European Journal of Molecular & Clinical Medicine

The foramen magnum (FM) is an essential feature of the base of skull and is of great
significance to several departments of medicine (1) Variations of the shape of FM have got
diagnostic, clinical and radiological implications. Also there exists some association between
the shape of FM and ancestry of an individual.
Clinical importance:
Because critical structures that pass through FM may be compressed, as in FM
achondroplasia and FM brain herniation, the dimensions of FM have clinical significance (2).
The transcondylar method is commonly used in neurosurgery to treat lesions that are ventral
to the brainstem and corticomedullary junction. According to some accounts, understanding
the bone architecture of the condylar area is crucial to this method. As a result, comparing
FM dimensions to hindbrain tissue can reveal information about the development and
progress of Chiari I symptomatology. Despite the fact that it is of great clinical importance,
there are only a few anatomical accounts in the literature. The goal of this study was to
document and investigate the morphologies of the foramen magnum (FM) in dry cadaver
skulls, as well as to compute the average FM measurements.
In forensic anthropology, a person's gender is determined through their skeleton. Even though
a complete skeleton is essential for accurate results, finding one that is both complete and in
good condition is extremely unusual. If the right methods are utilised, gender can be
determined from skeletal remains. In determining a person's gender, the pelvis, femur, tibia,
humerus, radius, mandible, and cranium are all useful. (3) However, the skull is second only
to the pelvis in terms of gender identification in archaeological contexts, where it has the
ability to identify an individual's sex with great precision, due to its superior preservation. (4)
The skull's dimorphic features are more stable than those of other skeletal relics due to the
skull's resistance to environmental alteration.

ToevaluateandcomparetheexpressionpatternsofCD34andCD117inbenignandmalignantp
rostatictissuesandtheirrelationtotheclinicopathologicalfeatures.
Methodology:The present study has been conducted at Department of Pathology,
atOsmaniaGeneralHospitalfromAugust2017toJuly2019.total100caseswerecollected.Rout
ineprocessingandHaematoxylinandEosinstainingofreceivedspecimensweredonefollowed
byimmunohistochemicalanalysiswithCD34andCD117.

Aim: To annalyseseroprevalence of HIV, HbsAg, HCV, syphilis and malaria in
pretransfusion blood and comparison with general population.
Methodology:It was retrospective study, conducted at Osmania General Hospital,
Telangana during the year from July 2016-June 2018. HIV, HBsAg, HCV tests were
done by enzyme-linked immunosorbent assay (ELISA) procedure using the third
generation kits.The donor questionnaire form with details of donor and results of
serological tests are maintained in the blood bank.Venous blood so collected is screened
for HIV, hepatitis B surface antigen (HBsAg), HCV, syphilis and malaria.HIV, HBsAg,
HCV tests were done by enzyme-linked immunosorbent assay (ELISA) procedure using
the third generation kits.

Introduction:Polycystic ovary syndrome (PCOS) is the most common endocrine
abnormality affecting women of reproductive age, but this condition is still not
completely understood. As it is linked with many chronic conditions such as
cardiovascular and diabetes, there is need to identify the condition at the earliest.
Methods: A cross-sectional Community-based study was conducted in urban
Visakhapatnam in November 2020 among 132 adolescent girls aged between 15 to 19
years to study the prevalence of PCOS among adolescents to identify the risk factors for
polycystic ovarian syndrome. Multistage sampling was used to select the study
participants from six urban zones, information collected using a PCOS validated
questionnaire modified to suit locally. Diagnosis of PCOS was based on
Rotterdam/ESHRE criteria examination for obesity, hirsutism, acne and acanthosis.
Results: Six percentof the study subjects were found to have possible diagnosis of
PCOS. Family history of risk factors for PCOS such as maternal menstrual
irregularities, diabetes and obesity was found in 12.1% of study subjects.Increased BMI
was seen in 6.8% girls and 24 .1% had abnormal menstruation.
Conclusion:Family history, increased BMIand presence of clinical findings as abnormal
growth of hair and acne are found to be significantly associated.

Introduction:Pretermdeliveryistheleadingcauseofneonatalmortality and morbidity.
Worldwide, prematurity accounts for 10%ofneonatalmortality, or around 500,000
deaths peryear. Prematurely born infants are also at greater risk of
havingsubsequentseriouschronichealthproblems.
Aimofthestudy: To assess the effect of funnelling of cervix
andthelengthofthecervixinthreatenedpretermlabour

Background & objectives: Class II and III mortality Class I deliveries werevaginal (62.5
percent). Thrombocytopenia in pregnancy causes hypertension in both motherand
foetus. Associated causes include abruption, dead foetus, septicaemia, and DIVC
worsenthe thrombocytopenia consequence. For both mother and foetus,
thrombocytopenia is morecommon with early pregnancy induced hypertension.Study of
pre-eclampsia withthrombocytopeniainhypertensivepregnantwomen.
Material andMethods:From the records of pregnant women admitted to the Osmania
Medical College's ModernGovernment Maternity Hospital, Petlaburz, from November
2020 to November2021.

Background: Preeclampsia isa state of insulin resistance. Insulin resistance features like
Hypertension, hyperinsulinemia, glucose intolerance, and lipid abnormalities are
associated with pregnancy-induced Hypertension.
Aimsandobjectivesofthestudy:
1. Tostudyinsulinresistanceinwomenwith pre-eclampsia.
2. TocompareandevaluatetheroleofmeasuringIR amongwomenwith
preeclampsiaandnormalpregnancy.
Methodology: AProspectiveandobservational one year study conducted in
GovernmentGeneralHospital.Kurnool. Atotalof 50Womenwith
preeclampsiaand50women withnormalpregnancy. Women were instructed for 12hrs
overnight fasting about 2ml of venous blood was collected in a
fluorideethylenediaminetetraacetic acid vial using proper aseptic precautions. Plasma
was separated by centrifugationand usedforestimationof
plasmaglucoseandplasmainsulinlevels. Values are presented as mean ± standard deviation
(SD) and the statistical analysis was done using SPSS 17.0software. Student’s unpaired ttest
was used for comparison of parameters between two groups. The p-value
oflessthan0.05was consideredas statistically significant.

Aim:To determine the effect of local application of vancomycin powder on surgical site
infection rate in patients undergoing instrumented spinal fusion surgeries.
Methodolgy:This is a prospective, cohort study which was conducted at SVIMS, a tertiary care
hospital. Informed consent was obtained from all the patients recruited in the study. The study
conducted during July 2015 to July 2016 with follow up of patients for 1 year post
operatively.The study cohort included consecutive patients undergoing posterior spinal fusion for
various etiologies. All patients received standard systemic antibiotic prophylaxis consisting of 1
g IV ceftriaxone within 1 hour of surgical incision followed by 1 g IV ceftriaxone every 8 hours
for 1 day. All patients underwent preoperative preparation with betadine solution.
Results:Total of 120 patients who underwent instrumented spinal fusion procedures were
included in the study with or without topical application of vancomycin powder.Mean age of
presentation in test group was 38.3 yrs whereas in control group it is 45.2 yrs.Most of the
patients who underwent operation for listhesis in the present study were females with F:M ratio
being 3.6:1.Only 4 of the patients from test group and 3 patients from control group gave history
of smoking and alcoholism. SSI developed in only one of the patients with both smoking and
alcoholism as risk factors.8 patients from test group and 9 patients from control group had
comorbidities like diabetes, hypertension, rheumatoid arthritis, hepatitis B.None of the patients
in the present study gave history of previous lumbar surgeryMost of the patients presented with
symptoms of low back ache and the most common neurological deficit encountered was motor
weakness related to respective spinal segment. In the test group 53 single level fusions and 7 two
level fusions were done whereas in control group 55 single level fusions, 3 two level fusions and
2 three level fusions were done .Mean operative time in test group was 239.6 mts and mean
estimated blood loss was 87.4 ml whereas in control group it is 221.25 mts and 88.08 ml
respectively.Two patients in the test group had deep SSI of which one required implant removal
on readmission and the other patient was managed conservatively when he was diagnosed to
have spondylodiscitis post operatively with appropriate antibiotics.

Immunoglobulins are heterodimeric proteins made up of two heavy (H) and two light (L)
chains. They can functionally be divided into variable (V) domains that bind antigens and
constant (C) domains that determine effector functions, such as complement activation or Fc
receptor binding. The variable domains are produced by a complex series of events in gene
rearrangement and can then be subjected to somatic hypermutation after antigen exposure.
Each V domain can be divided into three regions of sequence variability, called CDRs, or
complementarity determining regions, and four regions called framework regions, or FRs, of
relatively constant sequence. The three CDRs of the heavy chain are combined with the three
CDRs of the light chain to procedure the antigen binding site. Five major groups of heavy
chain C domains exist. The isotypes of IgM, IgG, IgA, IgD, and IgE are defined by each class.
To activate altered effector function while preserving antigen specificity, the constant
domains of the heavy chain can be switched. The aim of this review is to review current
development in our understanding of the structure, function and therapeutic effects of
immunoglobulin, as well as the immunological implications of Ig for the management of
autoimmune diseases and cancer. For that reason, a literature search on PubMed and Google
Scholar was carried out using the specific keywords.

Background:Surgery is the mainstay of treatment in gastric carcinoma management with a longstanding controversy regarding the extent of lymphadenectomy. Recent studies have shown 88%sensitivity of Sentinel Node biopsy for patients with gastric cancer. There is a need for evaluation of this technique using cost effective alternative of methylene blue dye.
Methods: This was a prospective study which included all adults with diagnosis of carcinoma stomach planned for surgical resection. Intra-operatively, methylene blue dye was injected into the tumor and the stained lymph nodes were removed along with other visibly enlarged nodes.
Results: A total of 32 subjects were recruited in the study period. Mean age of the patients was 56.59 (±12.02) years. Among all the specimens a total of 127 (35%) of 361 lymph nodes were found to be stained with methylene blue dye. Metastatic deposits were found in 132 of 361 lymph nodes. Bivariate analysis showed 79.52% of the lymph nodes stained with methylene blue were positive for metastases in contrast to 13.2% among those that remained unstained (p 0.001).
Conclusion:Sentinel lymph node mapping using methylene blue is a simple, cost and resource effective technique in all cases of gastric carcinoma undergoing resection, especially in early gastric carcinoma.

Background- Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death.
Objective- To study the pattern of breast cancer among low socioeconomic status patients attending a tertiary care hospital (Government medical college, Amritsar).
Materials and methods- A retrospective study was conducted in the department in which data was analysed in terms of demographical profile, stage of presentation, risk factors, histologic type and management strategies.
Results- A total of 1706 patients were studied in the study in ten year period. These were mostly poor and of low socioeconomic status who completed the treatment under Chief Minister Cancer Relief Fund (CMCRF) scheme. The mean age at diagnosis was 50.57+/-10years. Majority of patients were in age group 50-59 years (551 with 32.29%) and 40-49years (531 with 31.12%). Left sided breast carcinoma patients were more in number 913(53.51%) versus right sided as 791(46.36%). 936(54.86%) patients were from urban and 770(45.13%) patients were from rural areas. Male breast cancer patients were 17(1%), among females maximum number i.e.857 (50.23%) presented as postmenopausal followed by 511(29.95%) as perimenopausal followed by 321(18.81%) as premenopausal women. Infiltrating ductal carcinoma is the most common histopathology with 90.62%. Luminal type A comprises 45.72% subtype then 36.10% with Basal subtype followed by 11.43% with Her2neu enriched and 6.74% with Luminal type B subtype. There were 256(15%) patients in whom recurrence or progression of disease occurred.
Conclusion- In this study, breast cancer trend is rising with time and more patients presented in late and advanced stages mostly due to lack of awareness, so we conclude that public health education for early detection of breast carcinoma is necessary and at the same time government schemes like CMCRF helps in bringing more and more patients for free treatment to the government hospitals and thus giving them a chance for good survival.
 

Introduction- COVID -19 now become pandemic disease andChest computed tomography (CT) has very important role in diagnosis and characterizing the Covid patient severity by CT severity score.
Objectives:  The main purpose of this study was to evaluate the performance of MDCT in identifying & categorising the severity of COVID-19 inpatients.
Methods: This is retrospective cohort study and is performed on about 512 hospitalized COVID-19 patients in IGIMS from 15 April to July 2021. The CT severity score was assessed by two independent radiologists by involvement of percentage of area of each lobe of both lung parenchyma on HRCT lung. All admitted RT-PCR positive patient whose HRCT chest done in IGIMS were included in this study and OPD RT-PCR positive patient (COVID positive) & RT-PCR positive (COVID positive) patient with previous history of chronic lung disease, Tuberculosis, Lung mass, bronchiectasis etc were excluded in this study.
Results- In our study, Male (72.5%) are more affected in comparison to female (27.5%) and most of the patient are above the forth decade (69.5 %). Most patients are presented with severe CT severity score, i.e. > 15 CT severity score (about 41 percent) and about 20 percent & 22 percent present with mild & moderate CT severity score. Males are present with more CT severity than female.
Conclusion- Our studies show that older age group male patient (> 40 year) more affected in second peak of covid-19 and patient with chest involvement presented with severe CT severity score, so more mortality was noted , however this study is retrospective, needs prospective study for better correlation.

Introduction: Spinal anaesthesia (or spinal anesthesia), also called spinal
block, subarachnoid block, intradural block and intrathecal block is a form of
neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid
into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long.
Epidural anesthesia is a technique that may be used as a primary surgical anesthetic or
as a resource for postoperative pain management. It is safe and relatively easy to learn
and perform.A hernia is reducible if it occurs intermittently (such as on straining or
standing) and can be pushed back into the.
Material and methods: This is a prospective, comparative and randomized study was
conducted in the anaesthesia department of a tertiary medical Hospital. All patients
were male, age between 18 to 70 years. The present study included male patients of
uncomplicated inguinal hernia with American society of anaesthesiologist (ASA) grade
1 and 2. All patients were admitted for planned surgery; they were examined and
preanesthetic check-up done. All patients were explained about the techniques of
anaesthesia for hernioplasty and where randomized into two groups. They were
operated for inguinal hernioplasty according to recognised surgical guidelines.
Results: Total time taken for performing the procedure was significantly longer with
Epidural Anaesthesia than that of Spinal Anaesthesia (8.03±0.84 Vs 3.65±0.23 minutes,
p<0.001) but onset of action was comparable in both the groups (6.84±1.08 in Spinal Vs
11.23±1.21min in Epidural p<0.001 Significant). Intraoperative fluid requirement was
statistically higher in Spinal than Epidural (1612.43±163.3 ml vs 1102.54±94.53 ml)
(p<0.0001). Duration of Surgery was significantly shorter in Spinal as compared to
Epidural (91.43±8.64 vs 114.53±11.64 mins.) (p=0.021).
Conclusion: The spinal block induces a faster and more effective analgesia as well as a
more severe motor blockage than epidural block. In Spinal Anaesthesia, the
haemodynamic fluctuations and adverse effects are larger than in Epidural
Anaesthesia. As a result, both spinal and epidural anaesthesia may be utilised safely
during day surgery.

Introduction: Psoriasis is a chronic skin disease of unclear aetiology and pathogenesis
which is characterized by an inflammatory infiltration in dermis and epidermis,
proliferation of epidermal cells – keratinocytes which clinically manifests with the
formation of erythemato-squamose papules, and is often accompanied by the
engagement of joints and nails in the process of inflammation.
Materials and Methods: This is a case-control study conducted at Department of
Biochemistry, Central Research Lab and Central Clinical Lab of GMC Azamgarh. The
subjects will be selected as per the inclusion/ exclusion criteria. A detailed clinical
history including age, sex, and occupation will be collected from the patients after
obtaining written and informed consent. For ApoE: Genomic Dna is extracted from
blood using QIAamp DNA minikit. The genotypes of the APOE polymorphisms is
determine by using APOE strip assay kit based on polymerase chain reaction and
reverse-hybridization technique.
Result: A total of 380 patients who fulfilled the selection criteria during the study were
enrolled, they were divided into two groups case and control each group consist of 190
patients. Maximum number of (41.5%) patients are seen during <1 years of duration of
psoriasis followed by 1-2 years are 27.8%, 2-3 years are 22.1% and least are 4-5 years
are 1.5%. Most of the patients has plaque type of psoriasis are 88.4% followed by
Guttate 8.9% and few are Pustular and Exfoliative 1.5% and 1.0% respectively.
Severity of psoriasis is mild 17.8%, moderate 48.4% and severe 33.6%. Apolipoprotein
E alleles in cases are𝜀3 83.1% followed by 𝜀4 12.1% and 𝜀2 4.7%. On the other hand, in
control group 𝜀3 94.2% and 𝜀4 10%.
Conclusion: Apolipoprotein E may be used as a marker to predict those patients with
psoriasis who are at risk of dyslipidemia and probably CVD. Based on the results of our
study, we recommend regular monitoring of patients with psoriasis for the presence of
comorbidities which have a definite adverse effect on both psoriasis and the CVS.

Aim: To evaluate the mucormycosis cases in post Covid-19 patients.
Methods: This cross-sectional observational study was carried out in the Department of
Microbiology. Basic microbiological methods such as gram stain and KOH smear were
used for the detection of MC in the received clinical specimen and morphology was seen
in the microscope. Patients admitted in our hospital with a history of fever, cough, body
ache and shortness of breath for 4-5 days with have positive report of nasopharyngeal/
oropharyngeal swab for covid19 RT-PCR were included in the present study.
Results: Age, sex and other demography details were collected before sample collection,
the average age of the participants was 60.4 ± 7.5 years and the majority of participants
were male 75%. Although, 45% participants belong to below 50 year age and 55% of
participant belongs to above 50 year age. Out of n=50 specimens, total 9 specimen found
positive for fungal smear i.e. n=6 sputum, n=3 nasal swabs and n=0 BAL specimens.
Conclusions: The present study concluded that the cases of life threatening MC increase
day by day in central India as post complication of covid-19 disease.

Background:Subclinical hypothyroidism (SH) is defined as elevated serum levels ofTSH
with normal levels of free T4 (fT4) and free T3 (fT3). The prevalence of SH has been
reported to be 4–10% in general population. Since it is generally asymptomatic, these
patients are mostly identified through routine screening or evaluation of non specific
symptoms. About 2–5% of patients progress to overt hypothyroidism annually.
Objectives: To study the mean platelet volume in patients with subclinical
hypothyroidism and to study the association between MPV and CAD in patients with
subclinical hypothyroidism.
Material &Methods:We studied 89 subclinical hypothyroid subjects and estimated
theirMean platelet volume and their cardiovascular function by ECG and 2D ECHO
and then analyzed the data.
Results:MPVwas high (>11fl) in 75.3% of subclinical hypothyroid and MPV has
significant positive correlation with TSH Values. 70.8% subclinical hypothyroid
subjects had LVDD. ECG changes suggestive of IHD and RWMA in 2D ECHO was
present in 48.3% and 37.1% of the subjects respectively.
Conclusion:In our study we found that subclinical hypothyroidsubjects have significant
elevation in MPV. It is also associated with left ventricular diastolic dysfunction. Hence
it is necessary to screen and treat high risk group for subclinical hypothyroidism and its
adverseoutcomes to minimize serious complications.

Background:Allergic Rhinitis is a common and major chronic respiratory disease due
to its prevalence, impact on the quality of life, impact on school performance and
productivity, economic burden and its strong link with the Asthma. In recent years the
increase in prevalence of Allergic diseases has been found to be associated with low
serum vitamin D levels. A relationship has been seen between vitamin D deficiency and
Allergic Rhinitis and Asthma.
Aim and objective:This study aims to evaluate vitamin D levels in Allergic Rhinitis cases
and controls.
Materials and Methods:The study was carried out in the Department of Physiology at
Index Medical College, Indore, Madhya Pradesh. The study was done on 80 males and
female subjects of the age group 6 to 18 years. Forty males and females suffering from
Allergic Rhinitis attending Ear, Nose and Throat out-patient department of the Index
medical college hospital and research Centre Indore, were taken as cases. Forty healthy
males and females was taken as controls after careful selection as per inclusion and
exclusion criteria, “Vitamin D” estimation was done by ECLIA method (Electrochemi-
Luminescence Immunoassay using Beckmen’s commercial kit).
Results:The Vitamin D levels were significantly lower in Allergic Rhinitis cases
(P<0.001) as compared controls (P<0.000)
Conclusion:Theresults of the present study indicate that vitamin D levels are decreased
in Allergic Rhinitis cases as compared to the controls. Vitamin D deficiency increases
the risk of Allergic Rhinitis.

Background:Asthma is characterized by chronic inflammation of upper and lower
airways. Allergic diseases like allergic asthma, allergic rhinitis is increasing worldwide.
C-reactive protein is a marker of inflammation and infection. A positive relationship of
inflammation has been shown between raised CRP levels in allergic asthma.
Aims and Objective: The study aims to evaluate high sensitivity CRP levels in allergic
asthma cases and in controls.
Materials and Methods:The study was carried out in the Department of Biochemistry at
Index Medical College Hospital and Research Centre, Indore Madhya Pradesh. The
study was done on 80 males and females subjects of the age group 6 to 18 years. Forty
males and female children suffering from allergic asthma attending the Ear, Nose and
Throat outpatient department of IMCHRC, Indore were taken as the case. Forty
healthy males and female children were taken as controls after careful selection as per
inclusion and exclusion criteria. CRP was done by latex enhanced
tubidometericimmunoassay (CRP kit).
Results:The levels of CRP were significantly higher in allergic asthma cases (P<0.001)as
compared to controls (0.001).
Conclusion:The results of the present study indicate that the concentration of CRP was
increased in asthma cases as compared to the controls.In allergic asthma there
isincreased inflammation of upper and lower airways and so the levels of CRP are
increased.

Dengue is the most serious viral infection in recent years, resulting in major morbititesand mortality. This was a hospital based comparative study done from July – August2019. The purpose of this study was to estimate the hematological parameters and liverenzymes in dengue patients which could help to detect the severity of the
disease andintervene early. Participants included 75 cases and 75 healthy controls. Hemoglobin,WBC count, Platelet count along with SGOT and SGPT levels were analysed. Our studyshowed elevated SGOT AND SGPT levels of which SGOT is more elevated .WBC andplatelet count were reduced and showed negative correlation with
SGOT and SGPTvalues.Hence thisstudyshowedliver enzymesget affected by dengue and also itssever ity can beassessed by knowing hematological parameters which aids in early intervention and initiatethetreatment sooner.

Aim and objectives: The objective of this study is to determine the thickness difference
between the adult human heart's right and left ventricles, as well as their clinical importance
in the eastern Indian population, and compare it to the incidence in other races throughout the
world.
Introduction: Heart is a muscular motor that supplies blood to all parts of the body so that it
provides oxygen and nutrients to all the body parts. As we all know that this heart muscle
consists of four chambers viz., right atrium, right ventricle, left atrium and left ventricle. The
right ventricle receives from the right atrium and pumps the deoxygenated blood to the lungs.
The left ventricle directly pumps oxygenated blood to the rest of the body parts. The left
ventricle is usually narrower and longer than the right ventricle which extends from its base
of the atrio-ventricular groove to the cardiac apex. Moreover, the left ventricle walls are three
times thicker (8 – 12 mm) than those of the right ventricle which is relatively thin measuring
3 – 5 mm and the ration of the thickness between left to right ventricle is 3:1. There are four
borders of the heart. The right border is completely formed by the right atrium. The inferior
border is formed by the left & right ventricle. The left border is being formed by left ventricle
and little contribution from left atrium. Finally, the superior border is formed by right and left
atrium with the great vessels.

Introduction: Pleural effusion is common in medical ICU (MICU) patientsand may
affect patient outcomes.
Objective:This study aimed to determine the prevalence, causes, and clinical
significance of pleural effusion in critically ill patients.
Methods: A total of 500 patients included in the present study. The patients initially
had pleural effusion or effusion developed during their ICU stay.
Results: Overall, 350 patients were males and 150 were females, and their mean age was
51.5±18.6 years. Pleural effusion was found to be exudates in 60% of cases and
transudates in 40%. Uncomplicated parapneumonic effusion was the most common
cause (18%), followed by heart failure (16%). The cause of pleural effusion did not
significantly affect the patient outcome or duration of ICU stay. No significant
reduction in duration of ICU stays or ICU mortality was seen in patients who received
therapeutic aspiration or tube drainage compared with patients who received no
specific management for effusion.
Conclusion: The commonest cause of pleural effusion in MICU is parapneumonic
effusion, and chest ultrasonography is the best method of fluid detection. Different
methods of management do not significantly affect patient outcomes.

Background: Supracondylar fractures of the humerus are the most common elbow
fractures in children and adolescents accounting for 50-70% of all elbow fractures.
Supracondylar fractures may result in significant neurovascular compromise. The
present study was conducted to assess the prevalence of supracondylar fractures of
humerus among the patients who visited to tertiary care hospital.
Materials and Methods: The present retrospective study was conducted among 110
cases of supracondylar fractures reported to the department of both genders. General
information such as name, age, gender etc. was recorded. In all patients, the reason of
fracture and type were recorded. Data was collected and the data were analysed in
SPSS version 22 for windows. P value less than 0.05 was considered statistically
significant.
Results: In the present study out of 110 patients, 59.09% were males and 40.90% were
females. Gartland type II was seen in 28 males and 18 females and Gartland type III in
37 males and 27 females. The common reason for fractures was roadside accidents seen
in 47.27%, domestic violence in 35.45% and fall in 17.27%.
Conclusion:The present study concluded that supracondylar fractures of humerus were
more common in males than in females. The common reason for fractures was roadside
accidents.

Introduction: Elevated anti-thyroid peroxidase (Anti-TPO) antibodies and thyroid
stimulating hormone (TSH) levels in hypothyroidism have been linked to the alter the
vitamin B12 metabolic pathway thereby imparting the anemia. Thyroid peroxidase is
an important enzyme responsible during organification of iodide for synthesis of
thyroid hormone. Antibodies to TPO are formed as a part of autoimmune response of
body causing autoimmune thyroiditis in patients. Antibodies to thyroid peroxidase
(TPO) are clinically useful markers of thyroid autoimmunity
Objectives: Present study aims to correlate the thyroid stimulating hormone and antithyroid
peroxidase expression in Anti-TPO positive patients with the anemia.
Methods:60 patients who were anti-TPO positive and hypothyroid were recruited in
present study.TSH level, anti-TPO antibodies level and haemogram was analysed
among all patients.
Results: There was a positive correlation between the haemoglobin and TSH level (r=
0.09580). There was a negative correlation between the Haemoglobin and Anti-TPO
expression (r= -0.2086).
Conclusion: Present study revealed a correlation of anemia with TSH level and Anti-
TPO expression which have the diagnostic value. Anti-TPO positive hypothyroid
patients have risk of developing anaemia.

Background: Development of Human race took years from four years to two legs. The
lower limb in the process of development modified and consists of hip joint, femur, tibia
and fibula. The hip joint is one of the largest and most stable joints in the body. It is a
multiaxial ball- and-socket joint that has maximum stability because of the deep
insertion of the head of the femur into the acetabulum. The joint depends on the angle
from between the femur neck and the diaphysis, keeping the inferior limbs more distant
from the pelvis and allowing greater rotation of hip joint. The neck-shaft angle is widest
at birth and diminishes gradually until adolescence. It is smaller in females. The neck is
laterally rotated with respect to shaft (angle of anteversion) some 10-15o values of this
angle vary between individuals.
Objective: To measure and compare the difference between neck shaft angle of dry
cadaveric human femur and living human femurradiographically.
Methodology: The angle between the two lines of axes passing through the middle of
neck and middle of shaft is known as Neck shaft angle or angle of Inclination and was
measured by goniometer on a sample of 100 dryfemora.
Results and Conclusion: The mean neck-shaft angle in the present study was
129.62±5.5°. No difference was observed on sides (right and left), with respect to
the neck-shaft angle in cadaveric femur was observed in the present study.
Sidedifference with respect to the neck shaft angle was also noted in the present
study.Left side femora had mean neck-shaft angle of 128.28° which was
comparatively less than on the right side130.64°.

Background: The main purpose of investigating the damaged remains is to develop a
biological profile that identifies individuals by estimating the age, gender, and stature of
the remains. This profile helps to increase the likelihood of identifying the information
of the victim’s events or disasters. Estimating statures through human remains is based
on the principle that there is a linear relationship between statures and various parts of
the human body and bones. Hence; the present study was undertaken for assessing
stature and gender from thumb indices.
Materials &Methods: A total of 50 male and 50 female subjects within the age range of
25 to 40 years were enrolled. The length (in cm) of the thumb- was measured with the
help of Sliding Digital Callipers. The distance from the midpoint of proximal flexor
crease till the tip of the thumb when the subject’s hand was placed supine on a flat
horizontal surface with the fingers stretched and extended is taken as the length of the
thumb. For stature estimation, Stadiometer was used. All the results were recorded in
Microsoft excel sheet and were analysed by SPSS software.
Results: Mean length of left thumb among males and females was 7.23 cm and 6.85 cm
respectively. Mean right of left thumb among males and females was 7.21 cm and 6.88
cm respectively. Mean height among males and females was 164.9 cm and 155.3 cm
respectively. Significant results were obtained while comparing mean thumb lengths
and height among males and females. While assessing the correlation between thumb
length and stature among females and males, significant results were obtained.
Conclusion: Their exists a significant correlation between stature and length of both the
thumbs. So, even if only thumb is available it is possible to estimate the stature of
individual

Introduction: The present study aims to detect Cyclin D1 gene numerical aberrations in blood samples of OSCCs patients (50) and controls (30) by using fluorescence in situ hybridization technique (FISH) along with risk factors.
Materials and Methods: Present study is an observational, retrospective Case control study comprising samples from North Indian population. Peripheral blood samples were collected randomly from histological confirmed 50 OSCC patients from outpatient department (OPD) of Oncology and ENT of regional tertiary care hospital, and also from 30 healthy controls of 25 years or above age. FISH interphase technique was used to detect the numerical aberrations of Cyclin D1 using the Vysis protocol (Vysis CCND1 CEP11 FISH Probe Kit, Abbott Molecular Inc. Des Plaines IL 60018 USA). Mean and SD were calculated. Pearson Chi-square and the 2-tailed Fisher's exact test (FET) were used for comparison of parameters association among themselves (P value <0.05).
Results: Cyclin D1 gene numerical aberrations were absent in controls; where as 5 (6.3%) cases were positive in OSCC group. Among positive cases low and high level amplification were found in 3 (3.8%) and 2 (2.5%) cases respectively. Other than all factors measured Cyclin D1 gene aberrations showed a significant association only with lymph node metastasis (P=0.004) and stage of Carcinoma (P=0.001) respectively.
Conclusions: The present study suggests the prognostic importance of blood as a medium for assessing Cyclin D1aberrations in advance stage OSCC patients.

Introduction: Legal punishment and crimes are entirely based on the criminal
responsibilities and age of the person. The crime against the children and adolescent
and crime by the children and adolescent are increasing hugely in this modern era
where technologies are improving greatly. Evaluating the bone age in skeletally
immature patient gained importance for therapeutic decision-making, and the
knowledge about the skeletal development forms the basis for the results interpretation.
In Adolescence, the age of appearance of the ossification centers of their elbow has a
relatively well-established chronological sequence which are documented in literature:
humerus capitulum, radius head, medial or internal epicondyle, humerus trochleaand
lateral or external epicondyle.
Materials and Methods:The study was carried out on a total of 143 subjects out of
which 110 were males and 33 were females. After obtaining the written consent from
every individual, subjects were allowed for their radiological examination. The X-rays
of wrist were first taken with A-P view at 40- 44 KVp and 4 – 8 mAs (Focussing at mid
carpal area). The X-ray of elbow was then taken with A-P view at 42-44 KVp and 4–8
mAs (Centering at mid carpal area). The tube current was fixed at 40 inches and tube
current at 100 mA. The persons selected for the study were grouped as per their stated
age viz, 15-16 years, 16-17years, 17-18years & 18-19 years.
Results:The complete fusion of ossification centres around elbow joint in males starts at
the age of 15-16 years followed by individuals of 17-18 years showing complete fusion
from a range of 80-90% and all the 18 subjects between 18-19 years shows 100%
complete fusion. In females it showed that the complete fusion of all ossification centres
around elbow joint started at the age group of 15-16 years but was not complete and it
was followed by appearance of 100% complete fusion in 16-19 years age group of
individuals.
Conclusion:This study proves that the complete fusion of ossification centres around
elbow and wrist joint in females occurs earlier than in males by 1-2 years. 100%
complete fusion around elbow joint in females occurs at 16-17 years whereas in males it
is seen at 18-19years. 100% complete fusion around wrist joint is seen in females of age
group 18-19 years whereas it is just the lower end of ulna that shows complete fusion in
males at the same age as females.

Background:Transversus abdominis plane (TAP) block is a well-established analgesic
technique for postoperative analgesia in abdominal surgeries.In our study, we
compared the analgesic efficacy of adjuvant fentanyl and tramadol with Bupivacaine in
TAP block following percutaneous nephrolithotomy.
Methods:In this randomized, prospective, controlled study, 90 patients of ASA grade I
and II were divided into three groups; Group A, Group B, and Group C. Surgical
procedure was done under spinal anesthesia.At the end of surgery, we introduced TAP
block unilaterally in the triangle of petit by feeling two pop technique. Group A
received 28 ml of 0.25% bupivacaine with 50 μg of Fentanyl;1 ml normal saline was
added to make total 30 ml, Group B received 28 ml of 0.25% bupivacaine with 100 mg
of tramadol (2ml), and Group C received 28 ml of 0.25% bupivacaine with 2 ml of
normal saline. The primary outcome wasduration of analgesia (time to first rescue
analgesia) and the secondary outcomes were total dose of rescue analgesics and visual
analog scale (VAS) score recorded at 0,2,6,4,8,12, and 24 hr. If VAS score >4 or patient
complained of pain, then injection diclofenac 75mg intravenous was given as rescue
analgesic.
Results:Duration of analgesia was higher with fentanyl than tramadol & normal saline.
It was 7.01±0.176 hrs., 4.89±0.713 hrs. and 3.01±0.125 hrs. respectively with fentanyl,
tramadol, and normal saline. The total dose of rescue analgesic was lower with fentanyl
than tramadol and higher with normal saline. VAS score was also lower with fentanyl in
comparison to tramadol and normal saline.
Conclusion:Postoperatively many adjuvants were added in TAP block to improve the
quality of analgesia but fentanyl prolonged the postoperative analgesia effectively in
comparison to tramadol or plain TAP block.

Background:Diabetes mellitus has been postulated to alter the morphology of the
cornea.Aim of our study was to compare the morphological characteristics of corneal
endothelial cellsin type 2 diabetic patients with age-matched healthy subjects. We also
determined the association of corneal morphological features with the general
characteristics and laboratory data of diabetic patients, including disease duration,
urine albumin creatinine ratio.
Methods:A case-control study in a tertiary care hospital of northwestern India with a
total of 50 diabetic patients and 50 healthy controls were enrolled in the study. All
participants underwent a complete ophthalmological examination. Corneal endothelial
measurements were performed using a noncontact specular microscopy. Laboratory
data including serum fasting glucose, --HbA1c levels, creatinine levels, and the urinary
albumin-to-creatinine ratio were recorded. Diabetic patients were further subdivided
into 3 groups according to the presence and stage of diabetic retinopathy. Specular
microscopy findings and central corneal thickness of all patients were compared.
Results: The ECD and hexagonal cell ratio were significantly lower, while the average
cell size, CV%, and central corneal thickness were determined to be significantly higher
in diabetic patients than in healthy controls (p = 0.001). With the presence and
advancement of diabetic retinopathy, the ECD and hexagonal cell ratio decreased, while
the average cell size, CV%, and central corneal thickness increased. When correlation
analysis was performed between corneal morphological features and laboratory data of
diabetic patients, ECD showed a significant negative correlation with diabetes duration
(p = 0.028). Urinary albumin-creatinine ratio (p = 0.041), average cell size and CV
showed a positive correlation with these parameters.
Conclusion: In conclusion, keratopathy is an important complication of type 2 diabetes.
With an increase in the stage of diabetic retinopathy, alterations in corneal findings also
increased. In that respect, we can suggest that keratopathy should be evaluated more
cautiously in diabetic patients.

Objectives:1)To study level of serum highdensity lipoprotein (HDL) level in subclinical
hypothyroidism andeuthyroid patients 2) To study association between serum HDL and
serum TSH in subclinical hypothyroidism.
Materials and Methods:The study was hospital based observational study which
included15 patients of subclinical hypothyroidism and 15 patient’s euthyroid after
diagnosis based on theirserum thyroid stimulating hormone (TSH), freeT3 and freeT4
level done during their regular visit to outpatient medicine department.Bloodsample
was collected of all the participants after an overnight (12hours) fasting and serum high
density lipoprotein levels was estimated. Statisticalanalysis was done on collected data.
Results: Participants with euthyroidism and subclinical hypothyroidism showed no
significant difference in serum high density lipoprotein levels and a negative correlation
was found between serum TSH and serum HDL level in subclinical hypothyroidism
group.
Conclusions:Thyroid hormones have various effects on lipid metabolism.The
effects of subclinical hypothyroidism on serum HDL level were not statistically
significantand a negative correlation between serum TSH and serum HDL which was
suggestive of linear decrease in serum HDL with increase in serum TSH levels.

Background: Seizures are widespread illnesses that have been recognised since
antiquity and are commonly encountered in medical practice. The purpose of this study
was to determine the most often seen etiologies of seizures in elderly patients.
Methods: The present cross-sectional study include105 cases of Seizure in patients aged
50 years and above of either gender who were admitted between January 2020 and
December 2020 to the Medicine Department of the BRD Medical College in north-east
UP. Each patient's data were obtained using a custom-designed proforma that included
a complete history, clinical characteristics, past medical history, physical examination,
liver function test, renal function test, serum electrolytes, CSF analysis, EEG,CT Head,
MRI brain(if required).
Results: Seizures were more common in males (57.14%) when compared to females
(42.86%), with a male to female ratio of 1.44:1. The most common cause of Seizure
(26.67 %) was vascular (infarct) followed by Metabolic. Among metabolic causes,
Hyponatremia (22.86%) was the most frequent followed by Hyperglycemia (20 %) and
Hypoglycemia (5.71 %). The most prevalent type of Seizure (92.38 %) was
generalised(GTCS), followed by focal (7.62 %).
Conclusions: Seizures in the elderly deserve special attention in terms of aetiology, as
most are due to some underlying cause. Primary care physicians are crucial in
identifying individuals with elderly onset seizures and arranging biochemical testing
and imaging to provide a correct etiological diagnosis. However, additional large
multicentric studies will be necessary to increase the study's generalizability.

Background:Dengue is the most prevalent mosquito-borne viral disease affecting humans.
The present study was conducted to assess maternal and fetal complications of dengue
fever in pregnancy.
Materials & Methods: 96 antenatal patients diagnosed with dengue fever clinically and
serologically were included. Parameters such as parity, gestational age, symptoms at the
time of diagnosis, platelet count and haematocrit at the time of diagnosis were recorded.
Details regarding ICU admission need for transfusion and medical examination was
recorded. Maternal and fetal complications were also recorded.
Results: Gestational age at diagnosis (weeks) <12 was seen among 5, 12-20 in 8, 20-28 in
14, 28-34 in 16, 34-37 in 20 and >37 in 33. Trimester I was seen in 7, II in 23 and III in
66. Platelet count <20000 was seen in 10, 21000-50000 in 22, 51000- 100000 in 20, 1
lakh- 1.5 lakh in 32 and >1.5 lakh in 12. Fetal complications were IUGR in 3, fetal
malformation in 2, meconium- stained amniotic fluid in 8 and fetal distress in 5. Neonatal
outcome was prematurity in 11, low birth weight in 34, ICU admission in 5 and vertical
transmission in 6. The difference was significant (P< 0.05).
Conclusion: There were significant maternal and fetal outcome in pregnant women
suffering from dengue fever. Hence, there is need to have close monitoring of
complications.

Background:Hearing loss in children may be inherited, caused by maternal rubella or
complications at birth, certain infectious diseases such as meningitis, measles, chronic ear
infections. The present study was conducted to assess the cases of hearing loss in children.
Materials & Methods: 296 children with hearing loss of both genders were selected.
Histories of risk factors, causes, and type of hearing loss were recorded.
Results: Out of 296, males were 176 and females were 120. Common risk factors were
middle ear infection in 72, febrile illness and treatment in 144, sickle cell diseases in 56
and family history in 24 cases. The difference was significant (P< 0.05).
Conclusion: Common causes of hearing loss in children were middle ear infection, febrile
illness and treatment, sickle cell diseases and family history.

Background:Traumatic tympanic membrane (TM) perforation is an injury of the eardrum,
which is frequently encountered by otolaryngologists. The present study was conducted to
assess the cases of traumatic tympanic membrane perforation (TTMP).
Materials & Methods:136 cases of traumatic tympanic membrane perforation of both
genders were recorded. Parameters such as size, site, complaint and mechanism of injury was
recorded.
Results: Side involved was left in 80, right in 56. Site was anterior in 50, posterior in 60 and
undefined in 26. Complaints was otalgia in 48, tinnitus in 60, otorrhoea in 30 and vertigo in
104. The mechanism of injury was domestic violence in 32%, RTA in 54%, armed robbery in
8% and self- inflicted in 6%. The difference was significant (P< 0.05).
Conclusion: Common side involved in traumatic tympanic membrane perforation was left,
site was anterior, posterior and undefined. Complaints was otalgia, tinnitus, otorrhoea and
vertigo.

Background: Most effective and well-accepted treatment modality for correction of visual
impairment associated with refractive error is wearing spectacles. Visual impairment also
affects the social, professional, and developmental aspects of the affected subjects.
Aim: The present cross-section clinical study was conducted to assess the factors governing
the non-compliance towards spectacle-wearing in Indian children of less than six years of age
having refractive errors.
Methods: In 102 child subjects with the age group of less than 6 years, having refractive
errors, and were prescribed wearing spectacles for correction of refractive errors. Noncompliance
was considered when parents gave the history of not wearing spectacles by child
subjects for a minimum of 6 hours every day. Demographic characteristics and other
parameters assessed were the financial issue, peer pressure, broken glasses, lost glasses, glass
intolerance, squint, hypermetropia, myopia, anisometropia, and/or astigmatism. The collected
data were subjected to statistical evaluation.

Background: Surgical site infection is increasingly recognized as a measure of the quality of patient
care by surgeons, the incidence of SSI in our environment is still high when compared to the
developed world.
Objectives: This study was conducted to evaluate the incidence, risk factors and the types of Surgical
Site Infection (SSI) in postoperative abdominal surgeries.
Methods: Immediate postoperative period of the patients was followed up. Wound was examined on
day 2, then everyday till the day of discharge. Signs of SSI were looked for. If the patient developed
SSI in this period, then type of SSI was classified and swab culture was performed to identify the
microorganism and antibiotic sensitivity pattern. CDC (Centre for disease Prevention and Control)
criterion was used for diagnosis and classification of SSI. Patient was treated and discharged. All the
details were recorded in the proforma. The patients were followed up every week till 30 days.
Results: The SSI rate in our study was 14% and risk factors associated with SSI in our study are
smoking (p=0.001), preoperative stay of> 3days (p=0.000), ASA score (p=0.001), contaminated and
dirty wound (p=0.000), duration of surgery (p=0.010) and duration of drain placement (p=0.000).
Conclusion: Our study prompts us to look at the gaps in our surgical and infection control protocols
which will enable policy formulation that will foster a reduction in wound infection rate. SSI can be
reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies,
adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use
of drains and intraoperative maintenance of asepsis and following operation theatre discipline
properly.

Introduction: Haemorrhoids are dilated vascular structures that act as a cushion around the
anal canal. Haemorrhoidectomy is the gold standard surgical protocol for symptomatic
haemorrhoids in grades III and IV. The incidence rate of symptomatic haemorrhoids ranges
from 4.4 to 36.4% of the general population. There are many aetiological factors that can
cause haemorrhoidal disease, which include: constipation, pregnancy, increased intraabdominal
pressure with obstruction of venous return, diarrhoea, prolonged straining, aging,
and abnormalities of internal and sphincter. With the arrival of newer devices,
hemorrhoidectomy resulted in less postoperative pain and less perioperative blood loss
compared with haemorrhoidectomies done with conventional surgical techniques. Maximum
(KLS Martin Group, Germany) is the new launch in vessel sealing systems that has been
introduced recently. It is a bipolar electrosurgical device that is a combination of pressure and
radiofrequency. It seals the blood vessels with a diameter of up to 6 mm by denaturing elastin
and collagen from the vessel wall and connective tissue around them with minimal damage to
the collateral structures limited to 2 mm over the surgical site. This coagulation zone can
withstand up to 3 times the systolic blood pressure

Introduction: Alcoholic liver disease (ALD) is a life-threatening disorder which has deadly
consequences over uncontrolled alcohol consumption. Excessive alcohol ingestion is the
forefront cause of death in people aged 15-49 years. Alcohol is the most common cause of
liver cirrhosis in many countries in the world.1 Alcohol induced toxicity is the 3rd cause of
morbidity. The liver is the largest and the most complex organ in the body since it runs
multiple functions in the body which includes secretion of proteins and enzymes, purification
of toxins, anabolic and catabolic functions and regulation of cholesterol. It is primarily
involved in the metabolism of alcohol and hence it is the most susceptible organ that
undergoes alcohol related injuries. Alcohol acts as a behavioural stimulant at lower blood
levels but at its higher level it acts as a central nervous system depressant damaging the
cerebellum badly which alters the gait of a person.

Background: Hanging is one of the common methods of asphyxial deaths. A gross and histopathological changes in skin and subcutaneous Tissues at ligature Site in Cases of asphyxial deaths is helpful in making exact diagnosis of hanging and differentiating it from other form of asphyxia death like strangulation.
Objective: To assess the importance of histopathological analysis of tissue underneath the ligature mark in case of hanging.
Materials and Methods: The present study was done on medicolegal autopsies conducted at the department of Forensic Medicine and Toxicology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna from 01.01.2017 to 31.12.2019 to study the gross and histopathological changes in neck structures.
Inclusion Criteria -1. Asphyxial deaths (hanging) coming for medicolegal postmortem examination. Exclusion Criteria -1. Decomposed bodies. 2. Asphyxial cases due to drowning, suffocation.
Result: During study period 77 cases were examined for gross and histopathological changes.The gross study revealed that the ligature mark was complete in 24(31.16%) cases. In 71(92.20%) cases, the ligature mark was seen above the level of thyroid cartilage. The subcutaneous area of ligature mark showed microscopically dilated and congested vessels in 65(84.41%) of cases. Thinning of epidermis were seen in 54(70.12%) of the cases, followed by focal fragmentation of epidermis and rolling of epidermis was seen in 25(32.46%) and 17(22.07%) of the cases respectively.
Conclusion: In our study, findings in the cases of hanging varied and were found in many combinations. A correct interpretation of meticulous postmortem examination and histopathological finding is necessary to make a confirmatory diagnosis of death owing to hanging.

Background: There is an increased prevalence of various medical disorders and various
neonatal complications including perinatal death, chromosomal abnormalities, birth defects,
low birth weight, preterm delivery, admission to NICU, and/or low Apgar scores.
Aims: The present study was conducted to assess and evaluate the effects of advanced
maternal age on the pregnancy, and to assess adverse fetal and maternal outcomes in
advanced maternal age pregnancy.
Materials and Methods: 131 subjects in the control group and 136 subjects from the study
group were categorized into two groups based on the maternal age of >35 years for the study
group and 20-35 years for the control group. The primary outcomes assessed were cesarean
delivery incidence, gestational hypertension, gestational diabetes incidence, premature
membrane rupture, antepartum hemorrhage, and preterm labor were compared between the
control group and study group.

This research project is conducted between February 2019 To July 2021in the
Department of Microbiology. A total of 1000 various clinical samplesreceived in the
microbiology laboratory from the OPD & IPD Patients. Out of 1100 various clinical
samplesculture, were found total 450(45%) gram negative bacilli (Escherichia coli) from
urine samples

Background: To find correlation of clinical, hematological and biochemical parameters
in women with severe preeclampsia and maternal outcome and to study the maternal
and perinatal outcome in severe preeclampsia and.
Materials and Methods: The study was done in the Department of Obstetrics and
Gynaecology, Raichur Institute of Medical Sciences, Raichur. 140 patients with blood
pressure ≥ 160/110 mm of hg with proteinuria or Blood pressure ≥ 140/90 mm of hg
with proteinuria of ≥ 2+ were involved in the study. Statistical analysis was done by
applying chi-square.

Background: In thyroid surgeries, hypocalcemia is a very common complication mainly
because of the similar blood supply to both thyroid and parathyroids Objectives:
measurement of parathormone (PTH) during total thyroidectomy can identify at risk
patients of developing hypocalcaemia.
Materials and Methods: This is a Four-year prospective and cross-sectional study was
conducted in three hospitals i.e Study subjects in which all thyroidectomy patients 18
years or above will be screened for development of hypocalcaemia who met inclusion
criteria was taken up for study during the study period. The study is a time bound study
including all thyroidectomy cases done from October 2017 to August 2021 which
included a total of 62 patients.

Background: Neuraxial anaesthesia greatly expand the anaesthesiologist
armamentarium in many cases providing alternative to general anaesthesia. Spinal
anaesthesia is a popular technique for lower limb orthopaedic surgeries. Hyperbaric
bupivacaine in 8% glucose is often used. Unintended intravascular injection of
bupivacaine during regional anaesthesia may cause severe cardiovascular toxicity,
including left ventricular depression,atrioventricular heart block,life threatnig
ventricular tachycardia, fibrillation and sudden cardiac arrest which is difficult to
resuscitate However levobupivacaine has similar efficacy but better safety profile than
racemic bupivacaine.

Aim- To observe recurrence rate after conjunctival limbal autograft (CLAU) and tocorrelate
this with preoperative histopathological and morphologicalcharacteristics of pterygium.
Design: Interventional, Prospective, Hospital-Based Study.
Methods: 107 patients with primary pterygium were examined, managed by CLAU and
histopathology sample sent. The outcomes were assessed in terms of clinically significant or
insignificant recurrence till 6 months follow-up.
Results: 57% patients were female. 17.8% participants had Stockers Line and all patients
having stocker’s line had stationary type of pterygium. Fuchs spots were seen in 4.7% of
patients. Histopathology findings includeEpithelial Hyperplasia (80.4%), Vascularity
Overwhelms Fibrosis (39.1%), Vascularity Similar to Fibrosis (28.3%), Fibrosis Overwhelms
Vascularity (34.8%), Perivascular Stromal Inflammation (54.3%), Diffuse Stromal
Inflammation (37.0%). The following variables were significantly associated (p<0.05) with
the Recurrence: Age, Fuchs Spots, higher vascularity and Diffuse Stromal Inflammation on
histopathology.
Conclusion: Factors such as younger age group,higher redness and thickness of pterygium,
Fuchs Spots, higher vascularity and diffuseinflammation on histopathological examination
can be considered as a risk factor for recurrence. However, occupation, laterality, location
and type of pterygiumwere found not to be related to recurrence.

A quality can be defined as a set of properties, that characterize the individual units that are important in determining the degree of acceptance of the unit by the consumer, regardless of the animal species, skeletal muscles have similar structural and chemical properties, they all contain approximately 75% water by weight and 20% protein, with varying amounts of fats and carbohydrates and small amounts of dissolved organic compounds, these components have a role in the development of the different sensory properties of meat, water plays a key role in the juiciness of the meat, the meat tenderness. Fat has an important role in the development of both meat tissues, although the mechanism of this is unknown, meat flavor because fatty substances are the primary source of most of the volatile compounds responsible for the flavor of meat.

INTRODUCTION:
Intertrochanteric fractures are commonly seen in patients over 70yrs of age. In younger population, intertrochanteric fracture occurs due to high velocity trauma, whereas in elderly population, it is most often due to trivial trauma.Cephalomedullary device is used for management of intertrochanteric fracture
OBJECTIVES :
 To compare the surgical results in patients with inter-trochanteric femur fractures Treated by PFN with and without distal locking .
METHODOLOGY:  In a prospective study 40 patients were enrolled with mean age 59.05 years with proximal femur fracture which included 25females and 15 males who underwent Long proximal femoral nail with distally locked and distally unlocked. AO system of classification was used. 31 A1 was the commonest type. Operative time, overall fluoroscopy shots, intra-operative blood loss, the duration of hospitalization, and the surgical complications were noted. Patients were followed up at 6weeks, 3months, 6 months. Functional outcome assessed according to the Harris hip scoring system.
RESULTS:
            Mean age of 59.05 years in PFN without distal locking and 54.75 years in PFN with distal locking.  Mean duration of surgery in PFN without and with distal locking was 40.45 & 54.75 mints respectively.  Mean amount of blood loss  in PFN without  and with distal locking 154.7 ml and 206.3 ml respectively .Mean length of incision in PFN without  and with distal locking was 10.95  & 12.65 cm respectively.  Mean fluoroscopic time in PFN without and with distal locking was 61.3 & 71.3 shots respectively. Mean duration of hospital stay in Group A & B is 15.3 & 15.2 days respectively . Out of 40 cases no case was lost in follow up.  we had good to excellent results in 90%, fair in 10%, we had no case with poor results.
CONCLUSION:
             From this study, we consider that long proximal femoral nailing without distal locking shows subtle advantages for duration of surgery, amount of blood loss, incision length ,fluoroscopy exposure time ,post-op stiffness in stable  intertrochanteric fracture.

Aim: To evaluate the psychiatric morbidity using MINI questionnaire in patients diagnosed with
CKD.
Materials and Methods: Total 170 patients were interviewed over a period of one and a half
year starting from January 2014. Each patient was assessed twice: at the baseline and after 3
months. Patients were approached and after obtaining their consent, information was collected
about their socio-demographic details like age, sex, marital status and religion, duration of renal
illness (CKD). Each patient was then screened for psychiatric morbidity using MINI
questionnaire. Patients were then divided into two groups: those having psychiatric morbidity
and those without. The collected data was compiled in MS Excel sheet 2007. For analyses of this
data SPSS version 20 for Windows 7 was used.
Results: The study population consisted of patients between the ages of 18 to 72 years with the
mean age of 40.8(SD=14.8). There were 120 males (70.6%) and 50 females (29.4%) in the study
population. There were 134 married (78.8%), 30 single (17.6%) and 6 widowers (3.5%) in our
study population. 42 (24.70%) had a diagnosable psychiatric morbidity on Mini International
Neuropsychiatric Interview. The most common psychiatric diagnosis found in our study was
Major depressive disorder that was seen in 88.09% (n=37) patients followed by Generalized
anxiety disorder, which was seen in 3 patients (7.14%). Psychiatric morbidity was highest in the
age group of 51-60 years. Significant association was found between age group and psychiatric
morbidity (p<0.001). The impact of duration of illness and psychiatric morbidity revealed
significant association between these two factors (p<0.0001).

Background: The worldwide prevalence of anaemia among adolescents is high and even
higher in developing countries. The burden of anaemia is a major contributor for low
birth weight, lowered resistance to infection, poor cognitive and motor development,
weakness, fatigue, difficulty in concentrating and lower productivity. India had
reported high prevalence of anaemia among adolescent girls, which is apparently higher
when compared with the other developing nations. Objectives: To study the clinical
profile of anaemia among Adolescent (13-19 years) girl students and to determine the
factors associated with anaemia in Adolescent girl students like socio – demographic
factors, prevalence of anaemia and clinical profile.
Materials and Methods: Single centre, cross sectional study, sociodemographic and
clinical details were collected and analyzed. Blood test was done to estimate anaemia
and to classify type of anaemia. Prevalence of anaemia was compared with
sociodemographic and other details to look for association.
Results: The prevalence of anaemia in the present study was 25%, 78 (39%) girls
belonged to class IV. Students not wearing footwear, not washing hand, not consuming
jaggery, history of recurrent infections, passing worms, irregular cycle were anemic.
Majority of cases had microcytic hypochromic anaemia.
Conclusion: 25% prevalence is noted in our study which is of moderate magnitude.
Most commonly microcytic hypochromic anaemia 60% was noted followed by
normocytic normochromic 30%. High risk factors were students belonging to low socio
– economic groups, with Low BMI, not using foot wear, and present of menstrual
abnormalities like polymenorrhoea.

Background: The most common anorectal disease is Haemorrhoids. Ultrasonic
coagulation is an evolving technique which uses the ultrasonic coagulation device to
perform the classic Milligan and Morgan hemorrhoidectomy, which is arguably the
most used surgical option in treatment of grade III and IV haemorrhoids. Objective- To
compare the efficacy of harmonic scalpel hemorrhoidectomy and conventional
hemorrhoidectomy
Materials and Methods: A prospective randomized study conducted in the year 2020-
2021 on patients admitted in the department of surgery, Rajindra Hospital, Patiala
which included 60 patients, which were divided randomly into two groups of 30 each,
group A(undergone hemorrhoidectomy performed with classical Milligan-Morgan
hemorrhoidectomy)and group B(undergone Harmonic scalpel hemorrhoidectomy).
Results: The patients who underwent harmonic scalpel hemorrhoidectomy had
statistically highly significant p value in post-operative pain, post-operative defecation
and postoperative urine retention.
Conclusion: Harmonic scalpel hemorrhoidectomy is preferred because of less
postoperative pain at rest as well as on defecation and lesser postoperative urine
retention.

Background: Acute appendicitis is the most common cause of abdominal emergency in
both developed and developing countries, yet its diagnosis remains challenging. Several
scoring systems have been developed in order to aid the decision-making process to
reach diagnosis of acute appendicitis in the quickest way, which include the Alvarado
Score, the AIRS Score, and the RIPASA Score. The current study compares and
assesses the utility of the scoring systems in establishing a diagnosis of acute
appendicitis, as compared to a final histological report.
Materials and Methods: This was a prospective study conducted at the Department of
General Surgery, Rajindra Hospital, Patiala, including 60 patients presenting with right
iliac fossa pain for less than 72 hours and were planned to undergo appendectomy, from
2020 to 2021. A structured pre-prepared proforma was used to enter the complete
history, clinical examinations, hematological and biochemical investigations, the
calculated scores for the Alvarado, RIPASA, and AIRS scoring system, and the
histopathological report for each patient. Sensitivity, specificity, accuracy, PPV, and
NPV were calculated for Alvarado, RIPASA, and AIRS Scores for the diagnosis of
acute appendicitis with histopathologic diagnosis as the gold standard. Receiver
operator characteristics (ROC) curve was done, and criterion value was estimated
depending on the specificity and sensitivity.
Results: In our series, the RIPASA score had the highest statistical parameters amongst
all 3 scores. The sensitivity, specificity, PPV and NPV were 92.45%, 85.71%, 98%, and
60% respectively. It had the highest diagnostic accuracy (91.67%). It was followed by
the AIRS scoring system with a sensitivity, specificity, PPV, and NPV of 88.68%,
71.43%, 95.92%, and 45.45% respectively. Its diagnostic accuracy was 86.67%. The
Alvarado score had a sensitivity, specificity, PPV, and NPV were 81.13%, 71.43%,
95.56%, and 33.33% respectively. Its diagnostic accuracy was 80%.
Conclusion: It is concluded that the RIPASA Scoring system is a valid and better tool
with high discriminating power in the diagnosis of acute appendicitis, and for
minimizing unproductive admission and abdominal explorations, especially in Asian
ethnicity, as it outperforms the Alvarado and the AIRS Scores in all statistical
parameters, as per our study.

Introduction: Internet was developed to make communication easier, quicker, and to facilitate
safe exchange of information. With ever increasing presence of internet in our work and leisure
related activities the boundaries between functional and dysfunctional internet usage have
become blurred. This study was conducted among medical students in a medical college in North
India with the objective to assess internet behavior pattern, to estimate the prevalence of internet
addiction and whether internet addiction impacts their academic performance. Methods:This
was a cross-sectional study conducted among medical students from a medical college in North
India. Internet Addiction was assessed using Internet Addiction Diagnostic Questionnaire,
developed by K. Young in 1997. This contains 20 questions that examine the symptoms of
internet addiction based upon a five-point Likert scale. Academic performance was assessed on
the basis of Internal & University marks obtained in last one year. Results: The study shows that
internet addiction is very common among medical students with 44.2% of medical students
having some level of addiction. Mild addiction was observed in 21.9% students with 13.1% &
9.2% of them having moderate and severe internet addiction respectively. Being Male, using
internet mostly for entertainment, starting to use internet at younger age, longer hours of internet
usage & more frequent use of it everyday were found to significantly impact levels of internet
addiction. It also had a significantly detrimental impact on academic performance.Conclusion: A
substantial number of students had internet addiction with negative impact on academic
performance. Immediate measures such as early diagnosis and management need to be taken to
safeguard their educational progress and long-term career goals

Background:There are different systems utilized in the careful treatment of
hemorrhoidal ailment. The present study was conducted to compare stapler
hemorrhoidectomy and open hemorrhoidectomy.
Materials & Methods: 70 hemorrhoids patients of both genders were divided into 2
groups. Group I was stapler hemorrhoidectomy group (SH) and group II was Open
(Milligan Morgan) hemorrhoidectomy group (OH). Operating time (mins), first bowel
movement (hours), return to normal daily activities (days), pain and complications.
Results: Group I comprised of 25 males and 10 females and group II had 18 males and
17 females. Operating time (mins) was 24.3 in group I and 18.1 in group II, first bowel
movement (hours) was 19.2 in group I and 34.6 in group II, return to normal daily
activities (days) was 5.7 in group I and 7.2 in group II and VAS was 26.2 in group I
and 50.8 in group II. Complications was bleeding seen in 1 in group I and 2 in group II,
urinary retention 4 in group I and 5 in group II and bleeding and urinary retention 2 in
group I and 1 in group II. The difference was significant (P< 0.05).
Conclusion: Operative time, duration of hospital stay and return to normal activity
were satisfactory with stapler hemorrhoidectomy than the open method.

Background:Inguinal hernias are common, and although the results of surgical repair
are often satisfactory, postoperative recovery may be slow, and the hernia may recur.
The present study compared Rutkow–Robbins and Gilbert Double Layer Graft
Methods of hernia repair.
Materials & Methods: 60 patients of inguinal hernia of both genders were divided into 2
groups of 30 each. Group I were treated with Rutkow–Robbins method and group II
with Gilbert double layer graft methods. Parameters such as VAS and complications
were compared
Results: There were 18 males and 12 females in group I and 11 males and19 females in
group II. Anesthesia used was local in 16 in group I and 10 in group II, general 6 in both
groups and spinal 8 in group I and 14 in group II. The mean hospitalization (days) was
2.24 in group I and 2.31 in group II and operation time (mins) was 26.2 in group I and
24.6 minutes in group II. The mean VAS was 1.91 and 2.14 at day 1, 0.84 and 1.21 at
day 7 and 0.09 and 0.27 at day 30 in group I and II respectively.
Conclusion: Both methods of inguinal hernia repair was comparable

Background:Hearing loss (HL) can be defined as complete or partial loss of the ability
to hear and understand information, which limits or restricts an individual’s ability to
perform hearing-related activities. The present study assessed efficacy of two different
hearing aids in patients with hearing loss.
Materials & Methods: 94 patients with hearing loss of both genders were divided into 2
groups of 47 each. Group I comprised of channels ranged from 1 to 16. Group II had
the number of channels ranged from 2 to 16. Patient satisfaction levels was recorded
using the international outcome inventory for hearing aids, Turkish edition (IOI-HATR).
Total individual subjective satisfaction (TISS) scores were also recorded.
Results: Group I had 27 males and 20 females and group II had 29 males and 18
females. The mean TISS score at 1 month in group I was 48 and in group II was 62, at 6
months was 53 and in group II was 68 and at 12 months in group I was 60 and 74 in
group II. The difference was significant (P< 0.05).
Conclusion: There was better hearing with devices with good technologic features such
as more channels and a lower minimum frequency.

Background: Septoplasty is a well-accepted treatment for nasal airway obstruction as
well as for rhinologic headache due to irritation of the septum caused by contact with
the lateral nasal wall. The present study was conducted to assess cases of deviated nasal
septum.
Materials & Methods: 60 patients of deviated nasal septum of both genders were
subjected to a detailed NOSE questionnaire consisted of 0 being the lowest and 4 being
the highest.
Results: Out of 60 patients, males were 28 and females were 32. Septal deviation was
causal in 30, mid-septum in 14 and posterior septum in 16 cases. The difference was
significant (P< 0.05). The mean pre- operatively NOSE value was 54.6 and postoperatively
was 24.2. The difference was significant (P< 0.05).
Conclusion: Septoplasty resulted in significant improvement in NOSE score.

Aim: To assess the efficacy and safety profile or oral azithromycin with oral doxycycline
in patients with refractory meibomian gland dysfunction.
Material and method: This prospective randomized control study comprised of 60
patients attending the outpatient Department of Ophthalmology at Subharti Medical
College. All cases underwent a detailed evaluation including visual acquity, anterior
segment slit lamp examination of lid margins, tear minuscus, conjunctiva, cornea and
tear film. Patients aged 18-70 were included in the study and the age matched
randomization was done in two groups i.e. Group A (Oral Azithromycin 500mg on day
1 and then 250mg per day for next 4 days) and Group B (Doxycycline 100mg twice a
day for 7 days and then 100mg once a day for next 21 days). All patients underwent
complete ophthalmic examination and the signs and symptom scores were recorded
prior to the treatment subsequently at 1 month, 3 months and 6 months post treatment.
Results: At last follow-up, there was distinct improvement in all the symptoms and
mean score of all the signs in both the groups. The decrease in mean score was more in
group A as compared to group B, however statistically significant was found in bulbar
conjunctival redness, meibomian gland plugging, eyelid margin redness and ocular
surface staining. Side effects were more in Doxycycline group as compared to
Azithromycin group.

Background: LP (Lichen Planus) is a disease having unknown etiology, and is considered a
papulosquamous disease. The occurrence of lichen planus in children is an uncommon finding.
The data in previous literature concerning the clinical profile of children with lichen planus are
scarce and need further exploration with the majority of conducted studies being retrospective.
Aim: The present clinical study was conducted to assess the clinical profile of Lichen Planus in
the pediatricsubjects. The present study also evaluated the risk factors associated with childhood
lichen planus, if any.
Methods: The present study included 46 pediatric subjects of age less than 14 years and having
an either histopathologic or clinical confirmed diagnosis of Lichen Planus. The study was carried
out at LLRM Medical College, Meerut. For all the included subjects, detailed history,
investigations, and examinations were carried out.
Results:46 cases of childhood LP were included in the study and they constituted 1.2% of the
pediatric dermatoses. There were 25 males (54.34%) and 21 (45.65%) females with a male to
female ratio of 1.2:1. The age ranged from 6 months to 14 years with a mean age of 11.1 ± 4.6
years. The duration of the disease ranged from 15 days to 5 years with a mean of 9.2 ± 3.2
months. A history of recent hepatitis B vaccination (HBV) was found in 8 (17.4%) patients, and
exposure to X‑ ray radiation was seen in 5 (10.86%). A history of blood transfusion was present
in 1 (2.2%) patient. Classical LP was the most common variant, found in 30 (65.21%) patients,
followed by hypertrophic variant in 9 (19.56%) patients. Koebnerization was found in 31
(67.39%) of the patients. Oral mucosa was involved in 28.26% of patients, nail in 41.3% of
patients, and scalp in 8.69% of patients.
Conclusion: The present study concludes that childhood lichen planus shares a resemblance in
most of the aspects to the adult lichen planus. However, childhood lichen planus is still an underreported
condition.

BACKGROUND: Proximal tibial plateau fractures are serious and complex injuries that pose difficulty in management. Their management is challenging because of the severe displacement of the bony fragments, the concomitant depression and impaction of the cancellous subchondral bone, and the complications like Compartment syndrome, cartilage destruction, soft-tissue envelope damage, infection, knee instability, stiffness and arthritis.
OBJECTIVES: A comparative analysis of elevation of depressed tibial condyle fracture by autogenous bone graft and hydroxyl apatite crystals.
METHODS: A prospective study of 30 patients with Schatzker type II, III, V, and VI with depressed tibial plateau fractures were identified and divided into 2 groups, all the patients were treated by elevation of depressed tibial condyle fracture, patients in group A have been operated by using bone graft and in group B have been operated by using hydroxy apatite as void filler, 15 in each group.. The preoperative and intra operative and post operative data was noted and final evaluation was done using knee society score.
RESULTS: The patients were followed up at 1,3 and 6months, Fair results were seen in 53.30% of patients treated with bone graft and 80% of patients treated with hydroxyapatite crystals at one month, where as 46.70% of patients treated with bone graft and 20% of patients treated with hydroxy apatite crystals showed poor result at end of one month.93.3% of patients treated with bone graft and 86.7% patients treated with hydroxyapatite crystals showed excellent results, and 6.7% of patients treated with bone graft and 13.3% of patients treated with hydroxyapatite crystals have shown good results at 3 and 6 months.
CONCLUSION: We conclude that there was no much significant difference between functional outcome between both the groups but the complication of late collapse is higher in patients treated with bone graft when compared to those treated with hydroxyapatite crystals.

BACKGROUND:
COVID19 outbreak has become a pandemic worldwide. There has been a fairly high rate of clinical recovery among Covid patients but complete resolution or sequelae in terms of radiological findings need to be studied.
AIM OF THE STUDY:
1. To understand the common pulmonary sequalae , time taken for complete resolution and factors affecting the resolution process in covid-19 patients who have been discharged after recovery, with Chest HRCT follow up.
MATERIAL AND METHODS:
This is an observational study which included a total of 100 discharged patients diagnosed with covid-19 by RTPCR at Index Medical College, Hospital & Research Centre, Indore-MP-India, from March 15 to June 30-2021.All the patients underwent an initial chest CT scan done 3-5 days after the onset of symptoms ,followed by serial CT scans done at discharge and at 1st, 2nd and 3rd weeks after discharge. The radiological characteristics and patterns on CT chest were studied and a CT severity scoring was done for all the scans.
RESULTS:
GGO were the most common pattern seen (88%) on chest CT at discharge followed by fibrotic bands (61%) with the right lower lung (85%) most commonly involved.61% of patients showed complete resolution at the end of 3rd week after discharge indicating that COVID 19 induced pulmonary damage is reversible in majority of cases with no long term sequalae. However 39 patients demonstrated residual abnormalities. Older patients are at high risk for residual pulmonary lesions and there is no gender predilection. Patients having comorbidities like hypertension, diabetes or bronchial asthma were not at a higher risk of developing pulmonary sequalae.
CONCLUSION:
The resolution of most lesions by 3 weeks after discharge implies gradual resolution of inflammation with re-expansion of alveoli and perhaps the reversible nature of the lesions of Covid -19.

Background: Ligamentous injuries to the ligaments and menisci of the knee can lead to significant morbidity and may precipitate osteoarthritis.Arthroscopic diagnosis though invasive is considered as the gold standard. Various imaging modalities like CT scan and MRI have alsobeen used in the diagnosis of these injuries and the quest for the best technique goes on.
Aim: The aim of this study is to assess the diagnostic accuracy of 1.5 T MRI in cases of ligamentous injuries of the knee joint and compare its efficacy with arthroscopy.
Materials & Methods: This is a comparative observational study which included 50 patientswho were clinically suspected to be having ligamentous injuries of the knee. MRI was done for all these patients and all of them laterunderwent arthroscopy in the Department of Orthopaedics-IMCHRC.Statistical analysis was done to derive the sensitivity, specificity, positive predictive value (PPV) and the negative predictive value (NPV) and for this the findings at arthroscopy were taken to be the true diagnosis.
Results: The patients were commonly in the age group of 21-30 years and males with RTA being the commonest mode of injury and duration of injury commonly between 6weeks to 6 months.ACL tear was the commonest injury found in 76% followed by PCL tear in 38% , MM tear in 36%, LM tear in 32%. Regarding the efficacy of 1.5T MRI for ACL tears the sensitivity was 94.6%, specificity 76.9%, PPV 92.1%, NPV 83.3% and accuracy 90%. For PCL it was 94.4%, 93.8%, 89.5%,96.8%,94% respectively. For MM it was 94.7%,100%,100%,96.9%,98% respectively and for LM 83.3%,96.9%.93.9%,91.2%,92% respectively.
Conclusion: MRI is of proven diagnostic value in the evaluation of internal ligamentous injuries of the knee joint. It has a fairly good PPV and its routine use in all clinically suspicious ligamentous injuries of the knee may be recommended. Further since MRI has a high NPV, a normal MRI scan may be used to exclude any pathology and thus avoid an expensive and invasive procedure like arthroscopy.

Background: In pregnancy, anemia is a common disorder and is associatedwith an increased risk ofmaternal, fetal, and neonatalmorbidity and mortality. The present study was conducted to determine the prevalence and risk factors of anemia among III Trimester pregnant women attending OBG department, Government medical college &general hospital, Nizamabad.
Methods: A hospital based cross sectional study was conducted on 392 III Trimester pregnant women attending antenatal care at Governmentmedicalcollege&general hospital, Nizamabad from October 2020 to March 2021. Data on socio-demographic and clinical characteristics of the study participants were collected using a questionnaire and medical records. The haemoglobin was measured using an automated cell counter method and those with hemoglobin level less than 11 g/dl were considered as anaemic.
Results: The overall prevalence of anemiain our study was found to be 192 (48.9%).The age of the patients ranged from 18 to 35 years. out of all anaemic pregnant women about 100 were mildly anemic, 82 were moderate anaemic &10 were severe anaemic. Iron folic acid supplementation, antenatal care visit were significantly associated with the prevalence of anemia.
Conclusion: There is a high prevalence of anemiain III trimester pregnant woman attending tertiary care hospital in Nizamabad.Iron supplementation and health education to create awareness about the importance of antenatal care are recommended to reduce anemia.

Developments in materials and techniques, geographical locations, age, specialty, and affiliations of dental practitioners affect the preference of post-endodontic restoration. The restorative component of endodontic treatment should optimise the tooth’s survival with a good coronal seal, cuspal protection where required and prevention of further primary disease. It is also important to remember that the prognosis of endodontically treated teeth depends not only on endodontic treatment success itself, but also on the amount of remnant tooth tissue and the definitive restoration that will be placed onto the dental element. This article outlines the available evidence for the restoration of root filled treated teeth

Neonatal period that is first 28 days of life is very crucial period in terms of survival of a newborn. Durind this period, a newborn adapts himself for the changes that take place by transition from intra-uterine life to extra-uterine life. Though this period of just 28 days accounts for less than 2% of total under 5 childhood, it carries the greatest risk of morbidity and mortality for the newborn.
 In India SRS 2012 neonatal deaths accounts for 56% of under five and 69% of infant deaths. First week of death alone accounts for 45% of total under 5 years deaths[1].  The major causes of neonatal deaths as per Sample Registration System Report (2010-13) are Prematurity and low birth weight (48.1%), Birth asphyxia &amp; birth trauma (12.9%), Neonatal Pneumonia(12.0%), Other non communicable diseases (7.1%), Sepsis (5.4%), Ill defined or cause unknown(5.0%), Congenital anomalies(4.0%), Diarrhoeal diseases (3.1%), Injuries (0.9%), Tetanus (0.5%) and all other remaining causes (0.9%)[2].  Almost three fourth of all neonatal deaths occur among the low birth weight newborns. Of all the neonatal death about 40% occur within first 24 hours,  half within 72 hours and 3/4 within one week of birth[1]. Appropriate care of the mother during pregnancy and childbirth has positive influence on neonatal outcome. But still high neonatal mortality in India is a subject of great concern. According to the UNICEF report 2021, the current neonatal mortality rate (NMR) in India is 20 per 1000 live birth[3]. According to SRS, Infant mortality rate in INDIA is 30 per 1000 live birth, but in Madhya Pradesh, the Infant mortality rate (IMR) is 46, which is highest among all the states of India [4]. This study was conducted to study the mortality and morbidity patterns of newborns admitted in newly set up SCNU at a tertiary care centre of Madhya Pradesh.
 

By the end of December 2019, the world has witnessed arrival of a new virus, SARS-Covid 19, the novel corona virus from the city of Wuhan, China. After causing havoc in China, it speeded to each corner of the world. With over 36 lakh cases across the world, corona virus has already claimed around 2.3 lakh lives worldwide, according to data collected by agencies like world meter and WHO. ⁽¹⁾ On 11^th March 2020, the World Health Organization (WHO) declared COVID-19 a public health emergency of international concern. With introduction of this illness in India with case reported on 30^th Jan 2020, it is on a rise since then. However, to control and confine the disease Indian government had taken many measures including national wide lockdown from 24^th March 2020. ⁽²⁾ Apart from other issues health has a big concern during these lockdown periods and to get medical consultation became a real threat to common public. During the COVID-19 pandemic, mandatory social distancing and the lack of effective treatments has made telemedicine the safest interactive system between patients, both infected and uninfected, and clinicians. A few potential evidence-based scenarios for the application of telemedicine have been hypothesized

Background
Stapled hemorrhoidectomy has a number of advantages over excision hemorrhoidectomy, including less postoperative pain, a shorter stay in the hospital, and a faster recovery. Furthermore, stapled hemorrhoidectomy is linked to a reduced rate of hemorrhoidal recurrence during long-term follow-up.
Methods:
The study included 100 patients, 50 of whom received open and 50 of whom underwent stapled haemorrhoidectomy. Averages, standard deviation, unpaired student t test, Mann Whitney U test (for non-parametric skewed distribution), and Fischer exact test were used to assess significance levels. If the p-value ˂ 0.01 or 0.001, the difference is extremely significant. The difference is significant if the p-value ˂0.05.
Results
In terms of postoperative pain, operative time, and return to normal activities, the stapled method for haemorrhoids is preferable than the Milligan Morgan haemorrhoidectomy. It's simple and obvious to learn. Early functional and symptomatic results have been positive, and they appear to be comparable to or better than those obtained using conventional approaches. However, long-term assessment of these parameters is required.
Conclusion
I conclude that both treatments were effective for hemorrhoidectomy treatment, however Stapler hemorrhoidectomy had advantages in terms of shorter operative periods, less intra- and post-surgical bleeding, and a lower incidence of various post-operative sequelae. Patients with haemorrhoids frequently avoid surgery for fear of enduring excruciating pain after a haemorrhoidectomy.
 

Background: Exercise increases the production of free radicals, while vitamin E acts as a
scavenger of free radicals, while vitamin E acts as a scavenger of free- radicals. Thus exogenous
vitamin E supplementation has been shown to be effective against exercise- induced oxidative
stress.The study aims to investigate the effect of vitamin E (400mg) supplementation on the
endogenous antioxidant systems of the body viz. superoxide dismutase (SOD), glutathione
peroxidase (GPX) and catalase (CAT) of hundred healthy sedentary females of 18-21 years age
group and comparable height and weight. Material & Methodology: Endurance capacity of
each subject was determined by exercising them on Magnetic Break Bicycle Ergometer at a fixed
workload of 600KgM/ min till exhaustion. SOD, GPX and CAT levels were analyzed at pre and
post exercise levels. The subjects were divided into two groups --- control group (n=50) and the
group receiving 400 mg of vitamin E (Evion 400) (VE) supplementation for 15 days. The same
experimental procedure was repeated after the supplementation tenure. Results :Results
indicates that exercise caused a significant decrease in the CAT level (P<0.05) and an increase in
SOD level (P<0.001) and GPX level (P< 0.05). However, these changes in the level of SOD, GPX
and CAT were minimized after exogenous vitamin E supplementation.Conclusion: The entire
result signifies that vitamin E is highly effective in combating exercise- induced oxidative stress
in sedentary females.

Introduction: Intercostal drainage (ICD) tubes are indicated to drain clinically
undesired substances such as air, excess fluid, blood, chyle or pus from the intrathoracic
space. There are very few studies on pediatric patients managed with intercostal
drainage tube insertion for different indications.
Aims: To study the clinico-epidemiological profile, indications, complications and
outcomes of pediatric patients admitted in Pediatric Intensive care unit who were
managed with ICD tube insertion.
Material and Methods: Records of pediatric patients from Pediatric intensive care unit
(PICU) of Shyam Shah Medical college Madhya Pradesh during a period of one year i e
from July 2020 to June 2021 was collected and analysed prospectively.
Results: a total 25 patients were included in the study (male:female= 1.27:1; mean age
4.9± 3.7 years). Common clinical presentation of the patients were fever (n=18, 72%)
followed by fast breathing (n=11, 44%). Mean duration of stay was 18.7±11.7 days.
Common indications for ICD tube were pyothorax (n=8, 32%), pyopneumothorax,
empyema and pneumothorax (n=4, 16% each). 80 % cases were unilateral and 28%
required blood transfusion and inotropes for shock. Most common pathogen isolated
from cultures was staphylococcus aureus (>75%). 11 patients were started with
antitubercular treatment. In our study the mortality was 24%.
Conclusion: In this study, Staphylococcus aureus was the most common organism
isolated from culture whereas 44% cases were treated with antitubercular treatment
that reflects how common tubercular pleural effusions are in pediatric age group in this
area. Early diagnosis and treatment is the key of management. More extensive studies
are required in this topic of interest.

Background: Sepsis and septic shock cases in the Neonatal intensive care unit (NICU)
and Pediatric intensive care unit (PICU) remain one of the most significant causes of
morbidity and mortality in pediatric patients. Therefore, studying and comparing the
clinical features and outcomes of pediatric patients with sepsis in ICUs are important,
especially in developing countries.
Methods: From 1st July 2021 to 31st December 2021, we have collected data from both of
our pediatric ICU and neonatal ICU of Shyam Shah Medical College using a preformed
proforma. Complete blood count, C - reactive protein and culture sensitivity reports
were used to diagnose or screen sepsis. We compared clinical features, laboratory data,
microbiologic results, and final outcome for patients with sepsis in both NICU and
PICU.
Results: A total 1509 and 236 cases with sepsis from both NICU and PICU respectively
are included in the study (mean duration of stay in NICU 8.9 days±4.3; in PICU 12.5
days±5.3). Among these cases, culture positive cases with sepsis were 66% and 28% in
NICU and PICU respectively. Common pathogens isolated from blood cultures were E.
coli and pseudomonas in NICU and E.coli and S. aureus in PICU. Mortality, discharges,
refers and Left against medical advice cases were compared as outcomes in our study.
Comparing with NICU (n=24, 10.1%), mortality due to sepsis in PICU (n=111, 7.3%)
was less.
Conclusion: Sepsis in children both in NICU and PICU is associated with high mortality
despite aggressive treatment strategies, but more in NICU. Early recognition and
prompt treatment is the key to improve outcome of sepsis.

Introduction- Obstructive uropathy is one of the most commonly encountered problem in clinical practice. It is defined as structural impedance to the flow of urine anywhere along the urinary tract leading to pelvicalyceal dilatation. The resulting renal parenchymal damage caused by a virtue of the obstructive uropathy is collectively termed “obstructive nephropathy”.
 AIMS  
 Diagnostic Accuracy of Color Doppler in Obstructive Uropathy
Objectives- 

Role of Color Doppler in Obstructive Uropathy
To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography.
To evaluate the diagnostic accuracy of renal venous doppler ultrasound in diagnosing obstructive uropathy
To evaluate the ability of this modality to differentiate obstructed from non-obstructed kidneys.

Materials and methods- The study was conducted in Department of Radio diagnosis of Index Medical College Hospital and Research Centre, Indore .
Our study include 100 patients out of these 50 were  Obstructed Kidney and 50 were control
Results - PUJ and VUJ are most commonly involved in our study 30% and 30%respectively
On Color doppler Mean resistive index and mean venous Impedance value between Obstructed and control is statistically calculated 0.723 and 0.307. In our study mean arterial PSV in Obstructed and control group is calculate to be 31.14 and 17 respectively, and Mean venous PSV in obstructed and control group calculated to be 23.9 and 15.2 respectively
Conclusion- In conclusion from the study it is evident that the Arterial resistive index and venous impedance measurement by Doppler ultrasound has a high sensitivity and specificity in detecting acute renal colic.

Background: Regular training, in particular endurance exercise, induces structural myocardial adaptation, so-called "athlete's heart". In addition to the 2D standard echo parameters, assessment of myocardial function is currently possible by deformation parameters
Objective: To determine the impact of measures of cardiac function assessed by echocardiography on exercise capacity and to determine if these associations are modified by sex or advancing age.
Methodology: The Study was conducted on 100 subjects at Haldiram and Moolchand Heart Centre, PBM Hospital, S.P. Medical College, Bikaner. First a resting echocardiography was performed to evaluate cardiovascular diastolic function. After echocardiography the subjects were underwent Bruce protocol treadmill test.
Result & Conclusion:: There was no correlation between exercise capacity and end systolic volume index (p=0.089), between exercise capacity and ejection fraction(p=0.459), between exercise capacity and fractional shortening(p=0.467), between exercise capacity and stroke volume index(p=0.361), between exercise capacity and  cardiac index(p=0.475).
 

Aspergillus spp. is frequently isolated in respiratory samples from patients with severe
chronic obstructive pulmonary disease; however, the clinical significance of this mold is
unclear and its presence may indicate temporary passage, benign chronic carriage, or onset of
invasive disease. This hospital based cross-sectional observational study was carried out at
the Department of TB and Chest, Index Medical College, Indore (M.P.). Detection of
Aspergillus species was done using culture and Polymerase Chain Reaction. Sensitivity,
specificity, of 10.0% KOH, and culture findings against PCR was found to be 68.7%, 95.1%
respectively for KOH and 72.9% and 100.0% respectively for culture test. Species detection
in nested PCR was A. niger (2.0%), A.fumigatus (11.3%) and A.flavus (10.0%). This shows
more species specificity of PCR. Aspergillusfumigatus was the most dominant molds isolated
from sputum in aspergillosis patients. Molecular methods are more sensitive and specific
methods. It gives results for detection and speciation in short time which helps early
diagnosis and treatment of patient.

Background:Mechanical Ventilation (MV) is frequently used as one of the most
frequent life-supportive technology in Pediatric Intensive Care Units (PICUs). The
present study was undertaken to assess the clinical and etiological profile and outcome
of mechanically ventilated patients admitted in PICU at Tertiary Care Centre.
Methods: A total 120 children of age >30 days and <12 years, who were ventilated in
PICU mechanically from September 2019 to October 2021 were included in the
study.The demographic, clinical and etiological profile, complications and outcomes
(Extubated and died) were recorded.
Results: The mean age of patients was 3.32±1.19 years with male predominance (55%).
The commonest cause for intubation was circulatory failure (42.5%) and commonest
clinical diagnosis was septic shock (27.5%). In 71.67% patients rapid sequence
intubation (RSI) was used. Size of ET was appropriate in 92.5% and type of ET was
uncuffed in 90%. 13(10.83%) patients required reintubation and 9(7.5%) patients done
tracheostomy. Out of 120 patients, 21(17.5%) required T piece, SIMV in 9.17%, CPAP
in 5.83% and no weaning methods in 67.5%. Majority of patients required inotropes
(80.83%) and raised intracranial pressure (ICP) was seen in 27(22.5%) patients.
Nosocomial pneumonia (15%) and obstructive emphysema (15%) were the commonest
complications. 25(20.83%) patients had culture positivity and K. Pneumoniae (6.67%)
was the commonest organism isolated, among 25 cases, 7 had multiple drug resistance
(MDR) (28%). Majority of patients died (62.50%) while 37.5% patients extubated.
Conclusion:Mortality was high, hence the patients requiring MV require better
primary care availability at periphery so that they can be managed well at tertiary level
centres.Also better infection control and respiratory disease control are required.

Background
Cardiorenal syndrome (CRS) is not a newly discovered syndrome. The adverse outcomes of
the renal impairment in patients with Heart failure were known since long. Our aim in this
study was to evaluate the occurrence of AKI, to determine the outcome (morbidity and
mortality) in patients suffering with AKI.
Methods
The present observational prospective study was conducted for a duration of 1 yearamong
100 patients (age 18 years or more) admitted to hospital with acute decompensated heart
failure.A written informed consent taken from each patient and were then screened for
cardiac dysfunction by a detailed history, clinical examination and
echocardiography.Univariate logistic regression was used to find out association of various
outcomes with AKI. A p value of <0.05 was considered statistically significant.
Results
The mean age of the study population was 58.98 ± 17.16 years. The mean Boston criteria for
the population was 9.87 ± 1.36. Baseline S. creatinine, eGFR and even B. Urea were strongly
associated with the occurrence of AKI. Presence of diastolic dysfunction was associated with
AKI. Mortality and readmission were significantly higher in AKI group as compared to non-
AKI group.The predictive value of AKI was maximum with the baseline S. creatinine.
Conclusion
Cardio-renal syndrome is a commonly seen in patients admitted in hospital. AKI can lead to
poor cardiac output or pre-renal failure as a result of overuse of diuretics. The mechanism
involved is complex. AKI in patients admitted with ADHF has poor prognosis with increased
mortality and longer duration of hospital stay.

BACKGROUND:Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroidstimulating
hormone (TSH) level with a normal serum free tri-iodothyronine (FT3) & free
thyroxine (FT4) concentration. Hypothyroidism is associated with an increased risk of
atherosclerosis. SCH can progress to overt hypothyroidism. Carotid intima-media thickness
(CIMT) is a close marker of early atherosclerotic changes and is a widely accepted surrogate
end point for cardiovascular events.
AIMS AND OBJECTIVES: To study the CIMT in patients with SCH.
MATERIAL &METHODS:
35 individuals with newly diagnosed / untreated SCHwere studied. 35 age and sex matched
adults with normal thyroid profile were taken as controls. Serum TSH, FT3, FT4, and CIMT
were measured in all study subjects.
RESULTS:There was a statistically significant increase in CIMT on both sides.
CONCLUSION:SCH is associated with an increase in CIMT, which is a marker of
atherosclerosis, with a resultant risk of cardiovascular disease and stroke. Thus, it is
important to detect this condition early so that appropriate steps may be taken to prevent its
deadly complications.

Aim: Clinical evaluation of preoperative skin preparation with aqueous povidoneiodinealone
and in combination with alcoholic chlorhexidine in patients undergoing
electivesurgery
Material and methods: This observational study was carried out in the Department
ofGeneralSurgeryRamaMedicalcollegeandhospitalHapur.120Patientsofallagegroupsund
ergoing elective surgery in the Department of General Surgery with a clean woundwere
included in this study. 120 patients divided into 2 equals groups. For Group-
1antisepticregimenusedisthreecoatsofaqueouspovidone-iodineIP5%w/v.ForGroup-2
antiseptic regimen used is a single coat of agent containing chlorhexidinegluconate2.5%
v/v in 70% propanol followed by two coats of aqueous povidone-iodine IP 5% w/v.The
pre- operative antibiotic used is Cefotaxime 1 gram I.V given following a test
dose;onehourpriorto incision.
Results:Thereare7patientsingroup-1and2patientingroup-2whohadpositiveculturewhich
is found to be statistically significant. Post-operatively patients were followed upto the
time of suture removal (usually 7-10 days) to know the percent of cases whodeveloped
wound infections. There were 7 cases in group-1 and 2 case in group-2 whodeveloped
postoperative wound infections. It is noted that out of 7 cases with growth ingroup-1,
only 4 had post-operative wound infection and the other 3 were ward
acquired.Similarly,theonlyinfectionin group-2 is hospitalacquired.
Conclusion:Thepresentstudyconfirmsthesuperiorityofpovidone-iodineincombination
with alcoholic chlorhexidine over povidone-iodine alone in pre-operativeskin
preparation and warrants recommendation of it as a preferred antiseptic in
skinpreparation forelectivecleansurgery

Background:Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical
procedures worldwide is accepted as the gold standard in the treatment of symptomatic gallstones.
The present study was conducted to assess incidence of CBD injury who underwent LC.
Materials & Methods:180 patients who underwent laparoscopic cholecystectomy of both genders
were included. Predictors of CBD injury were assessed based on grading of degree of difficult LC and
visualization of critical view of safety (CVS). BDI was classified according to Strasberg
classification.
Results: Out of 180, males were 110 and females were 70. Diagnosis was acute cholecystitis in 90,
chronic cholecystitis in 40, empyema gall bladder in 30 and mucocele gall bladder in 20 cases. Degree
of difficulty was mild in 46, moderate in 84, severe in 28 and extreme in 22. CVS was seen in 160.
The difference was significant (P< 0.05). Type of bile duct injury was type A in 5, type B in 1, type D
in 2 and type E4 in 3 patients. The difference was significant (P< 0.05).
Conclusion: Majority of bile duct injuries, results mainly from the surgeon’s inexperience,
misinterpretation of anatomy and poor surgical technique.

Background:Obese children also suffer from emotional, mental, and social trauma. Obese
children are seen to have depression and very low self-esteem. Also, such children are teased
by society and have high peer pressure. Additionally, obesity and overweight pose a high
burden on the health care system.
Aims:The present trial was carried out to document the efficacy of counseling about physical
activity, nutrition, and weight on obese children of low socioeconomic status.
Methods: The study was carried out on 48 children and was based on the questionnaire on
the lifestyle modification and counseling sessions with questions based on healthy habits and
physical exercise. Associated comorbidities such as asthma or diabetes were also asked along
with their treating paediatrician. The collected data were subjected to statistical evaluation
and the results were formulated.
Results: Counselling for nutrition, physical activity, and weight were provided to study
participants and the results showed that 80% (n=12) obese, 66.6% (n=6) overweight, and
58.3% (n=14) healthy subjects received counselling for nutrition. In male participants
61.53% (n=16), 69.23% (n=18), and 65.38% (n=17) respectively were counselled for
nutrition, physical activity, and weight. Similarly, in females 68.18% (n=15), 63.63% (n=14),
and 63.63% (n=14) respectively were counselled for nutrition, physical activity, and weight.
Regarding diabetics in the study (n=2), all the subjects were counselled for weight, nutrition,
as well as physical activity. In subjects with asthma, the counselling for nutrition, physical
activity, and weight was given to 63.6% (n=7), 54.5% (n=6), and 54.5% (n=6) respectively.
Conclusion:The present study concludes that overweight and obese children do not get more
counseling sessions compared to their healthy peers. There is a need for more interactions at
home and more reinforcement of counseling sessions in the school curriculum with special
emphasis on overweight and obese children regarding their nutrition, physical activity, and
weight.

Background & objectives: The quantity of diabetes in India is expanding at a disturbing
rate. The impacts of active work as obstruction preparing or oxygen-consuming
activities on type 2 diabetes have not been examined in the Indian populace. The goal of
this study was to break down the impacts of about two months of Physical Readiness
Tests (PRT) contrasted and aerobic exercise (AE) on glycaemic control, metabolic
profile, cardiovascular wellness boundaries and general prosperity in grown-ups with
type 2 diabetes.
Methods: Thirty grown-ups (14 females and 16 males mean; age 53.8 ± 8.8 years) with
type 2 diabetes were arbitrarily allotted to an 8-week regulated PRT (n=10) or AE
(n=10) or control group (n=10). Glycosylated haemoglobin (HbA1c), lipid profile, blood
pressure, pulse, body mass index (BMI) and general prosperity were estimated before
preparing (for example 0 weeks) and after 8 weeks of preparing period.
Results: Plasma glycosylated haemoglobin levels diminished altogether (P<0.05) both in
the PRT group (7.57 ± 2.4% to 6.23 ± 0.8%) and in the AE group (8.11±0.9% to 6.66 ±
0.9%). Total cholesterol levels diminished essentially (P<0.05) by 13.3 percent in the
PRT group and by 6.1 percent in the AE group. Both exercise groups showed an
essentially decrease in systolic circulatory strain (P<0.05). General prosperity
improvement was significantly more in PRT (8.6%) when contrasted with the AE group
(2.7%).
Conclusions: Our discoveries showed that both PRT and AE were successful in working
on the metabolic profile of grown-ups with type 2 diabetes however the rate
improvement in fatty oils, complete cholesterol levels and general prosperity with PRT
was more contrasted with AE. Further investigations on a bigger example should be
done to affirm these discoveries.

Background: Measurement of HbA2 in sickle cell illness is critical for distinguishing
between sickle cell anaemia (HbSS) and Hb S/0-thalassemia. The goal of the current
research is of assessing the magnitude of HbA2 among sufferers diagnosed with SC
hemoglobinopathy and also HbSS, with or without associated alpha thalassemia, with
the help of High-Performance Liquid Chromatography (HPLC).
Methods: In the current retrospective study, 242 children belonging to the ages of two
to six years old who had HbSS or HbSC diagnosis were involved. The haemoglobin was
tested with the help of HPLC. Polymerase chain reaction (PCR) was instrumentalised
for detecting alpha thalassemia. Patients were categorised into three groups:
homozygous (3.7/3.7), heterozygous (3.7/), and homozygous wild-type (3.7/3.7). The
mean HbA2 values with alpha thalassemia were compared using variance analyses.
Results: The HbA2 concentrations in the HbSS group (n = 135) were 3.68 0.65 percent
on average (standard deviation). Individuals with HbSS who were heterozygous (n = 28)
or homozygous (n = 3) for alpha thalassemia had mean values of 3.98 and 4.73
respectively. The mean HbA2 of all HbSC sufferers (n = 107) was 4.01 0.507, with 4.29
0.41 percent heterozygous for alpha thalassemia (n = 23) and 4.91 0.22 percent
homozygous for alpha thalassemia (n = 7) respectively. HbA2 values were above 3.5
percent in all patients homozygous for alpha thalassemia. HbA2 values greater than 5.2
percent were seen in sufferers with HbSS and HbSC, regardless of the presence of alpha
thalassemia.
Conclusion: HbA2 levels are higher in patients with HbS or HbC, and alpha
thalassemia genotypes have a direct impact.

Introduction: Enterococci are normal flora of oral cavity, gut, and female genital tract
of humans and are known to cause nosocomial infections. E. faecalis is responsible for
80-90 percent and E. faecium 5-10 percent of the human enterococcal infections. Most
frequent infections caused by Enterococcus spp. are urinary tract infections followed by
intra-abdominal abscesses and bloodstream infections.
Materials and Methods: This is a prospective, descriptive and observational study
conducted in the Department of Microbiology, Index Medical College, Hospital and
Research center Indore from January 2019 December 2021. All isolates of Enterococcus
species during the study period will be included. All patients over 18 years of age having
chronic diabetic foot ulcers where ulcer duration is greater than three months were
included in the study
Results: A total number of 72 isolates of E. faecalis, 42 (58.33%) were isolated from
males whereas 30 (41.66%) from female patients of diabetic foot ulcers. In case of E.
faecium, 34 (68%) were isolated from males and 16 (32%) isolated from females. In our
study, Among E. faecalis organism, few strains were 100% sensitive to Amikacin,
Lenizolid and Teicoplanin respectively. Rate of resistance to Penicillin G 57 (79.16%),
Tetracycline 62 (86.11%), Gentamycin 53 (73.61%), Clindamycin 48(66.66%), Amoxyclav
48 (66.66%), Cefoxitin 43(59.72%) and Ciprofloxacin 57 (79.16%). Moreover,
Among E. faecium isolates shows maximum susceptibility to vancomycin. Clindamycin
(100%), Amikacin (50%) and Lenizolid (76%) respectively. Rate of resistance to
Penicillin G: 38 (76%), Tetracycline 19 (38%), Gentamycin 19 (38%), Clindamycin
38(76%), Amoxy-clav 19 (38%), Cefoxitin 32 (64%) and Ciprofloxacin 38 (76%) in
table 4.
Conclusion: Multiple drug resistant strains of E. faecalis and E. faecium are
progressively related to health care associated infections. This study emphasises the
need to screen for HLGR and Vancomycin in clinical isolates, active surveillance and
the prompt reporting of resistance by the laboratories to prevent injudicious use of
antibiotics.

Introduction: Biofilm protects Enterococci from host immune response and antibiotics.
Biofilm-producing Enterococci cause recurrent, chronic, and antibiotic-resistant
infections. According to the National Institute of Health, 80% of infections are related to
biofilm-forming microbes. Apart from biofilm-forming ability, Enterococcus spp. are
known to produce various virulence factors. Biofilm formation is a major mechanism of
adaptation that protects bacteria from antibiotics, due to several characteristics.
Materials and Methods: This is a prospective, descriptive and observational study
conducted in the Department of Microbiology, Index Medical College, Hospital and
Research center Indore from January 2019 December 2021. All isolates of Enterococcus
species during the study period will be included. Enterococci isolated from clinical
specimens like pus, wound swab and aspirates etc. received in Microbiology
Department. All samples were processed by standard bacteriological procedures. Gram
staining was done for pus, wound swab and aspirates and findings were recorded.
Culture was done on 5% sheep blood agar and MacConkey agar. Inoculated plates were
incubated at 37°C for 18- 24 hours.

A 67-year-old man with neurofibromatosis type 1 presented with multiple nodular
swelling all over the body and a swelling arising from posterior aspect of right thigh
suggestive of neurofibroma arising from the sciatic nerve with malignant potential. The
chief complaint of patient was severe excruciating pain into the whole left lower limb.
The differential diagnosis of malignant peripheral nerve sheath tumor,
neurofibrosarcoma was based on clinical, radiological, and histological evidence. The
tumor apparently originated in sciatic nerve at the posterior aspect of the right thigh.
The tumor mass was excised completely without neural damage to the sciatic nerve.
Patient is relieved of pain and totally asymptomatic after 2 year follow up.

Objective: Left Ventricular diastolic dysfunction (LVDD) is an asymptomatic disease
linked to eventual heart failure. Obesity and overweight are not known to be
independently linked to LVDD. The objective is to adjudicate whether increased body
size has an independent influence on LVDD.
Study design and sample: For this study, a total of 495 subjects were selected. LV
diastolic function was estimated using both traditional and tissue-Doppler imaging.
Peak early and late trans-mitral diastolic flow velocities (E, A) and early diastolic mitral
annulus velocity (E′) were utilized to calculate E/A and E/E′. The individuals were
categorised into three groups: overweight (BMI 25.0–29.9), normal weight (BMI 25.0),
and obesity (BMI 30).
Results: BMI was independently linked with greater E, A, and E/E′, an indication of LV
filling pressure, in multivariate models (all p<0.01). Overweight and obese participants
demonstrated lower E′ (both p<0.01) and greater E/E′ (both p<0.01) than respondents
with normal weight. Obese participants had a lower E/A than normal weight
respondents (p<0.01). When contrasted with normal weight people, the perils of
diastolic dysfunction were considerably greater among overweight and obese people.
Conclusion: Irrespective of LV mass or other risk variables, having an elevated BMI
was connected to poor LV diastolic performance. Both overweight and obese patients
have higher chances of LVDD, which may explain some of the heart failure associated
risks with both conditions

Objectives: Diastolic heart failure (DHF) and Systolic heart failure (SHF) are two
clinical subtypes of the Chronic Heart Failure (CHF) syndrome that is most frequently
seen in clinical practise. SHF and DHF are the two most common clinical subgroups of
Chronic Heart Failure syndrome. To assess the frequencies of CHF and the systolic
dysfunction (SD) and diastolic dysfunction (DD) in the community. To also ascertain
whether DD helps in predicting all-cause mortality.
Study design and sample: This cross-sectional study of 242 participants who have been
selected randomly will be conducted in the state of Bhubaneshwar, India. The inclusive
criteria of the sample are that the age groups must be 45 years or older. This study took
place between June 2020 to July 2021.
Results: Validated CHF was found in 2.2 percent of the participants, with 44 percent of
participants with an EF greater than 50%. 20.8 percent of participants had mild
diastolic disfunction, 6.6 percent had moderate DD, and 0.7 percent had severe DD.
There was a 6.0 percent occurrence of any SD, with 2.0 percent having severe or
moderate SD. People with SD or DD had considerably higher rates of CHF than those
participants with normal cardiac function. Even among individuals with severe or
moderate DD or SD, however, only around half had heard of CHF. Mild DD, severe or
moderate DD, and severe or moderate SD were predictive of mortality across
multivariate analysis, adjusted for sex, EF and age.
Conclusion: SD is present among people who do not have recognised CHF. DD is
common and is not accompanied by CHF. It is associated with an elevation in mortality.

Background: Cholangiocarcinoma (CCA) is one of the most prevalent diseases in the
South Asia. Failing to determine this disease on time tends to be a great challenge in its
diagnosis. In several human malignancies, indirubin-3'-oxime (I3O) has been found to
decrease cell growth, cause cessation of cell cycle, and cell death.
Objective: The anticancer effects of I3O on human CCA cells will be demonstrated by
exhibiting induced cessation of cell cycle and apoptosis in I3O-treated cells.
Methods: The viability, apoptosis of cells and cessation of cell cycle were all measured.
Analysis using Western blotting, flow cytometry and immunofluorescence.
Results: According to the findings, in CCA cells, I3O treatment inhibits cell growth and
induces cessation of cell cycle as well as caspase-dependent death.
Conclusion: These data imply that I3O, by regulating the cell cycle and generating
apoptosis, could inhibit tumour growth and hence be a viable treatment drug for
human CCA.

Introduction: Oral cancers contribute to substantial morbidity and mortality, by being
the sixth most common cancer worldwide. The most common malignant epithelial
neoplasm in the oral cavity is oral squamous cell carcinoma (OSCC), representing over
90% of malignancies of the oral cavity. The remaining include malignant tumors of
salivary gland, lymphoreticular disorders, bone tumors, malignant melanomas,
sarcomas, malignant odontogenic tumors, and metastatic deposits.
Material and Methods: This is a prospective study conducted at Department of
Pathology, Ayaan Insitute of Medical Sciences, Kankamidi from 2019 to 2020. The
present study was WT1 and Ki-67 immunoexpression in oral squamous cell carcinoma
was conducted on 80 cases of oral squamous cell carcinoma. Biopsy specimens received
to pathology department where gross examination of the specimens was done.
Specimens were fixed in 10% neutral buffered formalin and then processed in
automated tissue processor and embedded in paraffin wax. 4-5 microns sections were
taken and stained with haematoxylin and eosin. 80 cases reported as squamous cell
carcinoma of the oral cavity were taken for immunohistochemical staining with WT1
and Ki-67.
Results: A total number of 100 cases were studied, the test group included a total of 80
cases of OSCC. 50 cases (n=50/80) were well differentiated squamous cell carcinomas
(WDSCC), 20 cases (n=20/80) were moderately differentiated squamous cell carcinomas
(MDSCC) and 10 cases (n=10/80) were poorly differentiated squamous cell carcinoma
(PDSCC). The Ki-67 LI was calculated for all the cases of OSCC obtained from various
intraoral sites and the mode of the extent of proliferation was tabulated. Among the
cases showing well differentiation, 57.14% of the cases (n=4/7) had a low extent of
proliferation,28.5% of the cases (n=2/7) had a moderate extent of proliferation and
14.28% of the cases (n=1/7) had a high extent of proliferation.
Conclusion: OSCC is one of the most common cancers in India, contributing to
substantial morbidity and mortality. The right lateral border of the tongue is the
commonest site of OSCC in the present study. The prognosis of patients with Stage 1 of
oral tongue SCC, depends on the Ki-67 LI, with a good prognosis being associated with
a Ki-67 LI less than 33%. WT1 immunotherapy can be advocated to improve the
prognosis of patients with histopathologically proven WDSCC and a Ki-67 LI more
than 33%.

Introduction: Congenital cystic lesions of the lung are uncommon but share similar
embryologic and clinical characteristics. An overall incidence of congenital cystic lesions
of the lung is 1/10,000 to 1/25,000 births (and 2.2% as compared to acquired lesions).
Presentation varies from life-threatening symptoms at birth to incidental findings at
autopsy. Diagnosis is either made in utero or due to complications of the lesion, such as
lung abscess, pneumonia, or pneumothorax.
Materials and Methods: This is a prospective study conducted in the Department of
Pathology at Ayaan Insitute of Medical Sciences, Kankamidi from January 2020 to
December 2021. The present study was done to evaluate the demographic profile,
clinical, radiological and histopathological findings of cystic lung lesions in children and
to demonstrate efficacy of Ki 67 as a prognostic marker in predicting malignancy in
these lesions. A total of 53 lobectomy specimens received and studied in the present
study.
Results: Out of these 53 cases were lobectomy specimens of cystic lung lesions. Highest
number of cystic lung lesions were observed in the left upper lobe. (23 cases) and the
lowest number of cystic lung lesions were observed in the right upper lobe (3cases).
Highest number of cystic lung lesions were Congenital lobar emphysema (52.83 %) and
least number of cystic lung lesions were Bronchogenic cyst (5.66 %). Among all cystic
lung lesions maximum cyst had size range between 0.5 to 2 cm. Immunohistochemical
staining using Ki 67 showed a high proliferative index in 5 cases of CCAM. Remaining
all 7 cases of CCAM and 2 cases each of Bronchogenic cyst, Intra lobar Sequestration
and Congenital lobar emphysema had low proliferative index.

Background & objectives: Hyperthyroidism is related to expanded food consumption,
energy use and modified body synthesis. This study was meant to assess the job of
adipocytokines in weight homeostasis in patients with hyperthyroidism.
Methods: Patients (n=27, 11men) with hyperthyroidism (20 Graves' sickness, 7 harmful
multinodular goitres) with a mean period of 31.3±4.2 years and 28 sound Body Mass
Index (BMI) matched controls were examined. They went through an evaluation of
Lean Body Mass (LBM) and total muscle to total body fat (TBF) by double energy Xray
absorptiometer (DXA) and a blood test was taken in the fasting state for estimation
of leptin, adiponectin, ghrelin, insulin, glucose and lipids. Patients were reexamined
following 3 months of treatment as at that point every one of them accomplished
euthyroid state with carbimazole treatment.
Results: The LBM was higher (P<0.001) in sound controls when contrasted with
hyperthyroid patients even after a change for body weight (BW), though the absolute
muscle to fat ratio was similar between the two groups. Serum leptin levels were higher
in patients with hyperthyroidism than controls (22.3±3.7 and 4.1±0.34 ng/ml, P<0.001),
though adiponectin levels were tantamount. Plasma acylated ghrelin was higher in
patients than in controls (209.8±13.3 versus 106.2±8.2 pg/ml, P<0.05). The
accomplishment of euthyroidism was related to huge weight gain (P<0.001) and a huge
expansion in slender weight (P<0.001). The total muscle versus fat additionally
expanded however unimportantly from 18.4±1.8 to 19.9±1.8 kg. There was critical
lessening (P<0.05) in serum leptin and acylated ghrelin yet adiponectin levels stayed
unaltered after treatment. Serum leptin is decidedly associated with TBF and this
connection persevered even after changes for BW, BMI, orientation and age (r=0.62,
P=0.001). Nonetheless, serum leptin and acylated ghrelin didn't associate with the
presence or nonattendance of hyperphagia.
Conclusion: Patients with hyperthyroidism transcendently had diminished slender
weight which expanded after the accomplishment of euthyroidism with carbimazole.
The hyperphagia and the modifications in weight homeostasis related to
hyperthyroidism were autonomous of flowing leptin and ghrelin levels.

Background: Chest drains or the tube thoracotomy or intercostal drainage tube gives a
technique for eliminating the air and fluid from the pleural space. It is a most painful
cut repressing the hacking, breathing and decreasing the pulmonary functions. The use
of TENS gives a pain-relieving impact which decreases the nociceptive pathways and
helps in working on pulmonary functions. Consequently, the review expects to see the
impact of transcutaneous electrical nerve stimulation on pulmonary functions in
patients with an intercostal drainage tube.
Material and Method: The review consists of 10 patients with Intercostal Drainage
Tube were chosen by convenient sampling at Darbhanga Medical College. The patients
were taken in the age group of 20-40 years according to inclusion criteria and
intervention protocol was given for 2 weeks.
Outcome measures: Pulmonary Function Test (FEV1 and FVC).
Results: The mean contrast for FEV1 in litre was 0.225, t esteem 3.406, p esteem 0.0078
and Pred% were 16, t esteem 18.674,p value<0.0001.The mean distinction for FVC in
litre was 0.3010,t worth 3.4549,p worth 0.0062 and Pred% was 16,t worth 14.884,p
worth <0.0001.Both (FEV1 and FVC) have shown critical improvement after the
utilization of TENS for quite some time in patients with Intercostal Drainage Tube.
Conclusion: The review concluded that the utilization of Transcutaneous Electrical
Nerve Stimulation worked on the Pulmonary Functions in Patients with Intercostal
Drainage tubes.

Background & objectives: There has been a rise in the occurrence of diabetes mellitus
in the youth population of India. There is restricted information accessible on the
immunological profile of youth beginning diabetes mellitus (DM) particularly in type 2.
Hence, this study was embraced to assess the clinical and immunological profile of
youth beginning DM in east India.
Methods: Fifty-one successive patients of 7–36-year-old enough with diabetes mellitus
going to the Darbhanga Medical College Hospital, Laheriasarai were remembered for
the review. All subjects were tried for glutamic acid decarboxylase (GAD), an islet cell
antigen ICA512/IA2, and insulin antibodies. Stray and ICA512/IA2 were finished by
ELISA and insulin autoantibodies were tried by radioimmunoassay (RIA) technique.
These patients were likewise evaluated for hepatitis A to E, cytomegalovirus (CMV) and
Epstein-Barr Virus (EBV) as trigger elements for the beginning of type 1 DM.
Results: Of the total 51 patients, 38 were male and 13 were female. The mean age and
BMI of the subjects were 19.7 (±7) years and 21 (± 5) kg/m2, separately. Twenty
patients were beneath the age of 18 years and their stature was more than 75th
percentile of Indian norms. All patients were indicative and 12 of these gave
ketoacidosis. Just 48% (n=24) were positive for GAD, 14% (n=7) for ICA512/IA-2, and
28% (n=14) were positive for insulin neutralizer. Five of these patients had proof of
hepatitis E virus infection. None of the subjects had proof of dynamic CMV or EBV
infection.

Introduction: The medical word for sluggish eye is amblyopia. Treatment for
amblyopia, the medical word for lazy eye, have been documented since before 900 A.D.
"Amblyopia is a condition in which a person's best-corrected visual acuity (BCVA) is
reduced unilaterally or (rarely) bilaterally due to a lack of form vision and/or aberrant
binocular interaction with no visible pathology of the eye or visual pathway."
Method: An evaluation of the current study was conducted on78 amblyopic patients
who visited the Kalinga Institute of Medical Sciences and Hospital in Bhubaneswar's
ophthalmology outpatient department. All patients were included for the current study
who were diagnosed to have amblyopia and informed consent, going in age from 10 to
50 years and of both genders.
Result: During my two-year study period, 8600 new cases visited the Kalinga Institute
of Medical Sciences and Hospital's Eye OPD. There was a sum of 78 amblyopia cases
diagnosed. Due to such issues, the prevalence rate is 0.9 percent. Six of the 45
anisometropic individuals had a normal field, while the other 39 suffered from
widespread depression. Three of the thirty participants had a normal field, 21 had
global depression, 6 had a misplaced blind spot, and 15 had a central scotoma; some
had several abnormalities.
Conclusion: The prevalence rate of amblyopia was 1.1 percent in population-based
regional studies in India connected to childhood blindness and the common occurrence
of refractory mistakes (V Kalikiyavi et al)14, whereas it was 4.4 percent in a study on
urban population by GV Murthy et al15. According to a Chinese study by Andrey Chia
et al16 and Jing Fu et al17, the prevalence ranged from 0.8 percent to 2.5 percent in
different subsets of individuals in the south Asian region

schedule and accurate diagnosis. The research centre danger marker for necrotizing
fasciitis score can be useful for distinguishing between instances of cellulitis, which
ought to react to clinical administration alone, and NSTI, which requires usable
debridement notwithstanding antimicrobial treatment.
Objective: To concentrate on the relationship between clinical, lab boundaries and
imaging in the diagnosis of NSTI. To break down the importance of Wong's LRINEC
rules in assessing NSTI, to distinguish the comorbidities related to NSTI and to decide
the meaning of progress in research centre boundaries after the inception of treatment.
Methods: It is a retrospective report where patients with a clinical diagnosis of
complicated delicate tissue disease were enlisted and exposed to investigations at the
hour of confirmation and assessed according to proforma. Subjects were isolated into
NSTI and SSTI groups because of clinical elements, research facility and imaging
discoveries. An Intergroup examination was done to distinguish factors related to NSTI.
Results: Clinical highlights like tachycardia, tachypnea, hypotension, unbalanced
agony, rankles, skin putrefaction, ulceration and change in shading were all together
(p150mg/L, RBS>180mg/dl, Total count>16500cells/mm3, Calcium1.4mg/dl were
fundamentally connected with NSTI (p<0.05). LRINEC rules had responsiveness of
89.1% and a particularity of 94.3 %. Both X-ray and Ultrasonography are pretty much
similarly explicit, however, ultrasonography was more delicate in diagnosing NSTI.
Genuinely critical contrast was noted between boundaries done at confirmation and the
second post usable period following resurgery.
Conclusion: Previously mentioned clinical highlights and lab boundaries can be utilized
to analyze, visualize and screen patients with NSTI. LRINEC is a decent apparatus for
separating NSTI from SSTI. Ultrasonography is more explicit in diagnosing NSTI than
X rays.

Aim: Clinical evaluation of preoperative skin preparation with aqueous povidoneiodinealone
and in combination with alcoholic chlorhexidine in patients undergoing
electivesurgery
Material and methods: This observational study was carried out in the Department
ofGeneralSurgeryRamaMedicalcollegeandhospitalHapur.120Patientsofallagegroupsund
ergoing elective surgery in the Department of General Surgery with a clean woundwere
included in this study. 120 patients divided into 2 equals groups. For Group-
1antisepticregimenusedisthreecoatsofaqueouspovidone-iodineIP5%w/v.ForGroup-2
antiseptic regimen used is a single coat of agent containing chlorhexidinegluconate2.5%
v/v in 70% propanol followed by two coats of aqueous povidone-iodine IP 5% w/v.The
pre- operative antibiotic used is Cefotaxime 1 gram I.V given following a test
dose;onehourpriorto incision.
Results:Thereare7patientsingroup-1and2patientingroup-2whohadpositiveculturewhich
is found to be statistically significant. Post-operatively patients were followed upto the
time of suture removal (usually 7-10 days) to know the percent of cases whodeveloped
wound infections. There were 7 cases in group-1 and 2 case in group-2 whodeveloped
postoperative wound infections. It is noted that out of 7 cases with growth ingroup-1,
only 4 had post-operative wound infection and the other 3 were ward
acquired.Similarly,theonlyinfectionin group-2 is hospitalacquired.
Conclusion:Thepresentstudyconfirmsthesuperiorityofpovidone-iodineincombination
with alcoholic chlorhexidine over povidone-iodine alone in pre-operativeskin
preparation and warrants recommendation of it as a preferred antiseptic in
skinpreparation forelectivecleansurgery.

Background:Cardiovascular Diseases (CVDs) like ischaemic heart disease,
cerebrovascular diseases account for 17.7 million deaths and are the leading causes.
CVDs occurs in Indians a decade earlier than the western population.Lifestyle-related
behavioural risk factors are mainly implicated for the increased burden of CHD, and
research related to these risk factors among medical students is essential, considering
their role as future healers and role models in public health intervention programs.
Objective: Study the prevalence of coronary risk factors among students of a Medical
college in Mangalore.
Methodology: A cross sectional study was done among M.B.B.S students of a Medical
College from November 2017 to March 2018. The study comprised of 500 students. A
pre-tested semi structured questionnaire was used for collection of data. Data was
collected by interview cum, clinical examination and relevant laboratory investigations.
Statistical analysis was performed using SPSS software.
Results: Out of 500 subjects 293 were females and 207 were males. 380 (76%) subjects
were consuming transfattyacid food items. 150 (30%) subjects had overweight and 40
(8%) subjects had Obesity. 80 (16%) subjects had Truncal obesity, 135 (27%) subjects
were consuming alcohol and smoking was seen in 58 (11.6%) subjects.107(21.4%)
subjects had high cholesterol. 90 (18%) subjects had lack of physical activity, 71
(14.2%) subjects had family history of CHD. 8 (1.6%) subjects had Hypertension and
10 (2%) subjects had impaired fasting blood sugar.

Background: Knowledge of the size, location and type of the atrial septal defect is very important guideline for clinicians to decide the type of intervention required .The objective of the study was to determine the same using transthoracic echocardiography.
Method: Total 42 patients diagnosed with atrial septal defect were studied using two-dimensional echocardiography. Examination was done by Siemens ultrasound echo machine using a P5-1MHz transducer.
Results: In our study we found 41 cases of   isolated Ostium secundum type of defect .Single case of Ostium Primum type were also found.
Conclusion: Atrial Septal Defect is one of the commonest congenital heart defects, which if detected early, can be corrected easily by surgical intervention. Echocardiography is an easily available, cost effective and non invasive screening method. This study further boosts its role as screening and evaluating tool in cases of Atrial Septal Defects.

Introduction:. The present study was conducted with an aim to assess the role of MRI for evaluation of adnexal masses and to find out the diagnostic accuracy of MRI in the diagnosis of adnexal masses against the gold standard test ‘histopathology’.
Materials and Methods: This is a prospective comparative study conducted in the Department of Radio Diagnosis, Index medical college hospital and research centre.50 women were taken in our study. These patients were first referred for ultrasonography with history of adnexal masses from gynaecological department. The magnetic resonance imaging was done using 1.5 Tesla MRI machine with patient in supine position.Then the lesion sample was taken and sent for histopathological examination. The results obtained on the MRI were evaluated against the histopathology results and the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MRI was calculated.
Results: Out of 50 patients, 33 (66%) adnexal masses were benign, 15 (30%) were malignant and 2 (4%) were inconclusive on ultrasonography, 35 (70%) adnexal masses were benign, 15 (30%) were malignant on magnetic resonance imaging. 37 (74%) adnexal masses were benign, 13 (26%) were malignant on histopathology. The sensitivity of MRI in the diagnosis of malignant / benign adnexal masses against the histopathology was found to be 92.31%, specificity was 91.89%, positive predictive value was 80.00%, negative predictive value was 97.14% and diagnostic accuracy was 92.00%.
Conclusion: Ultrasound is unable to differentiate adnexal masses into malignant and benign in some cases and gives inconclusive results. While MRI provides better spatial and contrast resolution in delineation of the anatomical structures as well as characterization of pathological lesions. It is highly accurate in identifying the origin of a mass, characterization and staging and helps in the treatment planning. These parameters have been found quite in agreement with the findings of histopathology

INTRODUCTION- Cholesteatoma is a localized collection of keratinous debris and stratified squamous epithelium. It is located in the middle ear cavity and is very commonly associated with bony erosions of the ossicular chain, facial nerve canal, tegmen tympani, sigmoid plate and other structures of the ear.
AIM- To assess the role of HRCT and MRI in the accurate evaluation of cholesteatoma of middle ear with its histo-pathological correlation.
OBJECTIVES-
1. To study the HRCT findings in diagnosis of cholesteatoma.
2. To determine MRI diffusion restriction in differentiating middle ear focal lesions.
3. To determine the usefulness of these newer diffusion techniques to detect smaller lesions and in postoperative recurrent or residual lesions
4. To correlate the HRCT and MRI evaluation with its HPE findings.
MATERIALS AND METHODS- Our study was carried out in the Department Of Radio-diagnosis, Index medical College Hospital and Research Centre, Indore with 50 subjects.
SEQUENCES USED- Axial, sagittal and coronal views using 128 slice CT scan.
1.5 tesla MRI scanner
RESULTS - The most common clinical features in cholesteatoma is chronic ear discharge seen in 35 (70%), recurrent CSOM in 32 (64%). The least common was facial muscle weakness.
In our study, the Sensitivity to diagnose ossicular chain disruption on HRCT was 100%, specificity was 91.67%. PPV was 97.44% and NPV was 100%.
The Sensitivity of HRCT for diagnosing cholesteatoma was 79.55%, specificity was 66.66%,  PPV 94.59% and NPV was 30.77%
Overall, Sensitivity for diagnosing cholesteatoma on MRI DWI, was 97.73%, specificity was 66.67%,PPV 95.56%. Diagnostic accuracy of DWI was 94%.
CONCLUSION- HRCT is convenient in recognizing erosions of ossicular chain and structures like facial recess, scutum, tegmen tympani etc. DWI MRI is a highly sensitive and efficient modality to precisely detect incidence of novel and recurrent/ residual cholesteatoma in pre and post operative patients respectively.

The aim: of this study is to investigate the prevalence of anosmia and its impact on quality of life among COVID-19 positive patients. 
 
Objectives:
To confirm tthe high prevalence and severity of smell disorders among laboratory-confirmed SARS-CoV-2 patients.To assess the impact of anosmia on quality of life among covid patients. To evaluate anosmia features and duration.
 
Materials and Methods
 
Study Design: Cross-sectional study. Study population: Patients diagnosed with covid-19 in Hail city constitute the population of the study. Sample collection: pre-validated self-administered questionnaire. Sample collection and processing: pre-validated and translated self-administered electronic questionnaire. The sample size was calculated by using the Rao soft sample size calculator. We will be collecting a sample size of 137, with a confidence level of 95% and a margin of error of 5%.
Rationale:
The sudden onset of smell loss has been reported as a symptom related to COVID-19, the rationale of this study is to provide an insight into the prevalence of the olfactory disorder.
 
Results:
A total of 213 covid-19 patients complained of anosmia Between the ages of 18 and 60, with a mean age of 36.2 + 11.9 years. Covid-19 patients' anosmia and quality of life in Hail, Saudi Arabia.74.4 percent of patients who were not concerned about future changes in their sense of smell had an excellent quality of life, compared to 23.7 percent of those who were. This difference was statistically significant (P=.001).

Background: Cholestasis is a known complication of gram-negative bacterial infection,
especially in infants. This syndrome is more frequent in the neonatal period and may
account for as much as a third of the cases of neonatal jaundice. Objectives: to
determine the prevalence of neonatal cholestasis in neonatal sepsis and to determine the
prevalence of Gram negative septicemia in neonatal sepsis.
Materials and Methods: This retrospective, observational study was conducted among
267 neonates attending in neonatal ward department of pediatrics at Dr. B.R.A.M.
Hospital, Raipur, Chhattisgarh.
Results: Only 47 infants out of 267 cases were having Cholestasis jaundice.
Overwhelming majority of infection in our study were caused by gram negative
organism Klebsiella pneumoniae (78.72%), E.coli (17.02%), Acinobacter (2.13%) and
S.aureus (2.1%). Association of Cholestasis with infecting organism in subjects with
neonatal sepsis was assessed using Chi square test. No significant association was found
to exist between two parameters (p=0.07).
Conclusion: It was concluded that majority of infection in our study were caused by
gram negative organism Klebsiella pneumonia, E.coli, Acinobacter and S.aureus.

COVID-19 has presented predominantly with respiratorydisease, but neurological manifestations are being increasingly recognized including stroke, encephalitis, acute disseminated encephalomyelitis, and myelitis along with symptoms of peripheral nervous system, and as muscle diseases. The proposed mechanisms of neurological involvement are direct infection by the virus or inflammation of the nervous system and vasculature, which may be para-infectious or post infectious. ^[1]
This case of a 55-year-old woman from Central India presented with acute flaccid paralysis as Guillain-Barré syndrome due to COVID 19 infection. Guillain-Barré syndrome (GBS) is an acute, frequently severe, and fulminant polyradiculoneuropathy that is autoimmune in nature. It manifests as a rapidly evolving, ascending, areflexic motor paralysis with or without sensory disturbance. ^[2]
 

Introduction: Assuring pregnant women have access to safe birth and continuum of antenatal and postnatal care during COVID assuming great importance, though it indeed is challenging. With the numerous existing challenges in implementation of birth companion policies, COVID has made it more difficult to implement birth companion policy which has drastically reduced to a zero. The Health Ministry of India has advised “birth companion” during childbirth in all the public health facilities. This step is one of the parts of low-cost intervention initiated by the government of India to meet the sustainable development goals. Methodology: The adapted birth companion policy was introduced to all pregnant women through antenatal classes. After admission to labour room, birth companion accompanied parturient throughout labour and provided supportive care. To implement birth companion policy and to test benefits of intervention, a quality improvement team was convened. A special care and extra efforts were taken to implement this policy even in COVID-19 pandemic. 
Results: first PDSA cycle of 8weeks, birth companion support use remained low, with usage in only 20% of deliveries. From weeks 9 to 16 Improvements in adaptation of birth companion policy adherence was observed, with an average of 82% of parturient delivered received support of the birth companion of their choice.  At the end of week 32, caesarean section rate decreased from 29.16 % to 26.09 %. With the birth companion of their choice and favourable birthing positions, there was decreased need of operative vaginal deliveries from 2.24% on week one to 1.8 % on week thirty-two.
Conclusion: Providing birth companion of choice is the right of every pregnant woman. The current COVID-19 Pandemic is no exception. The Pandemic must not disrupt every woman’s right to high quality, respectful maternity care. In ‘New Normal’ of COVID-19, everyone should strongly adhere to birth companion policy which will result in emotional, practical and health benefits of having birth companion of choice. 

Introduction- Urinary bladder pathology (benign or malignant) are a common cause of morbidity or mortality in general population, so knowing the types of lesions is helpful in management.
Objective- The purpose of this study to find out the histopathological spectrum of urinary bladder lesions in TURBT and cystoscopic biopsies and to study the frequency of different  types of urinary bladder lesions particularly urothelial neoplasm in tertiary care centre of Bihar .
Material & Methods - 100 TURBT specimens of patients undergoing cystoscopic biopsies of all age and both sexes have been studies.
Results- Out of 100 patients undergoing cystoscopic biopsies, 30 cases were nonneoplastic and 70 cases were neoplastic, Out of those 70 cases, 21 were low grade urothelial carcinoma and 27 were high grade urothelial carcinoma.
Conclusion- Our study revealed that neoplastic lesions are more common. Most common age group is 51 to 60 years.  High grade papillary urothelial carcinoma with muscles invasion was the commonest urothelail neoplasm at the time of presentation. Hence inclusion of detrusor muscle in the cystoscopic biopsy is of utmost importance.
 
 

BACKGROUND: -
                         Acne Vulgaris is an extremely common disorder.More than ninety percent of the patients with acne vulgaris suffer scarring leading topsychological impact and cosmetic disfigurement after healing of their acne lesions.Atrophic acne scars are more common and difficult to treat .These can be sub-classified into icepick, rolling and box car depending on their width, depth and shape. Microneedling device performs acne scar remodelling via collagen induction therapy. Autologous platelet-rich plasma therapy combined with micro needling is a new adjuvant treatment modality of the wound healing cascadebased on the body self-healing mechanisms.
                         OBJECTIVE-:
                          Assesment of safety and efficacy of autologus platelet rich plasma therapy combined with  microneedling on atrophic acne scars.
METHODS: -
46 patients with acne scars of 18-25 years age group underwentthree consecutive sittings of  microneedling combined with PRP procedure, conducted  at an interval of 4 weeks followed by a last assessment done after 3 months of final sitting.
The lesions were classified on Goodman’s qualitative scale and serial photography.
RESULTS:
Two independent dermatologists performed evaluation and follow up at subsequent visits. Majority (34) patients with good response (improvement by Grade 1) constituting to (73.91%) in total. There was an overall improvement in 86.9% of cases without any serious complications.
CONCLUSION: -
Autologus PRP combined with Microneedling is an effective modality in enhancing clinical outcomes and overall cosmetic appearence of acne scars.

BACKGROUND
Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width.
METHODS
In total, 100 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant.
RESULTS
The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 38 patients had moderate and 62 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times.
CONCLUSION
In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

Background: Diabetes mellitus is a chronic, multi-system metabolic disorder which gives
rise to ernestful ocular complications. Cataract is believed to be the second most common
of these complications, next to diabetic retinopathy, and it poses special challenges to the
surgeon both in terms of management and post-operative outcomes. Materials and
methods: This was a comparative, prospective, interventional study to assess and compare
preoperative and postoperative central macular thickness at weeks 1 and 12 after
uncomplicated cataract surgery among 50 well-controlled diabetic subjects with no
evidence of diabetic retinopathy and 50 non-diabetic subjects, using Optical Coherence
Tomography (OCT).Results: Majority patients of the diabetic group (42%) belonged to the
age-group of 51 to 60 years, while the majority in the control group (36%) belonged to the
age-group of 61 to 70 years. 54% of the patients had duration of diabetes between 5 to 10
years, while 44% of the patients had duration of diabetes less than 5 years. Significant
increase in central macular thickness (CMT) from baseline was seen postoperatively at
weeks 1 and 12 in both the groups, but while making inter-group comparison, the changes
in macular thickness were not found to be significant. Also, the incidence of post-operative
complications was observed to be higher in the diabetic group in comparison to the control
group.Conclusion: Uncomplicated cataract surgery in diabetics with well-controlled
glycaemic profile and without any evidence of diabetic retinopathy yielded similar
outcomes as non-diabetics in terms of rise in post-operative macular thickness. However,
in terms of post-operative complications, diabetic group showed a slightly higher incidence.

Background: Different adjuvants are coadministered with local anesthetics to improve the speed of onset and duration of analgesia, and to reduce the dose, the selection of which is often left to the choice of an anesthesiologist.
Aims: Aim of the study is to evaluate the efficacy &safety of 0.75% Ropivacaine in epidural anaesthesia for lower abdominal surgeries.
Materials and methods: In the present clinical study, 0.75% preservative free ropivacaine is used through epidural route for patients undergoing elective lower abdominal surgeries belonging to ASA grade I and II with in the age group of 20 to 60 years.
We observed the time of onset , highest cephalad spread, two segment regression from highest cephalad spread and total duration of sensory block as well as degree of motor blockade and it's duration, haemodynamic changes, duration of post operative analgesia and side effects , if any.
Results: With 0.75% preservative free ropivacaine, the mean onset time of sensory block for S1, L1, T10, andT6 dermatomal levels are 22.9+/-5.01 mins, 8.48+/- 3.18 mins, 13.4+/-3.88 mins and 29.5+/-3.33 mins respectively. The maximum cephalad spread is T5 dermatomal level and mean time to reach maximum cephalad spread is 29.77+/-4.94 minutes.
The mean duration of sensory blockade and motor blockade are 406.25 +/- 23.22 minutes and 263.58 +/- 21.19 minutes respectively. The motor blockade time is far less than the sensory blockade. Only 6.66% of the total patients achieved the Modified Bromage scale3.
In our present study, the mean total duration of postoperative analgesia is 246.67+/- 42.86 minutes. There are not many changes in the haemodynamics and incidence of side effects and requirement of vasoactive drugs were minimal.
Conclusions: 0.75% ropivacaine has a longer duration of sensory blockade and the duration of motor blockade is for less than the sensory blockade, their by providing post operative analgesia for nearly more than four hours. It appears to be an ideal and safe local anaesthetic for these surgeries.

Gestational diabetes is defined as “carbohydrate intolerance of variables everity with onset or first recognition during pregnancy irrespective of the treatment with diet or insulin”. The prevalence of GDM in India varies from 3.8 to 21% in different parts of the country. Clinical recognition of GDM is important because timely intervention can reduce the well-described associated maternal and fetal complications.
The study was conducted at Department of Obstetrics & Gynecology, Ayaan Institute of Medical Sciences, Kanakamamidi, Telangana conducted with sample size of 400. All the antenatal women attending outpatient department during the study period are included as per the Inclusion & Exclusion criteria.
400 women had undergone 75grams OGTT test at 24weeks of gestational age and were followed up till 7days of postpartum for maternal and fetal outcome. In initial screening, 19 women had GDM out of 400 women accounting for 4.7%. After rescreening in 183 high risk women for GDM, 2 had GDM out of accounting for 1%. Out of 400 cases, 21 had GDM. GDM incidence was 5.2% using the DIPSI method. There was significant correlation between age>26 years and GDM. Incidence of GDM among primigravidawas5% and among multigravida was 5.4%. There was no significant correlation between gravida and incidence of GDM. Number of women who had pregnancy complications likegest. HTN, polyhydramnios, preterm labour, PPH in GDM group were 6(28.5%), 3(14.2%), 3(14.2%), 3(14.2%), Where as in the non GDM women number of women having these complications were 27(7.1%), 10(2.6%), 17(4.4%), 15(3.9%). There was a significant correlation between GDM and developing pregnancy complications.
Some of the local factors contributing to this high incidence are poverty and ignorance. Peopleare usually not aware of the nutritional and caloric values of food and its implication on body weight and health.

Labour can be defined as the natural and physiological event of delivery of the child. It has been proved that the dilatation of cervix is one of the important factors determining the duration of labour. The prolonged labour will result in maternal exhaustion. In this crucial situation, certain drugs which will overcome the functional over activity of the circular muscles of cervix. The aim of the present study is to compare the effect of drugs - Drotaverine Hydrochloride and Valethamate Bromide in Shortening the duration of active phase of labour.
Among the patients in the study group, most of the subjects involved were of active fertile age group. The rate of cervical dilatation in active phase was more in group II and least in group I. Mean duration of II-stage of labour was found to be more in group-I followed by group III and II. Active phase first injection delivery interval was more in group I and least in group II. The character of amniotic fluid was mostly clear in all the three groups. Mode of delivery was normal vaginal delivery mostly in all the three groups. While observation of relation between drugs and fetal outcome, APGAR score was >7/10 in all the three groups at 1 minute and 5 minutes after delivery.  Mean duration of active phase, Mean rate of cervical dilatation & Mean active phase are significant among the three groups.
Drotaverine hydrochloride is a superior cervical dilatation agent drug which significantly reduces the duration of labour with minimal ill effects on the mother and the fetus. It is significantly better than Valethamate bromide with minimal unwanted side effects due to its selective action.

Background: Direct laryngoscopy followed by endotracheal intubation is prone to
haemodynamic fluctuations which may be detrimental in subjects with coronary artery
disease, hypertension, and cerebral vascular disease. The aim is we wanted to compare
Dexmedetomidine with Magnesium sulphate to determine the better drug with regard
to attenuation of the haemodynamic responses during laryngoscopy and endotracheal
intubation.

Background: In pregnancy, anaemia has a significant impact on the health of fetus as
well as that of mother. It is one of the leading causes responsible for maternal and
perinatal morbidity and mortality. The objectives of the study are to find out the effect
of severe anaemia on women in labour affecting maternal and fetal outcome.
Materials and Methods: This a prospective case control study undertaken in the
Department of Obstetrics and Gynaecology, Govt Maternity Hospital, Petlaburz
attached to Osmania Medical College, Hyderabad. The period of study was from 1st
December 2019 to 31st December 2021.There were a total of 160 study subjects, 80 cases
of severe anaemia (Hb<7gm %) and 80 non anaemic controls (Hb≥ 11gm %).
Results: Low socio economic status (86.25%), inadequate antenatal care (38.75%),
multiparity (71.25%) and no iron supplementation (52.5%) were associated with severe
anaemia cases. Microcytic hypochromic anaemia was more prevalent (76.25%),
suggesting nutritional inadequacies as a cause of anaemia. It was seen that the incidence
of preterm labour (22.5%), atonic PPH (2.5%), sub involution of the uterus (2.5%),
CCF (1.25%), abruptio placentae (1.25%) and maternal mortality (1.25%) was more in
cases of severe anaemia than in the control group. Adverse fetal outcome in the form of
preterm birth (22.5%), low birth weight babies (41.25%), IUGR (13.75%), birth
asphyxia (11.25%), and perinatal mortality (11.25%) was more in the anaemic group
than the controls.

An attempt was made to study the Clinicopathological features of 100 ovarian tumours
met with during the period of 2011 to 2013 in the department of obstetrics and
Gynaecology of government general hospital, Kakinada. In 2 years period out of 100
tumours, 79 were benign, 16 were malignant, 5 were borderline malignant. An
incidence of 79% benign, 16% malignant and 5% borderline malignant. The incidence
of ovarian tumours was increased for the past few years. The cause for the increased
incidence was could not be made out. The crystallization of the simple clinical
classification of ovarian tumours in comparison with others were discussed. The
detailed structure of ovary was discussed. The detailed study in relation to age, parity,
socioeconomic status, educational standard, blood group, diet, menstrual function, signs
and symptoms, histological patterns and the treatment adopted with follow up of cases
in some were discussed at length with reference to benign and malignant tumours of the
ovary. Highest incidence of benign tumours was seen in the active reproductive age
group, whereas for malignant tumours the maximum incidence was seen between 41
and 60 years. Majority of malignant tumours noticed in multiparous women with low
socioeconomic status. However, the risk of malignancy was noticed more in nulliparous
compared to benign tumours. Largest group of women were illiterate. Early menarche
and late menopause were associated with increased risk of ovarian cancer. No definite
correlation was detected in particular blood group. The gross Histopathological study of
all tumours were studied and their correlation with functional aspect of the tumour
were stressed whenever possible. The incidence of all various histopathological pattern
of both benign and malignant were thoroughly studied. In 4 patients ovarian tumours
developed from retained ovaries after hysterectomy operation. 3 patients underwent
abdominal hysterectomy previously for dysfunctional uterine blooding, among this 1
patient developed malignant ovarian tumours and 2 patient s developed benign tumour.
One patient underwent vaginal hysterectomy for prolapse uterus, benign tumour
developed from retained ovary

Background: The objectives is to Screening of all the antenatal pregnant women for
thyroid dysfunction, To study the maternal and fetal noutcome in pregnancy thyroid
dysfunction, To provide adequate treatment and there by reduce adverse outcome,
Follow up of cases six weeks post partum.
Materials and Methods: Prospective, observational study. 110 patients were included.
The study was conducted at Department of Obstetrics and Gynecology (OBG), Modern
Govt MaternityHopsital, Petlaburz attached to Osmania Medical College, Hyderabad,
Telangana, India during the period from 1st December 2019 to 30th June 2021.Mothers
attending for ante-natal check-up and having either a detected or documented thyroid
dysfunction. An Institutional Ethics Committee approval was obtained. Written
informed consent was obtained from all the study participants. The mothers during
their first visit were included for detailed history, clinical examination and blood
investigations as follows.
Results: No age related influence in the presence of thyroid dysfunction, there was no
statistical significance. it was observed that 68% of abortions were in primigravida, it
was found that with increase in gravida abortion rate was less. the mode od delivery
had no significant variations in both hypo/hyperthyroidism. it was noted that
subclinical hypothyrid and overt hypothroid cases resulted in more preterm deliveries
than hyperthyroid patients.the study showed no significance difference in newborn
thyroxine levels among thyroid dysfunction groups.
Conclusion: The study showed that thyroid dysfunction is more among the pregnant
women. Hypothyroidism is the major thyroid dysfunction among the antenatal women.
The women with thyroid dysfunction had more incidents of adverse outcomes of
pregnancy like increased abortion rates, caesarean deliveries on the mothers and
preterm babies and lbw on the newborn.

Background: The aim is to study the serum electrolyte levels in thyroid patients
attending a tertiary care hospital.
Materials and Methods: Thyroid hormones plays vital role in maintaining body's
metabolism, BMR, thermoregulation and hemodynamic status and present study was
prospective study done in the patients attending TRR Medical College & Hospital. The
study was conducted over duration of 2 years from December 2019 to June 2021. All the
patients in the age group of 18- 40 years were taken in the study. Total 100 patients
were included in the study (50 cases, 50 controls) to study the evaluation of serum
electrolytes on thyroid patients.
Results: In the present study, with respect to association of cases and controls with age,
no significant causation was seen. In this study thyroid patients have no association with
age, with not much mean difference in age of cases (32.11 years) and controls (30.02)
years. Thyroid cases were found to be more females (90%) as compared to males (10%),
but the association of sex with disease is not significant. This further concludes that
though females are commonly affected with thyroid disorders, but their association is
by chance and not significant. All serum electrolytes (Na+, K+, Cl-), TSH shows a
positive relationship it signifies that as TSH increases in patient the level of these
electrolytes also increases, but this relationship of TSH with all the electrolytes was not
significant (p>0.05).

Background: Diabetes mellitus is a clinical syndrome characterized by hyperglycemia
due to absolute or relative deficiency of insulin. Type 2 diabetes (T2D) occurs due to a
progressive decline in the ability of the pancreas to secrete enough insulin as well as
insulin resistance in insulin target tissues. The pathophysiology of T2D is characterized
by excessive accumulation of ectopic fat in the liver, pancreas, and skeletal muscles,
eventually manifesting as insulin resistance in these tissues and pancreatic beta cell
dysfunction that ultimately leads to hyperglycemia.Metabolic abnormalities such as
dyslipidemia, hyperinsulinemia, or insulin resistanceand obesity play key roles in the
induction and progression of type 2 diabetesmellitus (T2DM). Objectives: To estimate
the levels of serum myeloperoxidase, apolipoprotein B and glycated hemoglobin in type
2 diabetic patients and also in healthy controls, to observe the relationship between
serum MPO with apo B and glycated hemoglobin and also between glycated
haemoglobin with apo B in type 2 diabetic patients and healthy controls.
Materials and Methods: Case control study was done taking 30 cases of type 2 diabetes
mellitus and 30 age and sex matched healthy controls. In all the subjects, concentrations
of HbA1c, serum apo B and serum MPO were estimated. HbA1c was measured by
turbidimetric method and serum Apo B by immune turbidimetric method using semi
auto analyser CHEM 5 Plus. Serum MPO was measured by ELISA method using
ELISA reader.

Background: Vernal keratoconjunctivitis (VKC) is a chronic, bilateral allergic disease
of the external eye that leads to chronic irritation, watering, and discharge. It occurs
universally but is more common in hot and dry environments. It typically affects
children in their first two decades and although the majority of cases have a good
prognosis and This study is undertaken to stress upon the importance of clinical
manifestations, management and prevent the complications of the disease and those
secondary to its long-term medication.Aim of study:To study the clinical features
(ocular symptoms, signs and type), the age and sex distribution, the seasonal variation
of symptoms,and the effect of topical therapy on VKC patients.

Background: Sinusitis, defined as inflammation of one or more of the paranasal sinuses,
is characterized as acute when lasting less than 4 weeks, subacute when lasting 4 to 8
weeks, and chronic when lasting longer than 8 weeks. Recurrent sinusitis consists of 3
or more episodes of acute sinusitis per year. A noninfectious form of chronic sinusitis is
termed chronic hyperplastic eosinophilic sinusitis. Viral upper respiratory tract
infections frequently precede subsequent bacterial invasion of the sinuses by
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These
organisms can also be found in chronic sinusitis, as well as Staphylococcus aureus,
Pseudomonas aeruginosa, and certain anaerobes. Fungi are being recognized
increasingly as a factor in chronic sinusitis, particularly in the southeast and southwest
parts of the countryDespite the prevalence of the disease there has been relatively few
studies on the etiological factors and various management options in sinusitis suggesting
the need to take up this study. Objectives: To study the etiological factors involved in
acute and chronic sinusitis. To study the effectiveness of conservative management in
sinusitis. To study the effectiveness of surgical procedures performed in the
management of chronic sinusitis.

Background: The present aim of the study is to compare the clinical efficacy of
dexmedetomidine versus fentanyl added to intrathecal levobupivacaine for orthopedic
surgeries on the lower limb.
Materials and Methods: The current study was a prospective randomized double-blind
comparative study. This study was done in 90 ASA grade I & II patients. The patients
were aged between 18 to 60 years scheduled for elective orthopedic surgeries under
spinal anaesthesia at Government General Hospital, Kurnool District, Andhra Pradesh.
The patients were distributed into three groups (30 patients each). Namely., Group-C
[Study group LN:15mg of 0.5% of Levobupivacaine + 0.5 ml of normal saline]-Total-
3.5ml, Group-D [Study group LD:15mg of 0.5% of Levobupivacaine + 5 mcg (0.05ml=2
units from insulin syringe) of dexmedetomidine+0.45 ml of normal saline]-Total-3.5ml
and, Group-F [Study group LF: 15 mg of 0.5% of Levobupivacaine + 25 mcg of
fentanyl]- Total =3.5 ml.

Background: Aim & Objectives: To study the ABG and electrolyte disturbances in
severe malaria. To assess the prognostic significance of these parameters.
Materials and Methods: The present study is a prospective study of 50 patients above
the age of 12 yrs. The patients were selected from those who were admitted with severe
malaria in Acute Medical Care Unit, Ganndhi Hospital, Secunderabad. Patients who
came with symptoms or signs of severe malaria like coma, convulsions, hypotension,
decreased urine output, anemia, jaundice, respiratory distress are assessed. Out of them
who fit the exclusion criteria are excluded.
Results: Acidosis is commonly seen with malaria and this most often high anion gap
metabolic acidosis contributed by lactic acidosis, renal failure and other anions.
Electrolyte abnormalities are common in malaria with hyponatremia, eukalemia,
hypochloremia, hypocalcemia and hypophosphatemia being the commonest.
Conclusion: Finally, we conclude, Strong predictors of mortality include acidosis, high
anion gap, hyperlactatemia and hyperkalemia

The present study was conducted in the Department of medicine,Gandhi Hospital,
Secunderabad. 100 malarial fever cases were taken up for the study, which consisted of
79(79%) males and 21% females. Among this, 55% cases were of p.vivax and 45%
p.falciparum. The maximum number of cases fell in the age group of 15-35 years (62%).
100% cases presented with fever, chills and rigors. Other presenting symptoms were
headache (25%)and vomiting (33%). Splenomegaly was seen in 32% cases, while
hepatomegaly in 22%, 15% showed pallor and 8%cases had icterus. Complete
hematological tests were done on cases taken for study and analyzed. Anemia ranged
from 6.0 to 15.6gm/dl, leukocyte count varied from 1.8 to 17.7cu/mm. Platelet count was
done on every patient on day 1, 2, and 3.Thrombocytopenia was seen in 31% (31) cases
of p.vivax, 24% of p.falciparum patients. Association of thrombocytopenia and effect of
treatment was completely analyzed in both p.falciparum and p.vivax the effect of
antimalarial drugs on platelet count was observed. On Day 1 platelet count varied
from 15,000 to 1,94,000. On Day 2 platelet count varied from 14,000 to 1,84,000. On Day
3 platelet count varied from 26,000 to 1,98,000.

Background: Context: Almost 50% of breast cancer cases and 58% of deaths occur in
less developed countries. Early detection plays a pivotal role in the treatment of breast
cancer. Better knowledge and attitude of healthcare professionals influences the uptake
of screening methods for breast cancer in the community.Aims: -1.To estimate the
knowledge, attitude, and practices of BSE in female medical students, 2. To identify the
areas of gap in knowledge and attitude of BSE between students who perform and do
not perform BSE. Settings and Design: This is a descriptive cross-sectional study
conducted among Undergraduate female medical students.
Methods and Material: The data was collected by self-administered closed ended
questionnaire through Google forms.Statistical analysis used: Statistical analysis was
performed using SPSS software 21 version.
Results: A total of 263 students participated in the study. 79.7% (208) of them had
heard about BSE. Analysis of practice aspect of data revealed that only 28.4% (74)
performed BSE sometime or the other. Those who had more negative attitude never
performed BSE.
Conclusions: Current study showed lack of knowledge, attitude and practice of BSE
among health professionals. Health professionals who don’t have strong attitude and
habit of practicing BSE will not be serious in percolating BSE in general population.
Therefore, there is strong need of intervention in health professionals in improving their
knowledge and attitude regarding BSE and making BSE a universal practice among
health professionals.

Background: The ovaries are important organs for reproduction. The ovaries are
paired pelvic organs located on the sides of the uterus close to the lateral pelvic wall,
behind the broad ligament and anterior to the rectum. Generally ovarian tumors occur
in perimenopausal and post-menopausal women, infrequently in children also. The risk
of developing an ovarian malignancy peak in fifth decade of life. Aim and Objectives:
To Study and characterize the ovarian tumors based on gross and histopathological
features. To compare the frequency of benign and malignant neoplasms of the ovary
with other studies.
Materials and Methods: This study is a prospective study. The cases were obtained
from Department of Pathology, at a tertiary care hospital in Alappuzha over a period of
1 year. The gross specimen received were fixed in 10 % formalin for 24hours and from
every specimen multiple sections were taken from representative site for histological
examination. The number of blocks varied from four to eight in number. Sections were
processed in paraffin, which were cut at five microns thickness. Sections were stained
with conventional hematoxylin and eosin stain. The lesions were classified and studied
as per the WHO classification of ovarian tumors (2014).
Results: A total of 80 SEOT ovarian tumors were studied. Of these ovarian tumors, 42
were benign, 11 were borderline and 27 were malignant. Right sided tumors of ovary 48
(60%) were more common than the left sided tumors 25(31%). 07(09%) cases were
bilateral. The commonest epithelial tumors were serous 64 cases (75 %), 16 mucinous
(25%), remaining are not presented on my study period. Serous tumors formed the
majority of ovarian neoplasms in the study. There was a total of 64 serous tumors,
constituting about 75%.
Conclusion: The findings of this study indicate that IHC marker report of ER, PR
status and Ki-67 If included in each pathology report will pave the way for better
Understanding of Biological behavior and modify treatment strategies.

Background: To evaluate the incidence, clinical manifestation and management of
duplex moiety in children and also to study the outcome of duplex system in children.
Materials and Methods: Retrospective and prospective study of children who
underwent treatment for duplex moiety in a total of 24 cases for a period of 2 years.
Results: Of the 24 patients included in the study, n= 7 (29.1%) were in the age group of
<1year, n= 10(41.6%) were in the age group of 1-3 year. Right side was involved more
commonly. Upper moiety was more commonly involved in this study. UTI was most
common presentation in this study. Out of 24 cases in this study, 22 cases were managed
surgically and 2 cases managed conservatively. Cystoscopic puncturing of ureterocele
was done in 2 cases of ureterocele in this study (n=2, 8.3%). 2 cases of PUJO were
managed surgically by Anderson hynes dismembered pyeloplasty (n= 2, 8.3%).Out of
22 cases managed surgically from 24 cases, open surgeries were done in 17 cases(n=
17,77.27%) and 3 cases were managed by laparoscopically (n=3, 13.6) and cystoscopy
was done in 2 cases (n= 2, 9.09%). Out of 22 cases managed surgically, in 20 cases
there are no post op complications (n=20), 2 cases had complications(n= 2).
Conclusion: The anatomy and function of the duplex moiety are critical for making
management decisions. In comparison to late identification, early detection of the
duplex moiety and early management had a positive prognosis

Background: Wound dehiscence is defined as separation of all layers of incision. It may
be partial or complete. Partial when one or more layers have separated but either the
skin or the peritoneum is intact. Complete when all layers of the abdominal wall have
opened apart and this may or may not be associated with evisceration of viscus. The
study aimed to find out and record the etiological factors for Burst abdomen.
Materials and Methods: This study was prospective, randomized and comparative
study conducted on 120 patients undergoing midline laparotomy in the Department of
General Surgery, Kalinga Institute of Medical Sciences over a period of 1 year. Patients
were selected who require midline laparotomy either as emergency or elective
procedure. 120 patients who were divided into two groups 60 each by sealed envelope
method and they were randomized into Group 1 and Group 2. The patients in Group 1
underwent closure of rectus sheath with conventional continuous closure technique and
in Group 2 underwent closure with interrupted X suture technique. A total of 60
patients were included in each group.
Results: In this study, there were 44% males and 15% females in Group -1 while there
were 49% males and 12% females in Group 2. In group 1, mean age was 48.03 years
and SD ± 16.15. In group 2, mean age was 46.44 years and SD ± 15.68 In Group 1, out of
60 patients wound dehiscence occurred in 22 cases while in Group 2, out of 60 patients
wound dehiscence occurred in 9 cases. In Group 1, 17 patients were anemic, 5 patients
were diabetics, 18 patients had uremia, 44 patients had hypoalbuminemia and 49
patients had chest infection. In Group 2, 11 patients were anemic, 7 patients were
diabetics, 17 patients had uremia, 41 patients had hypo‌albuminemia and 34 patients
had chest infection.

Background: To study serum insulin levels and atherosclerotic markers in patients with
acanthosis nigricans in a rural tertiary care center.
Materials and Methods: It was a Cross sectional study. The study was conducted in the
Departments of Biochemistry and Dermatology, Venereology, Leprosy (DVL), at
Kamineni Institute of Medical Sciences, India.
Results: Total number of patients recruited for the study was 50. Mean age of the
patient was 26.8 years. Females (60%) have outnumbered males (40%). Overall
majority of the acanthosis nigricans patients were students (46%). Among females
majority of them were housewives (22%). In a majority of the patients, neck was the
initial site of darkening (82%). Most of them have duration of darkening of skin for
more than one year (64%) and 84% of the patients had an insidious onset. Forty six
percent of patients had associated medical illness such as hypothyroidism (22%),
diabetes mellitus (10%), hypertension (8%), polycystic ovarian syndrome (4%),
psoriasis (2%). Neck(98%) is the most common site of acanthosis nigricans followed by
axilla(88%); elbow(42%); periorbital region(36%); groin(34%); knees(24%);
temples(22%); infralabial region(20%); antecubital fossa(14%); perioral and perinasal
(12% each); knuckles(10%); skin over hyoid bone(8%); sides of waist and
inframammary areas(6% each) and popliteal fossa(2%). Out of 50 patients, raised
serum insulin levels seen in 54% patients, of which 42% are non-diabetics and 12% are
diabetics. Also, 96% had normal fasting blood sugars (FBS <110mg/dL), 80% had
normal postprandial blood sugars (PPBS <140mg/dL). All patients (100%) had normal
total cholesterol (< 250mg/dL), 80% patients had normal HDLc (>35mg/dL), 98% had
normal LDLc (< 130mg/dL), 80% had normal triglycerides (<160mg/dL), 86% had
normal VLDLc < 40mg/dL, out of the total 50 patients with acanthosis nigricans.
Conclusion: Hypothyroidism was present in 22% of the patients with acanthosis
nigricans whereas diabetes mellitus was present in 10% of the patients with acanthosis
nigricans. Levels of fasting serum insulin were raised in 54% of patients having burke’s
neck severity score of 2, 3, 4 and neck texture score of 2,3 and axilla severity score of 2,3
in patients with acanthosis nigricans. About 20% of studied patients had decreased
HDL cholesterol levels(<35 mg/dL and increased serum triglycerides(>160 mg/dL).

Background:Breast cancer continues to be a significant health threat, being the second
most common cancer among Indian women. The present study was conducted to assess
total PSA and free PSA levels in female patients with breast cancer.
Materials & Methods: female patients with tumours growth of breast were included.
Patients were classified into benign and malignant growth according to WHO
classification. Patients were classified into group I (breast growth) and healthy subjects
were put in group II. Parameters such as serum total prostate specific antigen (TPSA),
serum free prostate specific antigen (FPSA) was recorded.
Results: Age group 20-40 years had 30 in group I and 28 in group II and 40-60 years
had 35 in group I and 37 in group II. There were 38 benign and 27 malignant lesions of
breast. The difference was significant (P< 0.05). The mean total PSA in benign lesions
was 12.2, in malignant was 15.7 and in group II was 1.8 and free PSA was 0.15 in
benign, 0.22 in malignant and 2 in group II. The difference was significant (P< 0.05).
Conclusion: Both benign and malignant breast tumour patients exhibited high level of
free and total prostate specific antigen.

Background:NFGNB are innately resistant to many antibiotics and have been documented
to produce extended spectrum β-lactamases and metallo-β-lactamases. MDR is common
and increasing among Non-fermenters. There are few studies from India that provide
identification and antimicrobial susceptibility pattern of NFGNB. Therefore, we conducted
this study to isolate and identify NFGNB, determine the antimicrobial susceptibility profile
of isolates and estimate prevalence of multidrug resistance in NFGNB from urinary
samples.
Material and methods: A total of 8362urine samples were collected from all clinical areas
of Sri Guru Ram Das CharitableHospital. These samples were inoculated on Blood and
MacConkey agar and incubated at 37ͦC for 24 hours. NFGNB were identified by various
conventional methods of identification and also by VITEK -2 system.NFGNB were
subjected to Antimicrobial Susceptibility testing (AST) by Kirby- Bauer diffusion method
and also by VITEK-2 system.The results were interpreted as per Clinical and Laboratory
standards institute (CLSI) guidelines.
Results:Out of a total 8362 samples, 2002 (23.9%) were culture positive. Among culture
positive samples, fermenters were 1637/2002 (81.7%), non-fermenters 201/2002 (10.0%),
gram positive cocci 109/2002 (5.4%) and Candida 55/2002 (2.7%). A total of
134/201(66.6%) of NFGNB isolated were MDR (resistant to at least one of the antibiotics
in three or more than three classes of antibiotics) in our study.
Conclusion:Treatment of infections caused by these MDR non-fermenting gram- negative
bacilli is challenging due to intrinsic and acquired resistance to commonly used antibiotics.
So, early and accurate identification of pathogen and appropriate antibiotic therapy is
mandatory

Background: Most demanding and challenging conditions to manage across the globe in
subjects of all ages are chronic idiopathic pain syndromes. Various diagnostic advancements
have been made, pain in these subjects still presents a challenge for all available diagnostic
and management methods.
Objectives: The present study was conducted to assess the efficacy and role of diagnostic
laparoscopy in the identification of the etiology of chronic abdominal pain which is not
diagnosed.
Materials and methods: In 30 subjects with chronic abdominal painwith unknown etiology
or who were refractory to the treatment for more than 3 months. Diagnostic laparoscopy was
done for all the subjects. The collected data were subjected to statistical evaluation and the
results were formulated.

Background:Chronic kidney disease (CKD) is a devastating medical, social, and economic
problem for patients and their families.The present study correlated findings in pulmonary
function test with stages of chronic kidney disease.
Materials & Methods:100 confirmed cases of CKD and 40 controls were included.
Standard spirometric pulmonary function tests were performed immediately before and after
the midweek hemodialysis session.
Results: Most common age group was 31-40 years [34 (34%)] followed by 21-30years [17
(17%)] and 41-50 years [16 (16%)].Most commonly observed PFT pattern was Mild
restrictive [22 (22%)] followed by moderate restrictive [19 (19%)]. 25 patients with mild
restrictive pattern, 13 (52%)belong to stage 3, 5 (20%) belong to stage 4, 6 (24%) belong to
stage 2 and 1 (4%) belong to stage 5 CKD whereas, out of 19 patients with moderate
restrictive pattern, 9 (47.36%) belong to stage 5 and 5 (26.31%) each belong to stage 2 and 3
respectively. Out of 12 patients with moderately severe restrictive pattern 6 (50%) in each
belong to stage 4 and 5 respectively. All two severe restrictive pattern patients belong to stage
5 CKD.
Conclusion: In CKD patients there exists a significant pulmonary morbidity in restrictive
pattern. This restrictive abnormality depends on stage of CKD and worsens as the CKD stage
worsens. Most common finding was mild restrictive pattern suggesting that clinically patient
may not get debilitating symptoms due to this.

Background: Most demanding and challenging conditions to manage across the globe in
subjects of all ages are chronic idiopathic pain syndromes. Various diagnostic advancements
have been made, pain in these subjects still presents a challenge for all available diagnostic
and management methods.
Objectives: The present study was conducted to assess the efficacy and role of diagnostic
laparoscopy in the identification of the etiology of chronic abdominal pain which is not
diagnosed.
Materials and methods: In 30 subjects with chronic abdominal painwith unknown etiology
or who were refractory to the treatment for more than 3 months. Diagnostic laparoscopy was
done for all the subjects. The collected data were subjected to statistical evaluation and the
results were formulated.

Background: Surgical site infection is increasingly recognized as a measure of the quality of patient
care by surgeons, the incidence of SSI in our environment is still high when compared to the
developed world.
Objectives: This study was conducted to evaluate the incidence, risk factors and the types of Surgical
Site Infection (SSI) in postoperative abdominal surgeries.
Methods: Immediate postoperative period of the patients was followed up. Wound was examined on
day 2, then everyday till the day of discharge. Signs of SSI were looked for. If the patient developed
SSI in this period, then type of SSI was classified and swab culture was performed to identify the
microorganism and antibiotic sensitivity pattern. CDC (Centre for disease Prevention and Control)
criterion was used for diagnosis and classification of SSI. Patient was treated and discharged. All the
details were recorded in the proforma. The patients were followed up every week till 30 days.
Results: The SSI rate in our study was 14% and risk factors associated with SSI in our study are
smoking (p=0.001), preoperative stay of> 3days (p=0.000), ASA score (p=0.001), contaminated and
dirty wound (p=0.000), duration of surgery (p=0.010) and duration of drain placement (p=0.000).
Conclusion: Our study prompts us to look at the gaps in our surgical and infection control protocols
which will enable policy formulation that will foster a reduction in wound infection rate. SSI can be
reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies,
adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use
of drains and intraoperative maintenance of asepsis and following operation theatre discipline
properly.

Background: For the evaluation and assessment of both non-gynaecologic and gynaecologic
specimens, extensive use of LBC (Liquid-based cytology) has gained popularity in the recent
past. Better assessment morphologically is possible owing to the monolayer cell suspension.
Also, LBC allows assessment of nucleolar prominence, smaller cell size, fragmented cell
clusters, lost, reduced, or altered background material.
Aim: The present study was conducted to comparatively evaluate the utility and efficacy of
Liquid-Based Cytology over conventional smears for assessment of the breast lesion, and to
assess their use as an alternative to the conventional preparation.
Materials and Methods: The present prospective clinical study included 374 female subjects
of the FNAC (fine-needle aspiration cytology) obtained from subjects having palpable breast
lesions. The second pass was given, whereas, the first pass was used for either LBC or
conventional smear. Several criteria were used to compare representative LBC and
conventional smear. Individual scoring of each criterion was done followed by statistical
evaluation.
Results: The study results showed that statistically non-significant difference was seen
between LBS and conventional concerning nuclear and cytoplasmic details, presence of
monolayer,cytoarchitectural pattern, and cellularity, whereas, a statistically significant
difference was seen for background blood-debris and informative background.

Background: Conventional vitiligo treatment on the hands and feet frequently yields
disappointing results. In the face, neck, and truncal areas, various ablative therapy
approaches were tested with positive results.
Material and methods: On 44 individual patients in each group with 44 pair-lesions of
non-segmental vitiligo on both hands, a prospective randomized study was done. In
(Group A) treatment with fractional CO2 laser, NB-UVB phototherapy, and 0.05 %
clobetasol propionate cream and NB-UVB phototherapy and 0.05 % clobetasol
propionate cream was given (Group B). For ten sessions, fractional CO2 laser was used
at four week intervals. NBUVB phototherapy was given twice a week for a total of 20
sessions. Twelve weeks following the last therapy, the patients were assessed. Standard
digital pictures, patient satisfaction, and adverse events were used to assess the
outcomes.
Results: Patients' satisfaction with lesions in group A was much higher than that of
group B. Lesions on dorsal surfaces of hands responded more quickly than those on
ventral surfaces.
Conclusion: In some individuals, combining fractional CO2 laser treatment with NBUVB
phototherapy and topical steroids enhances repigmentation in vitiliginous lesions
on the hands. Patients with vitiligo who have not responded to conventional therapies
may be offered this procedure.

cholesterol (HDL-C) are usually decreased. However, enough data assessing this relationship
is scarce in different literature commenting on kidney disease progression in patients having
chronic kidney disease
Aim: The present study was conducted to assess the correlation between the progression of
chronic kidney disease and serum high-density lipoprotein cholesterol levels to provide an
alternative to urinary albumin-creatinine ratio (UACR) measurement.
Methods:The present study assessed the relationship between the progression of chronic
kidney disease and serum high-density lipoprotein cholesterol levels in 542 subjects with
diagnosed chronic kidney disease. The primary and secondary outcomes assessed were a 50%
reduction in the estimated GFR (Glomerular Filtration Rate) from the baseline values or the
onset of end-stage renal disease (ESRD). The secondary outcomes assessed were the
development of end-stage renal disease.

Context: Hysterectomy is the surgical removal of the uterus and is the most common major
gynaecological surgical procedure performed worldwide.
Aims: To study the incidence and distribution of various types of pathologies in the
hysterectomy specimens in the population studied.
Methods and Material: A total of 500 cases were studied. The study material was obtained
from patients’ hospitals that underwent hysterectomy and also specimens sent from nearby
private or government
Results: Among various significant pathologies, benign accounted for 95.7% of lesions while
malignant for 4.3% of lesions. Among benign lesions, adenomyosis was commonest with 203
(136 isolated + 67 with leiomyoma) cases and it was most common in 41-50 years age group.
Leiomyoma was next common with 183 (116 isolated + 67 with adenomyosis) cases and it
was also most common in 41-50 years age group. 67 (13.4%) cases had both leiomyoma and
adenomyosis. CIN1 or LSIL accounted for 15 cases, serous cystadenoma of ovary for 12
cases, endometrial polyp for 12 cases, mature cystic teratoma of ovary for 8 cases,
endocervical polyp for 9 cases, cervical leiomyoma for 6 cases, mucinous cystadenoma for 3
cases, placenta accreta for 3 cases, simple endometrial hyperplasia without atypia for 2 cases,
infected decidua for 2 cases, CIN2/CIN3 or HSIL for 2 cases, adult granulosa cell tumour for
2 cases, endometriosis of ovary for 2 cases, broad ligament leiomyoma for 2 cases, acute
salpingitis for 1 case, endometriosis of fallopian tube for 1 case, complete hydatidiform mole
for 1 case, invasive hydatidiform mole for 1 case and adenomatoid tumour of myometrium
for 1 case. Among malignant lesions, carcinoma of cervix was commonest with 11 cases,
followed by carcinoma of ovary with 7 cases and carcinoma of endometrium with 3 cases.

Introduction: Adolescent girls constitute a more vulnerable group, especially in the developing countries where they are traditionally married at an early age and are exposed to greater risk of reproductive morbidity and mortality. Menstruation is a phenomenon unique to all females and associated with various mental as well as physical morbidities like premenstrual syndrome. Hence the objective of present study is to assess the status of menstrual problems among adolescence girls of Warangal city.
Methods: A cross-sectional study was conducted during conducted during October 2014 to September 2015 among the all adolescent Girls of age between 10 to 19 years of age present in the study area.  A semi-structured questionnaire was used for the collection of data by personal interviews method to 261 adolescent girls in study area.
Results: It has been observed that most of the study subjects (95.8%) had some or other symptoms during menstruation. The most common symptoms during menstruation were abdominal pain (76.6%), generalized weakness (39.5%), headache (27.2%) and other symptoms (50.2%) like irritability, back pain etc.10. It was found that around 73.6% subjects had dysmenorrhoea out of which only 45.4% were taking some form of treatment. About 78.2% of the subjects have experienced pre -menstrual symptoms. The most common pre -menstrual symptom was back pain (55.2%) and absenteeism was reported in 57.5% subjects due to these problems.
Conclusion: The Present study has found high prevalence of pre-menstrual as well as menstrual problems among adolescent girls. Hence health education should be imparted covering important menstrual problems among adolescents including advice regarding source of treatment and referral. At the same time, there should be regular visits by a female medical officer for specific advice on the management of menstrual problems including dysmenorrhoea.

Axillary Artery is a continuation of subclavian artery, extending from outer border of first rib to lower border of teres major muscle where it continues as brachial artery. The axillary artery is conventionally described as giving off six branches but the number arising independently from it, is subject to considerable variations. The aim of the study is to note for variations in origin and course of third part of axillary artery and to study the branching pattern of third part of axillary artery in relation to brachial plexus.

Axillary Artery is a continuation of subclavian artery, extending from outer border of first rib to lower border of teres major muscle and it continues as brachial artery. The axillary artery usually gives off six branches, but the number arising independently from it is subject to vary. The aim of the study is to note for variations in origin and course of third part of axillary artery. In the present study, the variations were predominant on the right side and the variations noted in subscapular artery were 8%, circumflex scapular artery were 4%, thoracodorsal artery 4%. Absence of subscapular artery was noted in two specimens and so circumflex scapular artery and thoracodorsal artery originated separately from main part of third part of axillary artery in one specimen and in another specimen, thoracodorsal artery arose from circumflex scapular artery which in turn originated directly from third part of axillary artery. Subscapular artery had variation in its site of origin in two specimens. In one case, subscapular artery originated from posterior side and in the other case, at the level of circumflex humeral arteries.

Background: Chest radiography is an important method of imaging, providing an cheap, accessible and effective diagnostic tool. Aortic knuckle is an important finding in chest radiography. Aortic knuckle enlargement suggests underlying cardiovascular comorbidity including diabetes mellitus and hypertension.
Aims and objectives: To analyze the contribution of aortic knuckle to left cardiac outline in normal population and compare with the patients suffering from cardiovascular comorbidity in Postero-anterior (PA) chest radiography.
Materials and methods: Postero-anterior (PA) chest radiography of 648 individuals between the ages of 18 to 75 years were evaluated. Curved length of aortic knuckle (AKC) and total length of left cardiac outline (LCOT) were studied and contribution of aortic knuckle to left cardiac outline in normal population versus the patients suffering from cardiovascular comorbidity was analyzed. Statistical analysis was carried out with the help of IBM-SPSS (IBM Corporation) and Microsoft Excel.
Results and Conclusion: Curved length of aortic knuckle (AKC) and total length of left cardiac outline (LCOT) were analyzed to compare normal population with those with cardiovascular co-morbidity. The contribution of aortic knuckle to left cardiac outline was 18.4% in normal population and 25.5% in co-morbid patients. Thus, simple measurement of aortic knob in PA chest x-ray may help in predicting cardiovascular comorbidity.

Background: Knowledge attitude practice study helps in improving the knowledge of the public, their awareness and promote positive message which could help in combating against Corona virus disease (COVID-19) or similar pandemic in future.
Objectives: The objectives of the study were to assess knowledge, attitude and practices of residents and students towards COVID-19 pandemic in Chhindwara, Madhya Pradesh.
Material and methods: This cross-sectional survey conducted in Chhindwara, Madhya Pradesh, from February 2021 to March 2021. Data was collected using Google form as an online survey. A self-designed questionnaire with four parts general instructions, knowledge, attitude and practice was prepared comprising of 07 questions on knowledge, 08 for attitude, and 08 for practice.
Results: Out of the 164 participants, 48.78 % males, 51.21% females, 82.31% of 18-30 years and 15% ≥31 years. 71.34% were medical students and 28.65% paramedical staffs. 98.78% had correct knowledge about the spread of COVID-19, 97.53% about use of washing hands with soap and water and hand sanitizer. 97.54% avoided crowded places, 87.80% agreed vaccination can prevent spread of COVID-19 infection. 68.71% said they have not visited crowded places, 99.38% said spread of COVID-19 was social responsibility, 95.67% were wearing masks, 75.92% said vaccination will overcome the COVID-19. 92.40% avoided unnecessary travel, 94.93% wearing mask, 94.93% showed good practice, 94.87% encouraged social distancing at office, 89.74% avoided hand shaking. Significant difference found in practice score of different genders (P<0.004).
Conclusion: The present study showed that participants had higher knowledge, positive attitude and good practices regarding COVID-19.

BACKGROUND AND OBJECTIVES: The rate of Caesarean delivery has been increasing steadily over the past two decades and is the most common obstetric operative procedure worldwide. Previous caesarean section has been found to be the most common indication due to the inability to precisely confirm the integrity of the scarred lower uterine segment (LUS). The purpose of this study is to evaluate the accuracy of ultrasonography (USG) in determining the LUS thickness in previous caesarean section patient.
MATERIALS AND METHOD: The present observation study was conducted on 120 pregnant women who had previous caesarean section and were planned for an elective CS in the department of obstetrics and gynecology, ESIC MC & PGIMSR, Rajajinagar, and Bangalore from January 2019 to June 2020. LUS thickness was measured by Transabdominal scan (TAS) and then correlated to scar integrity assessed intraoperatively. The sensitivity, specificity, positive and negative predicted values of the sonographic LUS thickness was determined.
RESULTS: Ultra sonographic LUS thickness assessed correlated significantly with intraoperative LUS thickness. (r value 0.272, p<0.001) The mean thickness of LUS in women with normal scar was 4.2 + 0.7 mm and in women with abnormal LUS was 2.8 + 0.5 mm the difference being highly significant (p < 0.001). A cut off of 3.5 mm was derived from ROC with sensitivity, specificity, PPV NPV of 90.3%, 82%, 64.2% , 92.6% respectively. In our study the rate of scar dehiscence/rupture noted was 5% and only 1 woman had rupture of uterus.
CONCLUSION: LUS measurement is a useful clinical tool in the prediction of scar integrity. It should be performed routinely in all women who have had a previous caesarean section so that a large proportion of women could be considered for a trial of labour which would decrease the cost of health care and maternal morbidity rate.

Surgical site infection(SSI) is the third most common nosocomial infection which are usually encountered in surgical indoor of hospitals.[1]It shows adverse impact on both hospital as well as patients. The Aims and objectives of this study was to find out the common bacteria causing SSI and its sensitivity to commonly used antibiotics, its incidence and common risk factors of SSI in our hospital. For this purpose 100 patients were selected undergoing routine and emergency surgery.T he swabs from infected site were taken and sent for culture and sensitivity. The duration and type of surgery performed were also taken into consideration. From this study we concluded that E. Coli (30.5%)was the commonest pathogen followed by staph aureus (24.67%) and pseudomonas aeruginosa (20%) . These organisms were found to be sensitive to commonly used antibiotics .It was also found that prolonged surgery ( > 2hrs) and undergoing stoma procedure were significantly associated with occurance of SSI[3] . Routine and clean surgery was associated with minimal risk of SSI .
 

Misuse and overuse of antibiotics results in widespread multi-drug resistance. The major cause of increased mortality and morbidity rates is Multi-drug resistance to antibiotics and it becomes a global heath challenges now a days, therefore it becomes a necessity and need for researchers to seek for alternative and natural sources of antimicrobials. In the present study an experimental trial (In-vitro and In-vivo) was undertaken to examine the antibacterial activity of extracts of Swertia chirata leaf against multi drug resistant (MDR) E.coli and S.aureus. Broth dilution test for MIC and Disc diffusion method for antimicrobial susceptibility test were applied to investigate Antibacterial activity of plant methanolic extracts. Twenty five albino mice weighted between 180-200g were used for bacterial inhibitory activity (In- Vivo). Plant extract showed broad spectrum of antibacterial activity against S.aureus in comparison to E.coli and showed MIC values of 20µg/ml. Swertia chirata plant extract contains lesser inhibition zone against E. coli (8.7±0.80) and showed highest zone of inhibition against S.aureus (16.2±0.60). It can be concluded that Swertia chirata plant extract was significantly better (P<0.05) against S.aureus than E. coli. The number of bacteria in treated groups was very low, These findings have cleared demonstrated that the clearance of bacteria from the blood of infected mice by sub-MIC of plant extract was significant. the findings of present study provide a suitable evidences for the use of a drug composed of plant extract as a new generation of drugs to attack the antibiotic resistance of bacteria.

Background: Healthcare workers are highly prone to contract serious blood-borne infections as common occupational hazard. These infections are most commonly acquired through needlestick (percutaneous) injuries (NSI), nurses being most commonly affected staff category.
Objectives: To assess knowledge, attitude and practices amongst nursing staff regarding needlestick injuries.
Methods: In this cross-sectional study, 164 nurses posted in different areas of a premier tertiary care hospital were subjected to a semi-structured, self-administered questionnaire capturing data regarding awareness, perceptions and practices vis-à-vis NSI amongst participants.
Results: 42.1% nurses encountered NSI during their career, 24.6% suffering more than twice. Most common site of injury was finger (85.3%). 80% and 65% were aware of procedures to be followed post-exposure and diseases spread by NSIs respectively. 84.05% of those who suffered did also enquire about patient’s disease history. 58.18% did not report injury. Amongst those not having reported, 20.4% were unaware of procedure, 6.1% felt landing into administrative troubles upon reporting, 6.1% didn’t feel important to report and 14.3% did not report considering it a minor prick. Only 88.4% nurses took Post-Exposure Prophylaxis (PEP). Only 13.1% completed the recommended PEP course. 50.6% and 34.1% admitted not wearing gloves always and practising recapping respectively. 34.6%, 23.1%, 17.9% and 9.0% incidences were observed during administration of injections, discarding needles, recapping and clean-up respectively.
Conclusion: A high incidence of NSIs with high rate of non-reporting, non-compliance to universal precautions and indifferent attitude towards PEP despite adequate knowledge substantially indicates need of a continuous educational-cum-training programme to be in place.

Background: Obesity is one such pre-existing maternal morbidity that puts a pregnancy at risk. Maternal obesity is a frequent high-risk factor with substantial prenatal, intranasally, and postnatal problems. This study aimed to analyze maternal and fetal outcome in obese pregnant women (BMI more than 30) at our tertiary care teaching hospital.
Material and Methods: This study was prospective & observational study, conducted in pregnant women, gestational age > 28 weeks, with BMI > 30, delivering at our labour room. Maternal and neonatal outcomes were analysed.
Results: Among 453 pregnant women with BMI > 30kg/m², majority were from 19—25 years age group (45.1 %), 48.03% were primigravida, 82.33% had > 37 weeks of gestation. In the study group 78.43% were moderately obese, 15.69% were severely obese and only 5.88% were morbidly obese. Most common pre pregnancy medical disorder in obese women were preeclampsia (21.57 %), previous LSCS (20.59 %), severe anaemia (19.54 %), gestational diabetes mellitus (12.75 %), gestational hypertension (9.80 %) & multiple pregnancy (1.96 %). Common intrapartum events were Preterm labor (16.67 %), PPH (6.78 %), Abruptio placenta (4.90 %), Mal presentation Breech (4.90%) & Eclampsia(1.96%).63.71%of obese pregnant women delivered by normal vaginal delivery, 31.37% of obese pregnant women underwent cesaerian section & 4.90% of obese women were requiring instrumental delivery. Common indication for NICU admission were infant of diabetic mother (22.55 %), preterm (14.71 %), meconium aspiration (5.88 %), macrosomia (3.92 %), asphyxia (1.96 %) & transient tachypnia of new born (1.96%). No maternal or neonatal mortality observed in present study.
Conclusion: In obese pregnant women with BMI >30kg/m², higher incidence of gestational hypertension, preeclampsia, gestational diabetes mellitus, anaemia, malpresentation, cephalopelvic disproportions and hypothyroidism isnoted,

Background: Smartphones have been the most popular electronic devices, especially among the young population. Smartphones are used for multi-purposes including communication, music, media, internet access, games, some applications, and professional fields. Using the smartphone frequently forces the users to adopt an awkward posture leading to an increased risk of musculoskeletal disorders and pain.
Purpose: To determine the effect of smartphone use on Craniovertebral angle (CVA) and the level of upper limb function.
Materials and Methods: Sixty adolescents of both sexes were enrolled in this study, their ages ranged from 14 to 18 years. They were assigned into two groups of equal numbers; Group (A) using smartphone less than 4 hours/day and group (B) usingsmartphone more than 4 hours per/day. The kinovea software program was used to detect the craniovertebral angle and theQuick-DASH questionnaire was used to measure the level of function of upper extremity.
Result: The study findings, revealed a statistically significant differences in all measured variables of groups A and B (p < .05). High significant difference was observed in group B when comparing the findings of groups, A and B (p < .05).
Conclusion: the overuse of smartphones has a negative effect on craniovertebral angle, and level of the upper extremities function.

Aim &Objective: To study Incidence of different types of heart disease in pregnancy and Maternal and Foetal Outcome of Heart Disease in Pregnancy in A Tertiary Care Centre.
Material & Methods: Prospective observation study was conducted in the Depatment of Obstetrics and Gynecologya tertiary care hospital in Aurangabad district of Maharashtra state from October 2019 to September 2021. All patients who fulfilled the inclusion and exclusion criteria during the study period were included in the study analysis.
Observations & Results: In present study, the incidence of heart diseasewas 0.53%, maximum cases 38.6% were from age-group of ≥25-29 years. 51.3% cases were reported from rural area and 41.9% belonged to upper lower class. 93.6% were booked. 51.3% of cases were having Class II of NYHA classification. The most common heart disease was rheumatic 101(53.4%) followed by congenital heart disease i.e 84(44.4%).Among congenital cardiac lesion the most common was ASD 36(42.9%). InRheumatic cardiac lesion the most common was Mitral stenosis 65(64.3%). Maternal mortality was reported in 05(2.6%) cases, causes of mortality were due to CCF in 3(1.6%) and pulmonary Embolism Sec to RHD and Left Ventricular Failure in CHD in Severe Pre-enclampsia. 01(0.5%)
Conclusion: This study concluded that pre-pregnancy diagnosis, counselling, appropriate referral, routine antenatal supervision and delivery at an equipped centre improve the pregnancy with heart disease outcome for both mother and baby. The study also observed the improved maternal and fetal outcomes in women who had undergone corrective cardiac surgeries before the pregnancy.

Background: Various adjuvants have been used with local anaesthetics in spinal
anaesthesia to prolong postoperative analgesia. Dexmedetomidine, the new highly
selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this
study was to evaluate the onset and duration of sensory and motor block, hemodynamic
effect, postoperative analgesia, and adverse effects of dexmedetomidine, or fentanyl
when given intrathecally with hyperbaric 0.5% bupivacaine.
Materials and Methods: Ninety patients classified in American Society of
Anaesthesiologists classes I and II scheduled for lower abdominal surgeries requiring
spinal anaesthesia were studied. Patients were randomly allocated to receive either 12.5
mg hyperbaric bupivacaine plus 10 μg dexmedetomidine (group D, n=30) or 12.5 mg
hyperbaric bupivacaine plus 25 μg fentanyl (group F, n=30) intrathecal. The control
group received 12.5 mg hyperbaric bupivacaine intrathecally (n=30).
Results: Patients in the dexmedetomidine group (D) had a significantly longer sensory
and motor block time than patients in the fentanyl group (F) and control group (B).
VAS score at rescue analgesia was significantly higher in the control group. Duration of
analgesia was significantly more in the dexmedetomidine, and fentanyl group as
compared to control. The total duration of analgesia was longer with dexmedetomidine
than fentanyl. Sedation scores were significantly higher in the Dexmedetomidine group.
No hemodynamic changes were noted in any group.
Conclusion: Intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric
bupivacaine prolong sensory and motor block with minimal hemodynamic instability
and reduced demand for rescue analgesia. Intrathecal dexmedetomidine has a longer
duration of analgesia than fentanyl.

Background: Cholestasis is a known complication of gram-negative bacterial infection,
especially in infants. This syndrome is more frequent in the neonatal period and may
account for as much as a third of the cases of neonatal jaundice. Objectives: to
determine the prevalence of neonatal cholestasis in neonatal sepsis and to determine the
prevalence of Gram negative septicemia in neonatal sepsis.
Materials and Methods: This retrospective, observational study was conducted among
267 neonates attending in neonatal ward department of pediatrics at Dr. B.R.A.M.
Hospital, Raipur, Chhattisgarh.
Results: Only 47 infants out of 267 cases were having Cholestasis jaundice.
Overwhelming majority of infection in our study were caused by gram negative
organism Klebsiella pneumoniae (78.72%), E.coli (17.02%), Acinobacter (2.13%) and
S.aureus (2.1%). Association of Cholestasis with infecting organism in subjects with
neonatal sepsis was assessed using Chi square test. No significant association was found
to exist between two parameters (p=0.07).
Conclusion: It was concluded that majority of infection in our study were caused by
gram negative organism Klebsiella pneumonia, E.coli, Acinobacter and S.aureus.

Stature is a minor criterion for establishing identity. As per Quetelet’s law there is one
in four chances of two persons having exactly same height. This study of
anthropometric assessment of stature from the five digits of both hands in male and
female was carried out among 100 second year medical students (55 Females and 45
males) in Government Medical College, Suryapet, Telangana to determine the stature.
Prior consent from the participating students had been taken. The digit length of both
hands was measured from proximal crease of digit to the tip using a vernier caliper. The
individual height was measured by height measuring scale. The estimated height by
multiplying the total digital length with five (05) in both right and left hands were found
to be similar with the measured height. Pearson correlation analysis had suggested
highly positive statistically significant correlation between estimated height and
measured height in all participants, males and females. So, this can be concluded that
the equation may be helpful to obtain approximate stature in situations where mutilated
remains are to be examined and all digits are available. This equation could be useful in
forensic anthropology or any anthropological research.

Background: Abnormal thyroid function tests are frequently observed in patients of
chronic kidney disease. Kidneys plays a significant role in thyroid hormone metabolism
by conversion of T4 to T3 (the active metabolite). Low plasma free T3 in ESRD is a
marker of the inflammation and endothelial activation; and is known to predict all
cause mortality. The present study was done look for the biochemical abnormalities of
thyroid function tests in chronic kidney disease and to correlate the severity of CKD
and alterations of thyroid indices.
Materials and Methods: In a cross sectional study, thyroid function test [TT3, TT4,
FT4, TSH] were estimated by CLIA in 50 patients of chronic kidney disease who were
in various stages. Symptoms of hypothyroidism, thyroid hormone abnormalities and
CKD stage were analyzed using Chi square test and ANOVA tests.
Results: Among the mean age was 48.8 ± 12.2 years of which 33 were male and 17
females. The mean value of TT3 in CKD stage 3, 4, 5 were 1.01±0.39; 1.05± 0.6;
0.95±1.09 μg/mL respectively. (p= 0.02 Significant). The mean value of TT4 in CKD
stage 3, 4, 5 were 6.3± 2.4; 5.5± 1.5; 5.11 ± 1.01 μIU/ml respectively. (p=0.71 Not
significant).
Conclusion: Total T3 and total T4 were found to be progressively decreased as stage of
CKD increased. There was no significant correlation between TT4 and CKD stage.
There was a significant correlation between the prevalence of thyroid dysfunction and
the stage of chronic kidney disease.Higher the degree of renal insufficiency, the higher
was the prevalence of thyroid hormone abnormalities, the levels of thyroid profile i.e
T3, T4 decreases and TSH increases as severity of renal failure increases. Thyroid
hormone abnormalities could represent a risk factor for cardiovascular disease and
might also be implicated in kidney disease progression.

Background: Aim- The aim of this study isto evaluate the etiological profile of new
onset focal seizures in adults.
Materials and Methods: It was a Prospective Observation Cross sectional study. The
ethical committee approval was obtained to carry out the study in the hospital.The
study was carried out during the year from September 2017 to November 2019 for a
period of 26 months. All Adults out- patients and in- patients in the age group of 18 –
70yrs with focal seizures admitted in hospital are evaluated during the period of Study.
Total 50 were included in the study. Detailed history was taken and seizures categorized
according to the classification based on new 2017 International League Against Epilepsy
(ILAE) classification of seizures.
Results: In our study Focal Seizures with impaired awareness are the most common
focal Seizure Type. The age group, most commonly affected is 18 to 30 years.
Granulomatous lesions and Cerebrovascular accidents are the most common cause of
Focal Seizure in younger age group in older age group patients, vascular Pathology is
the most common cause of Focal Seizures. Among Central Nervous System
infections/granulomatous lesions of brain, Nerocysticercosis and tuberculomas are most
common. Incidence in male is more than in female. T.B. Meningitis and Cerebral
Malaria can also present as focal Seizures. CECT & MRI Brain is helpful, when the CT
was inconclusive. There is no significant difference in incidence of Neurocysticercosis
between Vegetarians and Non – Vegetarians. All patients with cerebrovascular
accidents, with focal seizures responded well with AEDs, anti-cerebral edema
measures,& anti platelet drugs in ischemic strokes All patients of Ring enhancing
lesions responded well to treatment with Anti-Epileptic Drugs.
Conclusion: It is mandatory to deal carefully with each case of adult onset seizure with
a tailor-made approach. Identification and awareness about the etiological factors and
seizure type help in better management of these patients. Primary care physicians play
a pivotal role in identifying patients with adult onset seizures and should encourage
these patients to undergo neuroimaging so as to arrive at an appropriate etiological
diagnosis. In the face of recent advances in neuroimaging techniques, the future
prospective management of adult onset seizures appears bright and convincing

ABSTRACT
Background: Age determination in both living and dead plays animportant role in
medicolegal cases. There are various methods to assess the age by physical
characteristics, odonatological development but the most valuable method seems to be
the osteological changes observed by radiological examination ie., the appearance and
fusion of secondary ossification centerslike medial epicondyle, lateral epicondyle,
capitulum & trochlea. The present study was conducted on 131 subjects out of which
110 were males and 21 were females. The main aim of the study was to find the age of
fusion of secondary ossification centersof medial epicondyle, lateral epicondyle,
capitulum & trochlea and to compare the distribution of fusion of ossification centers
between males and females.
Materials and Methods: Firstly, informed consent was taken. Preliminary details of
each individual were noted that included general examination, physical examination,
dental examination followed by taking X-ray AP view of elbow for radiological
examination. The results were noted based on the degree of fusion as No Union (O),
Beginning union(B), Recent union(R), Complete union(C).
Results: The present study showed among males, the fusion for each ossification centers
ofmedial epicondyle, lateral epicondyle, capitulum & trochlea started by 15-16 years
and was completed by 18-19 years whereas in females it started fusion by 15-16 years
but complete fusion occurred around 16-17 years itself.
Conclusion: Based on the analysis of fusion of ossification centers it shows that the
ossification centers of medial epicondyle, lateral epicondyle, capitulum & trochlea fuses
earlier in females by 1-2 years than in males.

Background: Ovary is the commonest site of physiological and pathological lesions
which can present in any age group and are common gynaecological problems
encountered by gynaecologists in their daily practice. Aim of the study: To study
Clinical, Radiological and Histopathological examination of ovarian lesions ina teaching
hospital .
Materials and Methods: Prospective observational study was done in the Departmentof
Obstetrics and Gynaecology, ShadanInstitute of Medical Sciences, Teaching hospital
and Research Centrefor duration of 01 year ie, from January 2021 to December 2021 on
100 ovarian specimens.
Results: Non neoplastic ovarian lesions constituted 84% and follicular cyst constituted
51.1%,next common was Corpus luteal cyst comprised 19%. Among 16 neoplastic cases
Surface epithelial tumours occupied 75%. Germ cell tumors constituted 18.7% and sex
cord stromal tumors constituted 6.2%.
Conclusion: Weanalyzed 100 ovarian lesions with respect to their clinical and
histopathological profile. Abdominal discomfort was the most common clinical
presentation. Benign tumours were more common than malignant ones across all age
groups. On histopathological examination, tumours originating from the surface
epithelium were the most common variant.

Background: Magnesium is a critical ion that is essential for life. It is intimately
involved in over 300 enzymatic reactions. It also has important endocrine functions and
is required for protein synthesis. Studies have shown that magnesium levels are lower in
patients with diabetes compared with non-diabetic controls. Hence this work was
undertaken to evaluate the relationship between serum magnesium and diabetes
mellitus without and with microvascular complications. Aim: To compare the serum
magnesium levels in type 2 diabetes mellitus patients with and without micro vascular
complications. Objectives: To estimate serum magnesium levels in type 2 Diabetes
mellitus, to correlate serum magnesium level in type 2 diabetics with and without micro
vascular complications.
Materials and Methods: Serum magnesium levels of 60 patients having type 2 diabetes
with microvascular complications (cases) compared to 60 patients with type 2 diabetes
without microvascular complications (control).
Results: Mean duration of diabetes (yrs) was significantly high in cases (3.58) than
controls (10.15) (p<0.001). FBS and PPBS did not show significant difference between
controls and cases. HbA1c (%) was significantly higher among cases (9.93±2.50) than
controls (8.98±2.26). Serum magnesium levels were significantly lower among cases
(1.46±0.32) than controls (1.92±0.25). Hypomagnesaemia did not significantly differ
between various sub groups of micro vascular complications.
Conclusion: Serum magnesium levels were significantly lower in diabetic patients with
microvascular complications than in diabetic patients without microvascular
complications. Hypomagnesemia was more common in diabetics with poor glycemic
control.

Background: The aim of this study is to compare conventional cholecystectomy and
laparoscopic cholecystectomy.
Materials and Methods: The study subjects consisted of 40 patients with a diagnosis of
calculous cholecystitis that underwent cholecystectomy at Bhaskar Medical College and
General Hospital, yenkapally from January 2018 to June 2019. The patients will be
evaluated for detailed clinical history according to a definite proforma. All the patients
will be examined and routine blood investigations with LFT wherever necessary will be
done. Abdominal USG will be performed in all the cases.
Results: The commonest presenting complaint in both the groups was pain in the right
upper quadrant followed by vomiting, fever and dyspepsia. Majority of the patients in
both the groups had multiple stones. (15 patients in LC group and 14 patients in OC
group) The duration of LC was significantly more than for OC (median 105 min v/s
75min respectively). The intra operative blood loss and the complications were more for
the open procedure. Two patients of laparoscopic group required conversion to open
procedure. The drains were required in less number of patients of LC group and for
less number of days. Wound infection was seen in 1 of LC patient and 5 of OC patients.
One patient of OC group developed incisional hernia. The antibiotic requirement was
less in LC group (median 5days) compared to OC group (median 7days). The Visual
Analogue Scale for pain in the post op period was significantly less for LC patients
compared to OC patients (median Grade1 v/s Grade3 respectively). The duration of
pain in the LC group was significantly less (median of 2 days) compared to OC group
(median of 4 days). The analgesic requirement was significantly less in LC patients
(median for3days) compared to OC patients (median for 5 days). The LC patients
tolerated oral feeds earlier compared to OC patients (6- 8hours compared to 12-36
hours respectively). The duration of hospital stay was significantly longer for OC group
than for LC group (median 7 days versus 4 days respectively). The time to return to
normal work was delayed for OC group (median 8 days) compared to LC group
(median 5 days). The cosmetic end result was unacceptable in majority of OC patients
(14 of 20). While majority of LC patients were satisfied with the operative scar (16 of
20).
Conclusion: The laparoscopic procedure was costly compared to open procedure. But
this difference was overcome by the other costs incurred in post-operative period of
open procedure.

Background: Hypocalcaemia is a common complication following thyroid surgery,
cause of which is multifactorial. The aim of this study was to identify risk factors for
development of post-operative hypocalcaemia in cases of total thyroidectomy, near total
thyroidectomy, and completion thyroidectomy with or without neck dissection.
Materials and Methods: From 1st November 2020 to 31st October 2021, 40 consecutive
patients undergoing total thyroidectomy, near-total, sub-total or completion
thyroidectomy at Govt Medical College & Hospital, Suryapet were enrolled in this
prospective study, longitudinal, cohort study. The primary endpoints were the
occurrence of post-operative hypocalcaemia as by defined as a nadir corrected serum
calcium less than 8.0 mg/dL or symptomatic hypocalcaemia.
Results: 40 patients were analyzed. The average age was 42.53±15.86 years with 86.7%
female. The most common indications for surgery were benign thyroid disease (80%).
27 patients (67.5%) experienced postoperative hypocalcaemia with 14 (35 %) requiring
intravenous calcium infusion. Risk factors for postoperative hypocalcaemia included
inadvertent parathyroid removal during surgery further exemplified by the fact that
there is lesser incidence of post-operative hypocalcaemia in patients undergoing near
total thyroidectomy.
Conclusion: Patients undergoing total thyroidectomy and in whom parathyroid could
not be identified and preserved or auto transplanted may benefit from more vigilant
pre-operative preparation and postoperative calcium and vitamin D supplementation.

Background: Although appendicectomy is the most commonly done emergency surgery
still its diagnosis remains an enigmatic challenge, with persisting high rate of negative
explorations. Objective: The objective of the study was to evaluate the role of accuracy
of CRP measurement in the diagnosis of acute appendicitis and to reduce the morbidity
by avoiding negative exploration.
Materials and Methods: The present study was conducted in 30 patients who have been
clinically diagnosed by Surgeon’s as having acute appendicitis and posted for
emergency appendicectomy in General Surgery Department, Glocal Medical College &
Super Speciality Hospital. Preoperatively blood was sent for CRP estimation, after
operation, all specimens were sent for histopathological examination, results of CRP
were correlated with HPE reports to evaluate their role in diagnosis of acute
appendicitis.
Results: In present study, 24 patients had elevated serum CRP level (>2.5 mg/dl) which
is 83.3% of total study group. In these patients only one patient had high serum CRP
level inspite of normal appendix that was proved histologically. The cause of raised
serum level of CRP in this patient was mesenteric lymphadenitis which was found
peroperatively.Hence it was proved that CRP level can be used to rule out negative
appendicitis, so that surgery can be deferred in them and to reduce rate of negative
appendicectomies.
Conclusion: We continue to stress that history and clinical examination by a skilled
surgeon still remain indispensible in diagnosing acute appendicitis, and its importance
cannot be under mined. But CRP helps to reduce negative appendicectomy rate
drastically and hence should always be included in diagnostic work up of acute
appendicitis.

Background: Varicose veins are the most common chronic vascular disorders requiring
surgical treatment at one stage or other. Though considerable advances in
understanding of venous patho physiology and modern imaging techniques have
revolutionized the concept of management of varicosity of lower limb, the treatment of
primary varicose veins still remain unsatisfactory. Objectives of the Study: To study the
clinical signs & symptoms of the patients admitted for varicose veins. To study the
prevalence of varicose veins in the patients admitted to Govt Medical College &
Hospital, Suryapet, To study the age & sex distribution, To study the complications of
varicose veins, To evaluate & manage the varicose veins & its complications, To study
the outcome of surgery.
Materials and Methods: A prospective follow up study was undertaken for 40 patients
who were admitted for various symptoms of varicose vein during August 2012 to
August 2014. They were subjected to detailed history taking and examination with
relevant investigations including Doppler venous study and were subjected to
treatment. They were followed up to assess long-term morbidity and late complications.
Results: Total 40 patients admitted for varicose veins admitted during the period from
Aug 2020 to Aug 2021 were studied. Out of 40 patients studied, 24 (60%) patients were
agriculturists, who admitted of having been exposed to prolonged hours of standing
.Among the 40 cases studied, 57 limbs showed varicose veins, of which 32limbs had long
saphenous vein and communicating system involvement (64%). 20 limbs had long
saphenous vein involvement (40%) alone. Among 32 limbs with long saphenous
and communicating system involvement, 45 had pain (90%), 12 had edema (24%), 29
had disfigurement (58%), 14 ulcers (28%). Of the 46 limbs that underwent surgery 26
(52%) underwent saphenofemoral flush ligation with stripping of LSV and subfascial
ligation of perforators & 10 (20%) underwent saphenofemoral flush ligation alone.
Conclusion: Definite relationship exists between occupation involving prolonged
standing and primary varicose veins. The involvement of long saphenous and
communicating system together is commonest followed by long saphenous involvement
alone. Patients with involvement of long saphenous and communicating system or long
saphenous and short saphenous system were more symptomatic than others
Complications of varicose veins were responded well to operative treatment. Results of
surgical treatment are good.

Background: Acute intestinal obstruction (AIO) is a common surgical emergency,
requiring urgent diagnosis and prompt treatment. The cause of bowel obstruction has
changed dramatically during the past century. Varying etiologic pattern has been noted
in developing nations as compared to the industrialized nations.
Materials and Methods: This was a prospective study comprising of all the 68 patients
admitted between August 2020 and August 2021 in the Department of General Surgery,
Govt Medical Collge & Hospital, Suryapet with a clinical diagnosis of AIO and
operated. The aim was to study the etiological pattern and other characteristics of AIO
and to look for any variation in the pattern in this region.
Results: Cases operated for AIO constituted 6.84% of all emergency surgeries. The
most common cause of AIO was complicated hernia (n=23, 33.82%) followed by
adhesions (n=14, 20.59%) and abdominal tuberculosis (n=10, 14.71%). The mean age of
presentation was 46.55 years ± 15.76 years and male to female ratio was 2:1. The most
common symptom was pain abdomen (n=63, 92.65%) while the most common sign was
tachycardia (n=66, 97.06%). The most common preceding surgery leading to AIO due
to adhesions was open appendicectomy and the most common complication was surgical
site infection (n=15, 19.12 %). There were 4 mortalities (5.88%).
Conclusion: Obstructed hernia, though the leading etiology for AIO in this study, has
lower incidence compared to similar studies, mostly due to improving socio-economic
status of people and better accessibility to health care in this region. Adhesions, has a
considerably high incidence, probably due to increased number of timely surgeries for
diseases that previously went untreated, such as surgeries for various intra-abdominal
malignancies. Tuberculosis is the third most common cause of AIO in this study and is
mainly attributed to increasing incidence of HIV and its coexistence with tuberculosis.

Background: Infection in orthopedic surgeries is a serious complication mostly resulting in
removal of infected implant. But recently, with use of antibiotic loaded
polymethylmethacrylate, attempts have been made to prevent and cure orthopedic implant
infections in primary and revision surgeries. In this study, the role of antibiotic impregnated
bone cement in management of infection in infected implant (nailing or plating used for
internal fixation of fractures) with implant retained in situ is studied and compared with other
modalities of treatment where antibiotic bone cement was not used. This study aims to assess
the role of antibiotic impregnated bone cement to control infection in postoperative patients
with implant in situ (Nailing and Plating).

Background: facial injury has led to furtherance in techniques of internal fixation,
improvements in plating system. Trauma to the facial bones and exposure of the site
and internal fixation with micro and mini plates. Evaluating 10 patients with fractures
of maxilla and mandible and open reduction and internal fixation with and comparison
of micro and mini plates with load bearing capacity, stability at the fracture site and
postoperative complications. Objectives: Comparison of micro and mini plates in
maxillofacial trauma cases.
Materials and Methods: Sample consists 10 subjects, 5 each in two groups clinically and
radiographically diagnosed with Group 1 (maxillary fractures) and Group 2
(mandibular fractures) which were subdivided into 5 each treated with miniplate and
microplate respectively. All cases have been evaluated clinically for various parameters
for minimum of 1 months 2 month and 3 months of assessment of any postoperative
complications. Post operative evaluation for pain and fracture site stability and post of
infections, mouth opening, wound healing was observed.
Results: Study resulted as microplates are more and enough stability and have good
adequate capacity of adaptation when compared with mini plates because of flexibity of
plate and less size of the microplates feels less hard than mini plates when used in
maxilla.
Conclusion: Microplates have good adequate adaptation and rigid enough to provide
adequate stability of the fracture segment when compared with mini plates, many
number of fractures evaluation in maxilla and mandible finally concluded microplates
are good at maxilla fixation and mandible.

Background: The objective was the comparison effectiveness and evaluate the
postoperative complications of locking and conventional mini plates in mandibular
trauma.
Materials and Methods: The study group in this investigation consisted of 10 treated
patients who presented to the Department of Oral and Maxillofacial Surgery, St.Joseph
Dental College, Eluru for Open reduction and rigid internal fixation of mandible. The
mean age was 20-30 years, the case of injury and type of injury, since how many days of
injury were evaluated.
Results: Total of 20 patients have met the inclusion criteria in our study there are
changes in pain, swelling, paresthesia , infection of the site of fixation. In locking plates
there is subside of pain and swelling after 3rd week, we found difference between 1st
week, 3rd week and 6th week but pain was present till 6th week in conversional
miniplates Pre-operative swelling was present only in case of non-locking group.
Swelling was present in 60% of non-locking group and 0% in locking group. After one
week swelling was absent in 100% patients at 1rd, 3rd and 6th week. Swelling was
considerably decreased in locking group as compared to the non-locking group.
Conclusion: Our findings in our study conclude that locking plates have enough
stability, good adaptive capacity and withstand the masticatory forces in mandible and
clinical results almost similar to those seen with non-locking plate osteosynthesis.

Background: Standard assessment of renal function in pregnancy is by measurement of
serum creatinine concentration yet normal gestational ranges have not been established.
The aim of this systematic review was to define the difference in serum creatinine in a
healthy pregnancy compared with concentrations in non-pregnant women to facilitate
identification of abnormal kidney function in pregnancy.
Materials and Methods: The study was performed on 70 pregnant women. Out of which
35 women were pregnancy induced hypertensive and 35 were normal pregnant women.
Results: The result showed significantly high blood pressure (SBP-197.21±21.7 VS
187.28±8.69, DBP 124.36±9.41 VS 99.2±6.28) and Blood urea (42.31 ±7.81 mg% VS
41.30±9.29 mg%), serum creatinine (3.45 ±1.19 mg% VS 3.18±1.38 mg%), serum uric
acid level (9.89±3.16 mg% VS 7.34±0.9 mg%) in pregnancy induced hypertensive
women compares to normal pregnant women. In the present study, in pre-eclampsia,
there is elevation of serum uric acid and serum creatinine elevated values are
statistically significant.
Conclusion: There is a renal derangement of parameters in preeclampsia so it may be
advised to renal function test to confirm involvement of renal dysfunctions.
Measurement of renal function Test could be used as a biochemical indicator in
pregnancy induced hypertensive women.

Background: Thyroid disorders are the most common endocrine abnormality in the
world secondary to diabetes mellitus. Thyroid hormones are essential for growth,
neuronal development, reproduction and regulation of energy metabolism. It influences
the metabolism of all substrates including minerals. Many studies have shown that
mineral metabolism is frequently disturbed in thyroid disorders.
Materials and Methods: The study was conducted on sixty newly confirmed
hypothyroid cases based on the thyroid profile and sixty euthyroid cases were recruited
as controls. Blood samples were collected from all the patients for the estimation of
serum T3, T4, FT3, FT4, TSH, calcium, phosphorus and magnesium by auto analyzer
method. Modified spectrophotometric micro-method was used to measure Serum
copper using Bathocuprine Disulphonate Disodium Salt (BCDS) and Guanidine
hydrochloride salt. The Statistical software namely SPSS 18.0, and R environment
ver.3.2.2 were used for the analysis of the data.
Results: It was found that the levels of serum sodium, potassium and calcium were
significantly decreased in cases than the controls. Serum magnesium and phosphorus
were significantly elevated in cases than controls.
Conclusion: Serum calcium, magnesium and phosphorous levels are significantly
altered in patients having hypothyroidism. Thyroid diseases have wide spread systemic
manifestations including their effects on bone and mineral metabolism. Also thyroid
hormone affects the glomerular filtration rate, renal blood flow, tubular reabsorption
and excretion of minerals which have direct effect on Calcium, Magnesium and
phosphorous level. Thus monitoring of these minerals in hypothyroid patient will be of
great benefit in improving clinical manifestation and can be treated appropriately.

Background: The present study aimed to evaluate the levels of serum iron, total iron
binding capacity (TIBC), transferrin saturation and serum ferritin in diagnosed cases of
chronic kidney disease due to any aetiology not undergoing dialysis. Study also aimed to
determine the correlation between serum creatinine and serum iron levels in chronic
kidney disease in this group of patients.
Materials and Methods: The present study was conducted in the city of Dibrugarh and
which also included patients belonging to adjoining districts of Upper Assam from 20th
October 2018 to 19th October 2019 for a period of 1 year. A clinico-hematological study
was undertaken to evaluate the levels of serum iron, total iron binding capacity (TIBC),
transferrin saturation and serum ferritin in diagnosed cases of chronic kidney disease
(not on dialysis) due to any aetiology. Study included 110 old and newly diagnosed cases
of CKD attending the out–patient department not on dialysis. A cut-off off Hemoglobin
<13 g/dl in men and <12 g/dl in women was used to make the diagnosis of anemia.
Results: Prevalence of anemia among CKD cases was observed as 74.6% with Hb level
<6 gm% was observed in 6.4% cases. Normocytic normochromic picture was observed
in 53.6% cases. Decreased level of serum iron, ferritin, TIBC and transferrin saturation
was seen in 99.1%, 16.4%, 52.75 and 78.2% cases respectively. Mean levels of
haemoglobin, RBC and iron indices (except for TIBC levels) decreased significantly
with increase in the CKD stage. A significant positive correlation was observed between
eGFR levels with haemoglobin and iron indices (except TIBC) while an inverse
correlation was observed with creatinine levels.
Conclusion: Anemia among Pre dialysis-CKD cases is mostly normocytic and moderate
in severity. Functional iron deficiency was the predominant form of iron deficiency in
these patients. Both hemoglobin and other iron indices worsens with progressive loss of
kidney functions.

Background: This study compared the analgesic efficacy of the bilateral erector spinae plane
(ESP) with that of the bilateral transversus abdominis (TAP) postoperative delivery with
selected surgery.
Methods: Sixty mothers scheduled for caesarean section under random surgery were
randomly assigned to receive an ESP block or a TAP block. The ESP group received USG
guided block with 20 mL 0.2% of ropivacaine at the T9 level corresponding to T10 transverse
process e at the end of surgery. The TAP group received an ultrasound-guided TAP block
containing 20 mL of 0.2% ropivacaine at the end of delivery. The main effect was the
duration of analgesia achieved by each block. Measures of the second outcome were
postoperative pain severity, complete diclofenac use, patient satisfaction.
Results: The median duration (interquartile) block was longer in the ESP group than in the
TAP group (12 hours [10-14] vs 8 hours [8-10], p <0.0001). In the first 24 hours, the median
rate of analog pain observed at rest was lower in the ESP group. Intermediate diclofenac use
in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg
[100-150] vs 100 mg [75-100, p = 0.003]).
Conclusion: Compared with the TAP block, ESP block provides effective pain relief, has a
long lasting analgesic action, increases duration of first analgesic need, is associated with
minimal diclofenac use, and can be used in multimodal analgesia and opioid -sparing
medication after surgery.

Introduction: Dural arteriovenous fistula (DAVF) is an abnormal connection of vessels
in the tissues around the brain or spinal cord. Exact etiology of DAVF is not
known.They can cause multiple symptoms as per location and presents with
Haemorrhages. Diagnosis - Includes CT and MR,dynamic CTA, MRA or
DSA.Treatment ranges from conservative treatment to endovascular therapy, surgery,
and Radiation therapy.
Aim and Objectives: Tostudy aetiology,clinicaland radiologicalfeaturesandmanagement
ofDural Arterio-venousfistulae.
Methods: Total 33 patients of DAVF studied which divided in three groups as ncsDAVF
(18), csDAVF (8) and spinal DAVF (7) and were investigated and treated as per
radiological finding.
Results: Mean age of presentation of ncsDAVF is 44 years, csDAVF is 37 years and
spinal DAVF is 56 years. Male preponderance present in both. In intracranial DAVF, in
spinal DAVF, thoraco-lumbar region is the most common site. On angiographic follow
up of 11 Onyx treated patients, 10 patients were achieved complete cure (90.9%) in a
single session(9.09%).
Conclusion:In csDAVF, endovascular treatment has good results,In spinal DAVFalso
endovascular embolisation using Glue+ lipoidal solution. complete occlusion is seen.

Background: Intravenous regional anaesthaesia(IVRA), also known as Biers Block is a
technique of producing surgical anaesthesia by intravenous injection of a local
anesthetic into a limb whose circulation has been interrupted by a
tourniquet.Ropivacaine is a safer alternative among available local anaesthetics with
analgesic duration 4-8 hrs. Dexamethasone is a long-acting synthetic corticosteroid and
is beneficial anti-inflammatory agent for the management of acute surgical pain.This
study was done with the aim to comparethe effectiveness as well the onset and duration
of sensory block, motor block and analgesia between ropivacaine alone and ropivacainedexamethasone
in regional anaesthesia.
Methods: 50 adult patients of ASA grade I & II in the age group of 20-50 years were
randomized into two groups of 25 patients, scheduled for ambulatory hand surgery
andwere administered intravenous( IV)Ropivacaine (0.2%) 40 ml and IV
Ropivacaine(0.2%)40ml plus 8mg Dexamethasone after inflating the proximal cuff of
tourniquet and assessment was done with pin prick and visual analogue scale
(VAS)score.
Results:This study showed, the duration as well as the recovery of sensory block was
prolonged on adding dexamethasone. In group receiving dexamethasone as an adjuvant
to ropivacaine the duration of analgesia was prolongedas well as the total analgesic
consumption was reduced. Conclusion: IVRA is a safer technique and addition of
dexamethasone to ropivacaine increases the analgesic efficacy as well the duration of
sensory block which decreases pain scores and attributes to early recovery as well as
short hospital stay.

Introduction: Laparoscopic cholecystectomy (LC) has been proved to be the benchmark
treatment for symptomatic cholelithiasis. The overall morbidity and mortality rate is 5–
10% and 0.1% respectively, and an open conversion rate of 5–10% is commonly
reported in the literature. Over a century, classical cholecystectomy (Open method) has
been the method of choice in the surgical management of gall bladder diseases. One of
the risk factors for cholelithiasis is obesity, the incidence of which is increasing
worldwide due to the change in lifestyle habitat. Therefore, surgeons are likely to
encounter increasing number of obese patients who require a cholecystectomy for
symptomatic cholelithiasis. Conventionally obesity has been considered as a relative
contraindication to LC, as the technical difficulties associated with this procedure in
these patients were thought to be associated with higher morbidity and mortality as well
as increased open conversion rates. The aim of this study was to investigate the safety
[peri-operative morbidity and mortality and the incidence of bile duct injuries (BDI)]
and efficacy (duration of surgery, LOS and open conversion rates) of an elective LC in
the morbid/ super obese patients (BMI > 40) compared to patients with a BMI < 26 and
a BMI 26–40.

Objectives:Plantar fasciitis is a painful condition but can be self-limiting condition.
Among the different treatment which exit, physiotherapy and corticosteroid injection
are effective and popular. In this study, the author evaluated the efficacy of standard
care versus ultrasonography guided single dose of methylprednisolone acetate injection
for planar fasciopathy.
Design:This randomized clinical trial conducted in Physical Medicine & Rehabilitation
department of S M S medical college.
Method:Patients were allocated to standard care physiotherapy group (n=35) and
ultrasonography guided steroid injection group (n=35) equally. Pain and functional
ability on a visual analog scale (VAS), plantar fascia thickness and Foot Ankle
Disability Index (FADI) were evaluated at baseline and at 6 weeks after treatment.
Results:The mean age was not different between both groups (40.60±10.64 years versus
41.43±9.66 years, p=0.734). There was a reduction in VAS from baseline to weeks 6
(after treatment) (65.315±7.182 vs 32.57±4.235, respectively) (P<0.001). PF thickness at
6 weeks significantly reduced to 3.895±0.18 compared to baseline (P<0.001).FADI had a
considerable improved at week 6 (76.675±2.131) compared to baseline (62.915±1.823)
(P<0.001).
Conclusion:Both interventions caused improvement in pain and functional ability 2
months after treatment. Although inter difference were not significant.

Background: Bone marrow examination is an important tool in diagnosing and
controlling hematological disorders. Bone marrow aspiration and trephine biopsy are
compatible. Thus; compiled the current study to evaluate and compare the effectiveness
of bone marrow aspiration, imprint and biopsy in patients with acute leukemia.
Materials& Methods: The present study was conducted in 50 clinically suspected
patients of leukemia who attended inpatient and outpatient department of medicine,
department of general pathology at SMS Medical College and Hospital, Jaipur,
Rajasthan, India over a period of one year. All Patients with leukemia who underwent
both bone marrow aspiration and bone marrow trephine biopsy examination were
included in the present study. We analyzed all the results by SPSS software. One way
ANOVA was used for assessment of level of significance. P- value of less than 0.05 was
taken as significant.
Results: The age of the patients ranged from 6 months to 70 years with male to female
ratio of 1.5:1. In three cases, dry tap was observed, which was further diagnosed with
BMI and BMBx. Diluted marrow was observed in two cases which was further
diagnosed with BMI and BMBx. Findings of BMI and BMBx were in concordance with
each other in 100 percent of the cases.
Conclusion: Bone marrow aspiration, imprint and biopsy are complementary to each
other with aspiration smears being primarily used for cytological diagnosis and biopsy
sections mainly useful to identify histological features like architectural pattern and
fibrosis.

Aim: To study the impact of mild traumatic brain injury (MTBI) on patients with
regards to the course of quality of life outcomes.
Materials and Methods: 100 patients aged 18-65 who fulfilled WHO criteria for mild
traumatic brain injury (non-surgically managed) were evaluated at 1, 3 and 6 months
post injury data was collected with the help of following questionnaire- The World
Health Organization Quality of Life (WHOQOL)-BREF for evaluation of quality of life.
Percentage, Friedman Test, Repeated measures ANOVA tests were used. Statistical
analysis was carried out using Statistical Package for the Social Sciences (SPSS) version
17.0 (IBM SPSS, US) software. Data are reported as means and standard deviations
unless not indicated otherwise. For the study of paired observations Wilcoxon` signedranks-
test was used.
Results: 100 patients who were followed up till six months post trauma. The average age
of the study population in our study was 38.5 years. Males were at a higher risk. The
male to female ratio was 1: 0.26. Road traffic accidents were the major cause of MTBI.
Alcohol consumption has been found to be a major risk factor for the occurrence of
TBI. None of the two-wheeler riders or pillion riders were wearing helmets at the time
of road traffic accident. In our study the data on QOL was assessed by World Health
Organization Quality of Life BREF (WHOQOL-BREF-Tamil). Our study revealed that
there was statistically significant progressive improvement in all the four domains of
quality of life at 1, 3- and 6-months post trauma. The quality of life in social relationship
and environmental areas reached a score of normal healthy population by 3 months.
The psychological domain became normal between 3 to 6 months post trauma. The
physical health of the study patients continued to improve beyond 6 months post
trauma.
Conclusions: Our study revealed that there was statistically significant progressive
improvement in all the four domains of quality of life at 1, 3- and 6-months post trauma

Introduction: Cerebral venous thrombosis is mostly an uncommon but severe
thrombotic manifestation which has a high mortality rate, has the potential to end in
disability and the greater tendency of recurrence. There are some coagulation
abnormalities such as gain-of-function mutations in the genes that encodes factor V
(factor V Leiden) and prothrombin3 are presented with an increased risk of cerebral
vein thrombosis4-6 whereas there are no data currently reported on the role of
hyperhomocysteinemia as a risk factor for cerebral venous thrombosis. High plasma
levels of total homocysteine (tHcy) result from the connection between genetic and
acquired determinants. Cerebral venous thrombosis is one of the commonest causes of
stroke as far as Indian population is concerned. CVST usually predisposes in the state
of pregnancy and puerperium. The pathological hallmark that is reported in CVST is
haemorrhagic infarction. CVST predominantly occur in the young individuals and can
present with a broad spectrum of clinical manifestations which include headache,
altered sensorium, seizures, focal neurological deficits, papilloedema and cranial nerve
palsies. Headache is the most frequent and often the first reported clinical
manifestation. Homocysteine (Hcy) is a sulfhydryl amino acid compound that is
generated from protein breakdown and the essential amino acid methionine as it is
metabolized to cysteine. Hcy can be broken down in two pathways. When there is in
excess methionine, Hcy is directed to transulphuration pathway where it is irreversibly
conjugated to cysteine. Hcy can also be remethylated in a methionine conserving
pathway and this pathway requires folic acid and MTHFR.

Introduction: In the body, nutrients normally work together in a coordinated fashion.
The availability of certain nutrients influences the uptake of another nutrient in the
intestine. Magnesium and vitamin D are two critical nutrients that are required for
diverse organ physiologic activities.
Objectives: The present study was conducted to analyze the relationship between serum
magnesium and vitamin D and to compare the levels of serum magnesium in vitamin D
deficient patients and vit D sufficient patients.
Methods: Present study was a prospective, observational, cohort, single centric,
hospital-based study conducted over the duration of one year. Total 100 patients were
recruited in the study and relationship between Serum magnesium and vitamin D was
assessed. According to the levels of vitamin D the patients were sub-grouped into three
categories: Normal: Vitamin D >= 30ng/ml (10 patients), Insufficient: Vitamin D >= 20
and <=30 ng/ml (12 patients), and Deficient: Vitamin D <= 20ng/ml (78 patients).
Results: Vitamin D in normal group was 54.68 ± 8.965, in insufficient group was 25.79 ±
2.842 and in deficient group was 7.704 ± 3.909. The difference between three group was
significant. Magnesium in normal group was 1.572 ± 0.1098, in insufficient group was
1.603 ± 0.1014 and in deficient group was 1.625 ± 0.1092. The difference between three
group was not significant. Correlation analysis of Vitamin D and magnesium revealed a
negative correlation in normal group (r= -0.3561), and a positive correlation in
insufficient group (r=0.1277) and deficient group (r=0.01423).
Conclusion: Based on serum magnesium levels, the research can assess the need for
mediational cost and unfavourable side effects associated with multitherapy with
vitamin D and magnesium, as per current clinical practise.

Background: Cervical cancer is the second most common cancer among women
globally. There are different methods for control and prevention of cervical cancer
which include conventional cytology (Pap smear), liquid-based cytology, human
papillomavirus (HPV) screening, and vaccination against HPV. The aim of this study to
evaluate the pap smear and acetic acid test as cervical cancer screening tools with
histopathological correlation.
Material & Methods: The present study was carried out in department of pathology at
SMS Medical College, Jaipur, Rajasthan, India for one year period. A total of 150
patients attending the gynecology OPD were enrolled in the study. All the patients in the
study were subjected to colposcopy. The cervix was inspected with the naked eye than
with a colposcope. After taking the Pap smear with Ayre’s spatula and cytobrush and
was evaluated by the Bethesda system and then cervix was washed with normal saline
and visualized, followed by application of 3% acetic acid and visualization by
colposcope. Collected data was statistically analyzed to determine specificity and
sensitivity, PPV, NPV of Pap smear, VIA.
Results: Our study shows that majority of cases were seen in 40-50 years of age
group.Sensitivity of VIA was found to be 90% (versus Pap smear, which had 40%) and
specificity of VIA was 87.85% (versus Pap smear, which had specificity of 96.42%).
Conclusion: PAP smear screening needs good infrastructure, trained manpower to
make & interpret the slides which is not feasible considering the facilities available in
the periphery. However, VIA can be done even by sisters in the remotest place with
minimum facilities & patient is diagnosed.

Background: Acute malnutrition is a public health problem of epidemic proportions.
Feeding approaches for infants who are under 6 months of age with severe acute
malnutrition should prioritize establishing, or re-establishing, effective exclusive
breastfeeding by the mother or other caregiver. The aim of this study is to identify the
various risk factors and determinants of severe acute malnutrition as defined by WHO
growth reference standards in infants aged below 6 months of age at district hospital in
Rajasthan.
Materials& Methods: A prospective observational study was conducted in the
Department of Pediatrics, District hospital, Dholpur, Rajasthan, India during one year
period. 30 comprised infants with SAM as defined by current WHO guidelines:
weight‐ for‐ length Z‐ score (WLZ) <−3 and/or bilateral nutritional oedema (WHO,
2013); the other comprised age‐ and sex‐ matched infants who were not severely
malnourished (control group) defined as WLZ≥−2to<2and mid‐ upper‐ arm
circumference (MUAC)≥125 mm.
Results:Mean age of Cases and Controls was 16.03±1.18 and 20.38±1.23 weeks
respectively. Mean length of infants was 60.3±3.12 cm in cases and 67.7±2.78 cm in
control group, which was statistically significant (P<0.05*). The statistically significant
of MUAC (mm) in between groups, which was shorter arm circumferences in
malnourished infants. The duration of exclusive breast feeds was less (8.9±1.86 weeks)
as compared to control group (20.8±4.36 weeks), which was statistically significant
(P<0.05*).Mothers of the SAM infants were significantly lighter, shorter, and had lower
MUAC than control mothers.
Conclusion: The study findings will help to increase the knowledge about the factors
associated with severe acute malnutrition. There is a statistical correlation of Severe
Acute Malnutrition with rural area, maternal Illiteracy and low socioeconomic status,
and failure of exclusive breast feeding for 6 months.

Background: Birth weight should preferably be measured within the first hour of life
for live births, before significant postnatal weight loss has occurred. The socio-economic
factors associated with LBW are income, level of education in the mother and other
family members, occupation of the mother, household leadership and gender differences
related to roles within the family. The aim of this study to assess the socioeconomic and
maternal reproductive factors related to Low Birth Weight (LBW) of babies delivered
in district hospital in Rajasthan.
Material & Methods: A prospective observational study was conducted in the
Department of Pediatrics, District hospital, Dholpur, Rajasthan, India during one year
period. Consent was taken from every mother before interview and the weight of the
newborn was taken within the 24 hours of delivery and each questionnaire was
completed. Record review format was used for reviewing antenatal care cards. Data was
compiled in Statistical Package for Social Sciences (SPSS) software version 22.0 and
analyzed.
Results:A total of 800 birth occurred during the study period, of which 280 met the
inclusion criteria. Out of which 80 were LBW and 200 were normal birth weight
(NBW). Hence, the prevalence of LBW in this present study was found to be 28.57 %.
The univariate analysis of maternal factors associated with LBW. The factors associated
with LBW included age, education, family members, gravida, antenatal care smoking
and alcohol. The following variables were found insignificant: religion, residence,
occupation, family type, abortion, and gestational age at 1stANC visit.
Conclusion: We concluded that a number of factors play a role in determining a baby's
birth weight. Social factors (mother's age, level of education and economic status) and
maternal care are very important.

Introduction:The most commonly practiced method of orienting the occlusal plane is to
make it parallel to the ala-tragus or Camper’s plane. This study was, therefore,
undertaken to evaluate the validity of Tragus used in marking “ala-tragus line” while
establishing the occlusal plane by measuring the angle between landmarks and their
parallelism with occlusal plane.
Aims & Objective:The objective of the study is to evaluate the reliability of the most
commonly used extra oral landmark i.e. Ala-tragus line in determination of occlusal
plane in edentulous patients by comparing it with dentulous subjects.
Materials& Methods:Lateral cephalograms of Dentulous subjects were taken & were
subjected to Cephalometric analysis after tracing. Angles between Ala-tragus line &
occlusal plane was measured & subjected statistical analysis.
Conclusion:It was found that Ala-tragus line is not parallel to occlusal plane in natural
dentition as an angle exists between the two. However, it can assist in locating the
occlusal plane in edentulous patients.

Background:Inguinal hernias present with a lump in the groin that goes away with minimal pressure
or when the patient is lying down. The present study was conducted to compare minimally invasive
surgery versus open surgery for abdominal and groin hernias.
Materials & Methods:90 patients of abdominal and groin hernia of both genders were divided into 2
groups of 45 each. Group I underwent open surgery and group II laparoscopic surgery. Patients were
followed up at 1 week, 1 month, 3 months, 6 months intervals.
Results: Group I had 30 males and 15 females and group II had 26 males and 19 females. Type of
hernia was epigastric hernia seen in 5 in group I and 4 in group II, incisional hernia 7 in group I and 6
in group II, umbilical 20 in group I and 23 in group II and paraumbilical 13 in group I and 12 in group
II.
Conclusion: Laparoscopic group showed better treatment outcome as compared to open group.

Background: Acute scrotum is defined as acute pain with or without scrotal swelling,
may be accompanied by local signs or general symptoms. The present study was
conducted to assess usefulness of high resolution ultrasonography and color doppler in
diagnosis and differentiating of scrotal diseases.
Materials & Methods: 87 patients of scrotal diseases was included. A thorough
examination was performed and symptoms and clinical diagnosis was made. All the
patients underwent scrotal ultrasonography using 7.0- 12.0 MHZ high frequency linear
array transducer coupled with colour doppler in Esaote My Lab 40 and Phillips affinti
70G equipment. The ultrasound findings were recorded.
Results: Age group 20-30 years had 47, 31-40 years had 25 and 41-50 years had 15
patients. The difference was significant (P< 0.05). Common diagnosis was hydrocele in
25, epididymal cyst in 20, pyocele in 11, funiculitis in 4, epididymitis in 5, testicular
abscess in 8, varicocele in 8 and testicular tumour in 6 cases. The difference was
significant (P< 0.05). Left side was involved in 32, right side in 28 and both sides in 27
cases. The difference was significant (P< 0.05).
Conclusion: High frequency ultrasonography with color doppler is an efficient
diagnostic imaging modality in the evaluation of scrotal diseases.

Introduction: Malaria remains today one of the major health hazards in the tropics having
increased morbidity and mortality. It is one of the most common hematological parasites in
tropical and subtropical countries particularly in the continents of Africa and Asia. More than
40% of the world population reside in malaria-endemic area and it is accountable than 300-
500 million cases and 1.5-2.7 million deaths will occur in each approaching year.Among
these manifestations, thrombocytopenia is the most common complication presented in both
the species of malaria, viz-P. falciparum and P.vivax. The clinical diagnosis of malaria is
always challenging as signs and symptoms overlap with other febrile illnesses. The gold
standard technique for diagnosis is smear positivity. Among the hematological abnormality
thrombocytopenia is the most common but its correlation with the type of malaria and its
prognostic implications have not been evaluated in many of the studies.

Introduction: Cerebral venous thrombosis is a relatively uncommon disorder which has
an estimated annual incidence between two to seven cases per million in the general
population. 1 The incidence was likely underestimated before the advent of prompt noninvasive
imaging methods. It is estimated that five to eight cases per year might be seen
at a referral centre. Cerebral venous thrombosis or occlusion by extrinsic compression
that eventually progresses to a complete occlusion is an elusive diagnosis because of its
non-specific presentation and its numerous predisposing causes which can precipitate
the condition. It often affects young and middle-aged patients which more commonly
involved in women. It is an uncommon cause of cerebral infarction relative to arterial
disease which is an important consideration because of its potential morbidity. The
imaging characteristics of CVT that can be observed through MRI include: (1) brain
parenchymal imaging that appears in the form of non-specific lesions, such as
intracerebral hemorrhages or infarcts, edema, isolated or associated with infarcts or
hemorrhages, and it can even be considered normal in about 30% of patients.9 MRV
features include non-visualization of the arterial & venous vessels (i.e., no flow), flow
defect and presence of collaterals at the site of occlusion.

Background: The present study was conducted to assessthe effect of digital eye strain due to
online mode of teaching in school children during COVID Pandemic.
Materials & methods:A cross sectional study was conducted among school children during
the period 2020-2022to assessthe refractive errors during COVID Pandemic. A total of 4393
(1442,1532, 1419) schoolchildren were enrolled and examined for refractive errors during the
year 2020,2021,2022 respectively.Prevalence of various refractive errors was assessed based
on refractive error study in children (RESC) survey group.
Results:There were 2324(52.9%) male and 2069(47.0%) female students. Ocular
examination depicted enhancement of refractive errors in all the age groups. However among
the children in the age group of 9 to 12 years, refractive errors were detected among
612/1507(43.1%) children.
Conclusion: There has been an increase in use of digital devices after the initiation of the
COVID-19 lockdown, and has resulted in deterioration of ocular health of school going
children

Indwelling intravascular and urinary catheters are essential components of modern medical care. Unfortunately, indwelling devices significantly increase the risk of iatrogenic infection, particularly in an already fragile patient population. Most nosocomial infections in severely ill patients are associated with the very medical devices that provide life-sustaining care.¹ Indwelling urinary catheterization is the most common risk factor for complicated UTI; such catheter-associated UTI (CAUTI) accounts for 40.0% of all nosocomial infections worldwide and often leads to secondary bloodstream infections.² Though recognition of this risk has led to reductions in insertion or duration of use of indwelling urinary catheters, a sizable number of hospitalized patients still undergo urinary catheterization during their stay. In the United States, the 30 million Foley catheters used annually confer substantial risk for CAUTI. ³

Background: One of the most common reasons to visit OPD in subjects of age less than 5
years is fever. Very little attention is given to UTIs (urinary tract infections) as the cause of
fever compared to other infections getting more attention. Without evaluating UTIs
adequately, antibiotics are commonly given to children empirically. To minimize lifelong
morbidity and provide prompt treatment, identification of UTI in children with fever is vital.
Aims:The present study was conducted to assess the UTI prevalence in subjects of age under
5 years and to assess the validity of urine culture and urine analysis for diagnosing urinary
tract infection.

Introduction: Salivary gland tumours contribute for about 3 - 10% of all neoplasms of the
head and neck; from this, benign tumours are commoner than their malignant counterpart.
The most common benign neoplasm of salivary glands is pleomorphic adenoma which
constitute about 60 – 70% incidence in the general population. The overall incidence of
salivary gland tumours is roughly remains unchanged throughout the world and there is no
significant predilection for either sex. In the early 1940s, intracapsular enucleation was
performed as the management for pleomorphic adenoma. Leaving the tumour capsule in-situ
resulted with 45% of its recurrence. Patey and Thackray explained that the capsule of the
tumour is often incomplete and therefore, a lumpectomy was suggested to be replaced by
other procedures available. Extra capsular dissection removes 2–3 mm border of healthy
tissues without damaging the facial nerve and partial superficial parotidectomy removes 2 cm
of normal parotid tissue with partial facial nerve dissection. Furthermore, SP versus TCP
carries the advantages of avoiding post-operative temporary facial nerve weakness and Frey’s
syndrome. Hence, there is also evidence that 60% of parotid tumours lie in close contact with
facial nerve and exposure of the tumour capsule remains a great concern.3 this retrospective
study assesses the immediate and long-term results of Total Conservative Parotidectomy in
patients with benign parotid neoplasms.

training in developing physical fitness. The purpose of this study was to compare the effects
of yoga and Walking Exercise on Cardiac Function in Young Adults.
Material and methods: The present study was conducted among 100 first year students of
Medical College and Hospital in Kanpur. Baseline investigation, were done. They were
randomly allocated to Yoga group (Group I; n = 50) and Walking exercise group (Group II; n
= 50).Post-intervention investigations were made. The differences between the postintervention
and the baseline measures were calculated. Statistical significance was
established at p < 0.05. Data were analyzed by using SPSS software version 20.

Introduction: Bacterial presence in urinary tract infections (UTIs) is frequently reported. Several bacterial pathogens especially the members of Entero bacteriacae, Staphylococcus spp., Enterococci, other coliforms and Pseudomonas aeruginosaare commonly associated with urinary tract infections. Assessment of antibiotic resistance in prevailing bacterial flora is a crucial step in context of thein tricacies of developing resistance.
 
Aim of the study: The present study was conducted to isolate and identify the bacterial flora along with antibiogram profiling of the pathogenic isolates against routine antibiotics from patients with urinary tract infection sat HNB Base Hospital, Srinagar, Garhwal.
 
Materials & Methodology: A total of 816urine samples from clinically suspected patients (including 346 males and 470 females) of UTI were studied. Sample collection, Isolation and biochemical identification of aerobic bacteria followed by antibiotic sensitivity profiling of the pathogenic isolates were done using standard protocols.
 
Result & Conclusion of the study: Out of 816 samples collected, 337 bacterial pathogens were isolated. Among Gram-negative pathogens (48.96% of total isolates), Escherichia colialone accounted for 21.06% of the isolates followed by Klebsiellaspp. (10.38%), Acinetobacter spp.(5.34%), Enterobacter spp, Pseudomonas spp.,Proteus spp.(2.67% each), Citrobacterspp (2.07%), Salmonella spp.(1.1%) and Morganella spp.(0.8%). Among Gram-positive cocci (51.03%of total isolates), Enterococcus (25.51%) were more frequently isolated than Coagulase-negative Staphylococcus (CONS) (18.39%), Streptococcus (4.15%) and Staphylococcus aureus(2.96%). Morganella spp. And Enterobacter spp. were the most resistant pathogens among Gram-negative bacterial isolates.Among Gram-positive bacterial isolates, CONS along with Streptococci were the most resistant pathogens.

Background: Policy makers and public health professionals mention that Self-help groups (SHGs) may be powerful vehicles of change and can perform effective functions like other grass root level health workers. The objective of the study was to evaluate the awareness levels of SHGs regarding maternal and child health through structured training workshop.
Material and Methods: An interventional study was done at one of the government medical colleges in Mahaboobnagar District of Telangana State. Pretested validated questionnaire in local language was given to sampled 178 female SHG members. One and half day workshop was conducted covering various aspects of maternal and child health. The data analysis was performed by Microsoft Office Excel Sheet.
Results: The current study conveyed comparatively better knowledge of participants about specific topics like maternal welfare schemes, home delivery, breastfeeding practices, nutrition etc. Though, the poor knowledge was seen among participants about some of MCH elements. Conclusions: Structured workshop on MCH’ caused significant gain in knowledge levels of participants about maternal and child health aspects. They can be effective health educators and can improve the knowledge of Self-help groups especially in marginalized areas about maternal and child health.

Introduction:Leukemias (>95% of which are acute) constitute the most common diagnostic group of childhood cancers worldwide, and in India. Remarkable progress has been made in the treatment of acute lymphoblastic leukaemia (ALL) which constitute 75–80% of childhood acute leukemiaswith 5‐year overall survival rate reaching 90% in the high‐income countries. Aim: study the response to standard chemotherapy among acute leukaemia patients in central India at a tertiary health care centre. Methodology: Cases for the study  collected from Sri Aurobindo Medical College and PG Institute Hospital wards attached to Department of Medical Oncology. The study comprises 106 cases of acute leukaemia. Study period was from November 2015 to November 2017. Results: At 4 months the mean Hb in AML patients was 10.4gm%(7-11gm%) while WBC were mean-5547 (4000-17800/cmm), peripheral blasts were 1.73% (0%-20%),platelets mean being 168564 (80000 -202000/cmm).

Introduction: Leukemia is malignant neoplasm of the hematopoietic stem cells characterized by diffuse replacement of the bone marrow and/or peripheral blood by neoplastic cells. As per available information from population based surveys, the incidence of leukaemia in India varies from 0.8/1, 00,000 in Barshi (Rural area of Maharashtra) to 5/1, 00,000 in Delhi. Aim: to study clinical characteristics of acute leukaemia in central India at a tertiary health care centre. Methodology: Cases for the study  collected from Sri Aurobindo Medical College and PG Institute Hospital wards attached to Department of Medical Oncology.
The study comprises 106 cases of acute leukaemia. Study period was from November 2015 to November 2017. Results: Present study showed that prevalence of ALL (51.9%) was higher as compared to that of AML (48.1%).
 

Background: The share of ovalbumin, ovotransferrin, ovomucoid, ovoglobulins, ovomucin, and lysozymes are the main components of albumen protein. 12.5% (w/w) protein can be found in fresh egg whites. The principal proteins in egg white are albumen (water-soluble) and globular proteins (soluble in neutral dilute salt solutions). Biotin, niacin, and riboflavin are water-soluble vitamins that are present in substantial amounts in egg albumen. The major protein present in egg albumen is known as "Ovalbumin" and it is the only protein of egg albumen that contains free SH groups. Albumin is a natural plasma protein synthesized exclusively by the liver at a rate of 9 to 14 g/day in healthy individuals, with a median half-life of about 18 to 19 days. Albumin is catabolized in most organs of the body at a similar rate of about 9 to 14 g/day, by uptake into endocytotic vesicles on the endothelial surface; the final breakdown products are amino acids. Whatever the underlying mechanisms, hypoalbuminemia is associated with worse outcomes including increased complicationsand reduced short-term and longer-term survival in critically ill patients. Conclusion: Egg albumin has multiple physiological effects, including regulation of colloid osmotic pressure (COP), binding and transportation of various substances (for example, drugs, hormones) within the blood, antioxidant properties, nitric oxide modulation, and buffer capabilities, which may be of particular relevance in critically ill patients. It possesses antioxidant, antihypertensive, anti-cancerous properties. It can be used in critically ill patients with involvement of the liver, renal diseases, peripheral edema, cirrhosis, bacterial peritonitis, ascites, etc.

Introduction:-To balance a healthy way in life, sports are one of the most important social activity instruments to maintain our daily life. Physical activities of the individuals such as physical, social, mental and spiritual aspects that change certain rules are described in sports and sometimes performed individually or in teams. Maximum oxygen intake is a fundamental measure of the physiology of exercise. VO2 max and anaerobic power are known as the functional limitation of the cardiopulmonary system as well as the degree of aerobic fitness. VO2 max and anaerobic power is the maximum capacity of a person's body to transport and use oxygen during exercise, which indicates a person's physical fitness. Individuals with high cardiovascular function can generate more energy and perform better, such as athletes.
Aim and objective: To compare VO2 max and aerobic power in sportsmen and control groups.
Material and methods:Vo2 max (aerobic power) was calculated using the Astrands-Rhyming nomogram and Harward’s step technique. The present study was a cross-sectional study. 50 sportsmen were selected from a medical college. 50 sedentary medical students as a control in the age group of 18-25 years, who were playing that particular game for 3-5 years, were selected from the medical institute.
Result: VO2 max in sportsmen (4.48±0.31) lit/min was significantly higher than in the control group (3.29±0.29) lit/min and anaerobic power in sportsmen (1146.91±33.07) watts was higher than in the control group (994.41±27.43) watts.
Conclusion: Regular physical exercise like sporting activity improves cardio-respiratory fitness (Vo2 max and anaerobic power).

Aim: To evaluate the effect of topical Brimonidine 1% in prevention of intraocular pressure spikes after Nd: YAG laser posterior capsulotomy .
Materials and Methods:
The study was conducted in the outpatient Department of Ophthalmology at GMC Baramulla, over a period of one year from July 2020 to July 2021. It was a prospective, randomized, single blind; placebo controlled study which included post-operative cataract patients with diminished vision, diagnosed as having posterior capsular opacification after uncomplicated cataract surgery and underwent Nd: YAG laser posterior capsulotomy.
190 patients were recruited in our study and divided into two groups of 95 each. Group A received one drop of topical Brimonidine prior to laser and second right after laser. Group B patients received one drop of artificial tears (Lubricant) prior to laser and second right after laser. Follow up was done at one hour , three hours , day one and day three, for intraocular pressure, visual acuity and slit lamp examination .
Results:
In group A, fall in mean IOP was seen at 1 hour, 3 hours, (8% fall in IOP) and mean IOP remained less than the base line at day 1, on the day 3 it approached almost the base line.
 In group B rise in IOP from base line was present in 1 hour, peak of IOP elevation (27.17% rise in IOP) was present at 3 hours .Mean IOP remained almost same at day 1 and started decreasing after that approaching baseline, on day 3, the difference in mean IOP at 1 hour,3 hours and day 1 between 2 groups was statistically significant (P<0.05). IOP reached baseline in both groups at day 3. No ocular systemic side effects were seen in either group.
Conclusion:
 
As the post laser IOP rise generally reached its peak during first 3 hours after laser treatment under ideal circumstances. Any drug used to prevent this complication must reach its maximum effectiveness at the same time. Topical brimonidine reaches near maximum effectiveness 30 minutes after administration. The maximum Intra ocular pressure reduction is attained within two to three hours. Thus prophylactic use of topical brimonidine 1% produces maximum hypotensive effect to coincide with the potential IOP spike.
Effect of prophylactic topical Brimonidine 1% in prevention of intraocular pressure spikes following Nd : YAG laser posterior capsulotomy  in a hospital based study
 

Aims and objective: To study the functional outcome and duration of union of metaphyseo-diaphyseal fractures of tibia treated with Multidirectional Interlocking Intramedullary Nailing (ETN: Expert Tibia Nail) and Locking Compression Plating and achieve Restoration of axis, length, and rotation of the lower leg ;Sufficient primary stability of the osteosynthesis for early functional aftercare to maintain joint mobility
Methodology: We conducted a prospective study to know which definitive surgical treatment option (nailing or plating) is better for extra-articular proximal tibia fracture. Subjects who have sustained proximal tibia extra-articular fracture and who are admitted in Raja Rajeswari  Medical College and Hospital , Bangalore were the sources. The Sample Size is 30. With 15in each group ( group A Plating and group B Nailing) .The functional outcome was assessed using Klemm Borner Knee Scoring system during clinical follow up at 6 weeks, 3months  and at 6 months post surgery.
Results: Both Groups showed no significant difference in functional outcome assessed using Klemm Borner score , Klemm borner score in both groups initially at 6 weeks showed 26.7 % good results in plating group and 33.3 % good results in nailing group which progressed to give 60% excellent results in both groups  and 26.7% good results in plating group and 33.3% in nailing group  there were two complications encountered in our study patients post surgery which are osteomyelitis of tibia and non-union of proximal tibia fracture which were treated successfully accordingly.
Conclusion:: Considering lesser time for union, early weight bearing, lower chances of infection and lesser surgical duration, nailing seems to be more promising for extra articular proximal tibia fractures but Locking Compression Plating provides stable reduction in fractures like (AO41A2.2- simple metaphyseal oblique fracture in sagittal plane ) where as the reduction using nailing system in these fractures is cumbersome due to working length for a nail is shorter to control angulation n rotational deformity in these fractures ; But overall in our study there is no significant difference between two mode of treatment as far as early postoperative mobilization, intra operative blood loss, Hospital stay, klemm borner score and complication . It can be concluded that both the technique were equally effective and choice of methods for extra- articular proximal tibia fractures fixation depends on the surgeons own experience .

Background: Determining the factors affecting exercise capacity is extremely significant because it can improve the life span and the quality of life of subject as exercise capacity is related to prognosis in healthy people and in heart disease patients.
Objective: To determine the effectof cardiac diastolic function assessed by echocardiography on exercise capacity
Methodology: The Study was conducted on 100 subjects at Haldiram and Moolchand Heart Centre, PBM Hospital, S.P. Medical College, Bikaner. First a resting echocardiography was performed to evaluate cardiac diastolic function. After echocardiography the subjects were underwent Bruce protocol treadmill test.
Result & Conclusion:: There exists a strong association among VO₂max and diastolic function as observed by E/A and A’s positive correlation with VO₂max and negative correlation of diastolic function indices E,E/E’, LAVI with VO_2max

Introduction: Carotid intima media thickness (CIMT) is used as a indicator of atherosclerosis, whichcauses Macro-vascular diseases. with risk factors like age, HTN, Raised BMI, duration of uncontrolled DM, may actually have a correlation with CIMT either directly or indirectly influencing the disease processand causes atherosclerosis⁽¹⁾.
Materials and Methods: cross sectional study of 100 patients with type 2 DM admitted in civil hospital over a period of 1 year, age group between 35 to 75 years selected through simple random sampling. Macro vascular complications like CAD/CVD/PVD are dignosed with the help  of echocardiography, CT scan and with the help  of history and clinical examination. CIMT is measured with B mode ultrasound.
Result : 73 percent patients have macrovascular complications who have raised value of CIMT and 68 percent  patients with macrovascular diseases have raised value of CIMT.
Conclusion: increased value of CIMT in diabetic patients has more chances of macrovascular complication hence early detection of atheroscelerosis and early life style modification can prevent macro vascular complication⁽²⁾.

INTRODUCTION:- Stroke is the most common life threatening or disabling neurological condition in older population. Although it is not infrequent in young adult. Stroke in young adults poses a major socioeconomic health problem especially in developing countries. The traditional risk factors like hypertension, diabetes are associated with stroke in both young and elderly. In recent years, there has been increasing economic and demographic development in developing countries resulting in a shift from diseases caused by poverty towards chronic, non-communicable, lifestyle related diseases, this happening in the younger age group adds to the social and economic burden, and as such these patients merit special attention in diagnostic, therapeutic, and preventive care.
Material and Methods:- This was an observational study conducted in Department  of  Medicine, Sanjay Gandhi Memorial Hospital, associated with Shyam Shah Medical College, Rewa during the period between April 2018 to June 2019.
RESULTS:- Males were more affected than females and most common clinical presentation was hemiparesis. Hypertension was significantly associated with hemorrhagic stroke in young adults. CONCLUSION:- Stroke in young adults can lead to huge socioeconomic burden on society, as in our study we found hypertension was significant risk factor for hemorrhagic stroke. So by preventing these modifiable risk factors at various levels of prevention, we can decrease the incidence of stroke in young adults.
 

Introduction: Patients who receive epidural opioids have fewer respiratory issues and can be deployed sooner in the postoperative phase than those who get standard, intermittent IV/IM dosing.The present study was done to compare the postoperative analgesia between tramadol and Buprenorphine through an epidural technique in patients undergoing lower abdominal surgeries, along with their onset, duration of analgesia, and side effects.
Materials and Methods: This study was a prospective comparative randomized studyOur study comprised 60 patients who came in for elective lower abdomen surgery and were randomly divided into two groups of 50 individuals each..Group T received 50 mg of Inj. Tramadol hydrochloride and Group B received 100 micrograms of Inj.Buprenorphine hydrochloride through epidural route (epidural catheterization done).Both groups of patients were monitored for 24 hours after surgery. In the postoperative phase, the VAS(VISUAL ANALOG SCORE) score for pain severity, onset and duration of analgesia, and side effects was monitored.
ResultsThe onset of analgesia in Group T was quicker, but the duration of analgesia was shorter than in Group B. Group T had a mean onset of analgesia of 9.65±4.25 minutes, whereas Group B had a mean onset of 14.85± 4.75 minutes. The mean duration of postoperative analgesia in Group T was 345.12±78.65minutes, while it was 595.45±88.42minutes in Group B, with a P-value of 0.02which was significant. Throughout the study, all of the patients were hemodynamically stable, and no severe side effects such as respiratory depression were detected. However, Group B had a higher incidence of nausea, vomiting, and pruritus than Group T.
Conclusion: At the end of the study, It was observed that epidural Buprenorphine gives a substantially longer and higher quality of analgesia than epidural TramadolNausea, vomiting, and pruritus were the most common adverse effects associated with injectable buprenorphine, which may be alleviated by antiemetics and antihistaminics, respectively.

MODIFIED BIOPHYSICAL PROFILE(MBPP)  includes Non stress test (NST) as an indicator of present fetal status and the amniotic fluid index (AFI) as marker of long term fetal status. Antenatal foetal surveillance aims to identify foetuses in high-risk pregnancy groups, such as those with pre-eclampsia, eclampsia, anaemia, oligohydramnios, and other conditions that put them at danger of intrauterine hypoxia and mortality. In such high-risk circumstances, the fetal biophysical profile is one of the most commonly acknowledged tests for assessing foetal well-being. This is prospective observational study conducted between November 2019 to April 2021.
AIMS AND OBJECTIVES:

To study the effectiveness of modified biophysical profile as a primary antepartum fetal surveillance in predicting perinatal outcome of high risk pregnancies.
To compare morbidity and mortality in relation to each of the modified biophysical profile's characteristics, namely NST and AFI, individually.

INCLUSION CRITERIA: Gestational age of 30 weeks or more, Pre eclampsia, Anemia,Heart disease complicating pregnancy ,Gestational Diabetes mellitus/overt diabetes.
EXCLUSION CRITERIA: Patient refusal or inability to provide informed consent, Fetuses with congenital anomalies, Multifetal pregnancies,Intrauterine fetal demise.
RESULTS : Majority of the cases are in the age group of 21-25 years(46%) and majority of the cases were primigravidae(42%).
Hypertensive disorders of pregnancy is seen in majority of the cases(46%).
Mode of delivery in cases where MBPP was normal was vaginal in most of the cases and the incidence of LSCS in cases where MBPP was abnormal was increased.
Incidence of perinatal morbidity and mortality  is increased when both MBPP parameters were abnormal.
CONCLUSION : Modified biophysical profile (MBPP) is easier, less time consuming, cost effective and patient compliant test. When the Modified biophysical profile is normal, it gives reassurance that the fetal status is good with good perinatal outcome. At the same time, when MBPP is abnormal, it indicates that the fetus may be compromised.

Background: Bilirubin is a metabolic byproduct of the breakdown of hemoglobin degradation which itself must be metabolized for appropriate excretion. High levels of bilirubin are associated with decreased risk of coronary heart disease (CHD) and cardiovascular disease (CVD).
Objectives: To study the level is to see correlation between serum bilirubin level and Risk factor of cardiac disease in patients admitted in hospital.
Methodology:  This study includes 100 Male Indian subjects between 35 to 60 years of age who visited medicine OPD of our institute. Biochemical test like Lipid profile, Serum bilirubin and blood sugar(Fasting & Post Prandial) were measured on a fully automatedanalyzer along with quality control sera. Obtained Results were analyzed statistically to calculate p value and to see the difference of significance.
Results: HDL level between OPDand IPD (31.92 ± 4.25 mg/dl and 49.92 ± 7.23 mg/dl ) subjects respectively. In the same manner this table also showed a higher level of FBS 122.23±4.2 mg/dl and PP2BS 132.23±8.0 mg/dl in OPD subjects as compared to IPD patients but the difference among them was not significant. It was represented that the OPD subjects were more prone to risk of CVD because the level of S.choletserol was 220.92 ± 40.21 as compared to 209.45 ± 29.90 in IPD subjects.(p value:<0.001 significant)Regarding serum Triglyceride level , there is no such significant difference found among two group. While comparing the level of serum LDL it was 164.64±15.29 and 134.83±10.39 in Control and case Group Respectively.(p <0.001). The Level of Total bilirubin was 0.84±0.41 mg/dl in control group and 4.42±3.1 in case Group and difference among them was highly significant.
Conclusions: From my study it will be conclude that there is a significant negative relationship was demonstrated between baseline bilirubin levels and incident CHD and CVD death and the level of serum bilirubin is important parameter for defining risk of cardiovascular disease.

Present study is done with an aim to co-relate the clinico-pathological features with prognosis
(outcome) in patients having colorectal cancer.
The colorectal cancers usually occur in patients >50years of age (independent predictor of
poor prognosis) but can occur in younger individuals as well. There is a male predominance
in occurrence with male: female ratio of about 3:2. The majority of patients lie between the
age group of 41-70 years.
Rectal bleed, change in bowel habits, chronic abdominal pain and generalized weakness are
the common forms of presentation. Rectum is the most common site of presentation and
majority of them present with proliferative growth on colonoscopy and CECT abdomen. The
most common reported site of obstruction is the sigmoid colon.
Despite having a more advanced cancer(aggressive form), the younger patients do not have a
poor prognosis compared to the older ones. The right- sided and left sided colon cancers have
different disease charecteristics due to differences in their embryological origin.
In terms of pathological characteristics, the right- sided colon cancers have more mucinous
type cancer, more poorly differentiated tumors and more advanced TNM stage, more distant
metastasis, higher incidence of peritoneal seeding and thereby peritoneal carcinomatosis.
Patients with left- sided colon cancers have higher incidence of hepatic metastasis,
pulmonary metastasis and better survival outcomes.
Early detection strategies such as screening at a younger age may improve the survival of the
younger patients. On comparing the emergency with elective surgeries done for colorectal
cancers, the emergency colo-rectal surgeries were associated with a poorer outcome, higher
recurrence and mortality rates.

Exogenous foreign bodies in the tracheo bronchial tree are particularly common.
Complications are related to site, size, shape, nature and duration of foreign body.
Foreign body aspiration is associated with significant morbidity. Awareness of these
possible complications and a high index of suspicion is the key to successful
management. We report a case of bronchial foreign body in a 32 year old male patient
who had accidentally ingested a metallic foreign body. Foreign body was removed
successfully without complications.

Background: Fixation of intra-articular distal humerus fractures has remained a
challenge to orthopaedic surgeons due to complicated anatomy of elbow, comminution
at fracture site and osteopenia of articular surfaces. We aimed to evaluate the functional
outcomes and complications after dual plating for distal humerus fractures with triceps
tongue technique. Materials and Methods: We conducted a retrospective study which
consisted of 20 cases of distal humerus fracture with intraarticular extension and
treated with open reduction and internal fixation with dual column plating using triceps
tongue technique. Triceps Tongue approach allows exposure of distal humerus articular
surface by forming an inverted V-shaped flap of distal triceps at the musculotendinous
junction. Results: Union was achieved in all cases. Mean time of fracture union was
14.65±1.82 weeks. There was no case of non-union although elbow stiffness occurred in
one patient. The mean MEPS score was 83.45±9.18 with a range of 70-95. Conclusion:
Triceps Tongue approach is a simple and less technically demanding approach for the
surgeon that can be used in management of the majority of the distal humeral fractures,
giving adequate exposure of the surgical field, aiding in proper reduction of fracture
fragments and thus obviating the need for an olecranon osteotomy

Background:Amblyopia is an important public health problem leading to visual impairment
which is lifelong. Refractive error is one of the common causes of amblyopia. The present
study was conducted to assess pattern of amblyopia in children in the age group between 5
to15 years.
Materials & Methods:180 children in the age group between 5 to15 years with amblyopia of
both genders were included. All cases underwent ophthalmic examination using visual acuity
by Snellen vision chart, cycloplegic refraction by streak retinoscope, auto-refrectometer,
thorough anterior and posterior segment and examination by slit lamp biomicroscopy,
ophthalmoscopy and assessment of the ocular alignment by cover-uncover test and ocular
motility.
Results: Age group 5-10 years comprised of 100 and age group 10-15 years had 80 children.
common types were Myopia seen in 30, Hypermetropia in 65, Myopic Astigmatism in 60 and
Hypermetropic Astigmatism in 25 cases. The difference was significant (P< 0.05). Types of
Amblyopia was Monocular in 70 and binocular in 110 cases. The difference was significant
(P< 0.05).

Background:Diabetic patients might exhibit dry eye symptoms probably due to neuropathy,
metabolic dysfunction, or abnormal lacrimal secretions. The present study was conducted
to assess prevalence of dry eye diseases in diabetic patients.
Materials & Methods:92 diabetic patients of both genders were enrolled. Ocular
examinations, fasting blood sugar (FBS), postprandial blood sugar, and glycosylated
hemoglobin estimation (HbA1c) were recorded. Dry eye patient was diagnosed with the
help of slit-lamp examination, Schirmer’s test, tear film break-up time (BUT), and Rose
Bengal staining technique. Gradation of dry eye was done by the following standard
protocol.
Results: Dry eye was present in 70 and negative in 22. The mean duration of diabetes was
11.4 years in positive cases and 5.6 years in negative cases. The difference was significant
(P< 0.05).Grade was mild in 32, moderate in 20 and severe in 18 patients. The difference
was significant (P< 0.05). Age group (years)<50 years had 24, 50-60 years had 30 and >60
years comprised of 16 patients. Blood sugarcontrol (HbA1c) was good in 12, fair in 10,
action suggested in 28 and poor in 20 patients. The difference was significant (P< 0.05).
Conclusion: There was high prevalence of dry eyes in diabetic patients. Grade of dry eyes
was mild, moderate and severe.

Background:Retinal diseases are the major causes of visual impairment in developed
countries. The present study was conducted to assess vitreo- retinal diseases among
opthalmic out patients.
Materials & Methods:84 patients of vitreous retinal diseases of both genders were
included.
Best corrected visual acuity (BCVA) at presentation was measured using a Snellen chart.
Intraocular pressure was measured by Goldmannapplanation tonometry or an iCare
tonometer, and the anterior and posterior segments were examined under slit-lamp
biomicroscopy and 90D bio-microscopy. The funduscopic findings were confirmed by
binocular indirect ophthalmoscope.
Results: Out of 84, males were 54 and females were 30. Presenting symptoms were floater
in 23, poor vision in 15, headache in 11, watering eye in 27, discomfort eye in 32,
white eye in 10, traumain 5 and night blindness in 12. The mode of injury was road traffic
accident in 26, fall from height in 13, assault/fight in 10, electric wire in 14 and others in
21. Common vitreo- retinal diseases were retinal detachment in 20, hypertensive
retinopathy in 16, diabetes retinopathyin 12, retinal vein occlusion in 10, macular hole in
16, optic nerve involvementin 6 and vitreous haemorrhage in 4 cases.
Conclusion: Common vitreo- retinal diseases were retinal detachment, hypertensive
retinopathy, diabetes retinopathy, retinal vein occlusion, macular hole, optic nerve
involvement and vitreous haemorrhage

The metabolic syndrome is defined as a clustering of key cardiovascular risk factors,
namely, abdominal obesity, dyslipidemia, hyperglycemia and hypertension in a single
individual. Gerald Reaven introduced the concept of the syndrome in 1988.This crosssectional
study was conducted in 120 in which 60 non diabetic and 60 type 2 diabetic
patients, 2013 to 2015 in the department of biochemistry, Mediciti Institute of Medical
Sciences, Hyderbad. Ethical clearance was obtained for the study. Informed consent
was obtained. 60 subjects with type 2DM were included in the study. Subjects in the age
group of 30-65 yrs in both genders, meeting the Type 2DM, FBS and PLBS meeting the
criteria were taken up in the study. Maximum prevalence of Metabolic syndrome was
observed in diabetic male harmonised criteria (73.3%) and diabetic female WHO
criteria (76.6 ). A fair agreement was observed between WHO and HAR criteria by
Kappa statistics. A two tailed significant correlation were found in diabetic male
patients (using WHO,HAR criteria ) than female patients (using CDS) criteria

Aim: The aim of the study is to compare the results of myringoplasty performed using
temporalis fascia with that of tragal perichondrium.
Methodology: A Hospital based prospective study was conducted to compare the
success rate of myringoplasty performed with temporalis fascia versus tragal
perichondrial grafting at department of ENT,Govt ENT Hospital,Koti,Hyderabad..
Patients with chronic suppurative otitis media with tubo tympanic type were included
in the study.
Results: A total of 60 patients were studied among which 30 were in group A and 30 in
group B. Patients were diagnosed by clinical examination and otomicroscopy. Pre
operative hearing evaluation was done by pure tone audiometry. Myringoplasty was
performed using temporalis fascia and tragal perichondrium in group A and group B
respectively. Follow up was done at 3 weeks, 6 weeks, 3 months and at 6 months post
operatively. During the follow up, patients were assessed for graft uptake and hearing
improvement and the results were compared between both the groups. The results were
as follows: Age of pts was between 15- 60 yrs with majority between 20 to 40yrs. There
were a total of 33 males and 27 females. Right ear was operated in 33 patients and left
ear in 27 patients. A total of 14 cases were operated with presence of bilateral disease
(6:8). Overall graft uptake rate was 85%. Graft uptake rate was 83.33% with
temporalis fascia and 86.66% with tragal perichondrium. Mean improvement in
hearing for temporalis fascia was 9.81 ± 5.10 dB and for tragal perichondrium was 8.42
± 4.10 dB.
Conclusion: It is concluded that graft material does not influence the either graft uptake
or hearing improvement in safe type of CSOM when conductive hearing loss is less than
40 db and in the absence of central pathology and tympanosclerosis.

Background: Clavicle fracture is a common traumatic injury around the shoulder
girdle due to its subcutaneous position. Recent studies have shown a higher rate of
nonunion and shoulder dysfunction in subgroups of patients with clavicle fractures.
Aim: The purpose of the study was to prospectively analyse the functional outcome of
mid-third displaced clavicular fractures treated by open reduction and internal fixation
with plate osteosynthesis. To study the outcome of displaced middle-third clavicular
fracture streated by plate osteosynthesis.
Methods: This was a prospective comparative on-randomized study was conducted in
Government District Head Quarters Hospital Suryapet with a follow-up ranging from
August 2021 to December 2021 (6 months). Ninteen cases of middle third displaced
(Robinson type 2b1 and 2b2) clavicular fractures are treated with plate osteosynthesis.
We used a reconstruction plate, a locking compression plate, and a 1/3rd tubular plate
for study.
Results: The mean time to union was 9.5 weeks. At the latest follow-up, the entire
patients returned to the pre-injury activity level. One case had a superficial infection
which was treated with intravenous antibiotics. There is no difference between the
reconstruction group and the locking compression plate group in terms of functional
outcome and union rate. We also noticed that road traffic accident and direct injury to
the shoulder causes Robinson type 2b1 (12) fractures.
Conclusions: Open reduction and rigid internal fixation of displaced midshaft
clavicular fracture have resulted in a good fracture union rate and excellent functional
outcome.

Background: Platelet-rich plasma [PRP] has received increasing interest across many
musculoskeletal disciplines and has been widely applied clinically to stimulate tissue
healing in numerous anatomical regions. The known actions of platelet-derived factors
suggest that PRP may have significant potential in the treatment of pathological
conditions of cartilage, tendon, ligament, and muscle.
Purpose: The aim of this manuscript is to review current literature regarding the
biology of PRP and the efficacy of using PRP to augment healing of tendon ligament
and muscle injuries, as well as early osteoarthritis.
Methods: A comprehensive literature review of musculoskeletal applications of PRP
was performed, including basic science and clinical studies such as randomized
controlled trials, case controlled series, and case series.
Results: The most compelling evidence to support the efficacy of PRP is for its
application to tendon damage associated with lateral and medial epicondylitis. Although
some promising studies have been reported supporting the use of PRP in osteoarthritis
and ligament and muscle injuries, it currently remains unknown whether PRP
effectively alters the progression of osteoarthritis or aids the healing of ligament and
muscle tissues.
Conclusion: The rationale for the use of PRP to improve tissue healing is strong, but the
efficacy for many musculoskeletal applications remains unproven. PRP has been shown
to be a safe treatment. A number of questions regarding PRP remain unanswered,
including the optimal concentration of platelets, what cell types should be present, the
ideal frequency of application, or the optimal rehabilitation regimen for tissue repair
and return to full function