted for study outcome. Results: No difference was found between lateral pinning and crossed pinning groups in terms of the grade of the Modified Flynn grading system and complications like iatrogenic ulnar nerve damage, loss of reduction. Conclusions: When both techniques were performed carefully, successful clinical results were observed. If the intraoperative instability found, should not hesitate to pin the medial K-wire in order to increase stability.

Abdominal tuberculosis is defined as infection of the gastrointestinal tract, peritoneum, abdominal solid organs, and/or abdominal lymphatics with Mycobacterium tuberculosis. It constitutes approximately 12% of extrapulmonary TB cases and 1 to 3% of total TB cases.Approximately 15%-25% of cases with abdominal TB have concomitant pulmonary TB. However association of unilateral transudative pleural effusion with TB abdomen is rare.A 45 years female with no significant past history presented to us with chief complaints of progressive e dyspnea, distension of abdomen, low grade fever, loss of appetite for past 2 months. On examination her vitals were stable apart from a respiratory rate of 24/min and had diminished breath sound over right hemithorax. Per abdominal examination was unremarkable. Chest X-ray showed right massive pleural effusion. USG & CECT of abdomen& pelvis revealed circumferential wall thickening involving ileo-caecal junction & part of ascending colon with mesenteric lymphadenopathy. Colonoscopy guided biopsy from ascending colon showed granuolomatous inflammation in necrotic background. Biopsy specimen was negative for MTB in CBNAAT. 2300mlclearpleural fluid aspirated from right pleural cavity with fluid cytology being predominantly lymphocytic, ADA 3.1 IU/L, transudative effusion. ECG & 2D ECHO were unremarkable. Pleural fluid and induced sputum were negative for MTB on CBNAAT, as well as culture. Her blood investigations were normal. HRCT thorax showed centrilobular nodule involving bilateral upper lobes with bronchiectatic changes. Bronchoscopy guided BAL fluid & post bronchoscopy sputum were negative for AFB with 30% lymphocytes on differential count. Tuberculin test was positive with an induration of 20mm.Various causes of transudative pleural effusion were excluded. Patient was clinically diagnosed as abdominal tuberculosis and started with ATT and patient improved on subsequent follow up.

Background: Differentiating tuberculous from non-tuberculous pleural effusions remains a diagnostic challenge. This study evaluated the diagnostic utility of pleural fluid LDH/ADA ratio in this differentiation.Methods: This prospective observational study conducted at a tertiary care center included 150 consecutive patients with exudative pleural effusions. Pleural fluid analysis included LDH, ADA, and other biochemical parameters. The diagnostic performance of LDH/ADA ratio was evaluated using ROC curve analysis.Results: The study population comprised 72 tuberculous, 58 malignant, and 20 other non-tuberculous effusions. The median LDH/ADA ratio was significantly lower in tuberculous effusions [6.2 (4.8-7.6)] compared to malignant [20.2 (16.4-24.8)] and other non-tuberculous effusions [15.9 (12.8-19.6), p<0.001]. At the optimal cut-off value of 16.5, the ratio demonstrated sensitivity 92.4%, specificity 89.8%, positive predictive value 90.6%, and negative predictive value 91.8%. Multivariate analysis identified LDH/ADA ratio <16.5 as the strongest independent predictor of tuberculous effusion (adjusted OR: 8.64, 95% CI: 4.82-15.46, p<0.001). Conclusion: The LDH/ADA ratio represents a reliable, cost-effective tool for differentiating tuberculous from non-tuberculous pleural effusions, with excellent diagnostic performance at a cut-off value of 16.5. This ratio can be particularly valuable in resource-limited settings where advanced diagnostic tools may not be readily available.

Background: Acute appendicitis is a common surgical emergency, and diagnosing complicated cases such as gangrenous or perforated appendicitis remains challenging. Hyperbilirubinemia has been proposed as a potential diagnostic marker to aid in identifying these severe cases. Aim: To evaluate the role of hyperbilirubinemia in predicting gangrenous or perforated appendicitis and assess its diagnostic accuracy. Methods: A prospective observational study was conducted at Chamarajanagara Institute of Medical Sciences, Karnataka, from September 2022 to September 2023. One hundred patients with acute appendicitis who underwent emergency appendectomy were included. Serum bilirubin (total and direct) levels were measured, and intraoperative findings were confirmed via histopathology. Statistical analysis was performed to determine the sensitivity, specificity, and predictive values of hyperbilirubinemia. Results: Mean total bilirubin levels were significantly higher in patients with complicated appendicitis (2.4 ± 0.9 mg/dL) compared to those with uncomplicated appendicitis (0.8 ± 0.3 mg/dL, p < 0.001). Direct bilirubin levels were also elevated (0.8 ± 0.4 mg/dL vs. 0.2 ± 0.1 mg/dL, p < 0.001). Hyperbilirubinemia showed a sensitivity of 88%, specificity of 65%, positive predictive value of 60%, and negative predictive value of 90% in predicting complicated appendicitis. Conclusion:Hyperbilirubinemia is a useful adjunctive marker for predicting complicated appendicitis, showing high sensitivity and a strong negative predictive value. Its integration into diagnostic protocols may aid in the timely identification and treatment of high-risk cases.

Background: The Ponseti method is a widely accepted treatment for clubfoot. This study aimed to evaluate the role of age and Pirani score in the management of clubfoot using the Ponseti method.Methods: A prospective hospital-based study was conducted on 35 patients with idiopathic clubfoot treated using the Ponseti method. The patients were assessed based on age at presentation and initial Pirani score. The primary outcomes were the number of casts required for correction, duration of treatment, and final Pirani score.Results: The mean age at presentation was 1.8 ± 1.2 months, with 83% of patients presenting before 2 months of age. The mean initial Pirani score was 4.84 ± 1.46. The mean number of casts required for correction was 6.2 ± 1.4. The mean final Pirani score was 0.13, showing a significant improvement from the initial score (p<0.001). Patients presenting before 2 months of age had better outcomes, with a mean final Pirani score of 0.14 compared to 0.1 in the 3-4 months age group and 0 in the 5-6 months age group.Conclusion: The Ponseti method is an effective treatment for clubfoot, with better outcomes observed in patients presenting at a younger age. The Pirani score is a useful tool for assessing the severity of clubfoot and monitoring treatment progress

Background: Distal end radius fractures are common in orthopedic practice, especially in older adults with osteoporosis and younger individuals involved in high-energy trauma. Open reduction and internal fixation (ORIF) using volar buttress plates has become the preferred treatment method to restore anatomical alignment and enable early wrist mobilization.Aim: To evaluate the clinical, functional, and radiological outcomes of ORIF with volar buttress plates in distal end radius fractures and to assess the associated complications.Methods: A prospective study was conducted on 30 patients diagnosed with distal end radius fractures treated with ORIF using volar buttress plates at Al-Ameen Medical College, Vijayapura, from May 2022 to April 2024. Clinical outcomes were assessed using the Gartland and Werley scoring system. Radiological outcomes and complications were recorded.Results: Eighty percent of patients demonstrated significant improvement in wrist function at the 6-month followup, with a complication rate of 20%, predominantly involving tendon irritation. Conclusion: ORIF with volar buttress plates provides superior functional recovery with a manageable complication profile for distal end radius fractures.

The pulmonary arteries arise from the 6th aortic arch. The involution of the ipsilateral proximal 6th aortic arch may result in unilateral absent pulmonary artery (UAPA). Unilateral absent pulmonary artery is a rare disorder with an estimated prevalence of 1 in 200,000 adults.We report a case of absent right pulmonary artery with bronchiectasis presenting as obstructive airway disease (OAD).A 40yearold female presented with acute onset of fever, shortness of breath, cough and mucoid sputum production for 4 days. She had a past history of OAD since 15years.On investigation, Chest X ray showed trachea shifted to right, smaller right lung with a small hilar shadow on right side. CECT Thorax showed right side bronchiectasis with small right lung with absent right pulmonary artery, cardiomegaly & Pulmonary hypertension. Patient was treated with IV antibiotics, bronchodilators, mucolytics, moist O2, antihypertensive. Patient clinically improved and was discharged as obstructive airway disease

Background: Sepsis is a life-threatening condition characterized by a dysregulated host response to infection. Early diagnosis and risk stratification are crucial for improving patient outcomes. This study aimed to evaluate the diagnostic and prognostic utility of biomarkers in critically ill patients with sepsis.Methods: In this prospective observational study, 160 patients (120 with sepsis, 40 with non-infectious SIRS) admitted to the ICU were included. Levels of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and lactate were measured within 24 hours of ICU admission. The diagnostic and prognostic performance of biomarkers was evaluated using receiver operating characteristic (ROC) curve analysis and logistic regression.Results: PCT, IL6, and lactate demonstrated good diagnostic performance in differentiating sepsis from non-infectious SIRS, with AUCs of 0.88, 0.82, and 0.75, respectively. The combination of PCT, CRP, and IL-6 yielded an AUC of 0.92. Lactate, IL-6, and PCT were strong predictors of 28-day mortality (AUCs: 0.80, 0.78, and 0.75, respectively), organ dysfunction, and ICU length of stay. The sepsis group had significantly higher SOFA scores at day 7 (median 6 vs. 3, p<0.001) and longer ICU stay (median 12 days vs. 7 days, p<0.001) compared to the non-infectious SIRS group.Conclusions: Biomarkers, particularly PCT, IL-6, and lactate, have good diagnostic and prognostic utility in the management of sepsis in critically ill patients. The use of biomarker panels may further improve diagnostic accuracy and prognostic performance. These findings support the incorporation of biomarkers into clinical decision-making to facilitate early recognition and risk stratification of sepsis in the ICU setting.

Background: The diagnostic accuracy of computed tomography venography (CTV) in detecting deep vein thrombosis (DVT) among pulmonary embolism (PE) patients remains an area of active investigation. Objectives: To evaluate the diagnostic performance of CTPA combined with indirect CTV in diagnosing DVT in PE patients and compare it with Doppler ultrasonography. Materials and Methods: This prospective cross-sectional study included 50 patients with suspected PE who underwent both CTPA with indirect CTV and Doppler ultrasonography. The study was conducted over 12 months using a 128-slice CT scanner and standardized ultrasound protocols. Results: The study population comprised 58% males and 42% females, with the majority (54%) aged 31-50 years. DVT was detected in 50% of cases by Doppler ultrasonography and 46% by CTV. CTV demonstrated sensitivity of 76.0%, specificity of 84.0%, positive predictive value of 82.6%, and negative predictive value of 77.8%. The area under the ROC curve was 0.800 (95% CI: 0.671-0.929), with substantial agreement between modalities (κ=0.600, p=0.0005). Right pulmonary artery involvement was most common (18%), and additional pathological findings were observed in 70% of cases. Conclusion: CTV shows substantial agreement with Doppler ultrasonography in DVT detection, offering the advantage of concurrent PE and DVT evaluation in a single examination. The high diagnostic accuracy supports its integration into routine PE imaging protocols.

Background: Diabetes mellitus is a chronic metabolic disorder that can lead to various ocular complications, including corneal changes. This study aimed to investigate the correlation between HbA1c levels, central corneal thickness (CCT), and corneal endothelial parameters in patients with type 2 diabetes mellitus using non-contact specular microscopy.Methods: This observational study included 181 patients with type 2 diabetes mellitus who underwent a comprehensive ophthalmic examination, including non-contact specular microscopy. The correlation between HbA1c levels, CCT, endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) was analyzed. The association between the severity of diabetic retinopathy and corneal parameters was also evaluated.Results: A significant positive correlation was found between HbA1c levels and CCT (p6.5% had a mean CCT of 579.24±19.47 µm, compared to 537.73±16.92 µm in those with HbA1c levels between 4-5.6% (p<0.001). The duration of diabetes was also significantly associated with increased CCT (p<0.001). Patients with PDR had the lowest mean ECD (2091.88±121.34 cells/mm²), highest mean CV (51.01±4.78%), and lowest mean HEX (30.10±3.92%) compared to those with no diabetic retinopathy (p<0.001 for all).Conclusion: HbA1c levels and duration of diabetes significantly correlate with CCT and corneal endothelial changes in patients with type 2 diabetes mellitus. Non-contact specular microscopy is a valuable tool for detecting early corneal changes in diabetic patients, enabling timely intervention and prevention of visual impairment.

Background: Antenatal yoga may support natural labour and reduce medical interventions, improving maternal and neonatal outcomes. This study examines its effects on spontaneous versus induced labour among primigravida women. Methodology: In a randomized control trial at SMS Medical College, Jaipur, 200 primigravida women meeting inclusion criteria were divided into intervention and control groups. The intervention group received 60-minute yoga sessions from 28 to 38 weeks of gestation. Labour outcomes were recorded upon delivery. Results: Of the participants, 69% in the intervention group had spontaneous labour versus 57% in the control group (p = 0.043). The intervention group also had fewer labour inductions and cesarean sections. Conclusions: Antenatal yoga significantly increases spontaneous labour rates, reduces inductions, and supports natural delivery. This highlights the potential of antenatal yoga in prenatal care.

Background: Acute appendicitis is a common surgical emergency, with diagnostic challenges due to its varied presentations. Accurate diagnosis is crucial for effective management. This study compared the diagnostic accuracy of the RIPASA score and ultrasound in acute appendicitis cases.Methods: A cross-sectional analysis was conducted involving 100 patients with symptoms suggestive of acute appendicitis. The RIPASA score and ultrasound were evaluated against histopathological examination (HPE), which served as the gold standard.Results: The RIPASA score identified acute appendicitis in 73% of patients, with a PPV of 89% and an NPV of 44%. Ultrasound identified appendicitis in 68% of patients, with a PPV of 86.8% and an NPV of 34.4%. The integration of both diagnostic tools suggested potential enhancements in overall diagnostic accuracy. Conclusion: Both the RIPASA score and ultrasound are effective diagnostic tools for acute appendicitis. However, the RIPASA score showed a slightly better PPV, and when combined with ultrasound, could offer a more robust diagnostic approach, particularly beneficial in resource-limited settings.

This comparative study compared endovenous laser ablation (EVLA) and Venous stripping (anterograde and retrograde methods) for the treatment of varicose veins in a tertiary care hospital. Objective: Endovascular laser ablation (EVLA) is a minimally invasive procedure performed in the OPD or as a day care procedure with minimal blood loss and minimal invasion. The aim of this comparative study is to establish whether these technically improved outcomes are better than traditional venous stripping (anterograde and retrograde methods). Methods: Duration - 1 year (January 2023 to January 2024). Centre - Srinivas Institute of Medical Science & Research Centre, Mukka, Mangalore, Karnataka, India. Study Population: Patients presenting with varicose veins to General Surgery/ CTVS OPD. Study Design: Prospective study. This study compared postoperative patient comfort and the surgical outcome of endovenous laser ablation (EVLA) and high ligation venous stripping (Trendelenburg operation). Results: EVLA was found to be cost effective, OPD procedure. In our study, as compared between EVLA and venous stripping, study shows that EVLA is safer with minimal complications, early recovery, no recurrence and economically feasible. Conclusion: The findings of this study support the efficacy and safety of endovenous laser ablation (EVLA) as a superior alternative to high ligation venous stripping (Trendelenburg operation) for the treatment of varicose veins. These results advocate for the wider adoption of EVLA as the preferred treatment modality for varicose veins.

Primary Sjogren’s Syndrome which is an autoimmune disorder can rarely involve kidney resulting in Distal Renal Tubular Acidosis (RTA type I) which can result in severe hypokalemia resulting in flaccid Quadriparesis/Quadriplegia. However Sjogren’s Syndrome primarily presenting with hypokalemic Quadriparesis/Quadriplegia is rare. We report a case of 60 year old lady who presented with rapidly progressive hypokalemic Quadriparesis which responded to treatment with potassium salt was later confirmed to be suffering from Sjogren’s Syndrome.

Various dermatologic manifestations of COVID-19 and common side effects of drugs used in the treatment of COVID-19 have been identified previously. We report an observation of favipiravir-induced fluorescence of nails and hair in a 23-year-old woman who was treated for COVID-19. Further investigation is warranted to understand the exact pathophysiology behind the fluorescence and its clinical significance in patients treated with favipiravir.

Actinic Cheilitis is one of the common disease conditions of lip but many of the time it will gounnoticed and undiagnosed. As this is commonly observed among poor population, the serious consideration of this lesion plays an important role. The risk of malignant transformation is comparatively higher in this disease if the prior preventive steps are not taken. The importance of every such lesions or diseases needs to be understood by every practitioner who come across the oral diseases.

Introduction: The mesenteric small intestine diagnostic study is not principally dependent on endoscopic viewing. Increased speed and resolution of MDCThave made it a first line modality for the examination of small bowel diseases. MDCT Enterography differs from routine abdomino-pelvic CT as it makes use of thin sections and large volumes of enteric contrast material for better display of the small bowel lumen and wall, permits excellent assessment of hyper vascular lesions and hyper enhancing segments. Objectives: 1) To study the radiological features of small intestinal diseases. 2) To draw a systematic patterned approach to narrow down the differential diagnosis based on radiological findings. 3) To evaluate the diagnostic accuracy of MDCT Enterography with clinical, histopathological and surgical correlation. Materials and Methods: Total 40 cases of suspected small intestinal disease referred to underwent MDCT Enterography at Department of Radio-Diagnosis of SSIMS & RC, Davangere from the year June 2023 to December 2024.Imaging was done on a 128slice MDCT scanner manufactured by GE MDCT scan machine.Results:The common MDCT Enterography findings were distal bowel involvement, mucosal layer involvement, and homogeneous wall enhancement. Focal involvement was seen in majority of patients with mild mural thickness. Small bowel obstruction was commonest cause, followed by abdominal tuberculosis. Conclusion:MDCT Enterography is an efficient in detecting small bowel pathologies. Distal bowel and mucosal layer involvement, homogeneous wall enhancement, focal involvement with the mild mural thickening are most common findings. Small bowel obstruction and abdominal tuberculosis being the most common diseases.

Background: Accurate diagnosis and grading of brain tumors are critical for effective treatment. This study evaluated the diagnostic accuracy of Diffusion Weighted Imaging (DWI) and Magnetic Resonance Spectroscopy (MRS) compared to conventional MRI, with histopathology as the gold standard.Methods: This prospective study included 60 patients undergoing MRI for suspected brain tumors. Each patient was assessed using conventional MRI, DWI, and MRS. Apparent Diffusion Coefficient (ADC) values and metabolic ratios were analyzed, and diagnostic performance was compared to histopathological results. Statistical analysis was performed using SPSS, with p-values < 0.05 considered significant. Results:Glioblastomamultiforme was the most common tumor, comprising 26.7% of cases. MRS demonstrated a diagnostic accuracy of 82.5%, outperforming DWI (72.5%). MRS had a sensitivity of 75% and specificity of 90.9% for glioblastomamultiforme, while DWI had a sensitivity of 68.75% and specificity of 86.36%. The mean ADC values for high-grade gliomas (0.65 ± 0.13 × 10⁻³ mm²/s) were significantly lower than for low-grade gliomas (1.02 ± 0.16 × 10⁻³ mm²/s; p < 0.001).Conclusion: MRS is a reliable tool for non-invasive brain tumor grading, showing higher diagnostic accuracy than DWI. Combining DWI and MRS with conventional MRI could enhance diagnostic precision, guiding better treatment planning. Future research should explore integrated imaging approaches for improved tumor diagnosis and monitoring.

Background: The correlation between hypotension and acute kidney damage in an intensive care unit context is not entirely understood, despite the fact that the relationship between low blood pressure and kidney function has been thoroughly documented in an experimental setting based on evidence from animals. Based on the MIMIC II database, the current study is to estimate the risk of acute kidney injury (AKI) development in intensive care unit (ICU) patients as a function of both the severity of hypotension and the duration of hypotension.Methods: This is a retrospective comparative study performed in 100 patients admitted in ICU of a tertiary care hospital affiliated with a medical college. The study included all patients admitted in ICU from April 2023 to April 2024 with a myriad of aetiologies. The case records were extracted from the ICU records, and details of demographics, aetiology, intervention, ICU stay, days on ventilator and vitals during ICU stay, amongst other parameters, were recorded in a semistructured pro forma. Results:Mean duration of the hypotension was found to be 5.92 hours in the AKI group, while in the non-AKI group it was 4.32 hours. Mean arterial blood pressure of the AKI group was significantly lower than the non-AKI group (p = 0.0031).Conclusion: Our study indicates that the severity and duration of hypotension are both significant risk factors in AKI development in critically ill patient.

Background: Laparoscopic rectopexy is an established treatment for complete rectal prolapse. This study aimed to compare the short-term outcomes of laparoscopic posterior suture rectopexy (PSR) and anterior mesh rectopexy (AMR).Methods: A total of 30 patients with complete rectal prolapse were prospectively enrolled and randomly assigned to undergo either PSR (n=16) or AMR (n=14). Demographic data, clinical history, intra-operative findings, hospital stay, post-operative bowel movements, and complications were recorded and analyzed.Results: The mean age was 50.44±17.28 years in the PSR group and 56.44±12.50 years in the AMR group (p>0.05). The mean intra-operative blood loss was 23.44±3.9 ml in the PSR group and 20.71±3.3 ml in the AMR group (p=0.053). The mean duration of surgery was 85.75±7.5 min in the PSR group and 92.0±9.9 min in the AMR group (p=0.062). The mean hospital stay was 3.0±0.0 days in the PSR group and 4.0±0.0 days in the AMR group. In the PSR group, 62.5% of patients had their first bowel movement on postoperative day 1, compared to 21.4% in the AMR group (p=0.059). There were no cases of new-onset constipation in either group. One patient (7.1%) in the AMR group had recurrence, and one patient (7.1%) had retrograde ejaculation (p=0.467).Conclusion: PSR and AMR are safe and effective techniques for the treatment of complete rectal prolapse, with comparable short-term outcomes. The PSR group showed a trend towards earlier return of bowel function. Further studies with larger sample sizes and longer follow-up are needed to validate these findings.

Background: Post-operative shivering is a common complication following spinal anesthesia. This study compared the efficacy of tramadol versus paracetamol in preventing this complication.Methods: Sixty patients undergoing surgery under spinal anesthesia were randomly assigned to receive either tramadol (n=30) or paracetamol (n=30). The incidence, severity, and onset of shivering, as well as side effects and response to rescue medication, were assessed.Results: The overall incidence of shivering was 26.7%. Tramadol group showed a higher percentage of patients with no shivering (80% vs 66.7%) and lower incidence of severe shivering (3.3% vs 13.3%) compared to the Paracetamol group. Shivering onset was earlier in the tramadol group (10 ± 3 minutes vs 15 ± 4 minutes, p = 0.045). Tramadol group experienced higher rates of nausea (20%) and vomiting (6.7%) compared to paracetamol group (0% for both). Pethidine as rescue medication was effective in 80% of paracetamol group cases and 100% of tramadol group cases requiring intervention.Conclusion: Both tramadol and paracetamol demonstrated efficacy in preventing post-operative shivering, with tramadol showing higher efficacy but more side effects. The choice between these agents should be individualized based on patient factors and clinical context.

Polycystic Ovarian Syndrome (PCOS) is a metabolic syndrome affecting women’s reproductive health. PCOS is diagnosed using Rotterdam Criteria, and is often associated with insulin resistance. PCOS with insulin resistance (PCOS-IR) can both induce inflammation, in which the inflammation itself can worsen PCOS-IR. Moringa oleifera is a plant tested for its anti-inflammatory and anti-oxidant properties from pytochemicals that can be found in it. Aim: This research aims to study the effect of Moringa oleifera leaf extract administration to PCOS-IR rat models towards levels of C-reactive protein (CRP), a widely known biomarker of inflammation. Method: Female Wistar rats were divided into 3 groups (n=10): normal rats, PCOS-IR rats and PCOS-IR rats administered with 500 mg/kg Moringa oleifera leaf extract. PCOS rat model is created by injecting 1 mg / 100 gr testosterone proprionate for 21 days, and another 21 days for Moringa oleifera leaf extract administration. Blood is then collected and tested for CRP, and data collected will be statistically processed. Results: The PCOS-IR group showed increase in CRP level compared to control group, and the Moringa oleifera treated group showed significantly lower CRP level compared to PCOS group. The CRP level in Moringa oleifera treated group comes near to that of control group. Conclusion: Consumption of Moringa oleifera leaves can reduce inflammation in PCOS-IR shown by significant decrease of CRP levels.

Background: Inverted papilloma is a true epithelial neoplasm of sinonasal cavity. It has a incidence rate of 0.6 cases/100000 people/year. The characteristic features of inverted papilloma are the presence of associated nasal polyps, its tendency to recur, destructive potential and malignant transformation. Objectives: To review the presentation of sinonasal inverted papilloma and its management and review of literature.Method: A retrospective study consisting of 4 diagnosed cases of inverted papilloma of sinonasal cavity which were treated at our tertiary care centre between the period March 2022 to June 2023. Results: 1 out of 4 cases had bits of malignant tissue (squamous cell carcinoma) in the histopathological examination of the completely excised specimen and was referred to higher centre for radiotherapy. Rest 3 cases were completely cleared off the pathology and on regular follow up and no recurrence reported till date.Conclusion: Radical surgery is required for histopathologically proven cases of Inverted papilloma preoperatively, since there is high chance of recurrence if inadequately removed. All histopathologically proven cases of inverted papilloma have to undergo complete surgical clearance of the pathology. The entire specimen has to be sent to histopathological examination again to cross confirm and rule out malignancy. Also the patient should be asked to be on regular follow up to rule out recurrence.

Background: Uterine scar complications following cesarean delivery represent significant obstetric challenges with potentially severe maternal and neonatal consequences. Objective: To evaluate the incidence, risk factors, and outcomes of uterine scar dehiscence and rupture in post-cesarean pregnancies. Methods: A prospective observational study of 120 women with previous cesarean sections was conducted at a tertiary care center from January to December 2023. Participants underwent standardized antenatal monitoring including serial ultrasonographic assessment. Results: Scar complications occurred in 8.33% (n=10) cases. Short inter-pregnancy interval (<18 months) (adjusted OR 3.8, 95% CI 1.9-7.6, p<0.001) and multiple previous cesareans (adjusted OR 3.2, 95% CI 1.7-6.1, p<0.001) were significant risk factors. Emergency cesarean delivery was required in 90.0% of complicated cases. LUS thickness <2.0mm was associated with higher complication rates (60.0% vs 5.5%, p<0.001). NICU admission rates were significantly higher in complicated cases (40.0% vs 7.3%, p<0.001). Conclusion: Close monitoring of post-cesarean pregnancies, particularly those with identified risk factors, is crucial for optimal outcomes. Ultrasonographic assessment of LUS thickness provides valuable predictive information.

Background: Knee pain and swelling are the common complaints affecting approximately 26.9% of population. In recent time meniscal injury is on rise, 9 out of 1000 men and 4.2 out of 1000 women are affected approximately. Of these, traumatic tears account for 68 to 75%, causing lower quality of life. MRI has become most important diagnostic tool for evaluating meniscal injuries replacing arthroscopy.Aims: To determine the morphology and signs of knee meniscal injuries using MRI and also to assess yield in patients with suspected meniscal tear.Methods and Material: A prospective longitudinal study was conducted between July 2022 to June 2023 of individuals with traumatic knee injury referred for MRI, to department of radiodiagnosis. MRI was obtained with 1.5 T (Siemens Sempra XA12 platform). Intra meniscal signals were graded as described by Stoller and Colleagues. Also part of meniscus involved and type of tear was noted. Statistical methods used: Descriptive method of statistics are being used to portray the baseline profile. The chi-square and Fischer exact test are being used for comparing categorical variables and to compare means student-t test is being used.Results: Out of 53 individuals presented with knee injury, 47 individuals had changes on MRI. A total of 60 abnormalities were identified. Lateral meniscus (34) was most commonly involved than medial meniscus (26). In lateral meniscus, anterior horn was significantly involved (20) as compared to (12) of posterior horn. In medial meniscus, posterior horn was significantly involved, that is (19) compared to (3) of anterior horn (p value<0.000914). Of these, 43 had meniscal tears. Complex tears were commonly seen in lateral meniscus.Conclusion: These findings compel radiologists to focus on those specific regions, while looking into meniscal injuries and minimize the possibility of missing crucial findings, for patient management.

Background: The role of serum ferritin in predicting pregnancy outcomes among women with gestational diabetes mellitus (GDM) remains incompletely understood.Objective: To evaluate the association between serum ferritin levels and adverse pregnancy outcomes in women with GDM. Methods: This prospective observational study included 126 pregnant women diagnosed with GDM. Serum ferritin levels were measured at diagnosis, and participants were followed until delivery. Maternal and neonatal outcomes were analyzed in relation to ferritin levels. Results: The mean serum ferritin level was 85.6 ± 42.3 ng/mL, with 19.9% of participants showing elevated levels (>150 ng/mL). Significant positive correlations were observed between ferritin levels and glycemic parameters (HOMA-IR: r=0.51, p<0.001). Women with elevated ferritin levels demonstrated higher rates of pregnancyinduced hypertension (24.0% vs 9.0%, p=0.042), preeclampsia (16.0% vs 5.6%, p=0.038), and cesarean delivery (56.0% vs 34.8%, p=0.045). Neonatal complications, including macrosomia (32.0% vs 13.5%, p=0.028) and NICU admission (24.0% vs 10.1%, p=0.035), were significantly higher in the high ferritin group. Conclusion: Elevated serum ferritin levels are associated with increased risk of adverse maternal and neonatal outcomes in GDM patients, suggesting its potential utility as a predictive biomarker.

Background: Venous cannulation is a common yet painful procedure in healthcare settings. This study aimed to compare the efficacy of 10% Lignocaine spray with EMLA cream for pain attenuation during venous cannulation in adults.Methods: A prospective, randomized, comparative study was conducted on 88 adult patients undergoing elective surgeries. Patients were randomly allocated to receive either 10% Lignocaine spray (n=44) or EMLA cream (n=44) prior to venous cannulation. Pain scores were assessed using a visual analog scale (VAS), and hemodynamic parameters were recorded before and after the procedure.Results: The mean pain scores were 2.98 ± 1.45 for the Lignocaine spray group and 3.22 ± 1.38 for the EMLA cream group (p = 0.4287), indicating no significant difference in analgesic efficacy. Hemodynamic parameters, including heart rate, blood pressure, and mean arterial pressure, showed no significant differences between the groups at any time point (p > 0.05 for all comparisons).Conclusion: 10% Lignocaine spray demonstrated comparable efficacy to EMLA cream in reducing venous cannulation pain, with the advantage of a significantly shorter application time. Both methods maintained similar hemodynamic stability and safety profiles.

Background: Preterm premature rupture of membranes (PPROM) significantly impacts maternal and perinatal outcomes. This study evaluated outcomes and predictive factors in PPROM cases.Methods: A prospective observational study of 80 women with PPROM between 24 and 36 weeks' gestation was conducted. Maternal and neonatal outcomes were analyzed, and factors affecting latency period were evaluated.Results: The mean gestational age at PPROM was 31.3 ± 3.4 weeks, with a mean latency period of 8.4 ± 4.2 days. Chorioamnionitis occurred in 17.5% of cases. The cesarean section rate was 42.5%, with fetal distress being the primary indication (44.1%). NICU admission was required for 60.0% of neonates, with respiratory distress syndrome affecting 35.0%. Significant correlations were found between latency period and gestational age (r=-0.542, p<0.001), cervical dilatation (r=-0.486, p<0.001), and inflammatory markers (p<0.01). Conclusion: PPROM outcomes are significantly influenced by gestational age and inflammatory markers. Early identification of risk factors may improve management strategies and outcomes.

Plasma cell disorders, including multiple myeloma, are a group of diseases characterized by the abnormal proliferation of plasma cells. While pleural effusion is uncommon in multiple myeloma, it may result from myelomatous infiltration of the pleura or heart failure due to amyloidosis. In this report, we present a case of a 62-yearold male who was diagnosed with multiple myeloma after presenting with progressive dyspnea, cough, and generalized weakness over two months. Physical examination revealed diminished breath sounds over the left hemithorax. Chest X-ray and ultrasonography confirmed moderate pleural effusion, with 1000 mL of serosanguinous fluid aspirated. Pleural fluid analysis showed lymphocytic exudative effusion, elevated adenosine deaminase (76 IU/L), and plasma cell dyscrasias, indicative of multiple myeloma. Blood tests revealed anemia (Hb 7.5 g/dL) and renal impairment (serum creatinine 2.4 mg/dL). Imaging studies identified multiple lytic lesions in the skull and compression fractures in the thoraco-lumbar spine. Bone marrow aspirate showed 46% plasma cells. The patient was diagnosed with multiple myeloma and initiated on chemotherapy, showing clinical improvement with no recurrence of pleural effusion on follow-up. This case emphasizes the rarity of myelomatous pleural effusion and highlights the importance of early diagnosis and appropriate management. Treatment typically involves chemotherapy, with supportive care to manage symptoms, though the prognosis remains poor in cases of myelomatous pleural effusion.

Background:Migraine is a primary neurovascular headache disorder characterize by moderate to severe headaches, most often unilateral and generally associated with nausea and increased sensitivity to light and sound. Several factors can trigger migraine are probable contributing factors while others are possible or unproven such as:stress, hormonal changes, skipped meal, smoking, odour etc.Propranolol (non selective beta blocker) is the most common and one of the most effective first line medication used for migraine prophylaxis. Flunarizine (Calcium channel blocker) is acknowledged in numerous countries and included in numerous national guidelines for prophylaxis of migraine.We therefore intended to carry out this study and produce more data to support the choice of a medication for migraine prophylaxis that is both more effective and has a better safety profile.Aim: The aim of our study was to compare safety and efficacy of propranolol with flunarizine in adult patients suffering from migraine as prophylactic drugs. Objectives: 1) To evaluate safety and efficacy of propranolol.2) To evaluate safety and efficacy of flunarizine. Material and Methods: This comparative, prospective, randomized, and academic interventional study was conducted in tertiary care hospital of North India. A total of 76 patients satisfying the eligibility criteria were randomized into 2 groups to receive either the Tablet Propranolol 40 mg per day for first 5 days then 40 mg twice a day for 2 months or Tablet Flunarizine 10 mg per day for 2 months. A general evaluation, physical examination and routine investigations were performed on the first visit and repeated after every one month of treatment for next 2 months. Patient also assessed with VAS (Visual Analogue Scale) for headache intensity 1 (mild) to 10 (excruciating), to check extent of a patient’s disease. Results:Group A (89.2%) and Group B (52.8%) patients were in age group of 18-40 years. In Group A, dizziness (n = 20) was the most common adverse effect associated with propranolol, while in Group B; tiredness (n = 3) and weight gain (n = 3) were the most common adverse effects associated with flunarizine. There was statistically significant increase in BMI after 2 months among patients who were in Group B than those who were in Group A (p=0.045). There was statistically significant difference in the mean (SD) Heart Rate value of participants in Group A (75.65± 5.1) and Group B (80.14 ± 5.9) at the end of 2nd month (p=0.001).Also, there was statistically significant improvement in headache frequency (p=0.01) headache intensity (p=0.004) and headache duration (p=0.04) in Group A as compare to Group B. Conclusion: Flunarizine was associated with fewer adverse effects and Propranolol was associated with low headache frequency, headache intensity and headache duration as compared to flunarizine group. Trial Registration: Clinical Trials Registry – India (CTRI) Number CTRI/2023/06/053593 [Registered on: 06/06/2023].

Background: Traumatic optic neuropathy (TON) is a potential complication of traumatic brain injury (TBI) in patients with road traffic accidents (RTAs). This study aimed to investigate the correlation between TON and TBI severity and evaluate the fundoscopic changes and visual outcomes in these patients.Methods: A cross-sectional study was conducted on 30 patients with TON following RTAs. The type of TON (direct or indirect) was assessed, and the severity of TBI was categorized based on the Glasgow Coma Scale (GCS) score. Fundoscopic changes and visual acuity were evaluated and compared between TON types and TBI severity groups.Results: Indirect TON was more common (63.3%) than direct TON (36.7%). Direct TON was significantly associated with severe TBI (75.0%), while indirect TON was more prevalent in mild (77.8%) and moderate (76.9%) TBI (p=0.041). Optic disc edema was more frequent in direct TON (72.7%) than in indirect TON (31.6%) (p=0.027). Visual acuity was significantly worse in direct TON compared to indirect TON (p=0.027). Conclusion: The type of TON is significantly associated with the severity of TBI in patients with RTAs. Direct TON is more common in severe TBI and is associated with worse visual acuity and a higher prevalence of optic disc edema compared to indirect TON. Comprehensive ophthalmic evaluation is crucial in patients with TON and TBI to ensure early diagnosis and appropriate management.

Background: Few studies which have reported very low incidence of DVT in India have been conducted in patients undergoing elective orthopaedic surgery and used colour duplex for diagnosis.Despite having fewer comorbid conditions, orthopaedic patients with deep vein thrombosis remain particularly vulnerable to calf deep vein thrombosis. Rates of venous thromboembolism prophylaxis were inadequate. With the aforementioned facts, the need of this study is to establish evidence of deep vein thrombosis in patients with lower limb trauma as early as possible, adequately manage it and prevent its complications Methods: Total of 83 patients admitted in Orthopaedics department with lower limb fractures satisfying the inclusion criteria and exclusion were included in the study. Thorough history and clinical examination data were obtained, venous doppler ultrasound studies were done clinical scoring for risk of deep vein thrombosis was done using Well’s criteria and noted. Post operatively on day 4, another colour venous doppler study of the lower limbs was be performed and clinical scoring for risk of deep vein thrombosis was be done using Well’s criteria and noted. For patients who developed symptoms/signs of deep vein thrombosis during their stay at the hospital, appropriate chemoprophylaxis was started for these patients who developed deep vein thrombosis, follow up colour venous doppler study of the lower limbs was done after 3 months to look for re-canalization of the affected venous system Results: In our study among 83 subjects, 48.2 % are from 20 to 40 years of old. Male subjects constituted 68.7%. There were no associated comorbidities among 81.9%(n=68) of study subjects. Pertrochanteric fracture constituted common fracture. Majority had closed type of fractures. Pre operative Wells score was 1.5 and 3 among 50.6% (n=42) and 47% (n=39) subjects 15 respectively with mean value of 2.386. The mean post operative Well’s score was 2.512 and 61.4% (n=51) and 22.9% (n=19) subjects has Well’s score of 1.5 and 3 respectively. The preoperative doppler showed no evidence of DVT among 97.6% while both fat embolism syndrome and DVT was seen in 1.2% (n=1) subjects. While the post operative doppler showed no evidence of DVT among 98.8%(n=82) subjects. One subject out of 7 with hypertension suffered from DVT. Conclusion: In our study among 83 subjects, 48.2 % are from 20 to 40 years of old. Male subjects constituted 68.7%. There were no associated comorbidities among 81.9%(n=68) of study subjects. Pertrochanteric fracture constituted common fracture. Majority had closed type of fractures. Pre operative Wells score was 1.5 and 3 among 50.6% (n=42) and 47% (n=39) subjects respectively with mean value of 2.386. The mean post operative Well’s score was 2.512 and 61.4% (n=51) and 22.9% (n=19) subjects has Well’s score of 1.5 and 3 respectively. The preoperative doppler showed no evidence of DVT among 97.6% while both fat embolism syndrome and DVT was seen in 1.2% (n=1) subjects. While the post operative doppler showed no evidence of DVT among 98.8%(n=82) subjects. One subject out of 7 with hypertension suffered from DVT.

Background: Maternal thyroid disorders during pregnancy can significantly impact fetal development and increase the risk of adverse pregnancy outcomes, including miscarriage, preterm birth, low birth weight, and neonatal morbidity and mortality. This study aims to evaluate the prevalence of thyroid dysfunction in a cohort of 300 neonates (aged 1-28 days) at a tertiary care centre, with a focus on comparing the thyroid hormone levels between neonates born to mothers with and without thyroid disorders. Methods: This was a prospective, observational study conducted over a 12- month period. The neonates were further divided into two groups based on maternal thyroid status: (i) cases (N=150) and (ii) controls (n=150). In the first and third postnatal weeks, the study group's infants' thyroid tests were measured. Results: The mean TSH levels were significantly higher in neonates of mothers with thyroid disorders, while the mean free T4 level was significantly lower in this group. The prevalence of subclinical hypothyroidism (elevated TSH with normal free T4) was significantly higher. Conclusions: Early identification and management of thyroid disorders in newborns can help prevent the adverse effects on growth and neurodevelopment.

Introduction: Pancytopenia is the reduction of all three cellular elements of peripheral blood, leading to anemia, leukopenia and thrombocytopenia, and clinico-hematological entity commonly encountered in clinical practice as a feature of a myriad of diseases, ranging from non-malignant disease to malignant neoplasms. Material and Methods: In our study, a total of 100 cases of pancytopenia were included. Complete evaluation of clinical findings, haematological indices and bone marrow examination were carried out. Results: In our study the most common cause of pancytopenia was megaloblastic anemia (44%), followed by dimorphic anemia or nutritional anemia (32%) and less commonly observed causes were acute leukemia and iron deficiency anemia. Most common anemia found to be macrocytic hypochromic. Hypercellular marrow was seen in 64% of cases, whereas hypocellular marrow was present in 8% of cases. Conclusion: Bone marrow aspiration and haematological parameters are useful, economical, and safe diagnostic tool in the evaluation of pancytopenia.

Abstract: Polycystic Ovary Syndrome (PCOS) is a hormonal disorder characterized by irregular ovulation and the presence of small cysts on the ovaries. This condition is frequently associated with obesity, insulin resistance, and diabetes. Aim: This research aims to investigate the effects of Moringa oleifera leaves extract on HbA1c levels in white rats (Rattus norvegicus) that have been induced to model insulin-resistant PCOS. Moringa oleifera has various bioactive compounds such as flavonoids, that function as insulin sensitizers, which help improve glucose uptake. Method: This research employs a laboratory experimental design using female rats as subjects. The rats were divided into three groups (n=10): normal rats, PCOS-IR rats (received an intraperitoneal injection of testosterone at a dose of 1 mg/100 g BW for 21 days), and PCOS-IR rats with Moringa oleifera (received the same testosterone injection for 21 days followed by an administration of 500mg/kg Moringa oleiferaleaves extract for an additional 21 days).Blood samples are subsequently collected and analyzed for HbA1c, and the gathered data will undergo statistical processing. Results: The PCOS-IR group exhibited higher HbA1c levels than the negative control group, while the group treated with Moringa oleifera demonstrated significantly lower HbA1c levels than the PCOSIR group. The HbA1c levels in the Moringa oleifera treated group approached those of the control group. Conclusion: This research indicates that the 96% ethanol extract of moringa leaves may provide an effective alternative treatment for managing metabolic issues associated with PCOS-IR, particularly in relation to HbA1c levels.

Introduction: Total knee arthroplasty (TKA) is a highly successful procedure that can reduce pain and improve range of motion and function by correcting angular deformity and restoring the integrity of the articular surface. Currently, joint replacement for various types of knee arthritis is very common, and TKA can claim to be one of the greatest surgical advances. Objective: To determining about the suitability of implants available for Bangladeshi population by assessing the intra op measurement of patella in all its dimensions viz anteroposterior, superioinferior and mediolateral diameter in Bangladeshi patients. Methods: A cross-sectional study was carried out at Department of Orthopaedic Surgery, BSMMU, Dhaka, Bangladesh from January to June 2023. Total 60 patients of grade 4 OA knee were selected for this study and pre op x-rays were obtained, AP View, Lat View, Skyline view and Merchant view. Preop Morphometry of patella was recorded on x-ray findings. All patients were operated by standard midline incision with medial parapatellar arthrotomy. Intra op measurement of patella was done via Vernier caliper and measurements were recorded. Results:Total 60 patients of grade 4 OA knee were selected for this study. The smallest available patellar implant in Bangladesh is about 8 mm in size which is not suitable for Bangladeshi patient. most of the patients were having patellar morphometery lower than the expected size for patellar resurfacement. Hence, patellar resurfacement was not an option for many of the patients because of unavailability of patellar implants of appropriate size. Conclusion: Hence in this study we conclude that there is a need of better designed implants for Bangladeshi patients as the presently available implants are mainly designed for western population making it unfeasible to resurface patella for Bangladeshi surgeons.

An ulcer is defined as a break in continuity of covering epithelium, involving skin or mucous membrane and as a result of molecular death. Chronic ulcers of the foot are defined as a gradual breakdown of the epidermal and dermal tissue of the foot lasting for more than 6 weeks. Various factors have been implicated for an ulcer to develop in diabetic patients of which important is peripheral vascular disease which causes decrease in sensation as a result of peripheral neuropathy. This study was a prospective, comparative trial among patients diagnosed with non-healing ulcers in General surgery wards at Gadag Institute of Medical Sciences, Gadag. Duration of healing is significantly reduced in collagen dressing group, it has good compliance, reduced pain and infections, so collagen dressing is superior to routine conventional dressing.

Introduction:Ultrasound is the equipment used to diagnose the disease. Abdominal pain can be classified as visceral, somatoparietal or referred pain that can be a manifestation of a wide array of systemic and local causes. An ultrasound scan could be a medical test that uses high-frequency sound waves to capture real time images of the organ. Different sorts of transducer or probe are used to supply the USG image. Purpose: The aim of this study is to evaluate the role of ultrasonography in different diagnostic conditions of abdomen. Methodology: A quantitative prospective study was performed to assess the role of ultrasonography in abdominal pain in male patients who undergoes abdominal ultrasonography in the radiology department of BSM Medical University Dhaka, Bangladesh from February 2023 to March 2024. 90 male patients were selected according to the inclusion criteria of this study. Patients will be signing a consent before the investigation. History was taken from patients prior to investigation. Abdominal ultrasound was performed. Result: Out of 90 male patients, out of which 21 (23.3%) patients have fatty liver, 12 (13.3%) patients have right renal calculus, 9 (10%)patient have left renal calculus, 3(3.3%)patient have B/L renal calculus, 5 (5.5%) patients have acute pancreatitis, 3 (3.3%) patients have acute appendicitis, 2 (2.2%) patients have liver abscess, 7 (7.7%) patients have cyst, 7 (7.7%) patients have ascites, 19 (21.1%) patients have cholelithiasis and 1 (1.1%) patient have normal. Sonography play key role in to visualized gross primary investigation in abdomen. Conclusion: The study concludes uses of USG should be perform as a primary investigation for all patients. This study has shown a relatively high sensitivity, specificity and diagnostic accuracy of USG in cases of acute abdomen in a careful hand. USG is currently considered the preferred initial imaging technique for patients who are clinically suspected of having fatty liver, renal calculus, acute pancreatitis, acute appendicitis, ascites, cyst, liver abscess and cholelithiasis etc.

Introduction: One of the most common fractures is the distal radius fracture in all the age groups. Among Distal radius fractures, Radiocarpal stiffness is one of the worst complications encountered. This study is to record the incidence and potential risk factors of radiocarpal stiffness associated with distal radius fractures.Method: This is a retrospective study which includes 60 patients diagnosed with distal radius fracture who underwent volar plate fixation. Patient’s details such as basic data, radiological data and postoperative data were documented. The incidence of Radiocarpal joint stiffness during postoperative follow-ups were recorded and factors associated were determined.Result: This study comprised a total of 60 individuals who had their distal radius volar plate fixation. Multiple variables such as preoperative swelling, type of fracture (Intra-articular or Extra-articular), type of fixation (with or without k-wire), post-operative radiological changes pertaining to parameters such as volar tilt, Radial inclination and ulnar variance, rehabilitation was corelated with the incidence of Radiocarpal joint stiffness in distal radius fractures. Conclusion: Factors such as intraarticular extension, preoperative severe swelling, use of additional k- wire, unsatisfied volar tilt, improper rehabilitation is associated with a higher incidence of radiocarpal joint stiffness in patients with distal radius fracture. Re-operative risk notification and postoperative precautions are necessary for relevant patients.

Introduction: Urinary bladder cancer is a prevailing cancer of the urinary system. Worldwide it is the ninth most common type of cancer. There are broadly two histological types of bladder cancers: urothelial and non- urothelial. Urothelial carcinoma is the predominant type with an incidence of 90-95%. Non-urothelial cancers are further subdivided into epithelial and nonepithelial. Epithelial cancers include squamous cell carcinoma, adenocarcinoma,andsmall cell tumors whereas nonepithelial cancers which are further more rare, include sarcomas, melanomas, lymphomas,and paragangliomas. Neurofibromas of thegenitourinary tract arise, from nerves of thepelvic, vesical and prostatic plexuses. Cystitis glandularis is also a very rare benign proliferative disease of urinary bladder mucosa and is usually a microscopic diagnosis and rarely manifests as a large visible macroscopic mass of urinary bladder. Materials and Methods: This is a prospective study conducted in a tertiary care hospital comprising six cases of unusual urinary bladder lesions. We studied the cases according to their age, sex, clinical presentation, location within the bladder, radiological findings, histopathological findings, immunohistochemical findings and treatment provided. Results: This study comprisessix cases of unusual primary urinary bladder lesions which includes one case of squamous cell carcinoma, mucinous adenocarcinoma, clear cell carcinoma, paraganglioma, neurofibroma cystitis glandularis each. The patients belong to a wide age range between 3rd to 7th decade. There is male predominance. Hematuria is the common clinical presentation in all of them. Different locations within the bladder is involved in all these six cases. Histopathological examination followed by immunohistochemical staining of the formalin fixed paraffin embedded tissue sections confirmed their diagnosis. Conclusion:There are several histological variants of urinary bladder cancers, however squamous cell carcinoma, mucinous adenocarcinoma, and clear cell carcinoma are extremely rare. Extensive work-up, including immunohistochemical studies are required to rule out both the possibility of other sites of these primary tumors and possibility of metastasis. Isolated urinary bladder neurofibromas are extremely rare which requires clinical follow up to monitor potential recurrence or progression. Paraganglioma are even more rare and incidentally detected. Cystitis glandularis is a chronic disease and should be considered as a distinct clinical entity.

Parental violence related to school performance is a worrying and often underestimated phenomenon that can have serious, even fatal, consequences on children's well-being and lives. This article presents three clinical cases illustrating the tragic impact of academic failure in a context of family violence.The first case involves an 11-year-old boy who died as a result of severe head trauma inflicted by his father after poor academic results. The second case describes a 15-year-old adolescent who suffered physical abuse, initially consulted for a throat infection but showing signs of previous violence. The third case reports the suicide of a 12-year-old child following repeated abuse after poor school performance.Analysis and discussion: The analysis of these cases highlights the correlation between academic failure and parental violence. The clinical implications underline the importance of early recognition of signs of abuse and appropriate intervention. This study also draws on literature data, including international studies, to compare and deepen the understanding of this phenomenon. Conclusion: The cases presented demonstrate the need to raise awareness among healthcare professionals and society as a whole about the consequences of excessive parental pressure on children. Preventive and educational actions must be strengthened to reduce the incidence of violence and protect the mental and physical health of children.

Background: The distribution of blood groups within population is crucial for blood transfusion safety and understanding potential health risks associated with various blood types. This study addresses the research gap concerning the distribution of ABO and Rh blood groups among school-going children in the Jammu region of India, aiming to explore potential gender-based differences in these distributions. Methods: A cross-sectional study was conducted at Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, involving 200 randomly selected school-going children aged 6 to 15 years. Blood samples were collected and analysed to determine ABO and Rh blood groups using standard serological techniques. The data was statistically analysed using SPSS software, with chi-square tests employed to assess gender differences. Results: The study revealed that 38.0% of participants belonged to blood group O, followed by B (31.5%), A (22.0%), and AB (8.5%). Gender-wise analysis indicated no significant differences in ABO blood group distribution (P=0.9839), while 93.0% of participants were Rh-positive, with a slight female predominance in Rh-positive status. Conclusion and Implications: This study enhances the understanding of blood group distribution patterns, essential for optimizing blood transfusion services and evaluating disease susceptibility in the region. These findings have significant implications for local healthcare planning and blood bank management, ensuring the availability of compatible blood products and reducing transfusion-related risks.

Background: Anaemia, a condition characterized by a deficiency of red blood cells or haemoglobin, poses a significant public health challenge globally, particularly among vulnerable populations such as adolescents. In India, the prevalence of anaemia among adolescents is alarmingly high, with various studies indicating rates ranging from 40% to over 65% in specific regions. Materials and Methods: This study was a crosssectional study conducted in the Government High Schools in Tumkur and the participants were Adolescent girls between 12-18 years of age attending government schools in Tumkur and who were willing were enrolled for the study after obtaining the written informed consent. The sample size considered was 600cases. The study included children aged between 12 and 18 years of age and excluded the Age group 18 years, Girls with any genetic disease, metabolic problems or chronic diseases, Girls not giving consent were excluded from the study. Results: Mean height of 158.8+-7.37cm, Mean weight of 54.19+-9.34kg, Mean BMI of 22.03+-3.39 kg/m2. Mild anaemia -366 students, Moderate anaemia -32 students, Severe anaemia -44 students, Normal – 158 students. Stunting was noted in 308 anaemics .236 had LOW BMI with anaemia and 31 was obese. Prevalence of anaemia was 73.6%.Conclusion: Anaemia is prevalent among teenage female students. Implementing regular screening programmes and surveys can aid in the identification of these girls and provide prompt provision of therapy.

Introduction: The most prevalent menstruation problem during the perimenopause is abnormal uterine bleeding (AUB). A method of categorization (PALM–COEIN) for the etiology of the AUB in non-gravid women has been created by the International Federation of Gynecology and Obstetrics working group on menstrual disorders. The current study's objectives were to investigate the two parts of this system in clinical practice generally and, in particular, to demonstrate a clinico-pathological association between the AUB and the PALM component. Materials and Method: This study was conducted on 100 perimenopausal women with symptoms of abnormal uterine bleeding. The subjects were aged 40 years and above and till one year after menopause. A clinical diagnosis was established using the PALM–COEIN classification following a comprehensive history and examination, followed by pelvic ultrasound.Analysis was done on the relative contributions of the different causes of the structural (PALM) and functional (COEIN) components. Histology evaluated the hysterectomy specimen and endometrial sample following all recommended investigations. A statistical analysis was performed on a clinicopathological connection. Results: When evaluated clinically, the contributions of the COEIN and PALM components to AUB were almost identical. Conversely, the histological analysis demonstrated a notably higher number of instances of the PALM (structural) component of AUB, namely 63%versus 48% (p < 0.05). AUB-L was the most prevalent (43%) aetiology overall. The discrepancy was primarily explained by the discovery of more instances of AUB-M (malignancy and hyperplasia) in highly significant proportions (p ≤.01) and coexisting cases of AUBA;L.Conclusion: Since the two diagnostic modalities are complementary, the PALM– COEIN classification system should consider both the clinical and histological diagnoses in women with AUB around perimenopause. This will optimize the outcome by placing the clinical impression in the appropriate context of the classification.

Background: Febrile seizure is the common type of seizure disorder of childhood occurs in an age-specific manner, usually between 6 months to 5 years of age. It is associated with a fever of temperature 38.0℃ or higher, and presents without any evidence of definite causative diseases, such as metabolic abnormality or central nervous system (CNS) infection. Febrile seizure may be simple or complex. The prevalence of febrile seizures among different communities is between 2-4%, About 4 out of 10 children who had febrile seizure will get them later at some stage, although the risk factors differ from one child to other child. In most of the patients, fever is due to upper respiratory system and urinary tract infection. Objectives: 1) To identify the Risk factors associated with febrile seizure. 2) To analyse the CBC and CRP levels in febrile seizure. Methodology: This study was a cross sectional study. All the In patient and Outpatient children in the department of paediatrics who are diagnosed with febrile seizure and satisfying inclusion criteria was enrolled for the study after obtaining the written informed consent at Sri Siddhartha Medical College And Research Centre, Tumkur. The sample size considered is 70 cases. The study included children aged between 6 months to 5 years of age and excluded the children with seizures other than febrile seizure. Results: The study included 75 children with febrile seizure, Majority of the population had high grade fever (> 101 F). In this present study URTI was found to be the cause the fever leading to the seizures, almost all the children presented with GTCS. Only two had partial convulsions. The onset of seizure was within 24 hours of the onset of the febrile episode in 43/75children. There was a positive family history in 22/75 patients. The correlation of the previous history and the type of seizure, there was no significance. 40/75 of the patients had features of anaemia. The association with type of seizure was found to be statistically significant. In more than half the patients, we noted an elevated total leucocyte count. In 2/3rd of the patients, CRP was observed to be elevated. Conclusion: The most prevalent kind of febrile seizure was the simple febrile seizure. While a minority had positive family history and past history, we noted that majority had coryza that triggered the episode. Anaemia was also identified to be a significant risk factor for our study.

Background: Musculoskeletal disorders (MSDs) are a significant occupational health concern among nursing staff, leading to reduced productivity, increased absenteeism, and compromised patient care. This review aims to synthesize the evidence on the effectiveness of multimodal interventions in preventing and managing MSDs among nurses.Methods: A systematic literature search was conducted using PubMed, CINAHL, Embase, and Scopus databases to identify studies examining the effectiveness of multimodal interventions for MSDs in nursing staff. The search included randomized controlled trials, quasi-experimental studies, and pre-post intervention studies published from inception to the present date. Data extraction and quality assessment were performed independently by two reviewers.Results: The synthesis of evidence from the included studies demonstrated that multimodal interventions combining ergonomic modifications, exercise programs, educational strategies, and organizational support were more effective than single interventions in reducing MSD symptoms and risk factors among nurses. Key components of successful interventions included workplace ergonomic assessments, patient handling equipment and training, stretching and strengthening exercises, and participatory approaches involving nurses in the planning and implementation of interventions.Conclusion: The findings of this review support the effectiveness of multimodal interventions in preventing and managing MSDs among nursing staff. Healthcare organizations should prioritize the implementation of comprehensive MSD prevention programs that address the multifactorial nature of these disorders. Further research is needed to establish standardized outcome measures and evaluate the longterm sustainability and cost-effectiveness of multimodal interventions in diverse nursing settings.

One of the most prevalent dermatological conditions is psoriasis, a chronic inflammatory condition. Although it is linked to a number of illnesses, cardiovascular disease is the most prevalent. Since lipid abnormalities are seen in psoriasis sufferers early on, the condition may be genetically resolved. Therefore, it is crucial to investigate lipid abnormalities in psoriatic patients in order to assess the risk of atherosclerosis and vascular obstructive disorders, as well as the morbidity and mortality that go along with them. Aim: Estimating lipoprotein levels and associated cardiovascular disease risk in psoriasis patients. Materials and Methods: This crosssectional analytical investigation is centered in the community. The healthy ambulatory population in and surrounding Jay Prabha Medanta Super Specialty Hospital in Kankarbagh, Patna, Bihar, comprised the study population.40 psoriatic patients with a mean age of 50.68 ± 8.86 years made up the study group, while 40 healthy people of either sex with a mean age of 50.15 ± 9.6 years made up the control group. There were 55% males and 45% females in the control group and 59% males and 41% females in the test group. estimation of serum triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol the same day, lipoprotein levels were measured. The Enzymatic End Point Method is used to estimate the amounts of lipoproteins. The mean, standard deviation, p-value, and Chi-square test were computed in order to analyze the data. Results: Psoriasis patients had significantly higher levels of VLDL and total cholesterol than control subjects (p<0.05). Serum TG results showed a significantly significant difference between psoriasis sufferers (6.8 ± 1.49) and controls (3.08 ± 1.3) (p<0.001). Serum LDL levels in psoriasis patients and controls did not differ significantly, though. Serum HDL levels did not significantly alter in either the control group or the psoriasis patients. While there were no discernible changes in the LDL/HDL ratio between the psoriasis case and control, there was a statistically significant difference in the TC/HDL ratio (p<0.05). Conclusion: According to the current research, hyperlipidemia was linked to psoriasis patients. Thus, they are at a significant risk of getting cardiovascular disorders. We propose that assessing psoriatic patients' serum lipid profiles will aid in early risk assessment. Cardiovascular problems can be avoided in these patients with quick therapy.

Background: Leukocytosis is well known to be a significant indicator of inflammatory response and have predictive value on the functional outcome in ischemic stroke.Numerous studies have analyzed the correlation between leukocyte count and the severity of ischemic stroke based on National Institutes of Health Stroke Scale (NIHSS). However, studies specifically focused on neutrophil count are still limited. The aim of this study is to explore the correlation between neutrophil count and ischemic stroke severity evaluated using NIHSS.Method: This analytical observational study used cross-sectional design and purposive sampling, with a total sample of 27 ischemic stroke patients. The neutrophil count and NIHSS scorewere collected at admission and then analyzed using Spearman correlation test. Results: This research found a significant relationship between neutrophil count and ischemic stroke severity based on NIHSS, with a p-value of <0.001. The correlation coefficient is 0.858, indicating a linear and very strong correlation.Conclusion: There was a significant correlation between neutrophil count and the severity of ischemic stroke based on NIHSS score

Background: Postoperative infections remain a significant challenge in obstetrics and gynecological surgeries, leading to increased hospital stays and healthcare costs. Antibiotic prophylaxis aims to reduce microbial colonization during surgery. This study compares the effectiveness of short-term and long-term antibiotic regimens in preventing infections following elective caesarean sections and abdominal hysterectomies. Methods: An interventional prospective study was conducted over a year with 100 participants. Group 1 (50 patients) received a short-term regimen of ceftriaxone, while Group 2 (50 patients) underwent a long-term regimen. Key metrics, including wound infection rates, febrile morbidity, duration of hospital stay, and the need for additional antibiotics, were analyzed. Results: Wound infections were more frequent in Group 1 (14%) compared to Group 2 (2%), with febrile morbidity similarly higher in Group 1 (16% vs. 4%). The mean hospital stay was significantly shorter for Group 1 (3.12 days vs. 5.24 days). However, Group 2 demonstrated better infection control overall. Conclusion: While both regimens were effective, the short-term regimen was associated with reduced hospital stay and costs but increased infection rates. Long-term antibiotics offered superior infection control but at the expense of prolonged hospitalization and higher risk of nosocomial infections. Patient selection remains critical in determining the appropriate prophylactic approach.

Skin disorders are related to the dysfunction of skin’s components or layers defects of human skin. It has targeted all kinds of people regardless of age, gender, race, as well as social and economic status. Majority of the global population is affected by skin disorders to some extent this includes the three main categories namely dry skin, acne and hyperpigmentation. Because of the magnitude of the impact on the world population, this paper reviews skin disorders by looking three most common types which have become a great focus in many research works. The design of the review begins with profiling of literatures for as pan of 20years from 1999 to 2019 to accentuate the growing interest among research community in skin study. Skin anatomy is presented with focus on epidermis, dermis, skin turn over and the varying perspectives as well as the mechanical properties such as stress, strain, and absorption. On skin disorders, the number of literatures published for dry skin was found the highest and this is consistent with findings in other studies. Three skin disorders (dry skin, acne, and hyperpigmentation) have been critically reviewed by its physical evaluation and distinctive description. Etiologies of skin disorders are also reviewed and analyzed using relevant quality control tools.

Abstract: Background: Proximal one-third tibial fractures are challenging to treat due to the high incidence of malalignment and non-union. The use of poller screws in combination with intramedullary nailing has been proposed to improve reduction and alignment in these fractures.Methods: A prospective observational cohort study was conducted on 40 patients with proximal one-third tibial fractures treated with intramedullary nailing and poller screws. Radiological outcomes were assessed by measuring the antecurvatum/recurvatum and varus/valgus angles. Functional outcomes were evaluated using the Karlstrom-Olerud scoring system. The mean follow-up period was 9 months.Results: The mean antecurvatum/recurvatum angle improved from 2.72 ± 4.22° preoperatively to 0.4 ± 1.13° postoperatively (p = 0.0002) and 0.15 ± 0.7° at union (p = 0.0002). The mean varus/valgus angle improved from 6.25 ± 11.01° preoperatively to 1.45 ± 3.5° postoperatively (p = 0.001) and 0.68 ± 3.14° at union (p = 0.0003). The mean time to union was 13.27 ± 1.71 weeks. According to the KarlstromOlerud scoring system, 92.5% of patients achieved excellent or good outcomes.Conclusion: The use of poller screws in combination with intramedullary nailing is an effective method for the treatment of proximal one-third tibial fractures, resulting in significant improvements in fracture alignment, high rates of union, and good functional outcomes.

Invasive aspergillosis of the paranasal sinuses represents a life-threatening opportunistic infection that predominantly affects immunocompromised patients. Despite advances in medical therapy, it remains a significant cause of morbidity and mortality, particularly when orbital involvement occurs. We present a detailed case analysis and comprehensive literature review of invasive sino-orbital aspergillosis, focusing on diagnostic approaches, treatment modalities, and outcome measures. A 62- year-old female with poorly controlled diabetes mellitus presented with right maxillary pain and swelling, complicated by sixth and seventh cranial nerve involvement. Through systematic diagnostic evaluation including radiological imaging, surgical intervention, and histopathological analysis, invasive sino-orbital aspergillosis was confirmed. The patient underwent successful treatment with a combination of intravenous Liposomal Amphotericin B, oral Posaconazole, and surgical debridement via Functional Endoscopic Sinus Surgery (FESS). Following aggressive medical and surgical intervention, the patient achieved complete resolution of infection with no evidence of recurrence during the follow-up period. This case emphasizes the importance of early diagnosis and aggressive treatment in managing invasive sinoorbital aspergillosis.

Bell's palsy represents the most common peripheral facial nerve paralysis, accounting for approximately 70% of all peripheral facial palsies. This idiopathic condition results in partial or complete weakness of facial expression muscles, accompanied by potential alterations in taste, hyperacusis, and changes in lacrimation and salivation. We present a case of a 45-year-old female daily worker who presented with a three-week history of facial weakness, difficulty drinking, drooling, headache, and right jaw pain. The patient had a confirmed history of HSV infection. Comprehensive clinical examination and electrodiagnostic testing revealed 50% facial nerve damage. The patient was successfully managed with a combination of antiviral therapy, corticosteroids, and supportive care, including ophthalmological intervention and physiotherapy. This case highlights the importance of prompt recognition and appropriate management of Bell's palsy, emphasizing the value of a multidisciplinary approach combining pharmacological intervention with appropriate supportive care and rehabilitation.

Background: Balloon dilation of the Eustachian tube traditionally employs specialized devices, limiting accessibility and increasing costs. This study evaluated the feasibility and safety of using standard endovascular balloons for this procedure.Methods: A prospective, single-center study enrolled 75 adults with chronic Eustachian tube dysfunction. Standard endovascular balloons were used for dilation under general anesthesia. Primary outcomes included technical success and safety. Secondary outcomes included changes in ETDQ-7 scores, tympanometric parameters, and patient satisfaction at 6 weeks post-procedure.Results: Technical success was achieved in 96% of cases. ETDQ-7 scores improved significantly from 4.8 ± 0.9 to 2.1 ± 0.6 (p<0.001) at 6 weeks. The complication rate was 34.7%, predominantly minor and self-limiting, with 92.3% resolution within 6 weeks. Type A tympanograms increased from 0% to 77.3% at 6 weeks (p<0.001). Mean air-bone gap improved from 28.5 ± 8.4 dB to 12.8 ± 5.4 dB (p<0.001). Younger age (≤45 years, OR=1.8, p=0.023) and shorter symptom duration (≤12 months, OR=2.4, p=0.002) predicted better outcomes. Patient satisfaction reached 92% with mean recovery time of 3.2 days.Conclusion: Eustachian tube balloon dilation using standard endovascular balloons demonstrates favorable safety and efficacy profiles, offering a potentially cost-effective alternative to specialized devices.

Background: The role of topical antibiotic ointment in post-myringoplasty care remains controversial, with limited evidence supporting its routine use. This study evaluated the efficacy of topical antibiotic ointment in lateral graft underlay myringoplasty.Methods: A prospective, randomized, double-blind controlled trial was conducted with 120 patients randomly assigned to receive either topical antibiotic ointment (n=60) or petroleum jelly (n=60) following myringoplasty. Primary outcome was graft uptake rate at 12 weeks. Secondary outcomes included infection rates, healing time, complications, and cost-effectiveness.Results: Complete graft uptake was achieved in 90.0% of the antibiotic group versus 85.0% of controls (p=0.582). Postoperative infection rates were comparable (3.3% vs 5.0%, p=0.648). Complete epithelialization at week 6 was observed in 80.0% and 75.0% of cases, respectively (p=0.509). Complication rates were similar, with granulation tissue being most common (6.7% vs 8.3%, p=0.729). The antibiotic group showed significantly higher costs per successful outcome ($272.8 ± 42.6 vs $256.9 ± 38.4, p=0.038).Conclusion: Routine use of topical antibiotic ointment following lateral graft underlay myringoplasty does not significantly improve surgical outcomes and increases treatment costs. These findings support more judicious use of topical antibiotics in uncomplicated myringoplasty cases.

Background: Fulfillment of nutritional needs in pregnant women greatly affects the nutritional status of the fetus in the womb and will determine the growth and development of the baby, especially during the growth period (golden age). In the mother's womb, brain cells undergo various stages of development, namely from proliferation, migration, synaptogenesis to apoptosis. Adequate nutrition is the main and most important factor that plays a role in determining the success of body and brain growth in the fetus. The purpose of this study was to determine the effect of DHA intake on TNFa levels in underweight pregnant women. Methods: The research approach used was cross-sectional and interviews were conducted directly with 21 pregnant women patients in Made Suarabaya District. Results: The average levels of TNFa in underweight pregnant women before and after DHA administration were as follows: 163,746±66,591 and 133,339±39,159 respectively. Conclusions: There is a significant positive effect of providing DHA intake to underweight pregnant women.

Traumatic dislocation of the testis is an uncommon injury typically associated with high-impact trauma. We present the case of a 36-year-old male who sustained dislocation of the right testis into the thigh following a motorcycle accident. Diagnosis was delayed by two weeks, with confirmation made via ultrasonography and computed tomography (CT). Surgical management involved inguinal exploration and successful orchidopexy. This case underscores the importance of early recognition and appropriate management of this rare urological injury to preserve testicular function.

Background: Acute ischemic stroke is the leading cause of death and disability. An accurate and practical understanding of imaging modalities is essential for the management of the acute stroke patients. Due to its widespread availability and speed, unenhanced Computed Tomography (CT) scan remains the initial study of choice for evaluating an acute stroke patients and Diffusion Weighted Magnetic Resonance Imaging (DWMRI) can detect abnormalities due to ischemia within 3 to 30 minutes of onset, when conventional MRI and CT images would still appear normal.Objective: To compare the diagnostic role of CT scan and DWMRI in acute ischemic stroke and establish the agreement between them.Methods: This cross-sectional study was performed on 110 patients from the Department of Radiology and Imaging, BSM Medical University Hospital, Dhaka, Bangladesh from July 2023 to August 2024. Patients were immediately transferred to the Department of Radiology and Imaging where they underwent comprehensive CT scans. Suspicion of acute ischemic stroke was present.Results: Total 110 patients were enrolled in this study. Almost one third (32.7%) patients belonged to age ≥70 years. The mean age was 61.11±12.49 years with range from 32 to 90 years. Almost two third patients were male (60%) followed by (40%) female. More than (38.2%) patients were retired from job, followed by house wife (34.5%). It was observed that 20 (20%) patients experienced headache, (32.7%) vertigo, (49.1%) vomiting, (70.9%) hemiparesis/hemiplegia, Majority (81.8%) had speech disturbance. The location of infarct showed that (23.6%) patients were in M1 segment (anterior circulation ASPECTS) followed by 52 (47.3%) in lentiform nucleus and 52 (47.3%) in internal capsule. Mass Effect were observed in both CT and DWMRI in 14 (12.7%) cases. More than (76.4%) patients showed parenchymal hypoattenuation (CT) and diffusion restriction (MRI) [CT, 76.4% and DWMRI, 78.2%]. Regarding ADC value, it was observed that majority (74.5%) patients were below 0.6X10-3 mm2/s. The agreement analysis of the two modalities (parenchymal hypoattenuation (CT) with diffusion restriction (MRI)) was found showing a Kappa value of 0.858 and p value <0.01. Conclusion: DWI-MRI is a better imaging method in detecting early ischemic lesions in acute ischemic stroke patients.

Purpose: To investigate ability of parents to identify and differentiate between primary and permanent teeth and knowledge on eruption age of permanent first molar. Method: 337 parents (240 male, 97 female, mean age 39) were included in this study. All the children of age 6-12years were examined and first and fourth quadrant and parents asked to identify the permanent teeth among them. Each of their answer correct as zero(incorrect answer)one(correct answer) and the total score was calculated. Results: 43% correctly identified that first primary teeth erupt at 6 months of age and 29 % identified that first permanent teeth erupt at 6 years of age. Conclusion: Parents do not have sufficient knowledge to differentiate between primary and permanent teeth also eruption age of permanent teeth among Davangere population. Education and awareness is required about children’s oral health.

Background: Stroke is a growing disease and it is the second common cause of death in the world after coronary heart disease. In patients with acute stroke hyperuricemia was significantly higher than normal population with associated dyslipidemia..Female sex is still an independent predictor ofpoor prognosis even when adjusting for other predictors of functional outcome. Aim: Serum uric acid levels and serum lipid levels in female patients with ischemic cerebrovascular accident. Material and Methods: This was a cross-sectional study carried out between July 2019 – September 2019, which included 44 female cases of acute ischemic stroke. Serum uric acid levels and serum lipid levels was done in all the patients and was statistically analyzed. Result:Among the 44 female patients, 33 (75%) were postmenopausal and 11(25%) werepremenopausal. The mean age in study was 58.09±15.23. Hyperurecimic patients were higher inpostmenopausal women as compared to premenopausal The study showed that patients were withboth dyslipidemia and hyperuricemia.The positive correlation was present between serum uric acid level and Total Cholesterol, Triglyceride, LDL level. The negative correlation was present between serum uric acid level and HDL level. The patients with decreased HDL with Hyperuricemia were 15.90% (7 out of 44). Conclusion: Hyperuricemia and its accompanying dyslipidemia can be considered as the risk factor for acute ischemic stroke.

Background: Focal seizures are a notable complication in patients with poorly controlled diabetes, particularly in the context of non-ketotichyperglycemia (NKH). Seizures associated with NKH are refractory to conventional antiepileptic drugs (AEDs) but respond effectively to glycemic control. This study evaluates the efficacy of insulin and rehydration over AEDs in managing NKH-induced seizures, highlighting the importance of early blood glucose monitoring in seizure presentations. Methods: A single-case observational study was conducted on a 58-year-old female with type 2 diabetes mellitus presenting with focal seizures. Diagnostic evaluations included blood glucose levels, serum osmolality, and imaging studies. The patient received both AEDs and insulin-based therapy, and seizure outcomes were monitored. Results: Despite maximum doses of phenytoin, seizures persisted until blood glucose levels were normalized through insulin therapy and hydration. The patient’s seizures resolved completely following glycemic correction, allowing successful withdrawal of AEDs. Conclusion: Insulin and hydration are more effective than AEDs in managing NKHinduced focal seizures. Early recognition of hyperglycemia and appropriate glycemic management can prevent unnecessary AED use and improve outcomes.

In 2020, the incidence of low birth weight (LBW) was 27.6%. The high rates of neonatal morbidity and mortality in our country are largely attributed to factors such as poor nutrition, inadequate healthcare, and limited education for female children, early teenage marriages, frequent pregnancies, maternal malnutrition, fewer antenatal visits, and a history of adverse obstetric outcomes. These factors significantly contribute to the increased prevalence of LBW. The aim of this study was to explore the relationship between maternal haemoglobin levels and LBW.A hospital-based cross-sectional study was conducted on a total of 420 babies born at Sri Siddhartha Medical College and Hospital Research Centre in Tumkur over a period of 24 months. The study found that haemoglobin levels, and iron and folic acid supplementation were all positively associated with low birth weight (LBW) babies. The occurrence of low birth weight (LBW) is influenced by multiple maternal factors, highlighting the complexity of its causes. To reduce LBW rates, it is essential to address these factors through health education, socioeconomic development, and improving maternal nutrition during pregnancy.

Introduction: Phototherapy is considered to be a risk factor for hypocalcemia and its mechanism is probably multifactorial.Objective: 1) To determine the effect of phototherapy on serum Calcium level in neonates receiving phototherapy. 2) To compare Serum Calcium level changes in preterm and term neonates.Study Design: present study is a prospective hospital based comparative study conducted over a period of 1yr.Result: The study included 100 neonates. The majority of study participants i.e, 75 were born at term whereas, 25 were born preterm. Among preterm infants, the mean serum calcium level before phototherapy was 8.96±0.62 mg/dl, which decreased to 8.39±0.76 mg/dl after phototherapy. Among term infants, the mean serum calcium level before phototherapy was 9.08±0.61 mg/dl, which decreased to 8.38±0.77 mg/dl after phototherapy.Conclusion: The present study suggested that phototherapy is associated with significant reductions in serum calcium particularly in term infants. Preterm infants also showed significant changes in serum calcium levels, emphasizing their vulnerability and the need for close monitoring.

Background: Predicting the difficulty of laparoscopic cholecystectomy (LC) preoperatively is pivotal in reducing complications and improving patient outcomes. This study examines clinical, biochemical, and imaging factors contributing to challenging LC cases, aiming to develop a predictive model for better surgical planning. Methods: A prospective study involving 60 patients with symptomatic gallstone disease was conducted at Krishna Mohan Medical College, Mathura. Preoperative parameters such as demographic data, laboratory findings, and ultrasonographic features were analyzed in relation to intraoperative outcomes, including conversion rates and complications. Results: Gallbladder wall thickness, pericholecystic fluid, and WES (wall-echo-shadow) sign were significantly associated with difficult surgeries (p<0.05). Male gender was also correlated with higher conversion rates. Thirteen percent of cases required conversion to open cholecystectomy. Conclusion: Identifying high-risk factors like gallbladder wall thickness, pericholecystic fluid, and WES sign preoperatively can enhance surgical planning and mitigate complications. Tailored strategies are recommended for better management of challenging cases.

Introduction: Immediate condition just after root canal therapy takes a first impression of treatment as well as clinician’s ability. In this pretext, evaluation of reduction of PEP using two different file system with Endoactivator is done. Aim: Evaluation of post endodontic pain after using Endoactivator with ProTaper Gold and ProTaper Next file system in single visit root canal treatment. Material method: A total of 100 patients were assigned who required endodontic treatment. They were divided into two groups: Group 1 (PTG-EA) and Group 2 (PTNEA). Single visit root canal was performed under local anesthesia. Endoactivator was used for final irrigation protocol in all groups. The intensity of post endodontic pain (PEP) was evaluated by Visual Analogue Scale VAS score after 6,12,24 and 48 hours. Final data was combined and statically analyzed with the help of SPSS 20.0 software at a level of being significance being 0.05. Results: As compared to ProTaper Gold, ProTaper Next showed the least score at 6 and 12 hours of PEP, there was a statistically significant difference noted. At 24 and 48 hours no statistically significance difference was noted among two groups. Conclusion: The intensity of PEP was minimum when treated with ProTaper Next file system along with Endoactivator.

Desmoplastic Small Round Cell Tumor (DSRCT) is a rare malignant mesenchymal tumor that usually arises in the abdomen and pelvis and demonstrates a locally aggressive behavior with multiple peritoneal implants.The paucity of these cases and varied clinical presentations leads to a diagnostic dilemma, and there are noconsensus guidelines regarding management. We report 2 unusual presentations of DSRCT, one with testicular mass along with retroperitoneal lymphnodes and umbilical nodule, and another with left inguinal swelling and omental mass. These cases are being presented because of infrequent occurrences and unusual presentations that have been not reported in the literature so far.

Background: Despite national efforts to promote family planning, contraceptive nonacceptance remains high in India, particularly in urban slums. This study investigates the knowledge, attitudes, and practices influencing contraceptive use among married women of reproductive age in UHTC, Pardeshipura, Indore. Methods: A crosssectional study was conducted with 665 married women of reproductive age using a house-to-house survey. Simple random sampling was employed to select slum zones, and data were collected using a pre-designed and pre-tested proforma. Statistical analysis was conducted to identify associations between contraceptive use and demographic factors. Results:The contraceptive acceptance rate was 52.03%. Oral contraceptive pills were the most commonly used method (26.91%), followed by condoms (10.97%). Non-users (47.96%) cited barriers such as religious restrictions (15.49%), spousal disapproval (12.63%), and lack of knowledge (6.47%). Acceptance was significantly associated with literacy (p < 0.05), occupation (p < 0.001), and socioeconomic status (p < 0.05). Conclusion: Literacy status, socioeconomic-status and occupation were significantly associated with the use of contraceptives. Targeted educational initiatives and male involvement in family planning are needed to address cultural and informational barriers. Strengthening urban health systems is crucial for improving access to contraceptives.

Merely 0.05% of oral malignancies are oral mucosal melanomas (OMMs). The infrequency of OMM, the variation in clinical and histopathologic features, and the scarcity of genetic and molecular research to date have restricted our understanding of the etiopathogenesis of these tumors. A 67-year old male patient from a semi urban area presented for evaluation of swelling and occasional pain in the maxillary alveolar ridge and palatal area. A presumptive clinical diagnosis of mucosal melanoma was made, which was confirmed by incisional biopsy with subsequent histopathologic evaluation as well as immunohistochemical analysis. Microscopically H&E stained sections revealed the presence of stratified squamous epithelium extensively infiltrated by nests of large spindeloid cells with pleomorphic vesicular and hyperchromatic nuclei, prominent nucleoli, and abundant cytoplasm with brown pigment suggestive of malignant melanoma. IHC revealed intense immunopositivity of the atypical melanocytes towards HMB 45 and S100. The entire clinicpathological gamut of oral mucosal Melanoma has been presented through this case report.

Background: Iron and folic acid supplements are a key intervention and mandatory for all antenatal women, irrespective of their haemoglobin status, because as gestational weeks increase, nutrition alone is insufficient to meet the demands. On the other hand, the prevalence of anaemia remains persistently high, with 52% of antenatal women being anaemic, according to NFHS-5. IFAS has shown significant benefits in reducing maternal and foetal complications. Objectives: The aim of this study was to estimate the magnitude of anaemia and assess knowledge about Iron and Folic Acid Supplements (IFAS) among antenatal women. Methods: An observational, descriptive cross-sectional study was conducted among 142 antenatal women selected by convenience sampling at Government General Hospital (GGH), Kurnool. Sahli's method was used for haemoglobin estimation, and a structured questionnaire was used to assess knowledge after obtaining informed consent. Results: Out of 142 antenatal women, 45% belonged to the 18–21-year age group, 50.7% were primi’s, and 49% were multigravidas. The magnitude of anaemia among antenatal women was normal, mild, moderate 27.4%, 61.9% and 10.56% respectively. The proportion of antenatal women having good, fair, and poor knowledge about IFAS was 0.7%, 52.8%, and 46.4%, respectively. Conclusion: The study revealed that the majority of antenatal women 61.9%were anaemic, with only 27.4% having normal haemoglobin levels. Furthermore, 46.4% of the women had poor knowledge about IFAS..Hence should focus more on Information, Education and Communication activities(IEC).

Introduction:Salivary glands are exocrine organs responsible for the production and secretion of saliva and consist of the parotid, submandibular, sublingual and minor salivary glands that are numerous and widely distributed throughout the mouth and oropharynx. Salivary glands neoplasms accounts for less than 3% of all the head and neck tumors. (1) FNAC is a useful method for evaluating suspicious salivary gland lesions due to its low cost, minimum morbidity, rapid turn around time, high specificity and sensitivity. (2) Among the primary epithelial tumors, 64-80% occurs in the parotid glands, 7-11% occurs in the submandibular, less then 1% occurs in the sublingual and 9-23% occur in the minor salivary glands. (3) Material and Method: The study was conducted on salivary gland lesions over the period of 6months, with total number of 35cases in the Department of Pathology. Results:There is a definite male predominance in lesions of salivary glands. Parotid is the most common site for occurrence of salivary gland lesions. Benign neoplasm more common in age group below 50years and malignancies in above 50years of age groups. A total 35 salivary gland lesions were examined and 22 were males and 13 were females According to MILAN system majority of cases belongs to Neoplasm benign (37%) followed by non neoplastic(28.6%), malignant(25.7%), non diagnostic(5.8%) and Suspicious of malignancy(2.9%). Conclusion:FNAC has an immense significance as a primary and most effective as well as cost effective screening test in detecting and differentiating salivary glands lesions. The high sensitivity, specificity and diagnostic accuracy of cytologic reporting of salivary gland lesions based on Milan nomenclature in our study reflect the positive contribution of the MSRSGC towards accurately categorizing the lesions by which risk of malignancy can be assessed. This helps the clinicians for further management.

Leclerciaadecarboxylata is a gram-negative bacillus of the Enterobacteriaceae family. It is arare human pathogen that is often acquired via wound and/or contact with aquatic environment.Although multiple cases of L. adecarboxylata infections are described in the adult population,few have been documented in pediatrics. We are presenting case of L. adecarboxylata infectionsin the pediatric population. These cases highlight the growing emergence of this bacterium in thepediatric population and the need to become more aware of its threat even in patients who areimmunocompetent.

Introduction: A measurement of neutrophil to lymphocyte ratio (NLR) and of platelet to lymphocyte ratio (PLR) has been found to be one of the markers of tumour burden for patients with carcinoma ovary. It has been noted that higher the NLR and PLR values, lower is the overall and recurrent free survival. Thus, we undertook the present study to analyse the role of NLR and PLR as a predictor of outcome in advanced high grade serous adenocarcinoma of ovary. Materials and Methods: A retrospective study was conducted from January 2018 to December 2019 at a tertiary level regional cancer institute of Northeast India including women with high grade epithelial ovarian cancer. A total of 100 cases were analysed and neutrophil is to lymphocyte ratio (NLR) and platelet is to lymphocyte ratio (PLR) was calculated for all patients; pre and post treatment. For comparison of NLR and PLR values pre and post treatment, chi square test was used and p value of less than 0.05 was considered significant. Kaplan-Meier curves were used for comparison of recurrence to survival percentage at 1,3 and 5 years based on pre NACT NLR and PLR and pre-recurrence NLR values. Results: At initial presentation, the NLR and PLR values were calculated for all 100 patients and it was seen that NLR was less than 8 in 35% cases, 8 to 11 in 15%and more than 11 in 50% of the study population.All patients received 3 to 4 cycles of neo-adjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Post IDS, NLR was less than or equal to 1 in 61% and more than 1 in 39% cases. The PLR was found to be less than or equal to 5 in 53% and more than 5 in 47% cases. All patients had recurrence within 24 months of completion of treatment.It was seen that when NLR values (post NACT) was more than 11, early recurrence was seen in 61% cases and 35% cases showed late recurrence. This comparison was significant (p value: 0.004).Conclusion:The NLR has been proposed to be significant prognosis predictors for ovarian cancers. Yet, the cutoff value of the NLR is inconsistent instudies, which reduces its clinical applicability. In the present study the chosenmedian cut off value of pre NACTNLR > 11(HR:2) and PLR> 59 (HR:1.5) and a pre recurrence NLR> 9 (HR:2.6) had a significant impact on the post recurrence survival. A pre recurrence NLR> 9 was also a poor predictor of survival.

Introduction: Trauma to the upper extremities are very common especially in younger individuals who often sustain these injuries by way of moderate to high-energy mechanisms such as motor vehicle accidents or sports injuries, whereas elderly individuals are more likely to sustain injuries because of the sequela of a low-energy fall ̐[1]. There are numerous conservative treatment options available, the most common being the use of a sling or ’figure-of-eight’ bandage however, Surgical treatment is indicated if mediastinal structures are placed at risk because of fracture displacement, in case of soft-tissue compromise, or when multiple trauma and/or “floating shoulder” injuries are present [2]. In the latter, the common anaesthetic technique for patients is general anesthesia (GA) however Regionalanesthesia (RA) can be a preferred as an alternative to (GA) to avoid complications as well as to provide post operative analgesia. The aim of this study is to determine if Interscalene brachial Plexus block is a safe alternative to general anaesthesia for Clavicle surgeries. Objective: To report a case of Clavicle fracture fixation surgery done under interscalene block solely. Methods: A literature review was conducted using databases such as PubMed, Elsevier, and GoogleScholar to identify relevant studies comparing ISB and GA for clavicle fracture surgeries. Result: We present a case of a 40 year old male with right clavicle fracture following an alleged history of trauma, who underwent ORIF and plating in supine position under Interscalene block. Conclusion: We conclude that Interscalene Block is well tolerated and has favourable outcomes as compared to general anesthesia and can be considered for clavicle fixation surgeries.

Introduction:Oral Carcinomas being one of the most common cancers in India, surgery is the mainstay of management. Owing to the primary lesion or as a sequelae of radiation these patients often present with a difficult airway and pose a challenge to the Anaesthesiologist with respect to their intubation. The aim of this case report is to determine if Awake nasal intubation is a better and safer option for patients undergoing surgical resection of Oral carcinomas.Objective: To report a case of Awake nasal intubation in a patient undergoing wide local excision surgery of Buccal mucosa squamous cell carcinoma. Method: Search of relevant references from Pubmed, Elsevier and others with 15 considered relevant by authors were finally selected.Result: We present a case of a 40 years old female with a history of 20 years of tobacco chewing diagnosed with Left buccal mucosa squamous cell carcinoma who has undergone wide local excision of tumour under General Anaesthesia and was intubated awake, via the nasal route.Conclusion: We conclude that Awake nasal intubation is a safer alternative in patients with difficult airway, without the use of modern airway gadgets and peri-operative tracheostomy.Introduction:Oral Carcinomas being one of the most common cancers in India, surgery is the mainstay of management. Owing to the primary lesion or as a sequelae of radiation these patients often present with a difficult airway and pose a challenge to the Anaesthesiologist with respect to their intubation. The aim of this case report is to determine if Awake nasal intubation is a better and safer option for patients undergoing surgical resection of Oral carcinomas.Objective: To report a case of Awake nasal intubation in a patient undergoing wide local excision surgery of Buccal mucosa squamous cell carcinoma. Method: Search of relevant references from Pubmed, Elsevier and others with 15 considered relevant by authors were finally selected.Result: We present a case of a 40 years old female with a history of 20 years of tobacco chewing diagnosed with Left buccal mucosa squamous cell carcinoma who has undergone wide local excision of tumour under General Anaesthesia and was intubated awake, via the nasal route.Conclusion: We conclude that Awake nasal intubation is a safer alternative in patients with difficult airway, without the use of modern airway gadgets and peri-operative tracheostomy.

Gallbladder adenomyomatosis (GA) is a benign, proliferative condition characterized by gallbladder wall thickening and the presence of Rokitansky-Aschoff sinuses. Though generally asymptomatic, GA can mimic acute cholecystitis, leading to diagnostic challenges. We present a case of a 32-year-old male with a year-long history of recurrent right hypochondriac pain radiating to the shoulder, accompanied by nausea and vomiting. Initial clinical and laboratory findings suggested acute cholecystitis. Imaging studies, including ultrasonography and magnetic resonance cholangiopancreatography, revealed diffuse gallbladder wall thickening with cystic spaces, indicative of adenomyomatosis. The absence of gallstones and the presence of a dilated cystic duct further supported the diagnosis. The patient underwent elective laparoscopic cholecystectomy, and histopathological examination confirmed diffuse adenomyomatosis with smooth muscle hypertrophy and Rokitansky-Aschoff sinuses. The postoperative recovery was uneventful, and the patient remained asymptomatic during a six-month follow-up. Gallbladder adenomyomatosis is benign and can be detected by imaging or during cholecystectomy. Theoretically, adenomyomatosis doesn't need any special care unless it presents symptoms, whether or not cholecystolithiasis is present.