European Journal of Molecular & Clinical Medicine

The present study was planned in the Department of Urology, MMIMSR Mullana, Haryana, India. The study was performed for one year. Total 50 cases of the proven histological diagnosis of nonmuscle invasive urothelial cancer with either high grade or T1 cancers on histopathology were enrolled in the present study. The data generated from the present study concludes that TURBT is necessary in patients with solid bladder tumors. The presence of tumor at restage confers a higher risk of recurrence and progression. Poor patient compliance for a restage TURBT remains a matter of concern.

BACKGROUND: Eosinophilic gastrointestinal disorders (EGID) are the group of chronic, inflammatory conditions of the gastrointestinal tract. Little is known about the histomorphology as well as outcome of these after follow-up. The aims of the study are to study the histomorphological pattern of EGIDs and also to determine the changes post follow-up for a period of 24 months

Seroma, also called as Pseudocyst of pinna is a benign cystic swelling which commonly develops in the antero-lateral aspect of the pinna. It occurs due to accumulation of fluid between perichondrium and cartilage and does not have an epithelial lining. This study was conducted to compare and analyse the outcomes of the Window operation and aspiration and intralesional corticosteroid injection.

Emergency Medicine is a new discipline that started with the aim of effective and early resuscitation of critically ill patients. Medico-legal cases (MLC) are surged globally due to the population rise. Resource allocation for different MLC in terms of humans, infrastructure, and equipment is complicated. The present study aimed to find a pattern of Medico-legal cases with outcomes in the Emergency Department.

INTRODUCTION
Plantar fascitis is one of the most common tendinopathy and cause of heel pain. It may get resolved with time and conservative treatment like stretching exercises and oral medications. Recent advance in treatment of chronic plantar fascitis is the use of local PRP injections. It has advantages like being autologous and rich in growth factors. The purpose of this study is to determine the effectiveness of local PRP injection in chronic plantar fascitis.
MATERIALS AND METHODS
This study was conducted from September 2020 to March 2022 in Narayana Medical College and Hospital, Nellore. 30 patients who came to op were selected based on inclusion and exclusion criteria. 3ml of autologous PRP was extracted and injected into heel area. Patients were followed up at 0,1,3,6 months intervals and at each follow up pain was evaluated using Numerical pain score.
 
RESULTS
Patients are followed up at 0,1,3,6 months. At each follow up patients Numerical pain score was calculated and mean was obtained for all patients. The mean pain was 8.5 pre-injection. The mean Numerical pain score at 0,1,3,6 month was 8.5, 4.25, 0.89, 0.33 respectively.
CONCLUSION
Intralesional autologous platelet rich plasma injections were safe and effective in treatment of chronic plantar fasciitis with maximum effect observed after 3^rd month and sustaining till 6^th month

Distal end radius fractures constitute one-sixth of all fractures treated in the emergency department. These fractures often are unstable, are difficult to reduce anatomically. Various modes of treatment include plaster application, External fixator, Plate fixation with locking compression plate. Recently, there has been an increasing interest in plate fixation, especially volar locking compression plate fixation of distal radius fractures. The purpose of this study is to evaluate the functional and anatomical outcome of unstable distal radius fractures treated by volar locking compression plate.
METHODS AND MATERIALS:
Forty-eight patients with unstable fractures of the distal radius treated with open reduction and internal fixation with volar LCP were taken under the study. Lafontaine 's criteria for instability were used to assess the fracture stability. Volar Henry approach was employed in all patients. Post-operative follow up at 6 weeks, 3 months, 6 months, 1 year and every 6 months later on as necessary. The assessment of functional results was made using the Demerit system of Gartland & Werly and Sarmiento's modification of Lidstrom's criteria was used for assessing anatomical outcome.
RESULTS:
Out of 48 patients, 34 were males and 14 females.  26 met with road traffic accidents and 22 have fallen on their outstretched hand. The assessment of functional results was made using Gartland & Werley demerit system based on residual deformity, subjective evaluation, objective evaluation & complications. 22 cases had excellent results and 22 cases had good results and 4 cases had fair results at the end of 12 months.
CONCLUSIONS:
Volar LCP is an effective treatment option for unstable distal radius fractures which promotes anatomic realignment, prevents delayed collapse, allows early joint motion and results in successful functional and anatomical outcomes

Subfertility (also commonly known as infertility), which affects one in six couples, is the failure to manifest a clinical pregnancy after 12 months of regular, unprotected intercourse. Even though genetic, environmental and lifestyle factors play a pivotal role in subfertility, the etiology of the disease still remains enigmatic. The extent of somatic DNA damage and oxidative stress among subfertile subjects was studied. TORCH infection screening and several clinical parameters were also analyzed among 74 subfertile females and 45 age and sex-matched healthy individuals as control. The study concluded that subjects with subfertility showed increased oxidative stress and associated somatic DNA damages along with varying degrees of infections.

A 67yrs old male hypertensive on irregular treatment presented to emergency room in a drowsy state. Patient had history of one episode of generalized tonic clonic seizures with altered sensorium ,   evaluated and was found to have chronic hyponatremia. Fever, throat pain, fatigue and vomiting were also present. A history of fever and multiple vesicles over body , CSF analysis , TZANC smear positive with multiple varicella zoster lesions were pointing towards viral meningitis . Patient was treated for viral meningitis with acyclovir and he improved significantly. Thus , here we report an interesting case of viral meningitis with chronic SIADH presenting with seizures

Herbal products have become increasingly important worldwide in medical and economic terms. Antifungal herbal antibacterial soap of Luliconazole were prepared & evaluated for dermal infection along with the addition of the oils and the extract of Azadirachtaindica, Ocimum tenuiflorum, Aloe barbadensis miller, Santalum album. The API used for the preparation of antifungal herbal antibacterial soap belongs to the antifungal class of azoles, inhibits the enzyme lanosterol demethylase, which is required for the production of ergosterol, which is a major component of the fungal cell membrane. It is mainly used in the treatment of skin infections such as athlete's foot, jock itch, and ringworm. The physicochemical parameters of formulations (Physical evaluation, pH, Foaming ability and foam stability) were determined. The results showed that the formulation have pH level nearly equal to skin pH, foaming index was excellent. The %drug release, % drug content, % solid content and microbial study was performed for API

INTRODUCTION: Vacuum-assisted closure (VAC) is a non-invasive, active wound management system that exposes a wound bed to local sub atmospheric pressure, removes fluid from the extravascular space, improves circulation, and enhances the proliferation of granulation tissue. The purpose of this study is to know the rate of wound infection, number of days required for making the wound fit for skin cover procedures, number of days required for formation of uniform granulation tissue bed in the wound healing treated by Vacuum Assisted Closure after primary fixation of fracture.
METHODOLOGY: Patients between 18 to 60 years were included in this prospective randomized controlled trial. Primary internal Fixation of fracture was done as soon as possible followed by VAC application. Functional outcome of cases recorded during each follow up according to Johner and Wruh’s (1983).
RESULT: According to this study, 30 patients with open fractures of both bone leg after primary internal fixation with VAC application. During follow up effective decrease (mean ± SD) in wound size after VAC therapy was 9.97±9.59 cm2 with P-value 0.0481. This technique has resulted in the effective decrease in wound size, infection and give a better functional outcome.
CONCLUSION: The greatest advantage of VAC was found to facilitate rapid formation of granulation tissue on wounds with exposed tendons, bones, raw area wounds and exposed implants hence decrease healing time and minimize soft tissue defect coverage procedures.

Worm infestation is one of the major causes of childhood malnutrition, anemia, stunted physical and mental growth, psycho-social problems and this along with repeated gastrointestinal and upper respiratory tract infection contributes to high morbidity in children and remains a major cause of high infant and child mortality in our country. The infection is usually transmitted via ingestion of eggs from contaminated foodstuffs, an infection may occasionally occur via inhalation of eggs and swallowing of infected secretions.[1]
The overall prevalence of helminth infection in school-age children in India is about 50% in Urban and 68% in the rural area. Soil-transmitted helminths commonly known as worms form part of the Neglected tropical diseases which are associated with substantial acute and chronic morbidity, particularly among children [2].

AIMS: Emergency Medicine is a new discipline that started with the aim of effective and early resuscitation of critically ill patients. Medico-legal cases (MLC) are surged globally due to the population rise. Resource allocation for different MLC in terms of humans, infrastructure, and equipment is complicated. The present study aimed to find a pattern of Medico-legal cases with outcomes in the Emergency Department.
METHODS :This isaretrospective study done in a tertiary care teaching hospital over one year from January 2021 to December 2021. A total of 955 cases were registered, out of which 918 were selected. Patients data was recorded in proforma regarding the demographic profile, the pattern of MLC, and hospital outcome. Descriptive analysis expressed in frequencies and percentages using SPSS for Windows, Version 26.0. 
RESULTS : In 918 cases, males were 69.80 %, and females were 30.20%. The majority of patients were aged 21 to 40 years, accounting for 56.10%. The pattern of MLC cases is Road traffic accidents 34.50%, poisoning 23.10%, Assault 19.80%, Bites 13.6%, and burns 2.20%. Outcomes showed the discharges 55.10%, deaths 3.8%, Against Medical Advice 29.30%, and OPD Basis11.80%. Mortality was highest in road traffic accidents, accounting for 1.5%.
CONCLUSION : Present study concludes MLC cases were common in males of younger age groups. The majority of MLC cases are Road traffic accidents and poisoning. Mortality was more in Road traffic accidents. This study will guide the preparedness of the Emergency department in terms of resource allocation, training of staff, and formulation of hospital plans and policies by government /law agencies.

The prospective randomized open controlled study was done to compare tracheal extubation response following nitroglycerine (NTG) sublingual spray in hypertensive patients

Background information:
Pleural space is normally sterile but it gets colonized when fluid accumulates. Fluid accumulation occurs due to many causes of which infection is the most common cause. Pleural effusion when occurs in the setting of pneumonia increases the morbidity and mortality rates in patients if antibiotic therapy is delayed or improper. Identification of prevalent pathogenic organisms and their sensitivities is important in guiding antimicrobial therapy. The aim of the study was to determine the bacteriological profile and their sensitivity pattern.
Material and methods:
A total of 500 pleural fluid samples were processed. The isolates were identified by standard procedures and their antibiotic sensitivity determined.
Results:
12.8% of the samples had an identifiable etiology with gram negative bacteria as the predominant isolates. The organisms isolated were; Pseudomonas. aerugenosa, Klebsiella pneumonia, Escherichia coli, Staphylococcus aureus and Protues. Pseudomonas spp were the most common among gram negatibe bacteria. Imipenem, piperacillin-tazobactum, ciprofloxacin were most sensitive drugs.
Conclusion:
Continuous epidemiological monitoring and knowledge of sensitivity pattern of the organisms is a prerequisite in formulation of antibiotic policy which further helps in early and appropriate institution of the antibiotics and in controlling the antibiotic resistance

Background: Fractures of the distal radius are one of the most common injuries seen in our day-to-day practice. It accounts for almost 4% of the injuries seen in the emergency department. Despite its high incidence and the substantial possible implications of suboptimal management, no high-level evidence regarding the best treatment method yet exists.
Aim: Aim of the study is to compare the functional outcomes of extra articular distal radius displaced fractures managed surgically with those managed conservatively.
Materials and Methods: In this prospective cohort study conducted between November 2020 to December 2021, 18 to 65 years old patients with displaced extraarticular distal radial fracture were treated surgically or conservatively. Modified Mayo Wrist Score were calculated after a follow up of 12 months.
Results: At the end of 12 months the patients were evaluated, and it was noticed that patients who were treated surgically had significantly better functional and clinical outcomes, as indicated by significantly higher Mayo scores than patients treated conservatively by casting (all p values < 0.05).
Conclusions: Patients treated with volar plate fixation were able to resume activities of daily living few weeks earlier compared to those managed with K-wire fixation and conservative group. Therefore, we can conclude that volar plate fixation gives significantly better clinical and functional results than other methods of treatment.

Purpose:  Very few prospective studies are available on the surgical outcome in patients with lumbar canal stenosis having a motor deficit. The study was aimed at evaluating factors affecting recovery of neurological deficits in cases of lumbar disc herniation (LDH) treated by lumbar decompression.
Methods A prospective study was performed at J.K. Hospital and Research Centre, Bhopal, M.P. India, from November 2019 to November 2021, on 35 patients. These patients present to us with complaints of weakness in ankle dorsiflexors (ADF) and extensor hallucis longus (EHL). In our study, all those patients were included who gave positive consent, who have L4 and /or L5 nerve root involvement innervating the anterior compartment of the leg and those who have lower extremity (ADF and EHL) weakness resulting from lumbar degenerative diseases like lumbar canal stenosis due to ligamentum flavum hypertrophy, facet arthropathy, disc protrusion and spondylolisthesis at L4-L5 level or L5-S1 level. Postoperative evaluations of motor recovery were performed regularly on an outpatient basis, and the results of the latest follow-up were analyzed. The follow up was done at 2 weeks, 12 weeks and 24 weeks in our OPD.
Result: 22(67.8%) patients having duration of symptoms less than 3 months had 95% recovery, group with duration of symptoms more than 3 month showed recovery rate of 70%. Recovery rate of 90% in ODI score in group with duration of symptoms less than 3 months. Following Kaplan and Meier analysis median time to foot drop improvement was within 12 weeks of surgical decompression. After the Kaplan and Meier plot, we observe that maximum recovery is seen between 9 and 14 weeks after decompression.
Conclusion:   Better improvement is seen if the patient got operated on within 3 months of neurological deficit. Also, it is observed that those patients with mild to moderate motor weakness show better recovery. Younger patients of less than 50 years with single level involvement show better recovery. We have observed preoperative muscle strength and duration of palsy as a significant prognostic indicator of better outcome following surgical lumbar decompression

The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and its deficiency affects Knee stability, resulting in giving way symptoms in daily and sports activities with increased the risk of intra-articular damage. To prevent the deterioration of the existing lesions ACL reconstruction is necessary. Arthroscopic reconstruction of the injured ACL has become the “gold standard” method for treatment of ACL tear. However there is a controversy in literature regarding the best graft option is to replace the injured graft. The present study was aimed to study and compare the functional outcome of single bundle arthroscopic ACL reconstruction by Hamstring , Peroneus Longus and BPTB autografts  using Lysholm Knee Activity Score.

Background-It is known that impaired thyroid function affect the liver function and similarly liver disorders Also affect thyroid function. In this study we looked  at the clinical profile of cirrohosis and studied the correlation between cirrhosis  and thyroid function.
Methodology- The study was conducted as an observational cross sectional Study on patients with cirrhosis of liver reporting at Department of Medicine, SSMC Rewa (M.P.) during the study period of 15 months i.e. from 1^st April 2020 to 30^th June 2021. Detailed history regarding risk factors, duration of liver disease, history pertaining to its etiology was obtained. Severity of liver disease was assessed using Child Pugh score. All the patients were then subjected to relevant investigations including Serum T3, T4, TSH.
Results-A total of 100 cases of liver cirrhosis were enrolled in our study with mean age of 53.26±12.54 years. We observed a statistically significant association of Child Pugh Score with T3, T4 as well as TSH (p<0.05). We observed a moderate correlation of Child Pugh score with T3 levels and TSH (r=0.452 and
0.311 respectively; p<0.05), and weak correlation was observed with T4 (r=0.240; p<0.05).
Conclusion- In cirrhosis of liver majority of subjects show impaired thyroid functions. Thyroid hormone levels are helpful in assessing the severity as well as course of cirrhosis and among T3,T4,TSH value,TotalT3 faired as better predictor of severity of cirrhosis.

Cholesterol is an essential constituent of the cell membrane. It coordinates carbohydrate, major ions, and bone homeostasis respectively. ^[1] Cholesterol is the progenitor for all glucocorticoids, mineralocorticoids, sex hormones, steroids, and cholecalciferol. Cholesterol is transported into the blood via spherical macromolecules like chylomicrons, HDL, LDL, and VLDL. ^[2] These properties make it an essential biomolecule for most physiological mechanisms. Triglycerides performing a key role in providing energy to cells. ^[3] In excess amounts, these biomolecules are not good for health and produce hyperlipidemia. ^[4] Hyperlipidemia is responsible for many long-term side effects in the body. Hyperlipidemia increases the risk of formation of plaques, which promotes the risk of heart attack and stroke in persons with atherosclerosis and coronary heart diseases. ^[5] Statins are the evidence-based treatment option for hyperlipidemia according to published guidelines. 

INTRODUCTION: Patients Infected with CORONA VIRUS- 2019 (COVID-19) showed changes in their platelet counts and Mean platelet volume (MPV). The present study was aimed to observe any association between lowered platelet counts with mean platelet volume (MPV) from the corana positive individuals.
METHODS: It is a prospective study from 1-8-2020 to 30-9-2020 .Patients  who presented with complaints of Fever, sore throat, body pains, cough, breathlessness, diarrhoea were evaluated at the triage area of the Hospital. Throat swab was taken and RT-PCR was done and only 200 confirmed cases were included in the study. Patient blood samples were collected and processed in SYSMAX 5 -part Haematology analyser in the Hospital Central Laboratory. The patients CBP, Platelet count and MPV were tabulated.
RESULTS: Out of 200 COVID-19 confirmed cases, the numbers of males were 145 (72.5%) and females 55 (27.5%). Most of the patients belonged to age group 50 years (25.5%), 60yrs age group (21%).  The Maximum age in our study group was 80 years, minimum age was 19 years and mean age was 50 years. In our study it was noticed that Severe thrombocytopenia was seen in one patient with platelet count 38,000/μL,(0.5%), Moderate thrombocytopenia was seen in two patients(1%) and mild thrombocytopenia  was seen in 12 (6%) cases. In our study only fifteen cases (7.5%) showed thrombocytopenia. The MPV for all fifteen cases were studied and MPV was in Range of 9.6- 11.8 fl.
CONCLUSION: Low platelet count and high MPV are associated with disease severity. Platelet count is one of easy cheap method for the assessing the disease severity along with other parameters 

Background- Persistent and recurrent warts pose a challenge to physicians. Despite the availability of multiple treatment options, warts are resistant to treatment. Intralesional Vitamin D3 and Autoinoculation both are promising treatment modality for multiple warts. AIM- To compare the efficacy and safety of intralesional Vitamin-D3 and autoinoculation in treating multiple warts. Patients and method- the study included 60 patients divided in two groups (group-A and group-B), each containing 30 patients. Informed consent was taken from each patient. Group-A patients received intralesional Vitamin-D3 0.2-0.5 ml every 3 weeks for maximum of four sessions. Group-B patients were treated by autoinoculation every 4 week for 3 sessions. RESULTS- At the end of 3 months 86.6% of patients showed response in group-A, Complete clearance was seen in 76.6% patients. Three months post autoinoculation (group-B), 66.6% patients showed response. Complete clearance was seen in 56.6% post autoinoculation in group-B. CONCLUSION- Intralesional Vitamin-D3 had the edge over Autoinoculation in palmoplantar, verruca vulgaris and periungual warts, while autoinoculation had the advantage in the plane variants.

     Tamsulosin is alpha-1 adrenergic receptor antagonist which can alleviate the symptoms of urinary tract infections in elderly men because it reduces spasm of periurethral smooth muscle fibers and reduce the obstruction around bladder. Thirty animals were separated into 3 groups. Group (1) is control group, group (2) received 0.4mg/kg/day of the medicine orally for seven days. Group (3) received 0.4mg/kg body weight of the medicine for thirty days. Results:  Group (2) liver tissue sections showed dilatation of portal vein, ballooning degeneration and necrosis of some hepatocytes while group (3) showed Severe congestion of portal vein with inflammatory cell infiltration and necrosis of most of hepatocytes. Microscopic examination of testis tissue slides of group (2) showed the tubules were less numerous, degeneration and necrosis of germinal epithelium while in group (3) testis sections showed reduced number of atrophied seminiferous tubules with interstitial edema. Vacuolation of spermatocytes and distortion of the process of spermiogenesis. It is concluded that tamsulosin can produce some histological effects on both liver and testis tissues when used for short duration (one week) while it can lead to harmful histological damage when it is given for long period (four weeks).

Context/Background: COVID-19 is an emerging and rapidly evolving situation. Though several vaccines have been developed and brought into general use, vaccine hesitancy still exists among the public. Assessing the awareness toward COVID vaccine among medical students is important since their perception and practice will have a significant impact on their family members, friends and relatives.
Aims/Objectives: This study aimed to assess the knowledge, attitude and practices toward COVID vaccine among medical students.
Methodology: A cross-sectional study was carried out among the undergraduate medical students of a medical college in Belagavi between May - June 2021. A total of 802 students participated in the study. A framed questionnaire assessing their knowledge, attitude and practice toward COVID vaccine was distributed to each participant.
Results: Most of the study participants were female (51%), and most of them were in the first year of their course at the time of the study (23.6%). Majority of them received COVID-19 related information from healthcare workers (72.7%). 92.8% and 92.6% of the participants responded that the vaccines control COVID-19 and it was by developing antibodies, respectively. 70.5% said that the vaccines should not be given to immunocompromised individuals. 82.2% of the participants have taken 2 doses of COVID-19 vaccination. Almost all participants (98.8%) felt that even after vaccination other measures like social distancing, wearing mask and avoiding social gathering are to be followed.
Conclusions: The findings in the present study show good knowledge, positive attitude and practice towards COVID-19. It is necessary to keep on with further education and training strategies to get a better understanding and positive attitude toward the pandemic for all medical students.

Acetabular fractures incidence accounts for 3 patients / 100,000 / year during the last 2 decades. Among acetabular fractures posterior wall accounts for most common acetabular fracture type (25%). The aims and objectives of the study was to evaluate the functional and radiological outcome of posterior acetabular fractures treated with different surgical techniques and the possible post operative complications.
METHODS
A total of 27 patients who had a history of either motor vehicle accident or accidental fall and were radiologically diagnosed with posterior acetabular fracture as per Judet and Letournel classification and underwent surgery for the same. Radiographs were taken after each follow up and patients were evaluated for functional outcome by Modified Harris Hip Score and surgical complications. Statistical analyses were performed using the Statistical Package for the Social Sciences software A p<0.05 was considered statistically significant.
RESULTS
In the present study, the age group range was between 20 and 71 years, and the mean age in the study was 41.9 years. Road traffic accident was the most common cause of fracture (80%) followed by accidental fall (20%) in our study. Right acetabular fracture was the most common (60%) followed by left (40%). Radiological union was achieved in thirteen cases (45%) by 4 months and in 12 cases (55%) by the end of 12 months whereas 2 patients developed non-union. Functional outcomes of all the cases were assessed in terms of Harris hip score grading. 60% of the cases had good, 15% excellent, 20% fair and 5% poor outcome in our study.
CONCLUSIONS
Operative treatment of displaced acetabular fractures gives satisfactory functional results. Functional outcome is better with patient operated within one week of injury than a delay of more than one week

Background:Identification of a person is of prime and foremost importance in both civil and criminal cases. Investigating officer has to make rapid and accurate assessments in identification of a culprit in criminal cases. The present study was conducted to assess relationship between footprint length and stature.

Complicated tooth caries / deep periodontal infections spreading beyond the alveolar bone are usually main stay of odontogenic oro- facial infections. They extend to involve the fascial planes around the face and oral cavity causing facial swelling and contour abnormalities. They tend to spread along planes of least resistance involving the supporting structures of the affected tooth. The abscesses around the apices of the maxillary pre-molar and molar teeth usually results in Oro-antral fistula and periapical abscesses involving anteriorly located teeth notably the incisors can lead to Oro-nasal fistula formation

Introduction
Various Studies have shown that the early- and late-onset schizophrenia patients differ and accompanied by impairments in several domains of cognitive function. Hence studying Cognitive impairment will be helpful to understand pathology and phenomenology of schizophrenia and giving cognitive remediation therapy in a better way.
Aims
To evaluate the neurocognitive impairment in Early-onset Schizophrenia and Late-onset Schizophrenia. To find out difference in severity of neurocognitive impairment between two groups.
Materials and methods
This study was approved by Institutional Ethical Committee, Madras Medical College, Tamil Nadu, India. The study subjects were taken from the Institute of mental health hospital.  For each group, 150 samples were taken. Administration of NIMHANS neuropsychological battery to both groups testing domains of, Working memory, Verbal learning & memory,  Auditory verbal learning test, Visual learning & memory and Mental speed. The results were statistically evaluated with IBM SPSS 20.
Results
Verbal N Back test hits were comparatively higher in late onset schizophrenia patients than early onset. Similarly the error was more in early onset schizophrenia patients. Visual N Back test hits were comparatively higher in late onset schizophrenia patients than early onset. Similarly the error was more in early onset schizophrenia patients. The time taken was similar in both the groups. The error due to digital vigilance test was more in early onset schizophrenia patients. The time taken for color trail test was significantly higher in early onset schizophrenia patients. The time taken for complex figure test was significantly higher in late onset schizophrenia patients. The time taken for Digital symbol substitution test was significantly higher in early onset schizophrenia patients.
Conclusions
In this study, early onset schizophrenia patients had more cognitive impairment than late onset schizophrenia patients in most of the measured cognitive domains.

Title: Evaluation of distal femoral fractures with locking compression plate using minimally invasive plate Osteosynthesis (MIPO) technique.Aim: To prospective and retrospective analysis of clinical and radiological outcome of distal femur fractures treated with locking compression plate by minimally invasive plate osteosynthesis (MIPO) technique.

Introduction: Dengue is one of the major re-emerging viral infections. In recent years, dengue has become a major global public health concern. In small subset of patients, there is life threatening condition with severe cytopenias and significant systemic response. The presence of macropage activation in dengue fever is well reported and could be one possible reason for mortality and morbidity. Dengue being an infective condition, a modest rise in ferritin levels and CRP are expected in dengue fever as well. In dengue fever sr. ferritin is disproportionately raised compared to any bacterial or viral infection.
Material and Methods: It was a prospective observational study conducted at MKCGMCH Berhampur over a period of 2 years from 2019 to 2021.The study population consisted of adults admitted to department of general medicine with diagnosis of dengue fever. 100 dengue patients admitted in dengue ward/to different wards of medicine department of MKCG Medical College, Berhampur were observed. Only who were seropositive for dengue fever NS1 antigen or IgM ELISA were recruited for the study. Their serum ferritin and CRP levels on the day of admission and on the fifth day were measured. The relationship between serum ferritin, CRP, platelets and severity of dengue fever was observed.
Results: Total number of uncomplicated dengue fever is 78 and that of severe dengue (DHF/DSS) is 22. The mean serum ferritin and CRP are high on day one as compared to day five, but the mean TPC on day five is high as compared to day one. Serum Ferritin and CRP are Negatively Correlated with the TPC in Linear Pattern in day one, which is statistically Significant. Serum Ferritin and CRP are Negatively Correlated with the TPC in Linear Pattern in Day Five, which is statistically significant. The mean TPC level on day one of hospitalization among DF, DHF, DSS are 79766.7, 1006.3 and 19100 respectively. The mean TPC level on day five of hospitalization among DF, DHF, DSS are 79766.7, 1006.3 and 19100 respectively. The above figures show that, the mean ferritin and CRP level on day five are significantly high among DHF/DSS as compared to DF.

Fracture neck of femur is a leading cause of hospital admissions in elderly age group. The number of such admissions is on a rise because of increased longevity, osteoporosis and sedentary habits. Conservative methods of treatment is not acceptable because it results in nonunion with unstable hip and limitation of hip movement as well as complications of prolonged immobilization like bed sores, deep vein thrombosis and respiratory infections. The present study was a prospective study of 20 cases of fracture neck of femur admitted to hospital. Cases were selected according to inclusion and exclusion criteria i.e., patients with intra-capsular fracture neck of femur above the age of 50yrs. Medically unfit and patients not willing for surgery were excluded from the study. At the final one year follow up assessment with Harris Hip Score 6 patients (30%) achieved 'Excellent' result, 9 patients (45%) achieved 'Good' result, 2 patients (10%) achieved 'fair' result and 3 patients (15%) achieved 'poor' result. Overall, 75% of the patients achieved an excellent or good result. On enquiry regarding the overall satisfaction with the procedure and return to pre-fracture levels of activity, 8 patients (35%) were 'very satisfied', 12 (50%) were 'fairly satisfied' and 2 (15%) were 'not satisfied'.

Obstetric care begins with determining gestational age, which has the least variability in early pregnancy. This current study was planned to provide an overview of fetal kidney length and volume as a useful adjunct parameter for better determination of gestational age.
MATERIALS AND METHODS
Normal singleton pregnancies from 18–40 weeks of gestational age, referred to the department of Radio-diagnosis and Imaging at VIMS & RC, Bangalore. Fill PC-PNDT [Prenatal Diagnostic Technique] form i.e Obstetric ultrasonography were performed using Affinity 50 G pro ultrasound scanner using a 3.5 MHz convex probe. Images were recorded in the system as DICOM.
RESULT
Out of 200 patients who presented themselves for routine obstetric ultrasound scan within the period of study, 150 patients met the inclusion criteria [18^th week of gestation to term] and were selected for the study while patients were excluded from the study for the following reasons; for not remembering their LMP, fetus with IUGR, 10 patients presented with oligohydramnios, poly-cystic renal dilated renal pelvis. It correlates strongly with gestational age while the relationships between right and left kidney lengths with gestational age were established. However no correlation of gestational age with volume. Fetal kidney length increases with increase in FGA and shows excellent intra and inters class correlation coefficient which suggests good agreement and reproducibility of measurements. 

Circumcision is a procedure of removal of prepuce skin for various causes including religious reasons. Usually it is done after adequate sedation or regional anesthesia. In our study we performed the surgery using EMLA cream i.e eutectic mixture of lignocaine 2.5% and prilocaine 2.5%. This study is conducted in order to assess the suitability and efficacy of surface anesthetic cream for doing day care procedure. Results were obtained by observation during surgery and post operative period follow up. In our study we performed circumcision using EMLA alone in 45 out of 70 cases. Remaining 25 cases required additional form of anesthesia.
Thus we concluded that EMLA is beneficial for performing circumcision in limited number of patients only especially for adult patients. Pain is mostly experienced at frenular region only even before the start of the procedure. Thus additional anesthetic agents are given in order to perform the surgery.

Postoperative vomiting or retching (POV) can lead to rare but serious medical complications, such as wound dehiscence, bleeding, electrolyte imbalance, dehydration and pulmonary aspiration of gastric contents. Hence the present study was planned to find out the effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under combined spinal epidural block. Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives.
Methods: 110 female patients who are undergoing total abdominal hysterectomy were included in this observational study. Patients were divided into two groups. 54 patients in group A and 56 patients in group B. Group A received 8mg dexamethasone i.v along with premedication The primary outcome variable was to compare post-operative nausea and vomiting using numerical rating scale (NRS). Secondary outcome variable was visual analogue scale of post- operative pain and overall patient satisfaction.
Results: Age, height, weight, ASA and hemodynamic parameters were compared between the 2 groups but were statistically insignificant. The PONV scores were significantly lower in group receiving dexamethasone during 0.5, 6, 12, 24h postoperatively. The VAS score for post- operative pain was also significantly lower in group receiving dexamethasone. Over all patient satisfaction was much better in those receiving dexamethasone as part of premedication, the total analgesic requirement was also significantly lower. There were no complications.

Introduction: Immunotherapy is emerging as a new modality of treatment for cutaneous warts by enhancing cell mediated immunity. Immunotherapy is replacing destructive modalities such as electrocautery and cryotherapy due to its advantages over former, such as affordability, easy availability and minimal downtime. The most common immunotherapeutic agents for warts include intralesional vitamin D3, Measles Mumps Rubella (MMR), Bacille calmette-Guerin (BCG) and Purified protein derivative (PPD).
Aim: This study aims to evaluate the safety and efficacy of intralesional vitamin D3 for the treatment of cutaneous warts.
Objectives

To provide better quality of life.
To assess the clinical response regarding the treatment given.

Material & Methods: This is a prospective observational study conducted from February 2021 to January 2022. Forty clinically diagnosed patients with cutaneous warts were taken up for the study after taking written informed consent. Patients were injected with vitamin D3 (0.2 mL, 15mg/mL) at the base of the wart after injecting with lignocaine earlier. The injections were repeated at an interval of 2 weeks for a maximum of 4 sessions or until clearance of warts, whichever was earlier. A maximum of 2-3 warts were treated per session, and patients were followed up for 6 months after the last injection.
Results: Forty patients with multiple warts were recruited for the study. Of these, 26 (65%) had palmoplantar warts, 8 (20%) were verruca vulgaris, 4 (10%) had filiform warts, and 1 (3%) periungual wart. One patient had all the types of warts. Out of these, 26 (65%) showed complete resolution, 9 (22.5%) showed moderate response and 5 (12.5%) had a mild response. Recurrence was observed in 5 (13%) patients during 6 months of follow-up. Serum vitamin D3 levels were found to be low in most patients.
Conclusion: Intralesional vitamin D3 is safe, effective, affordable and hassle-free procedure both for patients and dermatologists with minimum downtime.

The rapid development of life is leading the demand of colors in biotechnology in field of food, textile, medicine and cosmetics and healthcare products. There is ever growing demand of eco-friendly/non-toxic dyes as coloring agents of food to overcome health hazards.  The risks of synthetic colors compel the industries to adapt natural pigments. The search for new sources of natural pigments has increased, day to day because of the toxic effects caused by synthetic dyes. Recently fungal species are being treated as the natural pigment producers with enormous biotechnological applications. Almost all the genus of fungi synthesize various pigments such melanin, phenazines,flavins,carotenoids, violacein, indioankaflavins. So far these pigments are isolated,screened, and characterized for many biotechnological purposes in food, textiles, medicine, cosmetics health care products. However sequencing of pigment producing genes and generation of new varieties of pigments by rDNA technology may lead to revolutionary success in pigment production market in food, textile, medicine, cosmetics and health care products by a natural means. Study on pigment producing fungi using cloning technology may pave a path for ecofriendly generation of varieties of colors which further can be explored in many biological applications.

In many cases, the analysis of a specific protein is hindered by the inability to purify large quantities of it from a native source. It's possible that proteins of interest are only found in trace amounts, or that attempts to purify them have been hampered by technical difficulties. DNA recombinant techniques have allowed researchers to overcome some of these limitations by producing large quantities of purified proteins from nonnative systems. Biotin labelling proteins with biotin is a useful tool for a wide range of applications because of the strong affinity between biotin and avidin or streptavidin. The biotin ligase from Escherichia coli, BirA, biotinylates a lysine side chain in a 15-amino acid acceptor peptide (also known as Avi-tag). We developed a method for producing recombinant BirA ligase for in vitro biotinylation of Avi-tag-bearing proteins. The target protein was expressed in both thioredoxin and MBP fusions, and the corresponding fusion was released by TEV protease. The HisTrap HP column was used to separate the free ligase from its carrier. In the case of thioredoxin and MBP fusion constructs, we obtained 24.7 and 27.6 mg BirA ligase per litre of culture, respectively. The recombinant enzyme was found to be extremely effective in vitro when it came to biotinylation. The procedure outlined here is an efficient way to make BirA ligase, which can be used to biotinylate a variety of Avi-tag-bearing substrates

Introduction: Liver disease is a common disorder affecting multiple system. It accounts for approximately 2 million deaths every year worldwide and 1 million due to complications of cirrhosis. Current epidemiological trends show that common liver diseases in Asia–Pacific countries are alcohol-related liver diseases, non-alcoholic fatty liver disease (NAFLD), hepatitis B and C, etc. Most of them lead to cirrhosis of liver. Renal dysfunction is one of the most common complications of cirrhosis with high morbidity and mortality.
Materials and Methodology: This study was adopted to be conducted as hospital-based study was carried on 133 cirrhotic patients admitted in the Tertiary care centre. Patients details that includes their demographic data, clinical examination findings and results of laboratory investigations were collected. CTP (Child Pugh) score and MELD (Model for End Stage Liver disease) Score of patients were also briefed. End results for continuous variables were expressed as means and standard deviation. Categorical variables were described as percentages. Significant factors that were associated with the presence of renal dysfunction was analysed using binary logistic regression analysis Bivariate analysis was carried out using pearsons coefficient of correlation. Odds Ratio (OR) was enabled to ascertain the strength of relationship between two variables.
Results: A total of 133 patients were included in this study. Male patients were in majority constituting 85.3% (n=113) of the total population, the rest were females (14.7%). Mean age of patients in the study group was 51.32 years (+ 13.72). The most common aetiology of cirrhosis was found to be alcohol, comprising of about 74.5%. 22 patients had more than 1 aetiology for cirrhosis, the most common of which has combined alcohol and NASH (Non-Alcoholic Steato Hepatitis) related, observed in 9 patients.
Conclusion: The present study has found significant correlation between the severity of liver dysfunction and some parameters of renal dysfunction. However, there is no such significant association was observed between the distribution of various renal parameters among different aetiologies of chronic liver disease.

Background: Urinary tract infection isamong the most common bacterial infections ingeneral population.The etiology as well as antibiotic sensitivity pattern of UTI varies with the widespread availability of antimicrobial agents; As a result of widespread use of antimicrobial agents, UTIs are becoming increasingly difficult to treat as pathogens with increasing resistance to commonly used antimicrobials are encountered more frequently in clinical practice.
Methods: A cross-sectional study done during April 2021-April2022. All positive urine culture and sensitivity reports of males and females aged 10-80years were included. A total of200 positive urine culture cases were taken from the culture and sensitivity register from Microbiology department of Hindu Rao Hospitaland details were tabulated using a questionnaire.
Results: Out of200 adults, males were 62 (31 %) and females were 138 (69 %). E. coli (63.1%) was the most common organism, followed byEnterococcus (17.68), Klebsiella Pneumoniae (11.1%) Pseudomonas and Staphylococcus. The incidence of UTI was morein female patients in the agegroup of21-30years.E.coli andKlebsiella weresensitive to Amikacin (97.1%), Nitrofurantoin (90.7%), Gentamycin and Imipenem. Both organisms were resistant to Ampicillin (>90%).
Conclusions: In this study, females were predominately affected and on culture the most common organisms were E. coliand Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. While planning treatment for UTI the sensitivity and resistance pattern ofuropathogensto common antimicrobial agents must betaken into account.

Background: Fast bowling in cricket is associated with a high prevalence of lumbar spine stress injuries, especially in adolescents. This cannot be correlated with risk factors identified in adult players. This study aimed to examine the incidence of lumbar spine stress injuries in adolescent fast bowlers as a prospective study so as to predict risk factors.
Methodology: 32 asymptomatic male fast bowlers (aged 14–17 years) received baseline & annual lumbar dual-energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI) scans, musculoskeletal and bowling workload assessment. These were followed up after one year to calculate the prevalence at baseline and annual incidence. Potential risk factors were compared between the injured and uninjured groups using T-tests with Hedges’ g effect sizes.
Results: At baseline, 7 cricketers (21.8%) had evidence of lumbar spine stress injury. Subsequent incidence was 27.3 ± 18.6 injuries per 100 players per year (mean ± 95% CI). Injured bowlers were older on average at the beginning of the season preceding injury (16.7 versus 15.5 years, g = 1.396, P = 0.047)
Conclusion: Risk of lumbar spine stress injury coincides with increases in bowling & cricketing workload as well as intensity as bowlers step up playing levels to more senior teams during late adolescence whilst the lumbar spine is immature and less robust.

Introduction: An intertrochanteric femur fracture is one of the most important health problems amongst the elder population.
Aim: To evaluate the functional outcome and complications of cemented bipolar arthroplasty in unstable intertrochanteric femur fracture in Indian elderly patients.
Methods: This study was conducted in the Department of Orthopedics, SMS medical college, and associated groups of hospitals, Jaipur between July 2017 to Dec 2019. 30 cases of unstable [four-part] Trochanter fracture have been included in this study.
Results: The average age of the study patient was 75 years with the involvement of the left side in 55%. There was no case with the poor radiological result. There were two cases reported with limb lengthening less than 2 cm, and two patients with limb shortening one with < 2cm and one with > 2cm but these patients had good harris hip scores. At the final 1-year follow-up harris hip scoring system, 36-36% of patients had an excellent result, 46.66% had a good result, 10% of patients have fair results and 6.66% have a poor result. The patients who showed poor scores suffered from multiple medical problems and poor preoperative general physical health.
Conclusion: According to our result, we believe that cemented bipolar hemiarthroplasty is of choice in the freely mobile elderly patient above seventy years of age with an intertrochanteric femoral fracture.

Introduction: As it has to aware that the breast cancer is the commonest cancer among women around the globe. Diffusion Weighted Imaging (DWI) helps to evaluate the physiological and functional environment of the lesion by observing the random motion of water molecules, tissue cellularity, fluid viscosity, membrane permeability and blood flow pattern that could be measured quantitatively by Apparent Diffusion Coefficient (ADC) values.
Materials and Methodology: A total of 70 patients with histo-pathologically proven breast carcinoma form the study sample in the study (3 patients had bilateral malignancy). MRI examinations were performed within 2 weeks before surgery. All the 70 participants who had done breast MRI underwent surgery. Statistical analysis was performed using SPSS (Statistical package for social science version16.0 for windows). Students T test and Analysis of Variance (ANOVA) were used to study the difference in ADC between two groups.
Results: Out of all the total 70 breast lesions, 53 lesions were (76%) single, while 9(13%) were multifocal carcinoma and 8 (11%) were multicentric multifocal breast carcinoma. Histological types included invasive ductal carcinoma no special type (65) invasive lobular carcinoma (1) mucinous carcinoma (2) papillary carcinoma (1) medullary carcinoma (1). The ADC value was correlated with pathological grading of the tumour (r = ‑0.497, P < 0.001).
Conclusion: DWI usually takes short acquisition time and post‑processing time and does not require any administration of contrast dyes and provides a real-time quantitative functional parameter for evaluating the tumour aggressiveness.

Background: The traditional way of classification of ascites by AFTP offers little insight to the pathophysiology of ascites formation and it has further drawbacks. In order to overcome it the classification of ascites based on SAAG has emerged. Even SAAG also has some draw backs like non correlation with ascites due to nonalcoholic cirrhosis and difficulty in identifying the ascites due to mixed etiology. So, the study is conducted to compare the serum ascetic fluid albumin gradient (SAAG) with ascetic fluid total protein (AFTP) in hepatic and non-hepatic causes of ascites at tertiary care center.
Materials& Methods: A hospital based prospective study done on 80 patientswho were admitted in the medical ward under Department of General Medicine, General surgery and radiation oncology in SMS Medical College, Jaipur, Rajasthan. They are classified on the basis of SAAG into High SAAG and low SAAG and on the basis of AFTP into Transudate and Exudate. After the etiology of ascites evaluated by various diagnostic procedures the sensitivity, specificity and diagnostic accuracy of SAAG and AFTP in identifying the pathophysiology of ascites calculated separately. The diagnostic accuracies of SAAG and AFTP compared statistically.
Results: Our study showed that the mean age was 50.23 years. Male to female ratio was 2.33:1. The cirrhosis occupies the maximum with 60%, liver metastasis, Antenatal with Hypertensionoccupiestheleastwith1.25%each. The diagnostic accuracy of SAAG and AFTP for individual aetiologies of ascites were found and compared. SAAG was found to be superior to AFTP with a P value of <0.01 which was statistically significant.
Conclusion: We concluded that the diagnostic accuracy of SAAG and AFTP was compared and SAAG was found to be superior to AFTP and it was proved statistically significant.

Background: Triage is performed for inpatient urgent surgery at the majority of hospitals and is determined by the degree of urgency as well as the time of surgical booking. It is possible that the postoperative course will be affected if, as a result of sharing resources among specialists, patients need to wait longer for semi-urgent surgeries. The purpose of this research is to investigate whether or not there is a correlation between the length of time before semiurgent surgery and the postoperative duration of stay in the hospital for neurosurgical patients.
Materials and Methods: A retrospective cohort study was carried out between June 2020 and  May 2022 at the  Guntur Medical College & General Hospital, and it included all of the adult patients who were admitted and placed on the semi-urgent surgery list during that time. A combination of linear and logistic regression analysis was carried out. The most important factor to consider for the exposure was the amount of time that passed between the surgical booking and the actual operation, whereas the most important factor to consider for the result was the amount of time that passed between the operation and the patient's discharge.
Results: The research looked at a total of 1,367 different instances of neurosurgical treatment. 54.3 years was the average age of the population. Before surgery, patients spent an average of 1.2 days in the hospital, whereas those recovering from surgery stayed there for an average of 12.5 days. In all, the amount of time that passed between the booking of the procedure and the actual discharge did not change. In the group of patients who were later transferred to another facility, a longer postoperative stay was related with increased age, a higher ASA score, and procedures done more than 24 hours after the initial patient booking.
Conclusion: Patients who neurosurgery procedures had scheduled to be performed within the next 24 hours had to wait longer for their procedures to be finished. Although there was an increase in postoperative stays among patients who were sent to another hospital and had their procedures conducted beyond 24 hours, there was not a significant association between the amount of time waiting for surgery and postoperative stay in the aggregate.

Background: To study and assess the predisposing factors, age, sex distribution, modes of presentation, and management strategies of chronic subdural hematoma.
Materials and Methods: It was a Prospective study. The study was carried out during the Period from March 2020 to January 2022. Sample size included 30 patients. Informed consent will be taken from all the patients included in the study.
Results: A total of 30 patients were included in my study.  In this study, the majority of the patients were > 60 year of age (40%). The youngest patient was 30yrs, and the oldest was 84 years. The mean age (59.2 years).   The mean GCS was 8 in patients with LOC, 8.36±0.74 in those with altered sensorium, and 9.5±3.78 in patients with seizures. The GCS was comparatively better in patients with weakness (12.14±2.79) and headache (15). In the present study 40% of pt came with GCS 13- 15, and 36.6% came with GCS 9-12. In the present study out of 30 patients, 17 patients (56.7%) had right side involvement, 12 patients (40.0%) had left side involvement and 1 patient (3.33%) had bilateral involvement. More than 95% of patients had FTP involvement. Out of 31 scans, 74.1% of patients had a homogenous type and 22.5% had a layered type appearance on CT.
Conclusion: All patients are managed with burr hole tapping and placement of a subperiosteal drain. On further follow-up, around 2 to 3 months, SDH is completely resolved in all 29 patients and no recurrence of CSDH is noted.

Nosocomial infections or healthcare-acquired infections are a common cause of increased morbidity and mortality among hospitals patients. Patients are at an increased risk for these infections due to their health states. Considering these adverse effects on and the socioeconomic burden, efforts should be made to minimize the transmission of these infections and make the hospitals a safer environment. These infection rates can be significantly reduced by the implementing and improving compliance with the “care bundles.” the common nosocomial infections such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSI).ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit (ICU). It is a pulmonary infection that occurs after at least 48 hours of intermittent positive-pressure ventilation (IPPV), and is a leading cause of morbidity and mortality. The incidence of VAP ranges from 10% to 65% of intubated patients depending on the risk factors. This study aimed: To assess prevalence and determinants for nosocomial inflections (NI) among patients in ventilator at Makkah Al-mukarramh hospital Saudi Arabia. Methods: A cross -sectional research design was carried out between Feb 2021 to May 2021 included 300 of patients in ventilator, who were randomly selected from hospitals. A structured questionnaire and observation checklist was used for data collection.  using 3part Questionnaire and analyzed via SPSS v24 software. Chi-square test was run to analyses associations between socio-demographic data. Results: The distribution of pathogens is demonstrated, level of education, monthly income, hospital stays, BMI, chronic Medical conditions show that a significant relation between Nosocomial infection and Chronic Medical conditions were P-value=0.000 Conclusion: The study's found that prevalence of nosocomial inflections among patients in ventilator in a Tertiary Care Hospital . Therefore careful disinfection and strict procedures of nosocomial inflections are necessary in places that serve nosocomial inflections patient. Moreover, a vision for the improvement of reports and studies in hospitals to report the rate of the nosocomial inflections, hence, there is a need to raise awareness as well as training on nosocomial inflections among patients in ventilator

Type 2 DM hyperthyroidism is reported to be more common as compared to normal people. In many patients, uncontrolled hyperthyroidism may be the reason for poor glycemic control and recurrent diabetic ketoacidosis. In response to hyperthyroidism gut absorption of glucose is increased along with endogenous glucose production. Randomly selected 100 patients, both male and female with type 2 diabetes mellitus above age of 40 years including newly diagnosed diabetics attending hospital were included in this study. Among the study group of 100 patients 2 patients had high T4 value, 8 patients had high TSH values and 4 patients were low TSH values.

Diabetes mellitus found to be leading cause of mortality and morbidity in worldwide in the future and it is a predisposing factor for cardiovascular disease. End stage renal disease, adult blindness, lower extremity amputation (non-traumatic) are the leading causes in diabetes mellitus. Diabetes mellitus is one of the most common health problems facing mankind and is a major public health problem. Randomly selected 100 patients, both male and female with type 2 diabetes mellitus above age of 40 years including newly diagnosed diabetics attending hospital were included in this study. Among the study group of 100 patients 46% patients had hypertension and 10% had ischemic heart disease. Among the study group of 100 patients 48% had positive family history and 52% had negative family history. Among the study group 100 patients 5% had HbA1C less than 6, 56% had between 6-7.5 and 39% had HbA1C above 7.

Thyroid hormones affect glucose metabolism through several mechanisms. Hyperthyroidism has been recognized to promote hyperglycemia. During hyperthyroidism, the half-life of insulin is reduced most likely secondary to an increased rate of degradation and an enhanced release of biologically inactive insulin precursors. Randomly selected 100 patients, both male and female with type 2 diabetes mellitus above age of 40 years including newly diagnosed diabetics attending hospital were included in this study. Out of 12 patients 4 patients (33.3%) had systemic hypertension and 1 patient (8.33%) had ischemic heart disease, compared with normal thyroid profile group it is of no statistical significance with P value of 0.896. Comparing mean HbA1C of patients with abnormal thyroid profile with that of patients with normal thyroid profile it has no statistical significance with P value of 0.7944

Headache is a commonly reported complaint among Covid19 patients, and cases of chronic head aching have lately been documented several weeks after illness recovery. Raised intracranial pressure (ICP) plays a key role in the causation of head ache, Raised ICP if not timely treated leads to brain complications. The study aims to compare the incidence of elevated ICP in post-covid populations to that of the general population, and the objective of study is to assess the features of raised intracranial pressure in post covid and in general population by using CT
Method:
Current study was conducted on 150 subjects who have headache symptoms, in which 75 had Covid history and other 75 from general population. The brain CT image of this 150 subjects evaluated to assess ICP And for identifying the comparison between post covid subject with normal subject. This is study done at DR. PSIMS&RF,Gannavaram,AndhraPradesh.CT brain examinations were performed on 16slice SEIMENS CT machine in the department of radiodiagnosis. CT brain images of patients with headache complaints were evaluated.
Results:
CT Brain images of 150 subjects who came with complaints of headache were evaluated.75 patients among them had past covid history, rest 75 were taken as general population group. In the post covid group 32 patients (42%) had raised ICP features&18 patients (24%) in general population had raised ICP features. Bilateral tortuous optic nerve sheaths were found in 34 patients (45%) in post covid group as opposed to 21 patients (28%) in the general population group. Partial empty sella was found in 35 patients (46%) of post covid group as opposed to patients 21(28%)in the general population group. Patients who had both partial empty sella and bilateral optic nerve sheath dilatation were considered to be of raised ICP to rule out other etiologies

Background: Complicated external hernia is common and serious; no definitive clinical criterion is able to differentiate strangulation or infarction. Surgeons therefore, have difficulty in choosing the appropriate treatment (manual reduction or emergent operation) and determining the ideal approach for these cases. This study was aimed at identifying the risk factors for developing complicated hernias and its predictive factors.
Methods: This is a prospective observational study of 53 cases with clinical diagnosis of all types and varieties of irreducible hernia. The patient information regarding type of hernia, time duration before occurrence of irreducibility, duration of irreducibility, type of complication of irreducible hernia and presenting symptoms were collected and  analysis was done by SPSS software version 2.
Results: Majority of the cases of irreducible hernias were males (77%) seen in 5th and 6th decade (47.2%). Contents of hernia and duration of irreducibility were significantly associated with viability of contents of hernia. Majority of the hernias with bowel as content and those with increased duration to irreducibility were non-viable. The Sensitivity and Specificity of ultrasound viability were found to be 50%, and 100% respectively in detecting the viability of hernia.
Conclusions: The factors affecting the viability of contents of hernia in our study are mainly contents of hernia and duration of irreducibility. Bowel as the content of hernia and increased duration to irreducibility poses higher risk for viability of contents of hernia.

Background: The anterior abdominal wall hernia is commonly encountered in surgical practice. When they present as complicated hernia, the complication, morbidity, and mortality are high even after standard protocol management. The present study was undertaken to assess the incidence of irreducible hernias presenting with complications, mode of clinical presentation and management of irreducible hernia.
Method: During the study period from May 2019 to Nov 2021, a total 53 clinically diagnosed case of irreducible hernia were studied which included groin hernia (66.6%) and anterior abdominal wall hernia [incisional hernia (22.6%), umbilical (1.88%), epigastric (1.88%), paraumbilical (3.9%)].
Results: The incidence of irreducible hernia was 3.2% (1650/53). Duration of existing hernia was common in 86.7% cases after 1-year. Maximum cases (74.8%) presented within 24-hours of onset of symptoms. The commonest symptoms were irreducible swelling (100%) and pain (85%). Maximum (52.8%) cases presented with bowel obstruction as complication. Cause of irreducibility was neck of hernial sac (56%) and adhesions (43.4%). Commonest operative procedure was release of constriction (56.6%) and adhesiolysis (43.3%). 56.6% cases developed post-operative complications and surgical site infections (SSI) was the commonest one (33.9%). No recurrence found during the study period. 3(5.6%) patients were expired, 2 patients died because of septicaemia secondary to anastomosis leak and 1 case ARDS. Conclusion: The present study clearly shows longer duration of existing hernia, existing co-morbidities, delay in operation in irreducible hernia is associated with definite complications and mortality. Hence, earlier hernia repair and not wasting crucial time when patient of irreducible hernia comes to hospital.

Background: The main aim of the present study was to assess the prevalence of caregiver burden among the family members of persons living with HIV.
Methods: A cross sectional hospital based study was conducted at ART PLUS centre GMC Jammu, over a period of 1 year from November 2018 to October 2019 after IEC permission. Written and Informed consent was obtained from each participant and predesigned and valid questionnaire was administered to each participant. During the interview, caregivers were asked about their demographics, including gender, age, educational status, employment status, marital status and annual income. Caregivers were asked about their level of caregiver burden through ZARIT QUESTIONNAIRE.
Results: There were a total of  100 caregivers participated in the study done over a period of 1 year conducted in GMC JAMMU. The majority were females (56%). Their age ranged from 17- 77 years and the mean age of the participants was 44.89 years (SD= 15.035). Most of them was in the age groups 17-30 years old (22.5%) and more than 60 years old (22. %).The mean caregiver burden score for the caregivers of PLHIV in this study was 51.85 (SD=17.5), range 0-88. The largest group of the participants (59%) reported “moderate to severe” caregiver burden. 29% caregivers living with HIV positive patients experience severe burden. 12% had only mild to moderate burden. Out of 100 caregivers, 91 were married (91%).26 out of 91 (28.8%) suffered severe burden and 54 (59.3%) suffered moderate to severe burden where as 3 of 9 (33.3%) unmarried caregivers suffered from severe burden and 5(55.6%) of them had moderate to severe burden. Mild burden is noted in 12.1 % married caregivers and 11.1% of unmarried caregivers.
Conclusion: Majority caregivers of PLHIV experience caregiver burden. Intervention including care plan should be given to caregivers to minimize risk of burden and depression and increase their quality of life. This study also emphasizes that correct interventions at the right time will give the caregiver a better quality of life with lower stress and higher wellbeing of a caregiver.

INTRODUCTION: -Heart failure is among key reasons of hospitalizations throughout the world. Prevalence is 1% among the ages of 50 and 59 years, gradually growing to >10% over age of 80 years. In patients with heart failure, concomitant and notable renal impairment is prevalent. Heart failure is increasingly being classified as a type of cardiorenal failure, in which there are contemporaneous cardiac and renal dysfunctions, each of which         accelerates the progress of the other.
AIMS AND OBJECTIVES:-To study the etiology, risk factors and clinical outcomes of heart failure and cardiorenal syndrome.
MATERIALS AND METHODS: - The present study is an observational study conducted at Sri Aurobindo medical college and Post Graduate Institute, Hospital ,Indore on 75 patients admitted in Medicine ward, Medicine emergency and Medicine ICU.
RESULTS:-The major risk factor which associated with mortality was coronary artery disease  73.5%.Type 2 diabetes mellitus was present in 62.5% patients while hypertension in 42.7%. Smoking was the risk factor in 46.2% and alcohol in 41.7% patients, COPD was present in 8.2% cases. NYHA grade 4 was more common and was seen in 79.2% while NYHA grade 3 in 22.8% cases.
CONCLUSION: Cardiorenal syndrome is very common in people who have heart failure. Patients with heart failure who have had two or more previous hospitalizations, sepsis, history of CAD and hypothyroidism are more likely to develop cardiorenal syndrome. The development of cardiorenal syndrome is an independent predictor of frequent readmissions, In addition to longer hospitalization and slower recovery, under treatment of the cardiorenal syndrome has the potential to be fatal on an individual level and have massive public health repercussions.

Background: In adult patients undergoing four-port elective laparoscopic cholecystectomy at a tertiary care hospital, the purpose of this study is to determine whether or not the removal of the gall bladder (GB) through the umbilical port is associated with more pain at the port site when compared to the removal of the GB through the epigastric port.
Materials and Methods: Patients over the age of 18 who were scheduled to undergo elective laparoscopic cholecystectomy at our facility in 2021 and who were randomly assigned to either group 1 or group 2 were evaluated for the purpose of this study. A VAS was used to evaluate the patient's level of pain at 1, 6, 12, 24, and 36 hours following surgery by a registered nurse.
Results: At 1, 6, 12, 24, and 36 hours following surgery, the VAS for pain measured at the umbilical port was lower than the VAS for pain measured at the epigastric port, and this difference was statistically significant (p-value 0.001). After correcting for age, sex, duration of surgery, and supplementary analgesic use, multiple linear regressions were done for port site pain after 24 hours. The results showed that the VAS at the umbilical port was lower than the epigastric port, with a difference in VAS of 0.9.
Conclusion: When patients are undergoing elective laparoscopic cholecystectomy, retrieving the gall bladder through the umbilical port is related with less pain at the port site than retrieving the gall bladder through the epigastric port. For the removal of the gall bladder, we recommend using the umbilical port.

Background: Inflammation and oxidative stress contribute to persistent heart failure (CHF). Bisoprolol is better than carvedilol at protecting CHF patients' myocardium, according to our earlier clinical trial. Low high-sensitivity cardiac troponin T showed this (hsTnT).
Materials and Methods: From the 87 people who took part in the trial, 48 (26 in the bisoprolol group and 22 in the carvedilol group) were included in this study because they had measurements of derivatives of reactive oxygen metabolites (d-ROMs) as an indicator of oxidative stress at the beginning and end of the trial.
Results: High-sensitivity C-reactive protein (hsCRP), a marker of inflammation, went down in both groups, but the drop in the bisoprolol group was bigger than the drop in the carvedilol group. Both groups also had a drop in d-ROMs, but the drop in the bisoprolol group was not as big as the drop in the carvedilol group. The change in hsTnT was linked to the change in hsCRP for all 48 patients (R = 0.467, p = 0.003).
Conclusion: Bisoprolol might be better than carvedilol at reducing inflammation, but carvedilol might be better at reducing oxidative stress than bisoprolol. Patients with CHF could benefit from the right use of bisoprolol or carvedilol based on their own pathophysiology.

Background: To outline the current patient profiles and treatment regimens, including antithrombotic care, for post-myocardial infarction (MI) stable coronary artery disease (CAD) patients from various geographical locations who are at high atherothrombotic risk.
Materials and Methods: 25 medical professionals (96% cardiologists) from india (2021-2022) enrolled patients 50 years old with prior MI 1-3 years ago and 1 risk factor (age 65, diabetes, second prior MI>1 yr ago, multivessel CAD, creatinine clearance 15–60 mL/min) in the prospective TIGRIS trial.
Results: 225 post-MI patients were enrolled (median 1.8 years): 52% with prior ST-elevation MI, median age 67, 24% women, 67% caucasian, 55% with 2 additional risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure 140/90 mm Hg. 81% of MI patients had PCI (66% with drug-eluting stents). 75% of patients were discharged on dual antiplatelet treatment, mostly clopidogrel (75%). 63% had stopped antiplatelet therapy (1 year) on doctor's advice (90%). At enrollment, 97% were taking an antithrombotic medication, most commonly ASA (88%), with 27% on DAPT (median duration 1.6 years); highest (39%) in Asia-Pacific and lowest (12%) in Europe.
Conclusion: 1 in 4 post-MI patients didn't undergo DAPT for 1 year, despite guidelines. Contrary to guidelines favouring newer ADPris, clopidogrel was given. Prior to current RCT results supporting DAPT>1 year post-MI/PCI, >1 in 4 patients continued on DAPT, despite international variation.

Background: The traditional view that the vast majority of clavicular fractures heal with good functional outcomes following non operative treatment is no longer valid. Recent studies have identified a higher rate of non-union, late neurovascular compromise and specific deficits of shoulder function in subgroups of patients with these injuries who are treated by conservative means. To study the functional outcome osteosynthesis of clavicle fractures using anatomical Locking compression plate.
Materials and Methods: Study was conducted on 20 patients with displaced/comminuted clavicle fractures. All the patients were treated by open reduction and internal fixation with 3.5mm anatomical LCP plate and screws. Functional outcome was recorded at regular intervals postoperatively at 6,12 & 24 weeks according to Constant Murley scoring system.
Results: According to Robinsons classification 2 were 1B1 type, 6were 2B1,8 were 2B2 and 4were 3B1 type. Range of motion was well maintained in all patients. The values were as of the normal contralateral shoulder, 82% of patients having >90% of the normal function (Excellent grade) at last follow up.
Conclusion: Clavicle fractures should therefore be viewed as a spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualized treatment, and plate osteosynthesis should be preferred for the treatment of indicated clavicle fractures in young active individuals.

Background: Acute renal failure (ARF) is a generic term for an abrupt and sustained decrease in renal function resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products. To determine the cause, prognosis and outcome in patients of Acute Kidney Injury (AKI) admitted in a tertiary care hospital.
Materials and Methods: A Hospital based Prospective study was conducted in Department of Medicine, NRI Medical College for a 1 year period (From Septembet 2021 to Aug 2022). Universal Sampling Technique was used for selection of study subjects. All the patients coming to medicine department during the study period and fulfilling the xiii inclusion criteria were taken for study after taking prior informed consent. Final sample size was 138 subjects of Acute Kidney Injury of varied etiology.
Results: Mean of study subjects was 48.9 years (range from 19-87 years) with M:F ratio of 4.75:1. Most common etiology for AKI was Sepsis (14.5%) and Malaria infection (14.5%) followed by Dengue, AGI and Leptospirosis (11.6% each). Multi organ dysfunction (14.5%) was observed in patients of Sepsis and Lepto. Out of total patients, 92 (66.7% %) had stage II AKI, while 46 (33.3 %) had stage III AKI according to AKIN staging.A total of 11.6% patients were on dialysis. Two out of 46 patients of AKI stage III (8.7%) and one patient out of 92 (2.2%) belonging to AKI stage II died during the study.
Conclusion: AKI was observed at a relatively younger age in present study with male preponderance. Most common etiologies were Sepsis and Malaria. Most of the patient of Sepsis, MODS and Leptospirosis were having stage III AKI. Overall mortality observed was 4.34%.

Background: Tuberculosis (TB) has affected humans for most of their history and remains a major cause of mortality in adults worldwide Prevalence of Tuberculosis (TB) has been on a dangerous and positive spike for over a decade and has killed millions of people year on year. Almost, 1.3 million people in 2012 alone lost their lives to TB. As per the massive prevalence of TB, it would be incorrect to say that the disease does not poses like a pandemic. Alongside HIV, it remains a top cause of death from an infectious disease. Hence the present study was planned to evaluate the role of fiberoptic bronchoscopy in sputum negative pulmonary tuberculosis cases.
Materials and Methods: The study was carried out at Department of Pulmonary Medicine, Era's Lucknow Medical College & Hospital, Lucknow. Sputum smear negative presumptive patients of PTB. All the relevant samples were sent for Cartridge based nucleic acid amplification test (CBNAAT)/genexpert for BAL, post bronchoscopy sputum, bronchial aspirate, TBLB, Endobronchial biopsy and Transbronchial needle aspiration. Culture for Mycobacterium tuberculosis (MTB) was also obtained for all the patients. Culture is done on liquid media (MGIT).
Results: Majority of patients in the study population were adults: 21-60 years (82.6%), while only a small proportion of patients were aged ≤20 years and >60 years (8.7% each). Majority of patients in the study population presented with Cough (88.0%), Fever (78.3%), Loss of appetite (67.4%), Expectoration (63.0%) & Weight loss (56.5%). Majority of patients had negative CBNAAT (81.5%), AFB (95.7%) and Culture (77.2%) for Bronchial Aspirate. Thus indicating that fiberoptic bronchoscopy helps in establishing the diagnosis.
Conclusion: Considering the short processing time and high diagnostic efficacy, CBNAAT evaluation of bronchoalveolar lavage for detection of tuberculosis among sputum/smear negative tuberculosis cases is highly recommended

Introduction: The coronavirus disease 2019 (COVID-19) pandemic in India, having caused 29 500 000 confirmed cases and 374 000 deaths as of June 14, 2021, continues to have devastating consequences, including a large epidemic of COVID-19-associated mucormycosis (COVID-Mucor), manifesting as rhino-orbito-cerebral mucormycosis (ROCM), which has worsened the morbidity among vulnerable populations (JHU, 2021) ¹. Reports have shown a much larger surge in the incidence of COVID-Mucor during the second wave in 2021 than during the first wave (Patel et al., 2021; Moorthy et al., 2021) ^{2, 3}. This rapid rise in COVID-Mucor is probably caused by several factors. For patients with diabetes mellitus, lockdowns, travel restrictions, and restricted access to medical care have worsened glycaemic control, the central risk factor for ROCM in India (Chakrabarti et al., 2006) ⁴. Addressing these could reduce morbidity and mortality among vulnerable populations.
Material and Methods: A Retrospective chart review was conducted in Department of General medicine Dr S N Medical College Jodhpur among population included all rhino-orbito-cerebral mucormycosis patients with Covid-19 infection who were admitted in Mucormycosis ward, Dr S N Medical College Jodhpur from Oct. 2020 to Sept 2021. Bed head tickets of all these patients were reviewed. The final outcome was noted from the bed head ticket, the outcome was correlated with random blood sugar and HbA1c level at admission.
Conclusion: Mucormycosis is angioinvasive fungal disease with significant morbidity and mortality. The disease has risen dramatically due to interplay of COVID 19 pandemic, uncontrolled diabetes and inappropriate corticosteroid use leading to pathogenic invasion and adverse outcomes. The treatment involves early detection, surgical debridement and antifungal drugs for better survival. Our study revealed an evident role of hyperglycemia as major risk factor for mucormycosis infection. Those patients who had HbA1c> 10 could not survive inspite of best treatment and those patients who survived their hospital stay was directly proportional to their HbA1c level. All those patients who had cerebral involvement could not be saved. Hence, we suggest that closely tracking the levels of blood sugar in COVID-19 patients is a valuable tool to stratify the risk that a patient will have mucormycosis.

Obesity is considered as a global epidemic. It is associated with risk of multiple health problems. Vitamin D deficiency is prevalent in India. Vitamin D deficiency is increasingly associated with insulin resistance, type 2 DM and CVD, conditions also commonly linked with overweight and obesity.
Aims:
Comparison of vitamin D3 levels in normal, overweight and obese individuals without comorbidities.
Settings and Design:
Cross sectional observation study
Methods and Material:
189 eligible individuals were enrolled, divided into 3 groups based on BMI- normal, overweight, obese according to guideline for Asian population. Excluding secondary obesity. Blood samples for vitamin D measurement and anthropometric measurements were taken.
Statistical analysis used:
Comparison among different BMI categories will be done using ANOVA (Analysis of variants) followed by post hoc comparison.
Results:
Our study revealed that Hypovitaminosis D was most common in the obese and subjects with central obesity. Overall 64.6% had Vitamin D deficiency, 22.2% had insufficiency, only 13.2% had normal vitamin D. Hypovitaminosis D was observed in 68% of subjects with central obesity as compared to 32% without central obesity.
Conclusions:
In our study there was hypovitaminosis D in all 3 groups, but the mean level of 25(OH) D was very low in obese and overweight individuals without comorbidities and hypovitaminosis D directly proportional to the central obesity. Overall vitamin D deficiency is present in even normal individuals.

Recurrent pregnancy loss (RPL), known popularly as recurrent miscarriage, is a clinical condition of two or more failed pregnancies, affecting 12-15% of total pregnancies. Besides genetic and anatomical abnormalities, stress and anxiety impart a vital role in repeated abortions. The Perceived Stress Scale, an extensively used psychological tool for assessing the perception of stress in an individual, was taken for evaluating the role of psychological stress among subjects with RPL. The oxidative stress marker, malondialdehyde (MDA) and several other clinical parameters were also analyzed among 150 women with RPL and 110 healthy women with one or two children. The study concluded that RPL individuals are shown to have higher rates of oxidative and psychological stress with elevated MDA concentration and PSS score respectively. 

Background: This drug resistant TB is a growing concern around the world. It accounts for huge financial and public health burden. Though drug resistant TB is not new to India but proper surveillance and treatment remains the mainstay in tackling this global problem. The primary objective was to study the clinical profile and drug resistance pattern of TB patients. The Secondary objective was to effectively diagnose and treat the DR TB.
Methodology: It was a cross sectional observational study conducted at department of General medicine at Raichur Institute of Medical Sciences (RIMS), Raichur. All the patients of Drug resistant tuberculosis (DR TB) who attended RIMS were included in the study. All the patients with drug resistance pattern were included in the study after taking their consent. Statistical analysis was done using SPSS Ver 21.
Results: A total of 552 TB cases were screened for drug resistance. Out of them 39 were found to drug resistant TB. The mean age of presentation in males was 39.92 years and in females it was 36.08 years. Patients who completed higher education and who were employed were more in number compared to others. All the classical symptoms of TB like cough with expectoration, fever, shortness of breath was seen in these patients. Among the 39 DR TB patients, 30 patients had previously suffered from TB. Out of these 30 patients, 18 (60%) were defaulters, 7 (23%) were irregular and 4 (14%) were treatment failure. Thirty two (82.05%) patient showed resistance to either Rifampicin or INH and remaining 7 (17.95%) patients showed resistance to both rifampicin and INH.
Conclusion: Drug resistance was predominantly mono resistance to either rifampicin or INH but MDR TB were also seen. Patients were educated regarding treatment compliance

BACKGROUND: The assessment of patients presenting with altered mental status (AMS) in the emergency department (ED) is challenging as these patients are characterized by a broad spectrum of illnesses and disease severity. The present study is to determine the etiology and outcome as well as the role of the GCS score as a prognostic value.
 METHODS: This prospective observational study was done in a tertiary care center, in India over a period of two years where patients with AMS were evaluated and subjected to relevant investigations. All available clinical and laboratory data were used to ascertain the cause of the altered sensorium. Patients were followed up until discharge or death.
RESULTS: Among 1000 study participants 57% were males with a mean age of 52.5years. The most common etiology was Metabolic Encephalopathy (32%) followed by poisoning (20%). Mortality was highest in Cerebrovascular accidents (84.4%) and partial recovery was highest in Neuro-infection. Glasgow Coma Scale score <6 was associated with mortality of 44.4%.
CONCLUSION: AMS is a vital warning signal, because of its potentially fatal and irreversible effects. Timely evaluation with the point of care investigation reduces mortality in metabolic and poisoning causes and greatly improves the cost-effective basis for treatment.

Aim & Objective:  to study Maternal and Perinatal Outcome in Emergency Obstetric Referrals in a Tertiary Care Centre.
Material & Methods:  This Prospective observation study was conducted in Labour room , Department of Obstetrics and Gynaecology tertiary care hospital during 1st October 2019 to 30th September 2021.
Inclusion criteria: All cases referred from Government or Private hospitals, who are having referral letter and who deliver in our institute and are willing to participate in the study. In present study we have enrolled 1297 cases during two years.
Observations & Results:  Out of 1297 pregnant women, maximum Pregnant women i.e. 557(43.0%) referred were from the 21 To 25 years of Age-group. The mean age of pregnant women was 26.93±7.37 years. Most Common reason of delay in decision taking‑by relatives in 1060(81.7%) of pregnant women, 121(9.3%) of pregnant women were reported in delay in transportation. Majority of 420(32.4%) of pregnant women were having referral place was District Hospital. Majority of the Pregnant women i.e., 784(60.4%) were referred because there was lack of trained health professional in the referral unit followed by non-availability of ICU and ventilator i.e. 289(22.3%).60(4.7%) of pregnant women observed near miss and 14(1.1%) of pregnant women reported mortality. 324(24.9%) of babies had had Apgar Score of less 7. 303(23.5%) babies had NICU admission, 21(1.6%) were having early neonatal death and 57(4.3%) of babies were still birth.
Conclusion: Timely referral is crucial for a satisfactory maternal and fetal outcome. Health education and awareness by mass media and non-government organisations can improve the health and social status of women in rural areas. Health education and awareness by mass media and nongovernment organisations can improve the health and social status of women in rural areas.

Background and Objectives - Covid -19 is a pandemic, which is known to be a multi organ disease with complex clinical manifestations. Covid 19 virus has predilection for lung involvement but can also cause hepatic dysfunction. This study aims to analyze the significance of abnormal liver function tests in SARS- COV2 positive patients.
METHOD- This retrospective study, involved 150 patients (75 MALES, 75 FEMALES) who tested positive for SARS COV2. After obtaining clearance from the ethical committee, clinical and biochemical data were collected retrospectively from patient records, for a period of six months. They were segregated into severe  and non severe SARS COV2 infected individuals.  liver function test  were compared among patients between these 2 groups.
RESULTS-
Of the 150 covid- 19 positive patients, 75 were males and 75 were females. The mean age was 50±5 years. 95 patients belonged to the non severe covid-19 category (22 hypoxic and 73 non hypoxic patients), who were admitted in the ward. 55 patients belonged to the severe covid -19 category (hypoxic patients who required NIV/ ventilator support), admitted in the ICU.
Severe hypoalbuminemia 63% , was observed in the severe category, compared to 6.32%  in the non- severe category. Raised transaminases were observed in 60%  in the severe category, compared to 23.15% in the non severe category.
The incidence of death observed in the ICU in our study was 25.45%, of which 35% were female patients and 64.28%  were male patients.
CONCLUSION- Hypoalbuminemia, raised transaminases and bilirubin were observed in covid-19 patients admitted in the ICU, indicating, they could be considered as a poor prognostic factor.

Introduction:Cervical cancer is fourth most common cancer in women and account for about 5% of cancer deaths in females’ worldwide. In India, cervical cancer ranks the first most frequent cancer among females between 15 and 44 years of age. About 99% cervical cancersare linked with Human papilloma virus (HPV).
Aim:To evaluate the immunohistochemical expression of p16/INK4A and MIB-1 in preneoplastic and neoplastic lesions of cervix.
Material and Methods:
The cross sectional study was conducted on 63 cases in department of pathology of our institute over a period of two year from Dec 2018 to Dec 2020. The specimens were processed and three sections of 2-3 micron thickness were made and one stained with H&E stain, examined and 63 cases were selected. Other two sections were used for immunohistochemical staining
Result:In the present study, out of 63 cases, maximum 40 (63.49%) cases were observed in 31-50 years age group. In this study on P16INK4a immunostaining, maximum cases (8/15) of CIN-I and (9/15) of CIN-II histology were found grade-2 and grade-3 positivity respectively. Maximum (2/3) cases of CIN-II and all cases of squamous cell carcinoma histology showed grade-3 positivity. In this study onMIB-1 (Ki67) immunostaining, Maximum (12/15) cases of CIN-I were found grade-1 positive. All cases of CIN-II, III and carcinoma cervixes were positive.
Conclusion: We concluded that p16 INK4A and MIB-1 over expression was observed in CIN I/LSIL, CIN II/HSIL, CIN III/HSIL. Significant up regulation of P16 INK4A and MIB-1 was observed in carcinoma cervix.

 
METHODOLOGY:  
Pregnant women who attended OPD or patients admitted in labor room; KGH, Vizag are opted for the study. Antenatal women with anemia are identified and subjected to blood tests like hemogram with peripheral smear, Sickling test and Hb electrophoresis and diagnosed cases of hemoglobinopathy are included in the study.
RESULTS
Most of the patients are in young age group between 20 to 30yrs of age.  Majority of the cases are booked patients who are diagnosed, followed up and managed in our hospital throughout their pregnancy.  78.33% of the patients are from tribal populations of Visakhapatnam.  Most of the patients are primigravida constituting about 48.33%  .Sickle cell trait is the common hemoglobinopathy observed in our study population.  Common obstetrical complications seen are preeclampsia and oligohydramnios. 11.6% had preterm labor and 15% had IUGR. Anemia was observed in 81.67% and blood transfusions are more common in sickle cell disease.  LSCS was the common mode of delivery and obstetrical causes are the common indications. Most of the patients carried till term and majority of patients had live births.  Most common neonatal complication was LBW.  Maternal mortality was 3.33%. Patients were known cases of sickle cell disease who succumbed to acute chest syndrome with ARDS and sepsis with AKI.  Neonatal mortality was observed to be in 3.7%. There were 54 live births.  Though incidence of the thalassemia minor is low in our study, the outcome of pregnancy in these variants is not a major obstetrical concern.  Pregnancy in sickle cell disease has various maternal, obstetrical and medical complications. So a multidisciplinary approach is essential to manage a pregnancy with sickle cell anemia

Background and Objectives: The leading cause of maternal mortality in world is obstetric haemorrhage. Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. The aim of the present study were  to study the maternal outcome in case of APH. METHOD: The study was a prospective and observational study conducted in The NSCB Medical College, Jabalpur from January 2020 to June 2021. Cases of pregnancy complicated with APH were taken. Cases with bleeding before 28 weeks and after delivery of the baby were excluded. Data collected from the records present in Labour ward complex and Medical record section. RESULTS: A total 193 cases were presented with APH, among these 61.13% were abruption Placenta, 34.19% were placentae previa, 4.66% cases were undetermined. maternal outcome was favorable in 179(92.75%) patients while 14 patients succumbed .out of 118 cases of abruptio placenta ,9 cases (7.62%) died. Out of 66 cases of placenta previa ,3 cases (4.54%) died.  Out of 9 cases of morbid adherent placenta ,2 cases (22.22%). Conclusion:  The morbidity and mortality in pregnancies complicated with APH can be prevented by early diagnosis, proper antenatal planning and terminating the pregnancy in a well-equipped tertiary health care center. Keywords: Abruption placenta, placenta previa, Antepartum hemorrhage & perinatal mortality.

Women have described birth as an intense powerful life experience that affects their whole life and being, making childbirth the most significant events in their life¹. Earliest records of maternal birth positions show the parturient in an upright posture, but over centuries delivering women in upright position has become a lost art². Current evidence-based practices for management of the second stage of labor supports the practices of delayed pushing, spontaneous pushing, and maternal choice of positions^{3, 4}. About 19,340 deliveries are conducted in our tertiary care center of mothers with traditional values and receptive to adopting various birthing positions. Thus, this study is conducted at our tertiary care institute to compare the various alternative birthing positions and their effects on maternal and perinatal outcome. Objectives-1.To study duration of labor in upright and dorsal position.2.To study maternal outcome in upright and dorsal position.3.To study fetal outcome with respect to APGAR score and need for neonatal resuscitation.4.To study mothers experience and acceptability by visual analogue scale. Material and Methods-A prospective observational study was conducted after ethical clearance in a tertiary care center among 800 mothers admitted to labor room, who were fitting into inclusion criteria and who gave their consent for participation. The data was maintained, compiled and analyzed. Result- Upright position is associated with significant reduction in the duration of second stage of labor in primipara as well as multipara. The rate of episiotomy, LSCS and instrumental delivery is significantly reduced in mothers opting for upright birthing position. When given a choice, mothers readily adopted the upright position as it had an advantage of “being in control” of the birthing process and is associated with decreased pain perception

Introduction: Hemiarthroplasty is a common treatment for patient with a fragility displaced femoral neck fracture. The surgical approach used for hemiarthroplasty is expected to affect the treatment outcomes, in terms of dislocations, performance in daily activities, quality of life after the procedure and the learning curve for surgeons. However, little is known about how the approaches influences the functional outcome following hemi arthroplasty. We hypothesized that both approaches would give comparable results.
 
Aim : To assess the overall functional outcome in patients undergoing hemi replacement hip arthroplasty using Moore’s approach and modified Hardinge approach.
Material and methods: In a prospective interventional study between January 2020 to June 2021 which included 43 hips with a displaced Fracture Neck of Femur at RajaRajeswari medical college and hospital, Bangalore. Sample size was calculated using formula n=Z²*(SD)²/L². Subjects were assigned to treatment groups using simple random sampling technique. Intra-operative and immediate post-operative parameters was entered in MS EXCEL spread sheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0. The student’s t-test was used for normally distributed data and the Mann-Whitney U test for ordinal data. The chi-squared test or Fisher’s exact test were used for nominal data. Patients were followed up for a duration of 6months post-operatively. Functional outcome was assessed by Harris Hip Score (HHS).
Results: The mean age was 70.46 years and 31 (72.09%) patients had left sided hip involvement. Mean operating time was significantly more in the Modified Hardinge’s group (112 minutes) compared to the Moore’s group (91.30minutes). Length of incision and amount of blood loss was significantly high in Moore’s approach (p <0.001). Two patients (8.6%) had posterior dislocation of hip postoperative and one patient (4.3 %) had superficial surgical site infection in Moore’s group. Mean Harris Hip score at 6weeks (65.42 ± 5.70, 70.68 ± 4.81, p value <0.03) and 3 months (71.21 ± 5.57, 76.35 ± 5.25, p value <0.004) follow-up was significantly higher in Modified Hardinge’s Group and 6 months (84.31 ± 6.19, 85.9 ± 2.55, p value >0.05) did not show any significant difference between the two groups.
 
Conclusion: Adopting the Modified Hardinge’s approach instead of the posterior approach in hip hemi arthroplasty for femoral neck fracture patients could lower the rate of complications

BACKGROUND AND OBJECTIVES:
Untill now, HRCT Temporal bone is preffered imaging modality for middle ear pathology prior to surgical exploration of ears with cholesteatoma. But it lacks specificity. The aim of this study is to understand the role of DWI (Diifusion Weighted Images) in detection, evaluation and diagnosis of primary and recurrent middle ear cholesteatoma and to correlate with intraoperative findings.
METHODS
A prospective study in which 30 patients who presented to the Department of  ENT and diagnosed to have cholesteatoma by clinical , otoscopic and audiometry  examination were subjected to HRCT temporal bone followed by DWI- MRI screening of the temporal bone and data was analyzed using standard statistical methods.
RESULTS
DWI- MRI is having a high sensitivity for identification of the disease at most of the sites within the temporal bone except for the incus , stapes and facial nerve canal region .
CONCLUSION
DWI- MRI scan acts as an excellent preoperative as well as postoperative  imaging modality for diagnosis of primary and recurrent middle ear cholesteatoma .

Introduction: Snakebite is a major public health problem throughout the world, more so in tropical and subtropical countries. In India, there are 216 species of snakes, of which only four are venomous snakes (Cobra, Krait, Russell’s Viper and Saw Scaled Viper). Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment center, where cost of treatment can constitute an additional hurdle.
Materials & Methods: This retrospective, observational study was carried out from January 2021 to June 2021, at Department of Medicine in Government General Hospital, Government Medical College, Mahbubnagar, a tertiary care hospital serving population of Rural areas of Telangana.
Result: A total of 150 patients with a history of snake bite and signs of envenomation were included in this study., (67.33%) were identified. Maximum incidences were in farmers (49.3%) and in rural areas (50.67%). Commonest vasculotoxic manifestation was Gangrene (6.67%). Commonest neurotoxic manifestation was Respiratory paralysis, failure (3%) The mean dose of ASV vials required for vasculotoxic snakebites was more (vials) and for neuroparalytic snakebite was less
(vials).
Conclusion: Snake bites are common in rural areas affecting mainly agricultural workers, in rainy season and the most common site is lower limbs. Most poisonous snake bites are due to hematotoxic bites in this region. From this study, it is inferred that delay in presentation following snake bite has an overall negative effect on the outcome and there is no substitute for early and effective treatment with ASV. Population awareness programs regarding prevention, first-aid, and the importance of the early transfers to be emphasized.

Background: Basal cell carcinoma is the most common form of skin cancer and most frequently occurring form of all cancers.it looks like growth with slightly elevated rolled edges or central indentation.lesion commonly arise in sun exposed areas.
Methods: We observed 10 patient who presented with nasal mass  with long standing history. Nasal defects that are too large to repair with other local flaps or full-thickness or composite grafts and defect wider than 2 cm in the horizontal plane or those with exposed and denuded bone and/or cartilage are taken into consideration. Forehead flap reconstruction done with lesser morbidity. Follow up was done till 6 months after flap detachment and inset and results were assessed.
Results: All patients underwent forehead flap reconstruction with good aesthetic outcome                              and lesser morbidity. The flap was viable in all patients with no recurrences. Cosmetic and functional outcomes were good. However few patients developed minor complications like post-operative trismus, severe wound contracture, ectropion and infection and wound dehiscence.
Conclusions: Large defect over nose can be covered with forehead flap with good aesthetic outcomes. It gives ideal quality of color and texture,reduced morbidity and maintained viability,greater versatility in movement and length .

Neck masses are any swelling or enlargement of structures in area between the inferior border of mandible and clavicle. As there are many potential causes of neck masses, it is important to correlate diagnosis clinically radiologically and pathologically. Sonography is mainly first imaging modality after clinical examination.Pathologically FNAC(Fine Needle Aspiration Cytology) and HPE(Histopathological Examination) can be considered. Thus the combination of them benefits in screening sensitivity and valuable diagnostics information in preparatory evaluation of patients. The intent of this study is to evaluate the correlation of clinical, radiological and pathological relation in study of  neck masses.
 
 METHODOLOGY:
Patients referred for neck swelling irrespective of age and sex. All indoor and outdoor patients of hospitals presented with palpable neck swelling.
RESULTS:
 The commonest age group was 11-20 year with mean age of 33.77 year. The male: female ratio of                        1:2.03 with most common anatomical site for swelling is posterior triangle. Highest number of patients had lymph node pathology 65%, followed by thyroid involvement 24.3%, salivary gland disease 2.4% and other soft tissue swellings 8.3%. All clinically diagnosed thyroid and soft tissue swelling were similar to radiological and cytological findings. FNAC of 18% lymph nodes, 20% thyroid swellings and 20% soft tissue swellings did not correlate on HPE.All cases of salivary gland swellings matched on HPE. USG of 93.8% of lymph node, 97.2% of thyroid, 96% of soft tissue swelling were found similar to FNAC/HPE finding.Salivary gland USG were similar to FNAC/HPE findings
CONCLUSION:
Neck swellings are common in all age groups in both sexes. USG as a primary investigation modality since it is non-invasive, cost effective and easily reproducible with accuracy of 94.98%.Fine Needle Aspiration Cytology is a simple, fast, inexpensive and minimally invasive technique with accuracy of 83.33%. Histo-pathological examination remains a gold standard for diagnosis of neck swellings

Hydatid cyst is a disease which is caused by the larval form of Echinococcus granulosus and seen endemically among sheep-raising communities. The larvas penetrate the bowel mucosa and arrive in the liver via the portal vein. Most common sites of cyst formation are liver and lung and 10% in other organs. Hydatid cyst of the breast accounts for 0.27% of all cases only. We report a case of 35 year old female presented to the surgical OPD with complaint of lump in left breast since 5 years, there was no other associated complaint. Fine needle aspiration cytology revealed features of hydatid cyst, the lump was subsequently excised under local anaesthesia.

Background and Objective: The preferred method for separating testicular torsion from inflammatory diseases is colour Doppler ultrasonography (US), which can help patients avoid needless surgical explorations.

Background: Hemodynamic response is considerable after laparoscopic procedures. Both magnesium and clonidine are known to reduce the hemodynamic response to pneumoperitoneum and block catecholamine and vasopressin production. The goal of this randomised, placebo-controlled trial is to determine which medication reduces the hemodynamic stress response to pneumoperitoneum the most effectively.

Background: As an alternative to surgical removal of the appendix, antibiotic medication has been suggested for the management of appendicitis. Those participants in the study who had an appendicolith were at a greater risk for complications and appendectomy than those participants who did not have an appendicolith

Background: To compare the efficacy standards and clinical status of two α-2 agonists dexmedetomidine and clonidine as adjuvant to bupivacaine in undergoing surgical procedures of lower limb and infraumbilical region. To estimate adjuvants analgesic property that provides superior anaesthetizing properties with sedation, haemodynamic stability in neuraxial anaesthesia.

         Fine needle aspiration is a well-established modality for the preoperative evaluation of salivary gland lesions. No standardized classification system was available for cytopathology reporting of salivary gland lesions until recently. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is an evidence-based standardized reporting system for salivary gland lesions which was proposed under the sponsorship of the American system of Cytopathology and the International Academy of Cytology in the year 2015.  MSRSGC consists of six diagnostic categories, offering the risk of malignancy and clinical management recommendations for each category. The main goal of this system is to improve communication between cytopathologists and clinicians and to enhance reproducibility in the management  salivary gland lesions. Here in, we review the essential features, diagnostic criteria and clinical management of each category in MSRSGC along with emphasis on ancillary studies

Introduction: The habit of alcohol consumption and alcoholism is known to adversely affect the health and well being of the people especially that of women but stillthe trends of its consumption is on rise even in India. Women in rural areas are exposed to limited source of knowledge regarding the ill effects of alcohol consumption

Curcuma aromatica is commonly known as wild turmeric and extensively used as an herbal excipient in the preparation of cosmetic preparations. It is indigenously grown in India and having anti-inflammatory, wound healing, antioxidant, anti-tumour, anti-cancer, antirepellent, antitussive, anti-platelet activity and ant nephrotoxic activities. The present research work is to characterise the individual chemical components present in the rhizomes of Curcuma aromatica by Gas Chromatography-Mass Spectroscopy method.

Background:Low birth weight is one of the most serious challenges in maternal and child health in both developed and developing countries. The present study was conducted to assess prevalence of low- birth weight babies

Introduction:Large epidemiological surveys have shown alcohol, tobacco (i.e., cigarettes), and marijuana has the highest prevalence rates across all age groups. Alcohol is a serious public health problem.There is a lacuna of evidence on screening for harmful alcohol use linked to ASSIST in Indian workplace settings. This prompted the us to explore this area to generate an evidence base while planning for workplace alcohol interventions.

Aim: To evaluate the clinical profile and the best therapy strategy for renal trauma patients.

Background:Iron deficiency is a major public health problem in developed countries. The present study was conducted to assess anaemia during pregnancy as a risk factor for infant iron deficiency.

Background:Urinary tract infections (UTI) are common in children, with an estimated incidence of 1%–1.5% and 3%–8% in boys and girls, respectively. The present study was conducted to assess urinary tract infections in malnourished children.

Background: Poisoning in children is a worldwide epidemic, and there is no region in the world that is immune to this catastrophe. In paediatric practise, it is one of the most frequently encountered situations that could have been avoided. Both the cause of poisoning and the type of poisoning can vary greatly from one region of the world to another. This is because the availability of poison to children is influenced by a variety of factors, including population, socioeconomic standing, level of education, as well as local beliefs and practises.
Martial and Methods: A future hospital-based study in India with a prospective design. Over the course of three years, beginning in June 2021 and ending in June 2022, children hospitalized to Sambaram Institute of Medical Sciences and Research with suspected acute poisoning were the subjects of a study that was designed as a prospective investigation. A parent or other relative who was present throughout the interview provided background information about the youngster.
Results: 210 children were found to be suffering from acute poisoning. There were 125 males, and there were only 85 girls. In 110 of the instances, household goods were involved, while pharmaceuticals were involved in 62, toxic plants were involved in 21, agrochemicals were involved in 13, and other substances were involved in 4.
Conclusion: In conclusion, I would like to offer some suggestions for some strategies that can assist to minimize the prevalence of childhood poisoning in India, in addition to the morbidity and death associated with it. Keep the containers of kerosene oil securely sealed and out of the reach of youngsters at all times. Do not keep kerosene oil in soft drink bottles. Make people aware of the potential risks associated with vomiting after consuming kerosene oil. Keep any agricultural chemicals in a secure location. Instruct the general public on how to properly dispose of unused medication.

Background: Trigeminal neuralgia is one of the most painful neurological disorders.In this study we aimed to describe the clinical and radiological spectrum of trigeminal neuralgia.
Martial and Methods: This is a single center prospective study conducted at a tertiary hospital in Southern India. A total of 50 patients  with clinical diagnosis of trigeminal neuralgia according to ICHD-3 criteria were included in the study. Demographic characteristics, detailed case history that included side of face involved – left/right, area of face involved (V1/V2/V3/V1+V2/V2+V3/  V1+V2+V3), pain characteristics, triggering factors, sensory abnormalities was  taken. MRI brain was performed in all patients. Classical,secondary,idiopathic trigeminal neuralgia was diagnosed based on ICHD-3 criteria.
Results: Fifty patients were included in our study, whose age group ranged from 32 to 77 years.The highest incidence was found in 51-60 years age group accounting for 36 % of cases. 30 (60%) were females and 20 (40%) were males. In 32 patients (64%) right side of face was affected and in 18 (36%) patients left side was affected. The most commonly described character of pain was lancinating type (32%) followed by mixed features (26%). V3 was involved in 24 patients accounting for 48% of cases. V2 was involved in 20 (40%) patients, V1+V2 in 1 (2%) patient, V2+V3 in 4(8%) patients, V1+V2+V3 in 1 (2%) patient. V1 involvement alone was not seen in our study.
Conclusion: Our study determined the clinical and radiological spectrum of trigeminal neuralgia patients. We conclude that the highest incidence is in 51-60 years age group with female preponderance, predominant involvement of right side of face and predominant maxillary division involvement. Lancinating type of pain was the most common type with touch being the most common trigger factor. Classical trigeminal neuralgia was the most common subtype.

BPH is the most common disease in an aging male affecting 50% at 60yrs , 90% at 80yrs of age. The most common symptoms being not only voiding symptoms but also storage and post micturition symptoms affecting quality of life. Inspite of various techniques used in treatment of BPH; TURP is still the Gold standard surgery. So we have conducted an study to assess the grading of BPH and studied the indications for surgery in BPH patients based on IPSS and assessed the improvement in IPSS after TURP.

Background: Volar Barton's fracture is an unstable distal radial fracture with wrist subluxation or luxation. The goal of treatment is to accomplish anatomic fracture union, regain hand function quickly, and avoid complications. Healing fractures require limited space, stability, and blood supply. The locking plate lowers compressive pressures on the bone to achieve stability, which may prevent periosteal compression and blood supply degradation. It is favoured for fracture healing.
Martial and Methods: 25 volar barton fracture patients were treated at Kakatiya Medical College/MGM Hospital, Warangal, Telangana, India, from July 2021 to July 2022. Open reduction and internal fixation with a 2.5 mm locking compression plate were used. We employed 2 forms of LCP, universal and fixed angle, through a modified Henry's volar approach and an ulnar palmar approach. We followed up until functional recovery and examined radiologically at 1, 3, 6, and 12 months.
Results: The study included 20 men and 05 women aged 18 to 59 with a mean age of 36.5. Injury-to-surgery averaged 2.35 days. 6 to 24 months of follow-up. Applying 55% excellent, 35% good, 5% average and 5% poor on Gartland and Werley's demerit scale.
Conclusion: Fixing distal radius fractures, especially intraarticular volar barton fractures, with a locking compression plate is satisfactory for both patient and surgeon. Locking plates improve wrist function after volar Barton's fractures.

Background: The paper reviews elastography's importance in distinguishing benign from malignant breast lesions. Breast cancer accounts for 27% of all cancers among women in India, according to NICPR. Breast lumps can be benign cysts or malignant lesions.4Incidence rises in early 30s and peaks in 50s-64s.
Martial and Methods: This prospective, cross-sectional, diagnostic study was done at NRI General Hospital, Guntur, and Andhra Pradesh, India. 82 individuals were excluded from ultrasound electrography using PHILIPS AFFINITY 70. November 2019-October 2021 was the study's duration.
Results: 53 of 82 research participants had benign lesions. USG found 29 women with malignant lesions. HPE found 45 benign and 27 malignant tumours. In the current study, most women had a bump and mastalgia. Malignancies often cause nosebleeds. Benign instances show mastalgia, lump, swelling. 13 asymptomatic patients. 2 had malignant lesions. 9 were benign. One case of malignant nipple ulcer was found.
Conclusion: Dense breasts reduce mammogram detection of breast cancer. Ultrasonography shows dense glandular tissue as hyperechoic, but breast tumours are hypoechoic and easily recognised. Ionizing radiation limits mammography's age and frequency. Ultrasound elastography is risk-free.

Background: Scrotal cystic swellings can grow to enormous sizes without generating any pain. They are often painless. It is necessary to research the best method of care for each type of scrotal cystic swelling that can be treated in nizams institute as there are several ways to treat different cystic swellings.
Martial and Methods: One hundred cases of scrotal cystic swellings that satisfied the methodological criteria were examined in advance. Ultrasonography of the scrotum and a clinical examination led to the final diagnosis. Surgery was used to treat every instance.
Results: The majority of patients (60%) were right-handed, and the majority of the patients (86%) had scrotal swelling as their primary complaint. Primary vaginal hydrocele was the most prevalent cystic swelling (76%) and was followed by epididymal cyst, spermatocele, and sebaceous cyst. The treatment known as the Lord's plication was linked to early patient discharge and few post-operative problems.
Conclusion: The most typical cystic enlargement of the scrotum was primary vaginal hydrocoele. The majority of the cystic swells were successfully surgically corrected. Lord's surgical technique had the fewest post-operative complications.

Background: The study aims to analyse expression of stem cell marker aldehyde dehydrogenases 1 (ALDH1) by Immunohistochemistry (IHC) in non-neoplastic and neoplastic lesions of the gall bladder.
Materials and Methods: The study was accomplished at the Department of Pathology Era’s Lucknow Medical College and Hospital, Lucknow. A total of 105 cases were enrolled for the study. The paraffin embedded tissue was subjected to haematoxylin and eosin staining. Immunohistochemistry was done further for the expression of ALDH1 stem cell marker, IHC was further done.
Results: Out of 70 non-neoplastic cases, ALDH1 came out to be positive for 12 cases and 15 cases came out to be positive for ALDH1 out of 35 neoplastic cases. The ALDH1 expression was found to be significantly higher in neoplastic than non-neoplastic lesions. Among the non-neoplastic lesions no significant difference seen with age, sex and cholelithiasis, whereas statistical significance was seen in cases with chronic cholecystitis, metaplasia, hyperplasia and low grade dysplasia as well as in ALDH1 expression in neoplastic lesions associated with cholelithiasis and histological grade of tumour.
Conclusion: ALDH1 expression in non - neoplastic & neoplastic gallbladder lesions may support the concept that the stem cells may be primary target of transformation in gallbladder carcinogenesis associated with prolong inflammation

Background: Cardiovascular disease in patients with breast cancer undergoing chemotherapy is of major growing concern. The commonly  used  chemotherapeutic  regimen have cardiotoxic effects  including  doxorubicin, trastuzumab and  other agents .these  have  acute  effects  on  cardiac  function and  longterm effects  on cardiac  remodelling  and  function. There have been a few studies on this regard, Hence we  aimed  to investigate  the  early  effects  of chemotherapy  on cardiac  function  in addition to association  of N –terminal  pro-brain  natriuretic  peptide and  echocardiagraphic indices.
Methods: This is a prospective, single-center study including 100 patients who received a breast cancer diagnosis in the Government Royapettah Hospital between July 2021 and April 2022 before beginning chemotherapy. Before beginning chemotherapy (baseline -T1), the day following the conclusion of the second cycle (T2), and the day following the conclusion of the fourth cycle (T3), 2D echocardiography was performed on all patients enrolled.
Results: It showed that the mean age of the subjects was 44.2 ± 8.80 years. Out of all the subjects, 40% had breast cancer of right side and 60% had breast cancer of left side. Thirty percent subjects had diabetes and 40% had hypertension. Maximum subjects had undergone surgery (70%). The chemotherapy regimen followed in most of the subjects was ACP- regimen in 70% subjects, followed by 20% having CMF- regimen and 10% having TCH-regimen. It was seen that out of all the variables, only TAPSE, and S’–TV have significant difference at T1, T2 and T3. In our study 20 % had LV systolic dysfunction, 20% had LV diastolic dysfunction and 30% had RV systolic dysfunction which correlate with NT pro BNP values.
Conclusion: Tissue Doppler echocardiography is currently used and is sufficient for providing chemotherapy patients with effective cardiac care in places with limited resources. Our study also enlighten that Echo should performed at T1 and T3 stage for all chemotherapy patients with focus on RV function as it is the earlier marker for cardiotoxicity. Future molecular mechanisms will facilitate the use of medications that operate on certain molecular targets to treat cardiotoxicity

Background: The advantages of bipolar hemiarthroplasty compared to total hip arthroplasty were that the surgical procedure was simple, the volume of blood was small, and the incidence of dislocation was low.The present study was conducted to evaluate the functional outcome of fracture of femoral neck with bipolar prosthesis.
Material & Methods: Patients who had fracture of neck of femur were selected for the study. Patient were analysed clinically and radiologically. Required investigations were done. A total of 40 cases were selected or the study. Allpatientswere followed upforaperiodof 1year atregularintervals.Diagnosisconfirmed by radiograph. HarrisHip Score was recorded.
Results: The maximum patients belong to age group 50-60 years (62.5%). Females were predominant in the study (67.5%). Patients with left side being affected in 65% of the patients. The most common prosthesis used in the study was uncemented bipolar prosthesis (87.5%) and in 12.5% patients cemented prosthesis was used. In our study, the final Harris Hip Score as evaluated at one year follow-up. Overall, 7 patients (17.5%) achieved Excellent result, 24 patients (60%) achieved Good result, 7 patients (17.5%) achieved fair result and 2 patients (5%) achieved poor result.
Conclusion: The present study concluded that hemiarthroplasty with bipolar prosthesis shows better results.

Introduction: Traditional treatment for inferior pole patella fractures is excision of the comminuted pole and Repair of a ruptured patellar tendon with the use of sutures that are passed through intraosseous tunnels within the patella. Difficulty with this technique is that Beath pin may penetrate the articular surface or may unduly injure the quadriceps through multiple passes. Obliquely oriented bony tunnels may cause abnormal patellar tilt, leading to uneven force distribution. This technique reports use of suture anchors for inferior pole patella fractures. Retrospective analysis of four cases of patients doing well at follow-up of one year. Materials and Methods: Four patients treated using suture anchors for repair of comminuted inferior pole fractures of patella between June 2020 to September 2020 (range 22 years-38 years).
Results: The average follow-up was 12 months. The patients were evaluated for range of motion, strength, patellofemoral scores and any alteration of patellar height.
Conclusion: Although pullout of the anchors may be a logical concern, but it is a novel technique of the use of suture anchor as this construct is more than sufficient to withstand the forces to which it is subjected.

Introduction: Stroke has many different aspects, depending on the type, demography, and severity. Vitamin D insufficiency may bear an association with acute stroke. Vitamin D deficiency is frequent in people who have been paralysed due to a stroke. Vitamin D, a neurosteroid with receptors found throughout the brain, plays a role in neuroprotection via a variety of mechanisms. Objective Role of vitamin D in stroke and its outcome. Materials And Methodology: A total of 325 stroke patients were included, with 130 instances of hypovitaminosis being randomised into two groups, GROUP A and B, each of which had 65 cases. Vitamin D levels and the Scandinavian Stroke Scale (SSS) score were measured before and after treatment. Intervention: In addition to conventional stroke treatment and physiotherapy, GROUP A got a single IM injection of 6 Lac IU of Vitamin D, while GROUP B (control) received standard stroke treatment and physiotherapy. Design of The Study: randomized control trial in a Tertiary Care Teaching hospital

The coronavirus disease 2019 (COVID-19) pandemic has led to considerable stress and anxiety, adversely affecting the quality of the sleep. A study was conducted to evaluate if the COVID-19 pandemic had any effects(s) on the sleeping pattern and on overall sleep quality. Study was conducted as a cross sectional, questionnaire-based survey in Indian population on an online platform utilising Pittsburgh Sleep Quality Index (PSQI) to assess pattern and quality of sleep before and during the pandemic. The survey questionnaire was conducted during pandemic; hence the data collected for “before pandemic” duration was retrospective. A total of 1615 participants’ responses were received of which there were 756 female and 859 male participants. The mean PSQI score (global) before the pandemic was 4.68 ± 2.98 while that during the pandemic is 6.02 ± 3.62 indicating a significant change in the sleep quality. The proportion of poor sleepers also increased dramatically from 26.1% pre-covid to 49.3% during covid. Both sleep deprivation and poor-quality of sleep are well-known to produce significant mood disturbances and to lower the immunity. Thus, it can be extrapolated that those individuals who developed significant sleep disturbances during COVID-19 are likely to be at a greater risk for negative health consequences even if they did not develop active COVID-19 infection. As sleep is vital for both mental and physical health of the human body, adequate measures should be taken at an individual level as well as at the community level to maintain quality of the sleep during pandemic or other disasters like war that trigger considerable stress

Background: Osteoarthritis (OA) and other disorders of the musculoskeletal system are the most frequently reported causes of impairment affecting the elderly population. The present study was conducted to assess incidence, prevalence and etiological factors for primary osteoarthritis knee in 40 years and less age group.
Materials & Methods: 200 patients in the department of Orthopaedics in the Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, U.P, India of either sex coming to the OPD of the department with chief complaint of knee pain were the subjects of the study. Cases were assessed and subjected to AP view of both knee in standing position. Parameters such as height, weight, BMI were recorded. Cases were divided as per the Kellgren Lawrence Grading system
Results: Out of the total of 200 cases observed, 64 % were in the age group (35-40) years, 28 % were in the age group of (30-34) years, 8 % were in the age group (25-29)years. there were 44 males and 156 females. 74% of the cases had BMI > 24.9 kg/m², 26% of the cases had BMI between 18.9-24.9 kg/m², while none of the cases had BMI below 18.9 kg/m². Primary osteoarthritis knee was present in 112 and absent in 88. Out of the 112 cases of OA, 60 (45.4%) had predominantly right side knee involvement while 16(12.1%) cases had left knee involved. 56(42.4%) had bilateral knee involvement. Bilateral cases had similar KL grading on both sides. Grade 0 were only symptomatic, 20(10%) had KL grade I, 32(16%) had KL grade II, 72(36%) had KL grade III while 8(4%) cases had KL grade IV. Grade II and III combined constituted 52% cases.60 (53.5%) had predominantly sitting/ squatting/kneeling as household habit. 48 (42.8%) cases had predominantly standing as household habit while 4 (3.5%) cases had nothing specific as a predominant household habit. Occupation was housemaker in 40, skilled workers in 4, tailor in 16, trader in 4, farming in 8, housemaid in 30, teacher in 2, nurse in 4 and paramedics in 4 cases.
Conclusion: OA knee is a significant contributor to pain and disability and poses severe burden on economy, primary prevention of knee OA should become a major aim of health care.

Background: Diarrhoeal disorders are considered to be a major cause of morbidity and mortality among children all around the globe. The present study was conducted to assess pattern of sodium disturbances in children suffering from diarrhoea with dehydration.

Background: Conversion disorder is defined by the presence of deficits affecting the voluntary motor or sensory functions lacking any known neurological cause. It occurs as response to any underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors, resulting in conversion especially among children. The objective of this study was to study the socio-demographic and clinical profile of conversion disorder in children and attempt to identify the stressors in these children.

Background: Adhesive capsulitis, or "frozen shoulder," is characterised by a variety of problems experienced by the glenohumeral joint, including discomfort, stiffness, and/or a loss of function. It is one of the most disabling consequences of diabetes that affects the muscles and bones. The aim of this study to evaluate the prevalence and risk factors for frozen shoulder in diabetic patients.

Introduction: The effective intrapartum analgesia greatly minimizes pain, stress, and anxiety which cause release of stress hormones as well as beta-endorphins. This this present study is followed to evaluate the effect of intrathecal labour analgesia on the progress of labour was compared between fentanyl 25μg alone and fentanyl 20μg plus bupivacaine 2.5mg. Materials and Methodology: Patients in the group SA (n = 33) were administered with an intrathecal injection of 0.5% hyperbaric bupivacaine 2.5 mg (0.5 mL) and fentanyl 25 µg (0.5 mL), volume made to 1.5 mL with normal saline. And the matching group C (n = 33) who refused to give consent for neuraxial analgesia. The two groups were evaluated with regards to the progress of labour, maternal hemodynamic variations, foetal heart rate, and neonatal outcome during labour in parturient undergoing normal vaginal delivery. Results: Parturient in group SA has gained excellent pain relief throughout their labour and VAS score remained less than 4 till delivery as compared to group C, in which VAS score was more than 7 at all time. There were no observed significant changes in FHR when compared to the baseline in both the groups and none had observed with the interventions of foetal compromise. The mode of delivery in all parturient in the study group was mostly vaginal delivery without any instrumental delivery. The parturient who required caesarean section due to other indication were excluded from the study. Conclusion: A a single dose of intrathecal fentanyl 25 μg and bupivacaine 25 mg which were given in the active phase of first stage of labour had rapid onset with satisfactory pain relief and minimal motor block, which completely regressed at the time of second stage of labour.

Background: Bone mineral density (BMD) is a quantitative measure of bone mass and represents the total mineral in a selected volume of bone in the hip or in the spine. Dual-energy x-ray absorptiometry (DEXA) is currently the gold standard in the measurement of bone mineral density (BMD). Present study was aimed to study bone mineral density in postmenopausal women at a district hospital.
Material and Methods: Present study was single-center, descriptive, observational study, conducted women who were post-menopausal for at least one year.
Results: 220 postmenopausal women were studied.  Mean age was 50.93 ± 5.19 years, mean height was 154.44 ± 8.20 cm, mean weight was 64.39 ± 14.25 kgs & mean BMI was 24.44 ± 3.51 kg/m², mean age at menopause was 48.24 ± 4.14 years & mean menopausal duration was 3.17 ± 1.91 years. Bone mineral density at lumbar spine was normal in majority of cases (44.55 %), while 32.27 % cases had osteopenia & 23.18 % cases had osteoporosis. While, bone mineral density at femoral neck was normal in majority of cases (46.82 %), while 30.91 % cases had osteopenia & 22.27 % cases had osteoporosis.
Conclusion: Estimation of bone mineral density is the key to early diagnose osteoporosis among postmenopausal women.

Background: The comprehensive global cancer statistics from International Agency for Research on Cancer indicated that gynaecological cancers accounted for 19% of the 5.1 million estimated new cancer cases, 2.9 million cancer deaths and 13 million 5-year prevalent cancer cases among women in the world in 2002, of which carcinoma Cervix accounted for 4,93,000 new cases and 2,73,000 deaths. More than 80% of cervical cancer was found to occur in developing countries. Among the population based cancer registries Barshi.
Aim & Objective: 1. To screen cervical cancer by conventional papsmear.2. To assess the prevalence of premalignant and malignant lesions of the cervix.3. To correlate the type of pap-smear reports with clinical presentation of the patient
Method: Study design: Prospective study. Study setting:  Department of Obstetrics and Gynecology at tertiary care centre. Study duration:……..Study population: The study population included all women who are more than 21 years of age and sexually active were selected
Sample size: 200
Results: 48% belonged to age less than 30years age group, 30% belonged to 31-40 yrs group, 9% belonged to 41-50 yrs. age group and 13% belonged to age more than 50yrs. 0% belonged to nulliparous group, 15% were para one,39% were para two , 36.5% were para three,8% were para four and1.5% belonged to group of para five. 10% patients has ASCUSpapsmear report,02% has HSIL, and 02% has LSIL, infections were found to be in 13patients.5% patients have unsatisfactory smears. NILM were reported in 70% of the patients. 48% of ASCUS reports belonged to age group of less than 30 years and 30% were of 31 – 40 years age group. 2 patients of HSIL belonged to 31-40 years group, all LSIL also belonged to the same age group. Total 53.8% patients has NILM with infections of age group between 31-40 years and 42.3% reported with infections belonged to age less than 30 years. ASCUS in Pap smear report had healthy cervix that is 65%. In HSIL patients 50% cervical erosion and 50% cervical hypertrophy healthy is seen. 50% of LSIL patients has cervical erosions and 50% has vaginal discharge. Infections were reported in majority in patients with healthy cervix (97.14%).
Conclusions: Carcinoma cervix is a preventable disease, but there is no perfect screening test that has 100% sensitivity and specificity.Pap smear testing is a very useful,simple,economical, and safe tool to detect preinvasive cervical epithelial lesions.

Background: Sodium potassium derangements and elevated serum amylase lipase levels are not rare findings among diabetic patients, they often occurs simultenously with increased blood sugar levels. We here by try to find out association between these blood parameters. Aims and objectives: to find out association between raised serum amylase, lipase levels and deranged sodium, potassium levels in patients with diabetes mellitus.

Background:  Appendicitis is one of the most common surgical emergency among children .Nearly 30% of children present  to hospital with complicated appendicitis, which is associated with higher morbidity than simple appendicitis. Controversy exists in the treatment of complicated appendicitis in pediatric age group.The goal of this study was to review the results of laparoscopic surgery in complicated appendicitis in terms of safety, efficacy and complications
Methodology-  A Retrospective observational study  was  conducted in a Tertiary care hospital in Bangalore from  2015 to 2020 over a period of 5 years . All children who underwent laparoscopic surgery for  complicated appendicitis (perforated, gangrenous and mass) were included in the study. Thorough history with respect to symptoms and their duration were recorded followed by general and abdominal examination. Routine blood investigation and imaging were done before surgery. Intra operative data regarding the type of complication, presence or absence of  Fecolith, position of appendix were documented. Post operatively duration of stay and complications were analyzed.
Results- 60 cases were included in the study. Mean age of presentation was 10.11 ±0.855 years. Out of 60 children 53 were males and 7 were females. The mean operative time was 55.8333 ±4.806 min. The rate of conversion from the laparoscopy  to open surgery was 11.5%. Mean time of duration of intravenous antibiotics was4.2778 ±0.446 days. Mean time for starting of oral feeding was 2.8333 ±0.307 days. Mean duration  of  hospital stay was 5.11 ±0.545days . Wound infection in immediate post operative period was seen in 6.6% of the children. No long term complications were noted.
Conclusion- Laparoscopic appendectomy (LA) for complicated appendicitis is safe and effective. Therefore, it should  be the first choice for cases of complicated appendicitis in children

Oral squamous cell carcinoma (OSCC) is the most common epithelial malignancy in the oral cavity. The risk of the development of OSCC is high in Fanconi anemia (FA) patients owing to the DNA repair deficiency in somatic cells. EGFR, and CTNNB1 genes are suggested to be effective in development of OSCC. EGFR has been reported to have higher expression in OSCC, there are limited studies of EGFR and CTNNB1 gene polymorphisms in the development of OSCC. Therefore, we aimed to investigate the potential connection between EGFR rs845561 and CTNNB1 rs3864004 gene polymorphisms, and OSCC and FA. We performed polymerase chain reaction (PCR)/sanger sequencing for detection of the variations in these regions. EGFR rs845561, and CTNNB1 rs3864004 gene variants were compared between OSCC patients, and controls, no significant difference was detected (P>0.05). The EGFR rs845561 C allele frequency was lower in OSCC patients who had lymh node metastasis (P= 0.001), a significant association was detected between the EGFR rs845561 T allele frequency, and tumor perineural invasion (P= 0.05) in OSCC patients. CTNNB1 rs3864004 A allele frequency was associated with increased tumor invasion in OSCC patients (P= 0.01).
The CTNNB1 rs3864004 G/G genotype was higher in FA patients compared with the levels in the control group however, the A allele frequency was found lower (p:0.049). EGFR rs845561 gene variant showed no statistically significant difference between FA and control groups (p>0.05). EGFR T allele frequency was detected higher in FA patients who develop OSCC (p:0.03). The EGFR rs845561, and CTNNB1 rs3864004 gene variants may be suggested to contribute to the development of OSCC however, further studies are required

Background: Ovarian malignant tumors have varied clinical and biologic behaviour. It is the sixth most common cancer among women (Age standaradised incidence rate being 6.6/100,000) and seventh leading cause of cancer deaths globally (age standaradised mortality rate being 4.0/100,00)In India, during the period 2004-2005, proportion of ovarian cancer varied from 1.7% to 8.7% of all female cancers in various population based registries of Indian Council of Medical Research. The proportion of this cancer was 6.0%-7.7% of all cancers among females in Gujarat.
Objectives: To Determine Diagnostic accuracy of ROMA Score using HE4 and CA 125 for Epithelial Ovarian Cancer. 
Methodology: This prospective study using a sample of 50 patients who attends the gynecology out Patient department and  Labour room between September 2018 and July 2019 for the evaluation of an ovarian mass. Blood specimens from these patients was obtained during their first assessment for laboratory work up. From the variables collection ROMA was calculated using CA-125 and HE4 results. Boththe receiver operating characteristic (ROC) curve and area under the curve (AUC) was calculated(accordingly), and the most valid cut-offs was determined accordingly. For all statistical comparisons, a p-value < 0.050 was accepted as statistically significant.
Result: Thirty-three subjects (66%) had Benign and Seventeen subjects(34%) had Malignant disease.For diagnostic modalities observation of my study is   Maximum number of benign cases found by histopathological(66%) and serum CA-125(66%). Maximum number of malignant cases found by USG(48%) and CECT/MRI(48%). Maximum number (54%) of cases were found in 18- 44 age- group.For CA-125, mean and median values were 70.35 and 75 respectively for cases with benign disease and 373.4 and 346.8 respectively for cases with malignant disease. This association was statistically significant (p<0.05).For HE-4, mean and median values were 42.28 and 38 respectively for cases with benign disease and 301.17 and 240 respectively for cases with malignant disease. This association was statistically significant (p<0.05).For ROMA score, mean and median values were 4% and 3% respectively for cases with benign disease and 56.33% and 50.65% respectively for cases with malignant disease. This association was statistically significant (p<0.05).
Conclusion:. HE4 and ROMA showed a high specificity, but were less sensitivity than CA-125 and RMI in premenopausal women. However, ROMA is of comparable sensitivity and HE4 has highest specificity as compared to CA125 in postmenopausal women

Background: Obesity is a health hazard throughout the world. weight gain and obesity are responsible for a growing threat to health throughout the world objectives: To evaluate and compare the cardiovascular autonomic response to cold pressor test and hand grip test among obese and non-obese adults.Methodology: Cardiovascular  sympathetic  function  tests were carried out in 100 obese adults  and  100 non obese adults  aged  between  28-58  years. Recording of ECG was performed in normal breathing, deep breathing and in condition of cold pressor.Time-domain method was used to record HRV Results: Study demonstrated significant decreased BP(BP)(systolic and diastolic) to cold pressor and to sustained handgrip. Responses in cases were significantly correlated to Body Mass Index. Our findings shows increased sympathetic activity was seen in obese patients and vagal activity was also withdrawn. Conclusion: There is remarkable change observed in the cardiac autonomic dysfunction responses between obese and non-obese subjects. Normal BMI showed a better HRV response to cold pressor test, indicating a better parasympathetic activity as compared to obese subjects. In cold pressor test BP was reduced in obese compared to non-obese individuals suggesting decreased vascular sensitivity to the amplified adrenergic activity in healthy obese individuals(adults).

ERCP plays a key role in biliary and pancreatic diseases diagnosis and treatment since its advent in 1979  and become an accepted modality in both benign and malignant biliary obstruction. ERCP  is  difficult and invasive endoscopic procedure with steep learning curve and continues to have high rates of complications[1]. Multiple  complications have been mentioned in the literature like perforation, migration of stent, pancreatitis and cholangitis[2]. Migration of stent is most common complication with incidence of  5–10% in  patients with biliary stents [3]. Perforation of Duodenum due to stent migration  is a  dangerous complication  with a low incidence rate and high  mortality rate of 4.2%–29.6% [1]. Less than 1%  of patients have perforation of any part of  git tract from duodenum to sigmoid colon due to stent migration.  [4–6]. Early diagnosis and appropriate modalities of management are main concerns.  Best  treatment methods for duodenal perforation in this scenario have not been established. Nonsurgical treatment methods can have  serious and life threatening  complications so decision of treatment modality  should be made carefully 

Background: ECE is one form of vertical integration between basic science and clinical subjects. Thus this study is an effort to explore the use of ECE as an effective teaching learning tool, toward better learning as vertical integrated method over traditional teaching method through student’s perception.
Materials and Methods: A cross-sectional study was conducted during April 2022. A convenience sample of 190 first- and secondyear MBBS students, enrolled in the medical curriculum, participated in an early clinical exposure program. To collect data from medical students, a questionnaire consisting of open-ended questions and structured questions, rated on a five-point Likert scale, was used to know students’ attitudes toward early clinical exposure.
Results: Of the 190 medical students, 160 completed the questionnaire. The results demonstrated that medical students had a positive attitude toward early clinical exposure. Most students (84.1%) stated that early clinical exposure could familiarize them with the role of basic sciences knowledge in medicine and how to apply this knowledge in clinical settings. Moreover, 67.4 of them believed that early clinical exposure increased their interest in medicine and encouraged them to read more. Furthermore, content analysis of the students’ responses uncovered three main themes of early clinical exposure, were considered helpful to improve learning: “integration of theory and practice”, “interaction with others and professional development” and “desire and motivation for learning medicine”.
Conclusion: Majority of students felt that early clinical exposure is a very good teaching learning tool, The present design involving a introduction of variety of dimensions of medical profession like scientific, ethical, interpersonal, professional and social to the new entrants in addition to enhancing their motivation to learn. A well designed ECE program could be the ideal first step in the making of a holistic doctor.

Background: Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU).Data comparing Dexmedetomedine and Fentanyl as an effective sedation in mechanically ventilated patients are lacking.
Methods: In a prospective, bouble blind study, we randomly assigned newly mechanically ventilated patients  to receive  Dexmedetomidine (0.3 to 0.7mcg/kg/hr) or fentanyl (1 to 3mcg/kg/hr) with doses adjusted to achieve target sedation goals set by clinicians according to the Richmond Agitation–Sedation Scale (RASS, on which scores range from −5 [unresponsive] to +4 [combative]). Midazolam 0.002 mg/ Kg bolus was administered as rescue sedation if the target sedation score could not be achieved within the infusion range. Primary end points were to assess the total dose of the sedative drugs, time required to achieve target sedation as well as total dose of rescue sedation administered.
Results:  62 patients were included in the study, of which 31 received Dexmedetomidine, and 31 received fentanyl infusion. It was observed that there was a significant difference among the two groups with reference to the time required to achieve target Richmond Agitation Sedation score (RASS) of -1.The mean time to achieve target RASS of -1 in Dexmedetomidine group was 2.97 ± 1.278 hours whereas in Fentanyl group  6.29 ± 3.388 hours  (p<.001  vhs) . The mean rate of infusion required to achieve target RASS of -1 in Dexmedetomidine group was 0.5 ± 0.1 mcg/kg/min and in Fentanyl group 2.7 ± 0.8266 mcg/kg/hr. The mean dose of Midazolam as rescue sedation was higher in Fentanyl group (2.29 ± 1.657) as compared to Dexmedetomidine (0.39 ± 1.202) mg (P < 0.01).
Conclusion:  Dexmedetomidine group achieved adequate sedation in lesser time and in doses within the prescribed clinical range as compared to fentanyl group, in mechanically ventilated patients. Further, the 24 hour midazolam requirement was higher in fentanyl group.

Melanoma is the most common malignant neoplasm of the foot and ankle and are associated with a poor prognosis. The aim of the current study was to evaluate the functional and oncological outcomes of salvage surgery using Fascio- cutaneous flaps for soft tissue reconstruction of the foot following the resection of a melanoma. A retrospective review was conducted to evaluate patients who presented with foot melanoma and underwent salvage surgery and defect reconstruction using Fascio- cutaneous flap between January 2015 and December 2021at Acharya Tulsi Regional cancer Treatment & Research institute, Bikaner. The postoperative morbidity, surgical complications, functional outcomes and oncological outcomes were evaluated.  10 patients were enrolled. The median follow‑up time of the patients was 52 months (range, 8‑84 months). A reverse sural fasciocutaneous island flap was used in all patients to perform the foot reconstruction. All 10 cutaneous flaps survived and provided satisfactory coverage. Only one cutaneous flap showed partial necrosis and required treatment comprising of debridement and regular changes to the wound dressing. The overall survival rate of patients was 69.0% and good oncological outcomes. Salvage surgery with Fasciocutaneous flap reconstruction was found to be a reliable option for patients presenting with malignant melanoma of the foot.

Background: Oral squamous cell carcinoma (OSCC), the most common cancer worldwide, disseminates to cervical nodes which strongly influences survival and prognosis. The present study was conducted to assess clinical spectrum of oral squamous cell carcinoma patients.
Materials & Methods: 264 histopathologically proven oral squamous cell carcinoma (OSCC) patients who underwent surgery including neck dissection of both genders were included in the study and parameters such as site of oral cancer, post-operative histopathological detail and type of neck dissection was recorded.
Results: Out of 264 patients, males were 160 and females were 104. We found that common site was buccal mucosa in 132, tongue in 48, alveolo-buccal in 52, alveolus in 14, lip in 10 and floor of mouth in 8 cases. T Stage clinical was T1 in 24, T2 in 70, T3 in 40and T4 in 130. Neck node clinical was seen in 184 cases. We found that on ipsilateral site, neck dissection done was RND in 24, MND1 in 28, MND2 in 128, MND3 in 20 and supra-omohyoid neck dissection (SOHND) in 64 cases. On contralateral side, neck dissection performed was MND1 in 6, MND2 in 10, MND3 in 12, SOHND in 37 and not done in 199 cases. Histopathological node status was positive in 42% and negative in 58%. Oral subsite wise pathological node positivity in buccal mucosa was 35%, tongue in 40%, alveolo-buccal  in 42%, alveolus in 38%, lip in 32% and floor of mouth in 30%. Groups of nodes involved were 0 in 60%, 1 in 14%, 2-4 in 18% and >4 in 8%.
Conclusion: Most common site of oral squamous cell carcinoma was buccal mucosa, followed by alveolo-buccal region. Type of neck dissection done was MND2.Most common level of nodal involvement was level 1 and level 2.Incidence of node positivity was relatively higher among locally advanced tongue cancer than early oral cancer.

Background: Black, brown, or blue skin lesions are referred to as pigmented skin lesions. Both melanocytic and non-melanocytic lesions are included in this group. Numerous pigmented lesions enhance the likelihood of melanoma and are challenging to categorize due to the wide range of histological findings. With this study, we aimed to compare the clinical and histological diagnoses while also evaluating the range of pigmented skin lesions in cases presenting to our hospital.
Methods: Based on the inclusion and exclusion criteria a total of n=36 cases were included in the study. Punch biopsy was taken for smaller lesions and excision was done for larger lesions. All the biopsies and resected specimens received in our department were properly labeled, numbered, and immediately fixed in 10% formalin for 24 hours. Tissue processing was done. Multiple sections were studied after staining with hematoxylin and eosin and were evaluated accordingly. The histopathological request forms were used to gather the clinical data and pertinent investigations for the patients during this time.
Results: In the present study of n=36 pigmented lesions n=24(66.67%) showed clinicopathological correlation and 12 (33.33%) were inconsistent with clinical diagnosis. Among the clinical cases inconsistent with the clinical diagnosis were benign melanocytic naevi 16.67% of cases. Pigmented seborrheic keratosis in 71.43% of cases and pigmented basal cell carcinoma in 75.0% of cases. The only case of pigmented actinic keratosis was also not found to be consistent with clinical diagnosis.
Conclusion: The most frequent non-melanocytic lesions are pigmented seborrheic keratoses, while benign melanocytic nevi are the most frequently encountered pigmented melanocytic lesions. Lesions with and without melanocytosis tend to occur more in females. Because pigmented seborrheic keratosis and pigmented basal cell carcinoma are the most frequent mimics of melanocytic lesions, rigorous pathological assessment is essential.

Introduction: Proximal tibia fractures are one of the commonest intra-articular fractures. Mechanism of injury usually is indirect coronal or direct axial compressive forces.Incidence of proximal tibial fractures is 1% of all fractures and 8% of the fractures in elderly. Most injuries affect lateral tibial condyle (55 to 70%) and isolated medial condyle fractures occur in 10 to 23% whereas the involvement of both condyle fractures is found in 10 to 30% of the reported series.Every different fracture type has its own characteristic morphology and response to the treatment. Apart from tibial plateau bony injury, meniscal tear and other ligament injuries of knee need to be assessed.
 
Material and Methods: This is a prospective study involving 60 patients with complex tibial condyle fractures with posterior column fractures. Preoperative computed tomography is taken with radiography for complete evaluation of fracture fragments even in the coronal plane. Fractures were classified as Schatzker type 4 or above with a posteromedial split depression. Plating is done with posteromedial locking compression for buttressing posteromedial fragment.
 
Result: Single-column fractures (Schatzker Type IV and Hohl and Moore Type I coronal split fracture), Two-column fracture (Schatzker type IV and type V), Three-column fractures (Schatzker Type V).  In our study majority of patients were Three-column fractures, followed by Two-column fracture and Single-column fractures.  Mean duration of surgery time of single column fractures were 65.41 minutes, two-column fracture 76.57 minutes and 94.91 minutes for Three-column fractures. After operative procedure, 18 (30.0%) patients got discharged on post op day-7, 12 (20%) patients on post op day-9, 10 (16.7%) on post op day-10 and 20 (33.3%) on post op day-12.
Conclusion: Based on our study we conclude that column specific fixation is a better option compared to conventional method of fixation as it provides better visualization, control over fragment, stable reduction and fixation of fragment. Even though radio-logical outcome is better in posterior column fixation group, functional outcome remains to be same in both the groups. It requires long term follow up and large number of patient study to assess the effectiveness of posterior column fixation.

Background: Optic neuritis causes substantial visual impairment and potential long-term visual defects in addition to serving as an important prognostic indicator for future development of demyelinating diseases such as multiple sclerosis. So, an ophthalmologist has a very significant role to aid in prevention of full blown MS. Fortunately, in most cases, optic neuritis recovers either spontaneously or with treatment. Recovery can be partial or absolute, depending largely upon severity and co-existing conditions.
Aim: To study the clinical profile and visual outcomes in patients with optic neuritis.
Material and methods:A prospective observational study was conducted in the Department of ophthalmology, MMIMSR Mullana, Ambala for which approval was obtained from the ethical committee of the institution. Patients of ON were included in the study after obtaining informed consent. Total 60 cases were studied. Analysis was done using SPSS and Pohnpei software.
Results:The mean age of presentation was 39.3667 ± 14.03563. ranging from 16 to 75 years.Out of 60 patients, retrobulbar neuritis was diagnosed in 34 [56.7%] whereas papillitis was diagnosed in 26[43.3%].After ONTT all patients showed improvement in vision. This improvement in vision is statistically significant.
Conclusion:The results revealed that the prevalence of papillitis and RBN were almost equal. Patients with RBN responded quickly to ONTT regimen while papillitis recovered late. VA improvement after ONTT was statistically significant. Colour vision and contrast also improved. Our study showed that ONTT regimen has a benefit in optic neuritis with fast visual recovery.

Background: Acute exacerbation chronic obstructive pulmonary disease (AECOPD) is the leading morbidity and mortality cause worldwide. Many studies showed the association of hyperglycaemia with poor results from a wide range of acute illnesses.
 Aim and Objectives: To investigate the association between concentrations of blood glucose & clinical outcomes in AECOPD patients admitted to the hospital.
Material and Methods: This is a hospital-based retrospective analysis carried out on AECOPD patients admitted during the period of January 2021 to March 2022. Detailed history, clinical examination, blood investigations were performed. Random blood glucose levels at the admission were noted, and the subjects were separated into groups of four on the basis of blood glucose levels (≤ 140 mg/dl, 141- 170 mg/dl, 171-200 mg/dl, >200 mg/dl). The clinical outcome was compared among these four groups.
Results: In this study majority were male patients (86%) with age ranging from 66-75 years (46%). About 85% of patients were smokers, and 15% were non-smokers. 68% of the study group population was hyperglycaemic (RBS >140 mg/dl). Among different quartiles, the mean length of stay in hospital was statistically considerable (p=<0.05), signifying an increased length of stay in hospital trend as the admission RBS levels increase. There was no statistically significant relationship amongst the RBS quartiles of ≤140 mg/dl and RBS quartiles of 141-170mg/dl (p=0.997). There was a statistically considerable correlation amongst the RBS quartiles ≤140 mg/dl and RBS quartiles ≥201 mg/dl(p=000), and this study’s crude rate of mortality was 5%. The population under quartile of RBS ≥201mg/dl had the highest percentage. All the people who died were over the age of 56 years. The mean HbA1c among dead (9.43 ± 2.25) and alive (6.78±1.70) showed significant relation (p=<0.05).
Conclusion: Higher the admission RBS, longer was the mean length of stay in hospital and mortality in the AECOPD diagnosed patients. Maintaining the blood glucose levels < 170 mg/dl than the strict glycaemic control, i.e.<140 mg/dl, could benefit these patients' outcome. This study indicates that for clinically treating the AECOPD patient population, targeted surveillance, as well as DM management, are critical.

Background: Early diagnosis and management of DM is extremely important to enhance the understanding to improve the outcome of the disease. These symptoms can be prevented easily just by managing the body metabolism.
Material and Methods: This study was conducted in the department of Dermatology and Medicine in a tertiary care teaching hospital. This study involved 200 consecutive patients attending Dermatology OPD with skin features related to Diabetes. The study was done over a period of 2 years.
Results: Out of 200 patients, 98 were males and 102 were females. Thus preponderance of female was noted in our study. Out of 55 Type 1 DM patients, 30(54.5%) were males and 25(45.5%) were females. Among all totally 37 cases (18.5%) had dermatophyte infections. Wet mount examination of the skin lesions in 10% KOH showed long hyaline branching septate hyphae and arthrospores in almost the cases.
Conclusion: The present study evaluated the prevalence and types of cutaneous disorders associated with DM and thus, established the role of dermatologists in their management. 

Background: In this study, we wanted to compare the accuracy of magnetic resonance cholangio-pancreatography (MRCP) with that of ultrasonography in cases of obstructive jaundice, and evaluate the cause of obstruction in case of obstructive jaundice.
Methods: This was a hospital based prospective study conducted among 30 patients who presented with obstructive jaundice/pancreaticobiliary disease to the surgical out-patient department (OPD) and referred for MRCP to the Department of Radiology, Adesh Medical College and Hospital, Mohri, India. The study was conducted over a period of 6 months from 1^st March 2022 to 31^st August 2022 after obtaining informed consent from the study participants.
Results:  For MRCP, sensitivity, specificity, positive predictive value and negative predictive value were 100 % each. Mass could be visualized in 90 % ultrasound (USG) and MRCP. Stricture was identified and localized in 90 % cases of USG while 100 % cases of MRCP. MRCP showed “double duct signs” in all the cases. MRCP was also able to comment on metastasis to lymph nodes and liver thus helping in staging and planning treatment. There was similar result between USG and MRCP in cases of periampullary carcinoma, choledochal cyst and carcinoma head of pancreas. All modalities were showing 100 % sensitivity and positive predictive value in these cases in diagnosing cause of obstruction. Overall sensitivity of USG and MRCP remained 68.57 % and 97 % respectively. Positive predictive value was 100 % with each modality.
Conclusion:  MRCP with modern apparatus can demonstrate anatomy and pathology in case of obstructive jaundice with almost equal or even better extent as compared to USG. Moreover, MRCP can better comment about entire extra luminal extent as well as lymph node metastasis in case of malignant pathologies, thus help in planning the treatment.

Introduction:Asymptomatic bacteriuria in pregnancy can lead to complications like urinary tract infections (UTI), pyelonephritis, pre-eclampsia, toxaemia, low birth weight, intra uterine growth retardation, preterm labour, preterm premature rupture of membrane and post-partum endometritis. There is insufficiency of data regarding prevalence, causative organism and antibiotic sensitivity pattern in all three trimesters of pregnancy. Thus to prevent the complications screening for ASB has been suggested for all pregnant women attending antenatal clinics.
Aims:To determine the prevalence of asymptomatic bacteriuria in three trimesters of pregnancy at a tertiary care hospital of north India.
Materials and Methods: All asymptomatic pregnant females attending the antenatal clinic at district hospital of Barabanki were included in the study except those with symptoms of UTI such as dysuria, urgency, frequency & fever. Isolation and identification were done as per standard laboratory protocol. Antimicrobial susceptibility test was done as per CLSI guidelines.
Results: In this study, 900 pregnant females were screened for ASB out of which 87 (9.6%) were culture positive.The prevalence of ASB was 10.24% (39 out of 381) in primigravida, 10% (30 out of 300) in secundigravida and 5.55% (9 out of 162) in gravida 3 and 15.78% (9 out of 57) in gravida 4. Theculture positivity associated with the gestational agewas found to be 24.13% (21) in the 1^st trimester, 34.48% (30) in the 2^nd trimester and 41.37% (36) in the 3^rd trimester. Majority (75.87%) of the culture positive isolates were gram negative viz, E.coli(34.48%), Klebsiella(24.14%) and Proteus(17.24%).
Conclusion: Routine antenatal urine cultures should be done periodically in every trimester in order to screen ASB and appropriate treatment should be provided along with general health education regarding personnel hygiene and habits to avoid further complications specially to the 1^st trimester OPD patients as they are found to be the most affected group in this study.

Background: Intraoperative pain control by means of local anesthesia is an intrinsic part of clinical practice in oral surgery. The present study compared efficacy of lignocaine, ropivacaine, and bupivacaine in control of pain during extraction of mandibular posterior teeth.
Materials & Methods: 90 patients of mandibular third molar surgical extractions of both genders were divided into 3 groups. Group I was third molar surgeries performed using 2% lignocaine with 1: 80,000 epinephrine, group II underwent surgical extractions of mandibular third molars under 0.75% ropivacaine local anesthesia. Group III were given bupivacaine. Each group has 30 patients. Subject response for pain was recorded using visual Analog Scale (VAS) and verbal Rating scale (VRS).
Results: Group I had 16 males and 14 females, group II had 15 males and 15 females and group III had 13 males and 17 females. VAS showed no pain in 20, 25 and 22, minimal pain in 10, 5 and 8. VRS showed little pain in 18, 28 and 20, moderate pain in 9, 2 and 10, severe pain in 2 and extreme pain in 1 respectively. The difference was significant (P< 0.05).
Conclusion: 0.75% ropivacaine is a better anesthetic when compared to bupivacaine and lignocaine for pain control during third molar extractions.

Introduction:Fosfomycin has recently gained popularity due to the emergence of multi-drug resistant bacteria and its wide range of spectrum with considerable activity against both Gram-positive and Gram-negative bacteria, including E. coli.
Objective:The present study aims to evaluate the susceptibility of ESBL-producing E. coli to fosfomycin among patients suffering from UTIs.
Materials And Methods: The study included all patients who presented to the hospital's various outpatient departments (OPDs) with symptoms of UTIs. ESBL-producing E. coli was detected by using cephalosporin/clavulanate combination discs. Fosfomycin susceptibility test was done by using fosfomycin 200 μg disc. Antimicrobial susceptibility testing was done for all the ESBL-producing E. coli.
Results:A total of 266 (37.2%) isolates were found to be ESBL producers out of 714 E. coli isolates. Only 8 (3%) isolates were resistant to fosfomycin.
Conclusion: Fosfomycin has proved to be highly effective in the treatment of multidrug-resistant bacteria such as ESBL producing E. coli, and its prudent use is advised to avoid the development of resistance.

Background: Unerupted or partially erupted teeth may be impacted, which means they are prevented from completely erupting into the normal functional position. The present study was conducted to evaluate third molar impaction status in different facial types and mandibular length.
Materials & Methods: 65 patients with third molar impaction of both genders were included. Parameters such as facial height, facial width, mandibular length, facial indexwas calculated as facial index= facial height ×100/facial width.
Results: Short mandibular length was seen in 45, normal in 12 and long mandibular length in 20 patients. The difference was significant (P< 0.05). Impaction was seen among 10 hypereuryprosopic males and 4 females, 22 Euryprosopic males and 16 females and 8 Mesoprosopic males and 5 females. The difference was significant (P< 0.05).
Conclusion: A significant association between mandibular length and mandibular third molar impaction was found.

Introduction: The postoperative pain can have a significant effect on patient’s recovery and increases hospital stay and cost of care. Hence, this study was conducted to compare post-operative analgesia in the group with lignocaine and a group with combination of lignocaine and magnesium sulphate by NRS score at 0, 2, 4, 12 and 24 hour and to compare hemodynamics between the two groups intra-operatively and post operatively.
Materials and Methods: In this prospective, randomized, double-blind, controlled trial, 100 patients were enrolled. The study was conducted by the Department of Anesthesiology, Indira Gandhi institute of Medical Sciences, Patna, Bihar. The study was approved at the Institutional Ethics Committee. The time period of the study was six months. Selected patients were randomly allocated to two groups, each containing 50 patients. Group A patients received only intravenous lignocaine 2mg/kg in bolus in 50 ml Normal saline and maintained at the rate of 3mg/kg/hour. Group B patients received the combination of intravenous lignocaine and magnesium sulphate 50mg/kg in bolus of 50 ml Normal saline and maintained at the rate of 15 mg/kg/hour and lignocaine at same dose.
The postoperative pain was estimated with two tools; consumption of analgesic during postoperative period and the time to request them. Each patient was assessed using NRS score which varies from 0 to 10 where 0 means no pain 10 means intolerable pain. Statistical analysis was done using Microsoft Excel.
Results: We found that a combination of lidocaine and magnesium sulfate resulted in significantly lower analgesic consumption. We also also found that lidocaine had lower pain score than Mg group, though statistical significance could not be established.
Conclusions: Hence, we concluded that usage of IV MgSO4 followed by continuous infusion leads to decrease in postoperative pain and analgesic consumption in patients undergoing laproscopic cholecystectomy.

Aim: The aim of this study was to evaluate the clinico-pathological profile of colorectal cancer patients in our tertiary care hospital.
Material and methods: This prospective as well as retrospective study was conducted in Gastroenterology division of Department of General Medicine at Ananta Institute of Medical Sciences & Research Center, Udaipur, Rajasthan, India. Total 174 patients presenting with colorectal cancer (CRC) from August 2019 to July 2022 were included in the study. Study tools were Study-questionnaire, investigations [routine blood tests, CEA, Colonoscopy, USG, CECT and MRI] and histopathological reports. Parameters studied were age, sex, site of lesion, clinical presentations and histopathology of the lesion.
Results: We observed that overall proliferative type was the most common type of tumor in our patients (n=75; 43.10%) with p value of <0.0001, followed by infiltrative (n=59; 33.91%), ulcerative (n=36; 20.69%) and ulcero-infiltrative (n=4; 2.29%). History of colorectal cancer in family was present in 45 (25.86%) of patients; with statistically significant p value of <0.0001. Out of 174 patients, 81 (46.55%) were smokers (p value 0.544). The most common clinical presentation of the patients in our study was change in bowel habits (n=136; 78.16%) followed by bleeding per rectum (PR) (n=117; 67.24%), abdominal pain (n=102; 58.20%) and generalized weakness (n=78; 44.83%). Most common site of involvement was rectum (n=78; 44.83%) followed by right colon (ascending colon and ceacum) (n=5531;61%), descending colon (n=18; 10.34%), sigmoid (n=16; 9.19%) and transverse colon (n=7;(4.02%). Together rectosigmoid comprise about 54.02% of total CRC. In our study we found elevated preoperative CEA levels (≥ 5.1 ng/ ml) in 80 (45.98%) patients, not elevated (≤ 5.0 ng/ml) in 36(20.69%) patients and not taken/unknown in 58 (33.33%) patients.
Conclusion: The incidence of CRC is increasing in younger age group and younger patients present at advanced stage. Lack of awareness about CRC in general population and lack of screening programs are responsible for advanced stage of CRC at presentation. Public awareness through mass-media, screening of high-risk populations, early diagnosis, cost-effective multi-modality treatment and regular follow-up is the call of the time for limiting the morbidity and mortality associated with colorectal cancer.

The importance of hydrogen energy has recently been recognized again, especially by the spread of a fuel cell from the viewpoint of an environmental issue. However, hydrogen is industrially produced by steam reforming of hydrocarbons such as methane. Dihydrogen has to be produced from water using a natural energy if one thinks of the environmental issue. Therefore, water splitting using a photocatalyst is a challenging reaction because it is one of the ultimate reactions to solve energy and environmental issues. Water splitting using photocatalysts is not a new theme. Water splitting has been studied in the research fields of catalysis, electrochemistry, photochemistry, organic and inorganic chemistry, etc. for about 30 years since the Honda–Fujishima effect was reported using a TiO2 semiconductor electrode [1]

INTRODUCTION
Pyogenic liver abscess is a life threatening disease. Management of pyogenic liver abscess has improved significantly with the advent of potent antimicrobial agents and advances in diagnostic imaging and imaging guided percutaneous procedures. Because of this progress, the classic traid of fever, upper right quadrant pain or fullness, and jaundice is rarely seen nowadays. Over the past three decades, percutaneous needle aspiration or catheter drainage guided by sonography or CT has become the therapy of choice for pyogenic liver abscess. Percutaneous pigtail catheterization reduces chances of exploration by surgery for liver abscess. Exploratory laparotomy is now indicated in cases of ruptured liver abscesses only. The advantage of sonographic over CT guidance is that sonography is a real-time imaging technique that allows monitoring of the course of the needles and catheters as they traverse tissues. CT usually is associated with longer procedure times because it is necessary to scan the region of interest every time confirmation of catheter is required.
A review of 30 patients with pyogenic liver abscess treated at general hospital of Ahmedabad over a 3 year period was undertaken who were managed by percutaneous pigtail catheterisation along with other supportive procedures.
 
AIMS OF STUDY
i)                To evaluate predisposing factors & incidence of pyogenic liver abscess in various age group, sex, socio-economic study, various medical diseases & its comparison with international studies.
ii)              To study patient, presentation and manifestations of pyogenic liver abscess and its complications.
iii)            To evaluate response of various diagnostic techniques and available resources.
iv)             To evaluate role of percutaneous pigtail catheter drain for management of liver abscess.
 
MATERIALS AND METHODS
The patients of diagnosed pyogenic liver abscess and treated at our institute were reviewed and studied for the following datas.
The cure was considered with the absence of symptoms and clinical signs. Though the cavity persisted in follow up ultrasound for much longer time.
A study of treatment of pyogenic liver abscess by placement of percutaneous liver aspiration drain.

Background: The current study compares the hemodynamic, sedative, and analgesia-potentiating effects of fentanyl and buprenorphine delivered epidurally in combination with bupivacaine.
Methods: A prospective study was performed by Department of Anaesthesia, Guntur Medical College, Guntur, India at Government General Hospital, Guntur. This study included 60 individual undergoing lower limb surgeries that were divided in two groups. Wherein group a received solution of 15 ml of 0.5% bupivacaine hydrochloride and 3 g/kg buprenorphine. And group B administered with solution consisting of 15 ml of 0.5% bupivacaine hydrochlori        de and 1 g/kg fentanyl.
Result: The mean time for onset of motor block in group A was 9.53±1.14 minutes and in group B it was 6.43±1.04 minutes. The mean time of onset of motor block was significantly lower in group B when compared to group A. The mean duration of return to Bromage sore 0 in group A was 230.17±12.70 mins and in group B it was 332.83±14.42 mins. There was a statistically significant difference in the mean duration of return to Bromage score 0 across the groups. The time required in group B was significantly higher when compared to group A. 
Conclusion: Buprenorphine performs better than fentanyl when administered epidurally in terms of providing effective long-term postoperative analgesia. For preoperative analgesia, buprenorphine, fentanyl, and 0.5% bupivacaine can be injected epidurally in a single dose.

Background: To assess and contrast the effectiveness, hemodynamic stability, and side effects of dexmedetomidine and magnesium sulphate when used to reduce intraoperative shivering.
Methods: The study was conducted at Department of Anesthesiology at Government general hospital, Guntur, India from January 2021 to March 2022. The study was performed on 100 patients undergoing lower abdominal and lower limb surgeries under neuraxial anesthesia.
Result: In the magnesium sulphate group, it took an average of 3.88+0.25 mins for the shivering to stop, but in the dexmedetomidine group, it took an average of 2.18+0.26 mins. The shivering score of magnesium sulphate and dexmedetomidine was 3+0 mins. Magnesium sulphate was provided in one case, and no one in the dexmedetomidine group experienced shivering again.
Conclusion: Together, dexmedetomidine 1 mcg/kg and magnesium sulphate 50 mcg/kg significantly decreased intraoperative shivering. Dexmedetomidine stopped the shivering in the shortest length of time while simultaneously raising body warmth and maintaining reduced pulse and respiratory rates.

In this study group of 30 patients, eight were diagnosed with appendicular tumour, nine with appendicular abscess, five with ileocaecal Koch's, four with Carcinoma Caecum, and one with Crohn's disease. Appendicular Pathology accounts for 59% of cases appearing as a tumour in the right iliac fossa, followed by ileocaecal Koch's, Carcinoma Caecum, and Crohn's disease. This study found that appendicular mass is the most prevalent mass in the right iliac area and is best treated conservatively, resulting in a favourable response with no morbidity. All cases of ileo-caecal TB that were surgically treated showed a satisfactory response. Cases with Crohn's disease treated surgically and then followed on a medicinal regimen showed a positive response. In the event of a mass abdomen, ultrasound was found to have 89 percent sensitivity in recognizing the right iliac fossa mass, with accuracy; correct diagnosis was made in 89.3 percent and found to be superior to clinical evaluation 82 percent. Ultrasound is proven to be 89 percent sensitive in the final diagnosis. It has been demonstrated to be useful in distinguishing appendicular mass from appendicular abscess. This is a critical preoperative examination when the management strategy shifts from conservative to surgical. In our study, 20 patients underwent computerised tomography for further examination of a right iliac fossa mass in which ultrasonography was inconclusive. When compared to final diagnosis, CT was 94 percent sensitive in detecting the underlying pathology in elderly patients who cannot tolerate procedures such as colonoscopy, patients who are reluctant for radiation exposure (barium studies), and those who cannot afford CT scanning. In rural areas where CT scans are not available, ultrasound has a definitive role in the diagnosis of the right iliac fossa mass, in its pre-operative evaluation, and management.

Background: Head and neck cancer is the sixth most prevalent cancer, constituting 3% of all localizations. In 48% of instances, oral cancers are squamous cell carcinomas. Epidermal growth factor receptor (EGFR) is an ErbB family tyrosine kinase receptor expressed in solid tumours, including head and neck squamous cell carcinoma (HNSCC). HNSCCs have various clinicopathological characteristics and a dismal prognosis.
Martial and Methods: 160 HNSCCs were studied in the Department of Pathology, Mallareddy Medical College for women 18 months [Nov 2020-April 2022] for the immunoexpression of Cyclin D1 and Ki 67 with relation to histopathological grade and various clinical parameters such as age, gender, history of smoking, alcohol consumption, tobacco chewing, anatomical site involvement, lymph node status, and cancer stage wherever available.
Results: 113 of 160 cases were male; 47 were female. 106 head and neck squamous cell carcinomas (66.25%) were male and drank. 26 of 160 cases were radical neck dissected. 73% of patients had metastatic lymph nodes. 14 cases (66.6%) had >50% immunoreactive cells. 13 of 21 patients (62 %) were Ki-67 immunopositive. Lymph node-positive HNSCC had higher Cyclin D1 and Ki 67 immunoexpression. In 160 of 29 patients, cyclin D1 positive was unrelated to clinical stage. Stage IV tumours (66.6 %) had the highest Ki 67 values, followed by stage III. Higher pathogenic stages enhanced Ki 67 expression (p=0.037). Cyclin D1 and KI 67 immunoexpression correlated with lymph node metastases (p = 0.005 and 0.008, respectively).
Conclusion: The present investigation found a link between Cyclin D1 and Ki 67 immunoexpression correlated with histopathological grade and lymph node status, and Ki 67 with advanced tumor stage.

Background: Snakebite remains one of the major public health problems throughout the world, affecting several million people each year. The majority of snakebites occur in rural areas and result from 4 species namely Russell's viper, Cobra, common krait, and saw-scaled viper. High mortality in rural areas is due to delayed visits to the hospital and a preference for traditional healers. There are limited studies available on the demographic and clinical profiles of snake bites from rural parts of Telangana, South India.
Aim: To study the clinical and socio-demographic profile of snake bites in children.
Materials and Methods: A record-based retrospective study was carried out at S.V.S Medical College and hospital, Mahabubnagar, Telangana, India. All the children aged less than 15 years with snakebite cases admitted to the hospital from January 2016 to July 2022 were included in the study. Socio-demographic, clinical manifestations, complications, management, and outcome were recorded. The data were entered into a Microsoft Excel sheet and analyzed using Statistical Package for Social Services (SPSS) software Version 23.
Results: Out of 58 snake-bite cases, 63.8% were males and 36.2% were females. Most snakebites were observed in the 5-10 age group (41.3%), and 82.8% were from rural areas. Snakebites commonly occurred between the May-August months (60.3%). Most of the people were bitten inside the house (62%), and Most of the victims (67.3%) were lying on the floor at the time of the bite; 40% of the bites happened between 00:01 to 06:00 hours of the day. Fang marks were seen in the majority of the victims (72.4%). The lower limb (44.8%) was the commonest site. Most of the patients developed neurotoxic symptoms and krait (52%) was the common snake responsible for envenomation. Ptosis (86%) was the most common clinical feature followed by difficultyin breathing (82.8%), pain at the bite site (68.9%), and epigastric pain (67.2%). ASV was administered in 94.8% of the children and 82.7% required mechanical ventilation. The majority of the children survived (91.4%) and three children died (5.2%).
Conclusion: Children between 5-15 years are vulnerable to snakebite due to outdoor activity, particularly in rural areas. Awareness must be created among the public on the early visit to health care after a snake bite. There is an urgent need to strengthen primary and secondary health care centers to manage snake bite cases. Training of healthcare providers is also essential to identify snake bite cases when the history of the bite is not obvious.

Background: In lower limb orthopedic surgeries there is significant postoperative pain, which is difficult to treat with oral or intravenous analgesics resulting in adverse endocrine, metabolic and inflammatory responses. Morphine, Pethidine, Fentanyl, and other opioids fall under the Narcotics Act whereas nalbuphine does not. So, the accessibility of Nalbuphine is not as major a concern in several hospitals in India as that of morphine and other such opioids. Present study was aimed to compare the effectiveness of 0.8mg nalbuphine with 20 mcg fentanyl as an adjuvant to hyperbaric bupivacaine in lower limb orthopedic surgeries. Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of either gender, age group of 18-60 years, belonging to ASA CLASS 1 and 2, With BMI < 30, undergoing elective orthopedic lower limb surgery. Patients were allocated in Group N- Received intrathecal 0.8 mg Nalbuphine & 3 ml 0.5 % H bupivacaine & Group F- Received intrathecal 20 mcg Fentanyl & 3 ml 0.5 % H bupivacaine.

Background: PRISMIII score was shown to be effective in predicting the risk of mortality and as well as the factors contributing to poor outcome. Therefore, we have evaluated our PICU using modified PRISMIII results. Martial and Methods: A Prospective observational study was conducted on 120 seriously ill infants and children meeting the inclusion and exclusion criteria admitted to PICU were taken up for the study at the Department of Paediatrics, Mahatma Gandhi Memorial Hospital, KMC Warangal, Telangana, South India. Results: Mean age among survivors was 57.16±49.35 months and among deceased were 34.8±43.4 months. Male to female ratio was 1.06:1.00. Our PICU is catered to the medical critical illness only. The overall mortality rate is 57.5%. The major causes of illness in the order of decadence were, infections, Respiratory, CNS, CVS and GIT disorders Altered sensorium, multiorgan dysfunction and need for mechanical ventilation were significant risk factors of mortality. The duration of hospital stay among non-survivors was less than the survivors. Conclusion: The mean PRISMIII score among non-survivors was higher than survivors. PRISMIII score at 24hrs, PRISMIII difference, length of hospital stay, showed a statistically significant correlation with the mortality (p=0.000). The probability of deaths increased significantly with increase in PRISM score. Area under ROC is 99.9%, with cut-off point at score 15.

Background: Aim of this study to estimate the diagnostic accuracy of clinical assessment with ultrasound guided axillary node core needle biopsy (CNB) / fine needle aspiration cytology (FNAC) for axillary staging in early stage breast cancer. Materials and Methods: This prospective study was conducted in a tertiary care centre of central India in medical college hospital Jabalpur. We identified 64 consecutive patients of newly diagnosed early stage breast cancer. After clinical examination, ultrasound axilla guided core biopsy or fine needle aspiration cytology was performed if the node was in ultrasound. Axillary node dissection was performed in all patients. Preoperative and postoperative nodal positivity was compared and analysed. Results: Clinically and by ultrasound sensitivity and specificity of metastatic nodes was 50 and 75% and 75 and 83% respectively. False negative rate of our study was 6.2% that is equivalent to sentinel node biopsy. Sensitivity of guided FNAC/biopsy was 50 % in our study. Conclusion: Our study showed use of detailed clinical assessment is a good alternative where facility of sentinel node biopsy is not available. It is a good and less morbid alternative to sentinel node biopsy and if the result is positive can proceed directly to axillary node dissection

Background: Breast lesions are a diverse range of lesions made up of various unique entities, each with unique properties. Patients' worry can be reduced and it may even save their lives if lesions are evaluated early and a quick, accurate diagnosis is made. Breast cancer, which affects 25.8 per 100,000 women, is the most frequent malignancy among Indian women. Materials and Methods: From June 2018 to June 2020, 100 instances of both neoplastic and non-neoplastic breast lesions were assessed and referred to the pathology department at CAIMS, Karimnagar. Specimens were preserved in 10% formalin. Selected regions of the specimen were processed, sectioned, stained with haematoxylin and eosin, and examined under a microscope. Results: Out of the 120 instances that were analysed, 40 are non-neoplastic and 80 are. Breast abscesses, duct ectasia, fat necrosis, galactocele, accessory breast, and granulomatous mastitis are the most prevalent non-neoplastic lesions. 50 benign and 30 malignant neoplastic breast lesions were found. Fibroadenoma 20, fibrocystic disease 5, sclerosing adenosis 2, benign phyllodes 2, and duct papilloma 1 are the most frequent benign breast lesions, respectively

Background: The objective of this study was to analyse the thyroid cytology smears by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), to determine the distribution of diagnostic categories and subcategories, to analyse cytological feature, and to correlate cytopathology with histopathology wherever surgery was done. Materials and Methods: In an institution based cross sectional study of FNAC done on 200 patients at pathology department at CAIMS, Karimnagar, 2017 to 2019 presenting with thyroid lesion were examined and categorized as per TBSRTC. Observation and Results: FNAC was done on 200 patients with thyroid lesions studied over a period of 2 years. Majority of patients were females accounting for 82 % and males were 18 %.Among the total thyroid lesions, Non- neoplastic constituted 92 %, neoplastic lesions were 3 % and 5 % were Non-diagnostic. Conclusions: TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow up FNA or surgery and also the extent of surgery

also the developed countries, with major consequences on their health and socioeconomic development. The present study was undertaken with an aim to find the prevalence of anemia amongst the patients attending tertiary care hospital. Material and Methods: Present study was single-center, observational study, conducted in children aged between 6 Month to 12 years, who are admitted in pediatric ward, diagnosed as anemia as per WHO classification. Results: Prevalence of anemia was 43.55 %. The prevalence of anemia was more in 5-12 year of age group (43.11%), boys (52 %), in lower socioeconomic class (40.89%), partially immunized children (58.58%), children on vegetarian diet (75.5 %). Most common degree of anemia at the time of admission was severe anemia (42.06 %), followed by moderate (39.37%) and mild anemia (18.57%). Microcytic hypochromic anemia was most observed peripheral smear seen (42.56%), followed by dimorphic anemia (28.82%). MCV was low in 71.47% patients, MCV was on higher side in 12.33% patients, MCHC was low in 76.07 % patients and MCH was low in 71.47 % patients. In 71.47% patients RDW was on higher side. 75.48% patients had iron deficiency, 50.81% patients had ferritin deficiency, and 42.15 % patients had vitamin B12 deficiency. 564 cases (83.80%) had nutritional anemia (42.64% had iron deficiency anemia, 12.33% had megaloblastic anemia and 28.82% had dimorphic anemia 561 patients were discharged ,91 patients were expired and 21 patients went DAMA. Most common cause of death is septicaemia and an acute respiratory distress syndrome (28.57 %), followed by congestive cardiac failure (26.37%) and disseminated intravascular coagulation (21.17%).

Background: A recent increase in the prevalence of overweight and obese women of reproductive age in India has been noted. Obesity during pregnancy is associated with an increased risk of gestational diabetes mellitus (GDM), pre‐eclampsia, miscarriage, venous thromboembolism, infection, and hemorrhage in the mother. The present study was aimed to explore various maternal and fetal outcomes, influenced by maternal obesity. Material and Methods: Present study was hospital based, prospective, observational study conducted in pregnant women, gestational age more than 32 weeks, singleton pregnancy, with BMI more than 30, delivered at our institute, willing to participate in present study. Results: During study period 107 pregnant women were considered for present study. Majority of women were from 26-30 years age (40.19 %), were primigravida (44.86 %), delivered at 37-40 weeks of gestation (40.19 %), 85.05 % had BMI 30-34.9 kg/m2 (moderately obese). In present study vaginal delivery was most common mode of delivery (52.34 %) followed by LSCS (40.19 %) & instrumental delivery (7.48%). Most common birth weight group was 2.5-3.99 kg (40.19 %), followed by 1.5-2.49 kg (34.58 %) group. Neonatal outcome noted was still birth (1.87 %), neonatal death (6.54 %) & rest of neonates were discharged with mother. 63.55 % babies required NICU admission. During postpartum period, complications such as wound infection (19.63 %), fever (14.02 %), wound dehiscence (6.54 %) & DVT (0.93 %) were noted. No maternal mortality was noted in present study. Conclusion: Maternal obesity is associated with development of gestational diabetes mellites, preeclampsia, need for labour induction, increased caesarean delivery as well as NICU admissions and increased incidence of postpartum infections.

Background: HIV impacts all body systems. Cardiovascular illness is a prominent non-HIVrelated cause of death in HIV patients. Traditional risk factors, HIV-related inflammation, and antiretroviral medication metabolic effects contribute to cardiovascular disease in HIV patients. HIV infection is a cardiovascular risk factor. Recent investigations show a link between HIV and cardiac events. Methods: 100 HIV-positive patients >12 years old at Government Medical College - Hospital, Suryapet, Telangana, India. All study participants had CD4 counts, ECGs, and echocardiograms. HIV patients were divided into four stages based on their CD4 cell count: >500, 200-500, 50-200, and 50. Results: In advanced HIV illness, cardiovascular problems tend to increase in frequency. To conduct the study, 100 HIV patients (both newly diagnosed and those already on ART) at the ART clinic at Government Medical College -Hospital, Suryapet, Telangana, India were randomly assigned to one of four groups according on their CD4 level and WHO stage. In the study, over half (49%) of participants were between the ages of 21 and 40, and nearly as many (43%) were between the ages of 41 and 50. About 85% of the study population was on ART, and 15% were recent diagnoses. The gender ratio of the participants in the study was quite close to 50-50. The people in the study were subjected to electrocardiograms and echocardiograms. Conclusion: Cardiovascular problems are more frequent and predictable effects of advanced HIV infection. A study was conducted to highlight the various circulatory issues brought on by HIV infection. Higher rates of morbidity and mortality are associated with a number of these anomalies.

Background: The purpose of this study is to determine whether immediate, intermediate, or delayed removal of an indwelling urinary catheter after an uncomplicated abdominal hysterectomy has an effect on the rate of recatheterization due to urinary retention, the rate of urinary tract infection, the amount of time patients spend walking around in the hospital, and the total length of their hospital stay. Martial and Methods: A Randomized controlled study was carried out at Narayana Medical College, Nellore, A. P, and India. A total abdominal hysterectomy was performed on two hundred twenty one women who were diagnosed with benign gynecological disorders. The patients were then divided into three groups at random. Urinary catheters were removed from the urinary systems of the women in group and as soon as possible after surgery. In group B, the catheter was withdrawn six hours after the surgery, while in group C, it was removed twenty-four hours after the surgery. The frequency of urine retention, the number of urinary tract infections, the amount of time spent ambulating, and the total length of hospital stay were the primary end measures. Results: The rapid removal group saw a statistically significant increase in the number of urinary retention episodes requiring catheterization when compared to the groups that underwent intermediate or delayed removal. The delayed urinary catheter removal was associated with a greater prevalence of urinary tract infections, a longer delay in ambulation time, and an extended hospital stay as compared to the early and intermediate removal groups. Conclusion: Removal of the urinary catheter 6 h postoperatively appears to be more advantageous than early or late removal in cases of uncomplicated total abdominal hysterectomy

Background: Dry eye disease (DED) is a common ocular surface disorder that is now days considered as a public health problem due to its impact on vision-related quality of life of the affected subjects.According to the recent official report of the International Dry Eye Workshop (DEWS 2017), that based on summary of the findings of current research, DED was defined as “a multifactorial disease of the tears and ocular surface that is associated with hyperosmolarity of tear film which in turn leads to inflammation and damage of the ocular surface that accompanied with ocular symptoms of discomfort, fatigue and disturbance in visioin” Aim & Objective: Method: Study design: A cross-sectional study. Study setting: Department of ophthalmology at tertiary care centre. Study duration: Dec 2020 to June 2021,Study population: The study population included all Subjects with current or previous diagnosis of DED were included in the study Sample size: 769 Results: The mean age of all participants was 43.61 ± 18.57 years with a range of 18 to 90 years. Of all study population, 405 (52.7%) subjects were females and 364 (47.3%) were males. Of the study population, 131 (17%) reported having diabetes milletus (DM), 161 (20.9%) reported having hypertension (HTN). DED was significantly more prevalent in older age group > 45 years (p = 0.002) and in females than males in all age groups (p = 0.00). Conclusions: The prevalence of DED is high in the study population. Older age and female gender were associated risk factors with the development of DED.

Background: Lipid and lipoprotein levels are interrelated with diabetes mellitus. Abnormalities in the levels of total cholesterol (TC) or triglycerides (TAG) or low-density lipoprotein (LDL) cholesterol or very-low-density lipoprotein (VLDL) cholesterol or high-density lipoprotein (HDL) cholesterol or lipoprotein (a) [Lp (a)] is traditionally named as dyslipidemia. Diabetes mellitus has been known to be associated with lipid disorders and cardiovascular diseases. In patients with diabetes mellitus, dyslipidemia occurs earlier in life, leading to increased morbidity and mortality rates. The study aims to assess the changes in lipids and lipoprotein levels in uncomplicated diabetes mellitus patients.
 
Methods: A case-control type of study was conducted for 18 months (September 2011 to March 2013) at the Department of General Medicine, Shadan Hospital, Hyderabad. Ethical committee approval was taken before the study from the institutional ethical committee. A total of 120 subjects, 60 non-diabetic (healthy) control subjects with matching age and gender and, 60 cases of subjects with uncomplicated diabetes mellitus were enrolled based on predetermined inclusion and exclusion criteria.
 
Results: This study was conducted to evaluate the changes in lipids and lipoprotein levels between control (normal and healthy subjects) and case (subjects with uncomplicated diabetes mellitus) groups. The Mean±SD levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and lipoprotein (a) were higher in the cases group and showed statistical significance when compared with the control group.

INTRODUCTION: Haematological disorders are one of the most common disorders encountered by physician ranging from anaemias to malignancies having wide range of presentations. Pancytopenia having various aetiologies poses a diagnostic challenge. Bone marrow aspiration and biopsy has a key role in diagnosis and treatment of haematological disorders and various systemic illnesses like pyrexia of unknown aetiology where the underlying aetiology is not obvious. The present study was undertaken to analyse the spectrum of bone marrow aspiration and biopsy findings in various haematological and systemic illnesses.
MATERIALS AND METHODS:  This is a retrospective and prospective study. Fifty patients were included in whom bone marrow aspiration and biopsy was done for various disorders. Patients with bleeding disorders and patients whose diagnosis was confirmed by clinical profile and initiated on treatment were excluded from the study.
RESULTS: The common indications of bone marrow examination in our study are Pancytopenia followed by anemia, leukemia and multiple myeloma.
Out of 50 cases, 2 cases were excluded from analysis due to inadequate sample. Of the remaining 48 cases – 4 were normocellular (8.4%), 22 cases (45.8%) are of hematological malignancies,  20 (41.7%)were non-malignant hematological disorders, 2 cases (4%) are of non-hematologic disorder.
Among 50 cases 33 (66%) cases were diagnosed on basis of clinical profile and  bonemarrow examination was just to strengthen the diagnosis, 15 (30%) cases were diagnosed only on bone marrow examination and the remaining 2 (4%) cases required further work-up.
CONCLUSION: Bone marrow aspiration is an invasive and useful technique which can diagnose and confirm many haematological and non-hematologic diseases accurately. The clinical profile alone cannot be sufficient at times for diagnosis of certain disorders and leaves physicians in a dilemma. This study emphasizes the need for Bone marrow examination in guiding the physicians for early detection of various underlying conditions and thereby  modifying the outcome of disease

Backgroud:- Poisoning is a huge epidemic of noncommunicable disease in this century. Among the unnatural deaths, deaths owing to poisoning fall next only to road traffic accident deaths. Management of these critically ill patients will largely get better if the general causes of poisoning are properly defined^[1] . The PSS is a classification scheme for cases of poisoning in adults and children^[2]. This scheme should be used for the classification of acute poisonings regardless of the type and number of agents involved. AIMS AND OBJECTIVES :- To evaluate the “Poisoning Severity Score (PSS)” and its ability to predict outcome in cases of poisoning. MATERIAL AND METHODS: - It is a Prospective Descriptive study consisting of total 60 cases of Acute poisoning. Severity score was assessed by the information in case sheets using Poisoning severity scoring (PSS) system. The outcome was measured in terms of morbidity and mortality. RESULT :- Out of 60 cases according to PSS 48% were grade 1 cases, 33% were grade 2 cases, 15% were grade 3 cases and 4% were grade 4 ordeath. 39 of patients did not require to be intubated. CONCLUSIONS. Poisoning is one of the medical emergencies and causes significant mortality and morbidity. Suicidal intent was significantly higher than other modes of poisoning (p=0.001). Organophosphorus compounds are the commonest agents involved in poisoning followed by rat killer poison. Banning or restricting their use may decrease mortality and morbidity from poisoning. In this study, we found that PSS was a very helpful tool in predicting the mortality in patients of poisoning. Keywords:-  Drugs, Organophosphorus compounds, mortality and morbidity

Asterion is the craniometric point at the junction of the lambdoid suture, occipitomastoid suture and the parietomastoid suture, it is closely related to the junction of transverse and sigmoid sinus.
Aim of the present study was to identify the safe zone in relation to asterion for initial burr hole placed before craniotomy in posterolateral cranial surgeries in order to prevent larger craniotomies and sinus injuries. As the position of asterion displays population specific variability its anatomic location was studied in adult human dry skulls of Telangana region.
Material and methods: 100 Sides of 50 human adult dry skulls of unknown sex and age from bone banks of medical colleges of Telangana region were studied. Measurements of the asterion from tip of the mastoid, root of zygoma and external occipital protuberance on both right and left sides were taken using digital vernier calipers. Surface projection of transverse sigmoid junction in relation to asterion was noted using transillumination.
Result: The mean distance between the tip of mastoid process and asterion was 49.87±2.09 mm on right side and 51.02 ± 2.01 mm on left side and P value was found to be significant. The mean distance from root of zygoma to asterion was 55.8 ± 1.91 mm on right side and 56.5 ± 1.89 mm on left side. The mean distance between external occipital protuberance and asterion was 62.4 ± 2.23 mm on right side and 62.9 ± 2.02 mm on left side. In majority of skulls (84%) transverse sigmoid junction was at the asterion, in 14% the transverse sigmoid junction was above the asterion and in 2% cases it was below the asterion.
Conclusion: Knowledge of the anatomical position of asterion using palpable bony landmarks, and its relation to the underlying venous sinuses plays an important role in performing safer posterolateral cranial surgeries

Hemovigilance terminology is entitled to the surveillance of adverse reactions that could be encountered by blood donors and untoward effects of blood transfusion in a recipient [1]. This is a broad-spectrum aspect of blood transfusion services (BTS) as it begins from the collection of blood to the transfusion of the same to a recipient. There are a number of quality steps involving various sections of blood banking while a unit of blood is collected for the purpose of blood transfusion. Hemovigilance programmes are currently in place in a vast majority of countries to monitor donor and transfusion reaction in the view of prevention of future occurrences. This article aims to review the various hemovigilance systems across the world.

A granular cell tumor is a rare benign tumor of neuroectodermal origin. It is derived from Schwann cells of the peripheral nerve. Granular cell tumors can originate anywhere in the body and about 5 to 15% of all granular cell tumors originate from the breast. Out of which 1 to 2% can show malignant change. Here we report a case of a 53-year-old female who came with complaints of swelling in the right nipple for 1 month associated with pain in the swelling. On examination 1X1.5cm lump in the right retro areolar region was present. The mammogram showed BI-RADS category 4(suspicious for malignancy). An excision biopsy was done for tissue diagnosis. Upon histopathological examination and the immunohistochemical study confirmed the diagnosis of a granular cell tumor.
The existence of granular cell tumors in the breast is uncommon and it can mimic carcinoma clinically and radiologically.

Foot arch is made up of bony arch and soft tissues which are acts as a shock absorber and helps in transmission and distribution of body weight. Body mass index (BMI) is one of the indicators used to detect body weight and nutritional status. Excessive weight of an adult can affect the occurrence of flat feet compared with adults who have normal weight. Flat feet are a disorder of foot structures that does not form the medial longitudinal arch (MLA) There are various studies who claim the association between high BMI and arch height of medial longitudinal arch in adult population. To know the association of arch height of medial longitudinal arch BMI in adult, this study was carried out.
Medial longitudinal arch, flat feet, (BMI) body mass index

Background – The brachial artery is the extension of the axillary artery starting at the lower margin of the teres major muscle and is the major artery of the upper extremity. The brachial artery reaches the cubital fossa and bifurcates into the radial and ulnar artery. The ulnar artery further gives short trunk called common interosseous artery which in turn divided into anterior and posterior interosseous.  In this study we observed that the anterior interosseous artery instead of arising from the ulnar artery it took origin from brachial artery and there was absence of common interosseous artery. Ulnar artery is very much thin which is continuing as its normal course in forearm as well in hand. Aim - To study the variations in origin of anterior interosseous artery. Material and Method- Dissection of the upper limb in dissection hall of anatomy department of National Institute of Medical Science & Research Rajasthan, India, in 24 cadavers of both sexes, who has donated their precious body to NIMS & Research institute. Result – We found higher origin of anterior interosseous artery in five cadavers out of 24 cadavers (20.83%); in that four were male cadaver and one were female cadaver. All variations were same in right upper limb of both cadavers. Conclusion- The purpose of this article is to highlight the need for the awareness of the potential existence of such anatomical variation during vascular and re-constructive surgery and how it can be preoperatively detected by color Doppler imaging, which would help the surgeons and clinicians to plan out vascular and re-constructive surgery and therapeutic interventions

Background: COVID-19 pandemic originated in the city of Wuhan in Hubie province of China and within three months of its origin the disease extended to nearly 221 countries in the world.
Objective: The objective is Study of hematological and various biochemical Markers in COVID-19 patients admitted in a tertiary care centre .
Methodology: In this single-center study, records of 170  patients hospitalized with COVID-19 were studied for hematological profile and biochemical markers. Records of patients with laboratory-confirmed COVID-19 disease hospitalized between April  2020, to August  2020, were included in the analysis.
Result: A total of 170  patients were enrolled of Age Group  20-80 year of which 80% (136/170) were asymptomatic and 20% (34/170) symptomatic. 17% patients had co-existing illnesses. Clinical spectrum among COVID-19 patients varied from being asymptomatic to having symptoms like fever, dry cough, breathlessness with few progressing to respiratory failure and multi-organ failure. In our study, 96.0% (163/170) recovered while 4.0% (7/170) died. Mean age, total leucocyte count (TLC), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lactate dehydrogenase (LDH) ,Procalcitonin, CRP, D dimer of severely ill patients were significantly higher than those of patients with non-severe illness.
Conclusion: The clinicians may consider the hematological and biochemical parameters in the patients with COVID-19 in future decision-making.  Elevated NLR, TLC, LDH, C-Reactive Protein, Procalcitonin, D dimer and lymphopenia were seen in the symptomatic patients especially manifesting severe disease. Early intervention and periodic monitoring of these parameters in patients, especially with severe disease may help in improving disease outcome

AIM: To evaluate the effect of music on the anxiety levels and vital parameters of patients undergoing refractive surgery under topical anaesthesia.
METHODS: After screening for inclusion and exclusion criteria, we included 100 participants undergoing refractive surgery for the study. The participants were randomly assigned into music group and control group with 50 participants each. Anxiety levels were assessed using State-Trait Anxiety Inventory (STAI) questionnaire before and after the music therapy. Vital parameters (heart rate and blood pressure) was recorded pre-operatively and intraoperatively. The data was compared and analysed.
RESULTS: There were 50 patients each in music and control group with similar demographic profile and baseline STAI-S score. The music group reported a reduction in anxiety score following 1-hour of pre-operative music therapy, but the difference was not statistically significant (P-value = 1.18). Mean heart rate during surgerywas lower in music group (91.7 + 24.75) compared to control group (97 + 7.07) and this difference was statistically significant (P-value < 0.05). No significant difference was found between groups in blood pressure.
CONCLUSION: Listening to music preoperatively can alleviate patient’s anxiety and improve the patient satisfaction with the procedure.

INTRODUCTION: Sub-trochanteric fractures accounts for approximately 10-30% of all Hip fractures. These fractures are difficult to manage and are frequently associated with complications, owing to high stresses in this region. Proximal Femoral Nail has immense potential advantages and suspected lower complication rates, hence long Proximal Femoral Nail in our system needed to be augmented and further studied . We evaluated the  functional outcome of long proximal femoral nailing in management of sub-trochanteric fractures.
 
MATERIAL AND METHODS: 30 patients of sub-trochanteric fractures of femur more
than 18 years of age and less than 80 years of age were treated with long proximal femoral nail and were assessed functionally by Harris Hip Score.
 
RESULTS: 30 patients of sub-trochanteric fractures with mean age 32.5 years treated with long proximal femoral nailing were included in the study. 19 were male and 11were female patients. Complications were seen in 4 patients such as 2 cases were of  superficial surgical site infection, 1 case of  slight varus deformity and shortening  and 1 case of  delayed union all with good functional outcomes.
CONCLUSION: Subtrochanteric fractures fixed using long proximal femoral nail have a stable construct which allows us to mobilize these patients early with less hospital stay and early weight bearing.Long proximal femoral nailing provides reliable and excellent to good results in the management of difficult sub-trochanteric fractures, with minimal complications, but the surgery is technically demanding and requires learning curve.

Objective: The current study aimed to compare the levels of zinc, alkaline phosphatase, and random blood sugar in people with leprosy to those in healthy controls from the Bundelkhand area. The second objective was to compare the correlation between study parameters in the leprosy group and the healthy control group. Material & methods:  The research was carried out in the Department of Biochemistry at Maharani Laxmi Bai Medical College (MLBMC) in Jhansi. In the healthy control group, forty human beings with normal glycemic status were age and gender matched. The leprosy patient group contained forty leprosy patients who were receiving treatment. Leprosy disease was diagnosed in accordance with the world health organization guidelines. Results: Age difference between the two groups was not statistically significant in the present investigation. Whereas, we found a statistically significant contrast between the two sets of data we analyzed, including RBS, ALP, and serum zinc levels. Leprosy patients showed a positive link between ALP and zinc, and a negative correlation between age and RBS; RBS and serum zinc. A positive connection between ALP and zinc was seen in the control group. We conclude that periodic monitoring of zinc concentrations in leprosy people may be prudent since zinc deficiency worsens insulin resistance and may lead to greater loss through urine.

The purpose of this study was to measure certain hematological parameters (Hb, PCV, and WBC counts), as well as the levels of malondialdehyde (MDA), glutathione (GSH), and insulin-like growth factor-1 (IFG-1). The study was carried out on blood samples from patients with thalassemia from the beginning of November 2021 to the end of March 2022. The study employed a total of (45) samples from the city of Tikrit city and (18) samples from a control group of healthy individuals. The age range for both groups was (15–17), The results showed that there were significant increase  at (P≤ 0.05) in the levels of (Hb, PCV and WBCs count) in patients group  which are (12.66±3.54 a) g/dl, (16.89±4.08 a) , (13.2±3.74 a ) respectively and control group were (8.59±2.84 b) g/dl ,(10.24±3.52 b) and (11.37±3.66 b) respectively ,the results also showed a significance increase (P≤ 0.05) in levels of IGF-1 in patients group which are (7.832±2.33 a) ng/ml and (2.181±0.72 b) ng/ml in control group, the study revealed that there was a significance decrease(P≤ 0.05) in levels of (MDA and GSH) in patients group which are (1.203±0.32 b)m mol/L ,( (0.0186±0.007 b)m mol/L and (2.671±0. 512  a) m mol/L and (0.0402±0.010 a) m mol/L in control group respectively

Background: To assess prevalence and risk factors for lower limb varicose veins during pregnancy.
Materials and Methods: 112 pregnant women during prenatal follow-up were enrolled. Varicose disease was clinically identified and classified according to Widmer’s criteria: trunk varicose veins, reticular varicose veins, and telangiectasias; being reclassified according to the criteria of the CEAP clinical classification. Patients without visible or palpable signs of varicose disease were considered as CEAP C0. The results of prevalence and risk factors were recorded.
Results: Age group 18-24 years had 62, 25-31 years had 34 and 32-38 years had 26 patients. The difference was significant (P< 0.05). CEAP C1 e C2 varicose veins were seen in 80 and CEAP C0 in 42. The difference was significant (P< 0.05). Varicose veins type C2 was seen in 22, C1 in 58 and C0 in 32. The difference was significant (P< 0.05). In multivariate analysis, age over 22 years and positive family history, were significant for varicose veins disease (CEAP C2) with odds ratio above 1.
Conclusion: The high prevalence of varicose disease during pregnancy, etiopathogeny and risk factors involved advanced age and positive family history

Background: To compare treatment modalities for the management of umbilical hernia in pregnancy.
Materials and Methods: 90 pregnant female patients with umbilical hernias were divided into 3 groups of 30 each. Group I were undergoing para-umbilical hernia repair by pre-peritoneal mesh insertion through CS incision, group II were undergoing paraumbilical hernia repair by infra- or supra-umbilical incision during CS incision and group III were undergoing paraumbilical hernia repair by infra- or supra-umbilical incision later on after healing of the CS wound. Each group had 30 patients. Complications were recorded in each group.
Results: Location was infraumbilical in 45%, 52% and 57% and supraumbilical in 55%, 48% and 43%. Surgical operative time (min) was 60 seen in 40%, 55% and 55%, 90 in 35%, 25% and 25%, 120 in 25%, 20% and 20%. Location of mesh was sublay in 100%, 42% and 25% and onlay in 0, 58% and 75%. Duration of hospital stay was 2 days in 30%, 35% and 38%, 3 days in 48%, 40% and 36% and 4 days in 22%, 25% and 26%. The difference was significant (P< 0.05). Complications in group I, group II and group III was wound infection in 1, 4 and 3, wound dehiscence in 1, 3 and 2, skin flaps ischemia  in 0, 1 and 2 and seroma in 0, 2 and 1 respectively. The difference was significant (P< 0.05) (Table II).
Conclusion: Performing para-umbilical hernia repair by insertion of a pre-peritoneal mesh simultaneously during performing CS through the same skin incision is the best method of management of para-umbilical hernia in pregnant woman

Objective: For individuals receiving orthodontic treatment, maintaining strict oral hygiene routines is essential to prevent periodontal health from declining. Thus, using the dental neglect scale (DNS) questionnaire, the current study was started to evaluate dental neglect and oral health condition among individuals receiving orthodontic treatment.
Materials and Methods: The 80 patients receiving fixed orthodontic treatment were the subject of the current cross-sectional study, which was designed and conducted. Two questionnaires were used in the study; one was a closed-ended one that asked about patients' practises for maintaining oral health, and the other was a DNS that was followed by an assessment of oral hygiene status using the Oral Hygiene Index Simplified. Chi square test was performed to statistically examine the data, with P <0.05 being considered a statistically significant value. The data were then subjected to analysis using SPSS version 20.
Results: According to the current study, 63% of the orthodontic patients were daily brushers, 26% were twice daily brushers, and 11% were three times daily brushers. Only 9% of the respondents reported utilising interdental assistance, while about one-fourth of them used a brush with soft bristles. With a P value of <0.05, the data showed a positive connection between DNS and the oral hygiene index simplified score.
Conclusion: According to the results of the current study, orthodontic patients' reduced frequency of brushing, mouth washing, and eating sticky and hard food can be ascribed to self-neglect.

A cutting-edge surgical method is the enhanced-view extended completely extraperitoneal (eTEP) approach for ventral hernia repair. We give an update on this strategy and the findings from the MGH Hospital's initial experience with eTEP repair Rives-Stoppa (eTEP-RS). The eTEP-RS was used to treat 38 patients with ventral hernia between July 2019 and July 2022. The traits of the patients, the specifics of the operation, and the complications were examined. The median follow-up period was 16 months, with a range of 6-24. Twelve (31.6%) patients with primary ventral hernias and 26 (68.4%) patients with ventral incisional hernias had an eTEP-RS operation. The average size of the prosthesis was 380 cm2, and the average defect area was 21 cm2. We noted problems in four cases (10.5%); on the tenth postoperative day, one patient developed intestinal obstruction, and two patients experienced an asymptomatic seroma (Clavien-Dindo grade 1). (Clavien–Dindo grade 3B). The median hospital stay was 3.9 days (with a range of 2–6). There was no recurrence of the hernia. A practical and secure method for ventral hernia repair using minimally invasive surgery is the eTEP-RS. To define patient selection and determine long-term outcomes, more research is required.

Introduction: Numerous metals go through redox cycling, which results in the production of free radicals and oxidative stress. This study looked into the in-vitro oxidative stress placed on orthodontic archwires comprised of different alloys.
Methods: The quantity of the oxidative stress marker 8-hydroxy-20-deoxyguanosine in DNA was measured after exposing mouse fibroblast cells L929 to 6 different types of archwires. Cell vitality and number were determined using trypan blue dye.
Results: Coated nickel-titanium, copper-nickel-titanium, and cobalt-chromium produced oxidative stress levels that were lower than those of standard nickel-titanium archwires (P <0.05), but higher than those of titanium-molybdenum and the negative and absolute controls (P <0.05). Standard nickel-titanium archwires generated the highest oxidative stress, significantly higher than all other wires and the controls (P The least tension was produced by stainless steel and titanium-molybdenum. The lowest viability was caused by nickel-titanium, which was lower than the negative and absolute controls, all other wires, and titanium-molybdenum (P< 0.05). The material with the highest viability was stainless steel. The largest suppression of cell growth was caused by nickel-titanium, which was higher than all other samples (P< 0.05) excluding the positive control and cobalt-chromium. The positive control, cobalt-chromium, nickel-titanium, and titanium-molybdenum showed the lowest inhibition (P< 0.05), followed by stainless steel.
Conclusions: Every orthodontic archwire causes oxidative stress in a test tube. The maximum biocompatibility is found in stainless steel archwires, and the lowest is found in nickel-titanium

Background: Breast cancer is the most common cancer in the Indian women accounting for 27.7% of all the female cancers in india. Breast lumps are common which require appropriate workup consisting of clinical examination, imaging and fine needle aspiration cytology. Imaging and cytopathology are crucial in categorising these lesions into benign and malignant. There is a requisite to determine the concordance of these these findings and evaluate the diagnostic efficacy. The objectives is to find  the correlation  of cytopathological diagnosis with imaging findings for provisional diagnosis of breast lumps and to evaluate the utilisation  of fine needle aspiration as a cheap, safe method for preoperative assessment of breast lumps.
Materials and methods: All Fine needle aspiration (FNAC) of breast lumps were included in the study from Jan 2019 to Dec 2020.Their imaging findings were retrieved from the records. Only those with imaging findings were included in this study.
Results: 275 patients came for FNAC for breast lesions, out of these breast Ultrasound/ Mammography findings were available in 255 cases which were included in our study. Cytohistological correlation was obtained in 243 cases. In this sudy the sensitivity-90.3%, specificity=87.41%,positive predictive value (PPV) was 83.18%,negative predictive value (NPV) was 92.9%, with diagnostic accuracy of 88.6% for imaging findings in diagnosis of breast lesions(in comparison with histopathology considered to be gold standard for diagnosis). The Sensitivity was 99.02%, specificity was 99.29%, PPV was 99.02%, NPV was 99.29%, and the diagnostic accuracy was 95.29%for FNAC in diagnosis of breast diseases (considering histopathology as gold standard).
Conclusion: Cytological evaluation is a standardised ideal cheap ancillary method in evaluating the breast lumps which many a times masquerades breast cancers.

Objective: The purpose of this study is to evaluate whether the biodegradation products produced by four distinct orthodontic wires—copper NiTi, nickel titanium (NiTi), titanium molybdenum alloy (TMA), and stainless steel—fall within acceptable limits by comparing their biodegradation properties.
Materials and Methods: In this investigation, four different wires were incubated in artificial saliva for 28 days while the amount of metal liberated from them was measured. Nickel, chromium, copper, cobalt, manganese, iron, molybdenum, and titanium were among the metals evaluated. To stop the artificial saliva from being saturated with metals, it was changed on days 7, 14, and 21. After 28 days, these four artificial saliva samples from each wire were combined and subjected to an inductively coupled plasma spectroscope analysis to determine the presence of the eight metals.
Results: Only nickel, chromium, and iron were released from stainless steel wire, nickel from NiTi wire, nickel and chromium from copper NiTi, and none from TMA wire, according to the data.
Conclusion: The metals emitted from arch wires are in too small a quantity to pose a threat to human health. Metal release levels are well within accepted biocompatible ranges. Even though different orthodontic wires' biodegradation was examined in this study, mechanotherapy never uses orthodontic wires by themselves. More metals may be released by orthodontic wires in combination with the multiband appliance system, which is always employed, and with accessories like face bows.

In this study, young adult orthodontic patients' subjective assessments of their own social competence (SC), intellectual ability (IA), psychological adjustment (PA), and beauty were evaluated. With 260 undergraduates, a cross-sectional analytical questionnaire study was done. Each participant was required to see a single, randomly chosen colour photograph of a young adult girl before making assessments of her personality traits. The same young adult female was depicted in five altered photos: (1) with no appliance, (2) with a fixed stainless steel orthodontic appliance, (3) with a fixed ceramic orthodontic appliance, (4) with a fixed gold orthodontic appliance, and (5) with a clear, colourless aligner. Likert scales were utilised, with higher scores denoting more favourable reviews. The chi-square test was used to analyse the results. For SC and PA, there were no discernible differences in the looks of the various orthodontic appliances. There was a tendency where the transparent aligner or no appliance appearance was viewed as more attractive than the visible buccal fixed appliances. In the absence of additional information, a young adult's perceptions of a young adult's personal traits are influenced by their teeth's look and the design of their orthodontic appliances. This might affect how you choose your orthodontic device.

Background: Diabetes Mellitus is an important health problem affecting major populations worldwide. The purpose of this study was to find out how well the thyroid works in people with type 2 diabetes mellitus with or without nephropathy.
Materials and Methods: Group I did not have any diabetic nephropathy patients, and Group II did not have any diabetic nephropathy patients. All patients were subjected to a detailed history and clinical examination,
Moreover, 5 ml of venous blood was drawn by aseptic technique and various lab investigations, such as thyroid function tests, were done.
Results: Group I had 16 males and 14 females, and Group II had 15 males and 15 females. Thyroid function in group I and group II was normal in 21 and 15, low T3 syndrome in 5 and 6, subclinical hypothyroidism in 3 and 5, and overt hypothyroidism in 2 and 4, respectively. The difference was significant (P< 0.05). There was a correlation of TSH with SCr, eGFR, and UACR in group II (P< 0.05).
Conclusion: Thyroid dysfunction was more prevalent in patients with diabetic nephropathy.

Background:To assess the clinico-demographic profile of patients with ileal perforations.
Materials & methods: A total 50 patients were enrolled for the present study. Complete demographic and clinical details were obtained. A Performa was made and complete medical history was recorded separately. Clinical examination of all the patients was carried out. Ultrasonographic examination of all the patients was done afterwards. Based on the clinical history, etiologic spectrum of all the patients was established. Detailed description of the ileal perforation was recorded separately
Results: Mean age of the patients with ileal perforation was 41.3 years. Out of 50 patients with ileal perforation, 76 percent of the patients were males while the remaining were females. Among the 50 patients with ileal perforation, most common presenting complaint was abdominal pain and distension found to be present in 100 percent of the patients. Constipation, fever and vomiting was seen in 92 percent, 70 percent and 40 percent of the patients respectively. Typhoid was the chief etiologic factor responsible for ileal perforation, found to be present in 50 percent of the patients. Tuberculosis and traumatic cause of ileal perforation was seen in 20 percent and 16 percent of the patients respectively. In 14 percent of the patients, the cause was non-specific/unknown. 
Conclusion: Typhoid is the most common cause of ileal perforation with abdominal distension and abdominal pain being the most common clinical manifestations.
 

A palpable breast lump is defined as a dominant mass if it is 3-dimensional, distinct from surrounding tissues and asymmetrical relative to the other Breast. A method of definitive diagnosis of patients who present with palpable breast lump at the outpatient department is needed. It must be accurate, easy to perform affordable and acceptable to the patient. This study was conducted to correlation of the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in differentiating the benign and malignant lesions of palpable breast lump with histopathological correlation.
A Prospective descriptive study done in 50 patients presenting with palpable lump in the Breast to Surgery department, history taken, clinically examined and sent to Central Diagnostic Lab, cytopathology section for FNAC. Patient underwent Surgical procedure after correlating with clinical examination and radiological investigations. Post-operative specimen sent for Histopathological examination. Cytological diagnosis was compared with Histopathology. Specificity, sensitivity, accuracy, and predictive values were calculated using standard formulas. Diagnostic accuracy of FNAC was 94% and overall sensitivity of FNAC in diagnosing the palpable breast lump was 94%, specificity was 100%, positive predictive of 100% and negative predictive value of 93%. Study concludes that the diagnostic efficacy, sensitivity and specificity of FNAC were comparable to Histopathological examination. Hence FNAC becomes a very important diagnostic tool in palpable breast lumps as it shows a high degree of correlation with the final histopathology report.

Purpose: To study the functional outcome of Total Hip Replacement in primary and secondary osteoarthritis of hip.
Materials and methods: The study consisted of 20 patients with diseased hips treated with total hip replacement operated in the Department of Orthopaedics, Vijayanagar Institute of Medical Sciences, Ballari from August 2020 to August 2022. Information of the patients was compiled from clinical details, case files and operation theatre records. This was a prospective study. The patient follow up was for a minimum of 6 months to maximum of 24 months (2 years). Modified Harris hip score was used for evaluation of functional outcome.
Results: Functional outcome of the procedure was done by following Modified Harris hip score. The results showed excellent results in 10 (50%) diseased hips, good in 06(30%) hips, fair 04(20%) hips. No poor outcome was noted in the study.
Conclusion: Our study demonstrated that total hip replacement provides an overall satisfactory functional and clinical outcome. Even though the study was not free of complications, the overall functional and radiological outcome showed excellent results.

Background and Objectives: Supracondylar fractures of humerus is a common injury in children accounting to 60% of the fractures around the elbow. The management of displaced
supracondylar fracture of the humerus is one of the most challenging, since it requires accurate reduction and internal fixation to prevent complications. Conservative treatment results in malunion. Open reduction and internal fixation is more invasive and recovery is prolonged. Closed reduction and percutaneous pinning is preferred method of treatment for displaced supracondylar fracture of humerus in children. The objectives of this study is to report the results of closed reduction and internal fixation with percutaneous k wires in the displaced Gartland type 2 and type 3, supracondylar fracture humerus in children.
Materials and Methods: A prospective clinical study conducted at the Department of Orthopaedic Surgery, Vijayanagar Institute of Medical Sciences, Ballari. from August 2020 to August 2022. This study consists of 30 cases of displaced supracondylar fracture humerus treated by closed reduction and internal fixation with k wires. The cases were selected according to inclusion and exclusion criteria. The final results were evaluated according to Flynn et al. criteria.
Results: In our study based on Flynn et al. criteria, the following results were made. Of the 30 cases, 21 patients obtained excellent results, 5 patients had good results, 3 patients had fair results, that is 29 patients had satisfactory results and one patient had poor result, that is unsatisfactory result. The results were comparable to other studies.
Conclusion: It can be concluded from the present study that closed reduction and internal fixation with percutaneous k wires, for displaced supracondylar fracture humerus in children gives good anatomical reduction, stable fixation and good functional outcome with minimum complication.

Introduction: Peritonitis is defined as inflammation of the serosal membrane that lines abdominal cavity and organs contained therein. Secondary peritonitis caused due to non-traumatic hollow viscous perforation is a common occurrence in this country which requires emergency surgical intervention. In our prospective study we tried to find out the incidence of perforative peritonitis which presented to our tertiary care hospital with respect to age and gender, relative frequency of anatomical site of perforation, their causes, presentation, treatment and outcome.
Methods: The study has been based on the analysis of 98 cases of non-traumatic perforated peritonitis patients admitted to our tertiary hospital, during the study period with prior inclusion criteria.
Each patient was examined thoroughly, after taking a detailed history and social demographic factors were noted. Cases were admitted as emergency and relevant immediate investigations were done. The diagnosis was made with history, clinical features and radiology to support the diagnosis.
Out of 98 cases, 92 underwent emergency laparotomy, at laparotomy the site of perforation, its pathological conditions, the amount of peritoneal contamination were noted. Perforation site specific operative procedures were done. In post-operative period, patients were closely monitored and complications were managed appropriately.
Results: Out of 98 cases 84(85.7%) were males. 25(32.7%) of the patients were in a age group of 21-30 years. Majority (35.7%) of the cases presented after 24-48 hours to our hospital. Pain abdomen was the most consistent symptom present in all the cases. Smoking (43.12%) and NSAIDs(21.4%) were the most important risk factors. Duodenum was the most common site of perforation (43.9%) followed by ileal (24.5%) and gastric (21.4%). In postoperative period 34.3% of patients had some form of complication and death occurred in 8 patients (8.16%).
Conclusion: Non-traumatic perforative peritonitis is more common in young age group (21-30 years) with male preponderance and is more common in rural population. Smoking and NSAIDs are the most common causative factors although it is multifactorial. Peptic ulcer disease is the most common cause of perforation. Delayed presentation to the hospital is the most common cause of morbidity and mortality

Aim: The comparison of diagnostic accuracy for prostate cancer detection between elastography plus MRI image based TRUS biopsy versus extended core biopsy.
Methods: This Comparative study was carried out in the Department of Radio Diagnosis, RVM Institute of Medical Sciences & Research Centre for the period of 9 months. 50 Patients with age group of 35 to 75 years, with Serum PSA greater than 4.0 ng/dl were included in this study. All patient underwent TRUS biopsy based on the MRI and elastography images, followed by TRUS guided extended core biopsy (13 cores) done by radiologist randomly. The rate of prostate cancer detection was compared between the two types of biopsies. Group A consisted of cores from MRI plus Elastography guided TRUS biopsy and Group B were cores from extended core biopsy.
Results: The mean age of patients was 64.71. The mean serum PSA for patients was 14.70 ng/dl (6.5 to 40.7). 20 cases presented with AUR and patients were catheterized. The mean size of prostate was 51.07 mg (29 to 84 mg). The mean size of prostate and serum PSA of patients with carcinoma prostate were 14.1 mg and 18.4ng/dl respectively. Prostatic carcinoma detection with extended core biopsy was 42% (n=21). The incidence of prostate cancer detection by MRI plus Elastrography guided TRUS is 41 cases (82%). MRI plus Elastrography guided TRUS biopsy method is considered to be statistically significant as the p value is 0.0369 (since p<0.05) as obtained by fishers exact test. In our study majority of the patients had adenomatous hyperplasia (n=30,60%) as the HPE diagnosis, followed by adenocarcinoma (n==20,40%). The sensitivity of mpMRI plus Elastography image based TRUS biopsy method in detecting Prostate cancer was 84.5% and specificity was 82%. The positive predictive value of this method was found to be 80%.
Conclusion: Even while mpMRI and Elastography are each useful alone for detecting prostate cancer, using both diagnostic methods together for TRUS guided enhances the likelihood of cancer diagnosis over extended core biopsy.

Aim: To compare modalities like ultrasonography (USG) and computed tomography (CT) in the evaluation of suspicious ovarian masses.
Methodology: This prospective comparative study was carried out in the Department of Radiology, RVM Institute of Medical Sciences & Research Centre for a period of 15 months. Total 50 women were included in this prospective study. All patients underwent abdominal Ultrasonography and CT scan with determination of the ovarian mass characteristics. Detailed history of allergy and renal function tests were taken before doing CT scan and if there was history of allergy then non-ionic contrast was used. Site, size, papillary projections, wall characteristics, capsular infiltrations, the presence of solid areas inside the mass and presence of as cites were recorded both by US and CT scan.
Results: Out of 50 patients, majority of patients belonged to 40-50 years of age group (19, 38%) followed by 30-40 years of age group (10, 20%). 8 patients (16%) belonged to 20-30 years age group, 7 (14%) belonged to 50-60 years, <20 and >60 years of age group included 3 patients each. There are total 29 cases of Pre-menopausal stage and 21 cases of Post-menopausal stage having ovarian cyst. Out of 29 cases of pre-menopausal conditions have 7 number of malignant and 22 number of benign types of ovarian masses. In the Postmenopausal group there are 17 cases of malignant and 4 cases of benign ovarian mass was observed. Overall, CT was found to have 96% sensitivity, 92% specificity, and an accuracy of 92% in the differentiation of benign and malignant ovarian masses, while PPV and NPV were 94% and 90%, respectively. The sensitivity of USG was 90%, specificity was 86% and PPV and NPV were 88% and 86% respectively.
Conclusion: CT and USG imaging all have approximately similar accuracy in staging ovarian carcinoma but the sensitivity of CT scan for all ovarian cancer detection greater than that of US. Among women with ovarian disorders, CT can be primarily in patients with ovarian malignancies, either to assess disease extent prior to surgery or as a substitute for second look laparotomy.

Background: Nasotracheal intubation consists of blind nasal passage and external manipulation of the endotracheal tube through the glottis (‘conventional technique’), a technique associated with a high incidence of nasal trauma, bleeding and tube cuff damage.
Aims: Aim of our technique to compare old blind technique with new tech niques for ease of intubation using bougie and nasal airway with bougie techniques which facilitate ease of intubation and reduce nasopharyngeal trauma, pain and bleeding.
Settings and Design: These techniques including routine post-induction nasotracheal intubation by blindly passing a nasotracheal tube vs. passing a bougie blindly (‘bougie technique’) verses using a nasopharyngeal airway to guide bougie for nasotracheal for tracheal intubation.
Methods and Material: One hundred fifty adult patients were randomly assigned to three groups A, B and C50 each for the blind techquine, bougie technique and combined nasal airway bougie technique.
Statistical analysis used: social science statistical analysis.
Results: Significant intergroup difference was observed with intubation timings with groups A to B&C (p = 0.0027). The groups B and C showed no significant (p =0.1699) and bleeding during intubation. Differences were observed in bleeding 5 min after intubation or postoperative epistaxis in groups. No inter-group differences were observed in complications related to nasal intubation and nasal pain.
Conclusion: Nasal intubation over a bougie or passing bougie through nasal airwayis as successful as the conventional technique; it also significantly decreases both the incidence and severity of nasopharyngeal trauma and complications

Background: 
Spinal anaesthesia remains one of the basic techniques despite the waxing and waning of its popularity over last 100 years since its introduction various agents have been used with local anaesthetics in spinal anaesthesia to improve the quality of block and to provide prolonged postoperative analgesia.
AIM: In the present study, we tried to study effectiveness of intrathecal 0.5% bupivacaine (heavy) alone and with Dexmedetomidine as an adjuvant for lower limb and lower abdominal surgeries.
Material and Methods: The study was conducted in the department of anaesthesiology, KIMS, Narketpally during Oct 2021 to Sep2022.This study was a prospective, randomised controlled, single blind, study conducted in 60 patients of ASA grade I and II undergoing elective surgeries. The patients were divided by random number table into two groups, containing 30 patients in each group. Dosages of drugs selected are divided as Group B: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) and Group BD: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) plus 5 µg Dexmedetomidine. Spinal block characteristics, haemodynamics and side effects were observed.
Results: It was found that in Dexmedetomidine group time to reach T10 sensory blockade and complete motor blockade and was earlier and a higher and prolonged when compared to the control group. Haemodynamic parameters were preserved both intra-operatively and postoperatively. There were a small percentage of patients who had minor side effects.
Conclusion: Intrathecal low dose Dexmedetomidine in a dose of 5µg along with 0.5% hyperbaric bupivacaine given intrathecally prolongs significantly the duration of sensory and motor blockade

Background: Papillary thyroid carcinoma is the commonest malignancy of thyroid. The diagnosis of such lesions can be easily rendered by using standard histological criteria. However, distinguishing the follicular variant of papillary carcinomafrom other follicular neoplasmsis difficult. Objectives:  In this study we investigated the role of CD56, CK19 and p63 in differentiating papillary carcinoma thyroid from follicular neoplasms.
Materials and Methods: The immunohistochemical expression of CD56, CK19 and p63 was evaluated individually and in combinations in 30 samples of thyroid lesions. Thyroid lesions included: 26 Papillary carcinoma thyroid [classic papillary carcinoma (21) and follicular variant of papillary carcinoma thyroid (5)] and 4 cases of follicular carcinoma.
Results: CD56 was found to be 100% sensitive and 84.62% specific in differentiating papillary thyroid carcinoma from follicular neoplasms. p63 was 50% sensitive and 57.69% specific in differentiating papillary thyroid carcinoma from follicular carcinoma.CD56 and CK19 were more specific than p63 in differentiation of Papillary carcinoma thyroid from follicular neoplasms. (p=0.039,0.001 respectively).Combination of all the three markers showed sensitivity and specificity of  100% and 53.85% respectively.
Conclusion: Combined utility of CD56, CK19 and p63 is helpful in diagnosing papillary thyroid carcinoma including follicular variant and it’s differentiation from follicular carcinoma.

Ultrasound guided supraclavicular block has emerged as an effective and feasible mode of providing analgesia in upper limb surgery. Participants were allocated to two equal groups of 60 each using a computer generated random number list. Group A patients received 25ml of 0.5% Levobupivacaine with 1mcg/Kg IBW of fentanyl (addressed as LF in the study) and Group B patients received 25ml of 0.5% Levobupivacaine and 1mcg/Kg IBW of Dexmedetomidine (addressed as LD in the study). Results: Mean time of onset and completion of the sensory block and motor block was significantly lower in LD group when compared to LF group  (p=0.001). Mean total duration of the sensory block and motor block was significantly higher in the LD group when compared to the LF group (p=0.001). Conclusion: Ultrasound guided supraclavicular block using dexmedetomidine 1mcg/Kg IBW  added to 25ml of levobupivacaine 0.5% in patients undergoing upper limb surgery significantly reduced total analgesic consumption in first 48 hours and provided longer duration of analgesia postoperatively compared to levobupivacaine with fentanyl

Background: Appendicitis is anticipated to affect about 6% of the population at some point in their lives. The reduced prevalence of acute appendicitis in Asian and African nations is likely due to the dietary patterns of these populations. Objectives: To compare the diagnosis of acute appendicitis by Alvarado score to that by histopathological examination as well as to determine whether there is any correlation between dietary intake pattern and the occurrence of acute appendicitis. Methodology: It was a prospective cohort study involving 148 participants attending surgery OPD between 08 months from June 2021 to January 2022. Detailed history and clinical examination was done followed by admission and laboratory investigations. Confirmation of diagnosis was done based on modified Alvarado scoring system and ultrasonography. Results: After analysis of 148 study participants, it was found that 88% of them belong to age group of >18 upto 40 years and 63% of them were males. No significant association was found between diet and appendicitis.Conclusion: Both Modified Alvarado Scoring System (MASS) and histopathological examination was found to be diagnostic for appendicitis.

Background: Electrolyte abnormalities can precipitate life-threatening events. In such situations, rapid and accurate assessment of electrolyte abnormalities may enable the institution of focused therapies. The present study was conducted to determine efficacy of electrolytes assessed by point-of-care testing.
Materials & Methods: 60 patients of both genders were selected and from each patient, paired sample of arterial blood and venous blood were collected at the same time. Whole blood electrolytes were analyzed using a point-of-care blood gas analyzer and serum electrolytes were analyzed in the central laboratory.
Results: Out of 60 patients, males were 35 and females were 25. ElectrolytesABG value (mmol/L) and serum value (mmol/L) of Sodium < 130 was 127.6 and 129.3, sodium 130–145 was 134.2 and 138.5 and sodium > 145 was 150.7 and 149.3, potassium < 3 was 1.8 and 2.5, potassium 3-4 was 3.5 and 3.8, potassium >4 was 4.6 and 4.8 and potassium >5 was 6.7 and 6.0 respectively. The difference was significant (P< 0.05).
Conclusion: Practitioners should be aware of the difference between whole blood and serum electrolytes, particularly when urgent samples are tested at point of care and routine follow-up electrolytes are sent to the central laboratory

Background: Spinal anaesthesia is preferred technique for conducting abdominal hysterectomy, but it is insufficient to provide post-operative analgesia adequately. The addition of local anaesthetic adjuvants increases subarachnoid block efficacy and prolongs postoperative analgesia. Due to its fast onset with a limited time of action with minimal cephalic spread, Fentanyl is preferred as an adjuvant in spinal anaesthesia. Adding Fentanyl to a low dose, Bupivacaine offers improved surgical anaesthesia and increased block reliability. Ketamine has several clinically useful properties, including analgesia and less cardiorespiratory depressant effects than other anaesthetic agents, in fact it causes some stimulation of the cardiovascular system.
Objectives: To compare the Duration of the postoperative analgesia (Time of 1st rescue Analgesic) between intrathecal administration of Ketamine and fentanyl with bupivacaine. To compare the duration and onset of sensory and motor block (modified bromage scale), the effect on hemodynamic parameter, Degree of sedation and side –effects (post-operative nausea and vomiting, pruritus, shivering, urinary retention and any other).
Methodology: Two group were included in this study i.e. Group A & Group B. Both group had 18 cases for total abdominal hysterectomy Group A(n=10)- received 15mg of Bupivacaine 0.5% along with Fentanyl 25 mcg intrathecally and Group B (n=10)-received 15mg of Bupivacaine 0.5% along with Ketamine 25 mgintrathecally. The onset of sensory and motor block, duration of block, hemodynamic parameter, sedation score, total postoperative analgesia time, and side effects if any will be recorded.
Results: Demographic variables were compared between both groups A and B. Group A is A significant faster onset of sensory block was found in ketamine group in comparison to fentanyl group. (p-value<0.001). While the time to achieve the highest level of sensory block was found to be almost similar in both the groups.
Conclusion: ketamine or fentanyl to spinal bupivacaine were equally effective in pain control after abdominal hysterectomy

Background: Creatinine clearance is a test used to assess renal function(glomerular filtration rate-GFR)) and also for staging chronic kidney disease (CKD) . Urine creatinine estimation requires collection of 24h urine which is a cumbersome and tedious process. Our study proposes a unique fractional urine collection method for urine creatinine estimation that would entail collection of small volumes of urine each time patient voids over 24h period and then compare this new method with conventional 24hour collection method.
Methods: It is a Cross-sectional, prospective study in tertiary care hospital. Volunteers (57) with normal renal function and chronic kidney disease subjects (22) were recruited. Unique method was compared with a conventional method  after centrifugation and with and without preservative. Interclass correlation coefficient (ICC) and Bland Altman analysis was used to evaluate for agreement between the two methods.
Results: All the values were combined without categorization into the subgroups. Creatinine results of fractional urine collection method without preservative (UF1) and with preservative (UF2) was compared to conventional method (U24), ICC was 0.86 (C.I, 0.80 to 0.90) and 0.84 (C.I, 0.77 to 0.89) respectively.
Conclusions: The urine creatinine results of unique collection method is comparable and reliable as traditional 24-hour method

Background: Multiple myeloma (MM) is a clonal plasma cell disorder with the hallmarks of bone marrow plasmacytosis and in most cases, production of an abnormal monoclonal immunoglobulin detectable in serum or urine protein electrophoresis. Assays that detect free light chain (FLC) are important in the diagnosis and monitoring of light chain only multiple myeloma (Bence Jones myeloma) and AL amyloidosis. Serum free light chain (sFLC) measured by scanning densitometry and electrophoresis lacks sensitivity in diagnosis and has a detection limit many times greater than the upper end of the normal range. Our study was done to know whether sFLC and their ratios can be used in diagnosis suspected cases of MM.
Methods: The study was conducted in a tertiary care hospital suspected of multiple myeloma. This is a descriptive analytical study involving subjects requested for Serum Protein Electrophoresis (SPE) and sFLC. Descriptive statistical analysis was carried out in the present study. To find out the association between the categorical studies variables we have used Chi square test. Pearson’s rank correlation is used to find the correlation between SPE results and sFLC.
Results: sFLC was able to diagnose 30 out of 33 subjects as multiple myeloma but 11 were diagnosed as false positive. When sFLC and SPE combined, all cases of multiple myeloma were diagnosed but false positive was high with 11 cases and none were diagnosed as false negative.
Conclusions: Combination of SPE and sFLC is more sensitive in identifying nearly all patients with clinically relevant monoclonal gammopathy.

Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation usually extends to the adenoid and the lingual tonsils; therefore, the term pharyngitis may also be used. Most cases of bacterial tonsillitis are caused by group A betahemolytic Streptococcus pyogenes (GABHS). Tonsillitis remains one of the common diseases in developing countries. Prompt and appropriate treatment based on the knowledge of the causative microbiota and their antimicrobial susceptibility pattern will improve the treatment outcome and reduce time and resources spent on treatment. This study aims to the main organisms responsible for tonsillitis, their sensitivity and resistance to antibiotics, one hundred and forty five patients with Acute and chronic tonsillitis who presented to the (ENT) department in ENT in Al-Husain Teaching Hospital, Samawah city, from March 2021 to April 2022 were prospectively studied, The proportion of the cultures that were positive of significant growth, the proportion of these positive isolates that were Streptococcus spp. and varied sensitivity pattern obtained underpinned the important to advocate for culture isolates and susceptibility pattern guided treatment.

Background: Corneal blindness is the fourth most common cause of blindness in the world (5.1%) and the significant causes are ulceration of cornea and trauma of eyes. The importance of microbiological evaluation of an etiological component and antibiotic sensitivity is very important. Aim: This study was conducted to evaluate sociodemographic risk variables, assess the diagnostic value of Gram staining, the responsible microorganisms, and examine the antibiotic sensitivity profile of bacterial isolates in this tertiary care centre. Materials and Methods: This study was conducted in a tertiary care hospital and was observational, descriptive, and cross-sectional in nature. Before collecting data, Institutional Ethics Committee (IEC) approval was obtained. 100 patients with corneal ulcers having an infectious aetiology were included in the study. Results: Male to female ratio was 1.2:1. The highest incidence of corneal ulcers was observed in industrial labours (32%), followed by housewives (24%). Staphylococcus epidermidis (30%), Staphylococcus aureus (20%) followed by Pseudomonas aeruginosa (11%) were the major organisms isolated in corneal ulcers. Sensitivity, Specificity, PPV and NPV of Gram staining with culture as a gold standard in present were 66.32%, 97.11%, 97.89% and 64.75%, respectively. Bacterial isolates were sensitive to Sparfloxacin (88%) followed by Ciprofloxacin (72%) and Netilmycin (64%). Bacterial isolates were resistant to Penicillin (83%) followed by Carbenicillin (70%) and Piperacillin (69%). Conclusion: Gram stain findings, culture data, and in-vitro tests of antibiotic sensitivity from microbiological work up can all be very helpful in determining the best course of treatment for bacterial keratitis.

Objective: Adjuvants prolong the action of intrathecal local anesthetic agents. They have shown to have significant analgesic effects in the postoperative period much after the regression of the sensory and motor blockade. Our objective of the current study was to compare the hemodynamic profile and adverse effects (nausea, pruritus, sedation and respiratory depression) in two groups of adult patients undergoing infra-umbilical and lower limb surgery under spinal anesthesia using either intrathecal clonidine or intrathecal fentanyl as an adjuvant to intrathecal bupivacaine (0.5% heavy).
 
Materials and Methods: It was a prospective randomized study in which eighty patients posted for lower limb orthopedic surgery were divided into two groups of forty each. Group A – Received intrathecal hyperbaric bupivacaine (2.5 ml) +50 µg clonidine (diluted to 0.5 ml). Group B – Received intrathecal hyperbaric bupivacaine (2.5 ml) + fentanyl 25 µg (diluted to 0.5 ml). Duration of postoperative analgesia, sensory and motor block characteristics, hemodynamic parameters, and side effects were recorded and analyzed.

Results: Both the groups were comparable in demographic data, hemodynamic parameters, but the duration of sensory and motor blockade and duration of analgesia was significantly longer in Clonidine group when compared with the Fentanyl group, with a mild increase in sedation score.
Conclusion: Addition of 50 μg clonidine to intrathecal bupivacaine offers longer duration of postoperative analgesia than 25 μg of fentanyl but with higher sedation. Both the drugs offer similar surgical conditions and prolongs postoperative analgesia (clonidine more than fentanyl), so we suggest fentanyl as better choice when sedation is not desirable and clonidine is recommended where sedation is acceptable.

Objective. The purpose of this work is to give a systematic review of the research on the best methods for treating severe pain in hospitalized patients. Background: The value of effective pain management in perioperative settings in improving patients' ability to cope with and recover from acute diseases cannot be emphasized. The VA/DoD Clinical Practice Guidelines for the management of acute post-operative pain have been extensively embraced even though many of their recommendations are based on expert consensus rather than scientific facts. Methods: From January 2019 through April 2022, we searched Medline, PubMed Clinical Queries, and the Cochrane Database for systematic studies on the assessment and management of acute pain in inpatients, including those with poor self-report or pharmaceutical reliance. To better understand the effects of patient-controlled analgesia (PCA) for nonsurgical pain, we conducted a systematic literature analysis of trials addressing assessment timing and frequency. Two researchers analyzed the available literature critically and wrote narrative summaries to answer the research questions. Conclusions: Hospitalized patients frequently experience excruciating pain. The evaluation and treatment of pain in this situation are best governed by clinical studies.

Background: The cesarean section increases the likelihood of requiring a blood transfusion, the risk of anesthesia complications, organ injury, infection, and thromboembolic disease. Present study was aimed to study, various intraoperative complications observed during lower segment caesarean section surgeries at a tertiary care hospital.
Material and Methods: Present study was retrospective, descriptive study, medical records of women had intraoperative surgical complication/s duringLSCS surgeries at our hospital were analysed.
Results: Incidence of intraoperative complications was 4.87 % (104 out of 2134 LSCS surgeries). Majority were from 26-30 years age group (38.46 %), had parity 1 (46.15 %), had history previous 1 LSCS (38.46 %) & previous 2 LSCS (33.65 %). Common risk factors noted were Obesity (BMI > 25 kg/m²) (37.5 %), hypertensive disorders of pregnancy (20.19 %), Anaemia (19.23 %), previous laparotomy (17.31 %) & h/o intraoperative complication in previous LSCS surgery (16.35 %). In cases with previous LSCS, common indication was impending scar dehiscence (34.62 %) followed by elective LSCS for previous ≥ 2 LSCS (25 %), Antepartum Hemorrhage - Placenta previa (10.58 %), Fetal Distress (9.62 %), Obstructed Labour / Second stage LSCS (8.65 %). Intra-operative complications noted were extension of uterine incision (37.5 %), Dense uterine adhesions (35.58 %), intra operative atonic post-partum haemorrhage (28.04 %), scar dehiscence (18.27 %), bleeding from placental bed (14.42 %), bladder injury (3.85 %), Injury to inferior epigastric vessels (2.88 %), placenta accreta spectrum (1.92 %) & bowel injury (0.96 %). Maternal mortality was observed in 2 cases (1- placenta accreta, 1 – post-partum hemorrhage)
Conclusion: Pregnant women posted for LSCS with pre-operative high-risk factors such as obesity, hypertensive disorders of pregnancy (20.19 %), history of previous laparotomy/intraoperative complication in previous LSCS surgery are prone for intraoperative complications. 
LSCS, obesity, intraoperative complication, previous LSCS surgery 

Background and Objectives
Intertrochanteric fracture is one of the most common fractures of the especially in the elderly with osteoporotic bones usually due to low energy trauma like simple falls. Internal fixation is appropriate for most intertrochanteric fractures.  Optimal fixation is based on the stability of the fracture. PFNA2 is biomechanically considered one of the most effective methods of treatment with promising results.
Methods: This is a prospective study of 30 cases of fresh trochanteric and subtrochanteric fractures admitted to DMMC Wayanad between June 2019 to June 2022. Cases were taken according to inclusion and exclusion criteria i.e., patients with Peritrochanteric fracture above the age of 18yrs. Medically unsuitable and patients not willing for surgery were excluded from the study.
Results: In our series of 30 cases there were 18 males and 12 females, maximum age of 94 yrs and minimum age of 22 yrs, most of the patients were between 41 to 60 yrs. Mean age of 55.18 yrs. 45% of cases were admitted due to slip and fall and with predominance of right side. Out of 30 cases, 22 were trochanteric and 8 were subtrochanteric. In Trochanteric class 50% were Boyd and Griffin type 2 33.33% were of type 3, in Subtrochanteric class 37.5% were Seinsheimer’s type 3a and 25% were 3b. Mean duration of hospital stay is 20.67 days and mean time of full weight bearing is 16.5 wks. Good to excellent results were seen in 91.66% cases of trochanteric fractures and 87.5% cases in subtrochanteric fractures.
Conclusion: Proximal femoral nail antirotation in Peritrochanteric fracture is a good method of fixation.  The procedure is easy with reduced operative time and radiation exposure. So we strongly recommend PFNA2 for fixation of Peritrochanteric fracture of hip.

According to (GPT-9) the action of pouring or injecting a flowable material into a refractory mold. The object formed is also referred to as “a casting”. There are various steps of fabrication of a simple full metal crown. Casting failures of alloys in dental technology should be the exception, not the rule. They have to be detected in time and associated with possible causes. For the experimental part base metal alloys single tooth restorations were achieved using the conventional lost wax process for casting in order to be evaluated. Some casting defects obtained during the experimental part are exemplified: incomplete castings, absence of the castings, voids, distorsions, nodules, porosities. Selecting the appropriate casting techniques for each alloy and dental restoration and accurate following of the technologycal steps are essential to avoid casting defects.

Introduction: Ankle fractures are extremely common. However, the outcomes of operatively treated bimalleolar and trimalleolar ankle fractures remain unclear. We aimed to evaluate clinical, functional and radiological outcomes of operatively treated bimalleolar and trimalleolar ankle fractures.
Materials and Methods: A retrospective review of all patients with operatively treated ankle fractures for a period of 3 years was performed. Demographics, fracture pattern, operative details, postoperative radiographs, and complications were obtained,studied and analyzed statistically. Outcome variables included union rates, pain ratings using the visual analogue scale (VAS) and the Olerud and Molander (O&M) score,satisfaction with surgery and surgical complications.
Results: Sixty patients with bimalleolar and trimalleolar ankle fractures were recruited. At 1 year postoperatively, most patients regained good function and had mostly good O&M scores. There were no notable differences in terms of VAS and O&M scores for both the bimalleolar and trimalleolar ankle fracture patient group. However, 33 (55%) of 60 patients had residual pain. Thirty seven (62%) patients complained of stiffness, and 27 (45%) patients had ankle swelling.
Conclusion: Most of our patients despite some residual deficits recovered well in their second year following surgery. No difference was observed in functional outcome between bimalleolar and trimalleolar ankle fractures, although it is a great concern that notable number of patients will continue to have residual symptoms . Hence residual symptoms and functional limitation must be emphasized to patients prior to surgery to manage postoperative expectations.

Introduction: The imaging modalities available for temporal bone analysis include plain radiographs, multidirectional tomography, angiography, CT and MRI. HRCT is excellent for air spaces and cortical bones, whereas MRI is superior for soft tissue anatomy and vascular abnormalities.
Material and Methods: A prospective study of 100 cases was done. The study included all patients who had HRCT temporal bone and had clinical signs and symptoms of external, middle, and inner ear diseases, congenital abnormalities, or trauma.
Results: Infectious aetiology accounted for 60 of the total 100 cases, making it the most prevalent aetiology affecting the temporal bones. Out of 60 infective cases 25 cases were of cholesteatoma, 30 were of otomastoiditis /CSOM, and 5 were of otitis externa. A total of 20 traumatic aetiology patients with temporal bone fractures were observed. Out of these 20 patients 5 had longitudinal fracture ,9 had transverse fracture and 6 had mixed fractures. Four individuals in the current research exhibited symptomatic congenital abnormalities, including two cases of microtia with EAC atresia, one with an anomalous facial nerve, and one with fused ossicles.
Conclusion: HRCT is beneficial for diagnosing, planning surgery, managing temporal bone diseases as well as post surgical follow-up. HRCT is superior to radiographs in depicting detailed anatomy as well as diseases of temporal bone. It is better than MRI in providing bony details.

Background: Corona virus emerged in China in December 2019 and quickly spread over the world, causing a pandemic. The probable link between the occurrence of neurological abnormalities and the CT severity score (CTSS) in COVID-19 participants is less understood. The purpose of this study was to look at the neurological symptoms of COVID-19 on CT head and determine whether there was a link between thorax and brain imaging abnormalities in COVID-19 patients.
Methods: Total 135 Hospitalized COVID positive patients with acute neurological symptoms underwent both CT head and CT thorax during their hospital stay were included in the study. All the patients with neuroimaging were divided into 2 groups: first being patients with acute neuroimaging findings and the second being the patients with chronic/normal neuroimaging findings.
Results: The most common CT head imaging findings in these individuals were acute ischemic infarcts in 54 (40%) and acute intracranial haemorrhage in 8 (6%). When compared to individuals with normal/chronic neurological results, a greater mean chest CTSS was found in patients with acute abnormalities on CT head (14.1 [SD-3.2] versus 6.5 [SD-3.3]). However, no statistical correlation could be shown between a greater CTSS and the occurrence of acute neurological disorders.
Conclusions: There was no link between a greater CTSS and the occurrence of neurological disorders on CT scans. As a result, increased lung involvement severity may not be a good predictor of brain involvement in COVID patients.

Introduction: Hypertension is a non-communicable disease, which is emerging as a major public health problem in the developing countries such as India. According to National Cardiovascular Disease Database, supported by Ministry of Health & Family Welfare, Government of India and World Health Organization, the prevalence of hypertension is gradually raising now a days, which leads to coronary heart disease which constitutes 54.1% of all cardiovascular disease deaths. Lifestyle of an individual such as diet, physical activity, environment etc plays major role in development of hypertension. Physical inactivity is a major risk factor for cardiovascular disease, and persons who are less active and less fit have a greater risk for high Blood pressure. Aim and Objectives: Study aimed to determine the effects of effects of aerobic exercise on blood pressure in patients suffering with pre or stage-1 hypertension.
Material and Method: It is a prospective, cross-sectional and descriptive study. This study was conducted in the Department of Physiology, Malwanchal University over a period of three years. Experimental study design was carried out with a sample of 60 participants in each group of exercises assigned randomly. Following the inclusion and exclusion criteria, informed consent was taken from all the participants included in the study.
Results: After three months aerobic training Mean Systolic Blood Pressure is changed in pre-test 135.65 ± 6.35 mm of Hg to post-test 133.65 ± 6.12. In aerobic group Mean Diastolic Blood Pressure in pre-test 91.63 ± 5.83 mm of Hg and post-test 87.73 ± 5.33.
Conclusion: The present study conclude that aerobic exercise training has therapeutic effects in the pre or stage-1 hypertensive patients.
 

Background: Malnutrition is the one of the leading cause of morbidity and mortality in children of under-five in developing countries. Globally combating malnutrition in all its forms is one of the greatest public health challenges. Hence the present study was undertaken in anganwadi of urban and rural ICDS projects in Karimnagar to explore the morbidity pattern of under-five children covered under the ICDS project.
Material and Methods : A community based cross-sectional study was undertaken in the rural and urban anganwadi centers of Karimnagar ICDS projects during a period of one year from March-2013 to February-2014. A semi-structured questionnaire was used to collect the data, it was analyzed and valid inferences were drawn. Chi square test was used to test the significance. Results: The present study found that the undernutrition (28.2%) is the most common morbidity seen in children, followed by acute respiratory infections (8.87%), Worm infestations (8.06%), anemia (8.06%) and diarrhea (5.64%). The other morbidities are Viral fever (4.84%), Scabies (3.22%), Boils (2.42%), Vitamin A deficiency (1.61%), Injuries (1.61%) and UTI (0.8%).
Conclusion: The present study revealed that the morbidities like undernutrition, respiratory diseases and various vitamin deficiencies among under-five children were very common. Further studies are required to assess the knowledge, attitude and perceptions of parents towards malnutrition. A widespread health and nutrition awareness campaign is desired in the study area to prevent and reduce the burden of morbidities and malnutrition.

Introduction: Acute kidney injury is a leading cause of morbidity and mortality in critically ill patients. We hypothesized that inadequate fluid resuscitation and high vasopressor use before admission to the ICU can predict the occurrence of AKI in critically ill patients.
Objectives: The aim of this study was to determine the ability of IVC collapsibility index (measure of intravascular volume inadequacy) and the vasopressor therapy at ICU admission to predict the development of AKI.
Material and Methods: We prospectively recruited 103 patients in our 12 bed ICU from October 2017 to June 2018, after written informed consent from the next-of-kin, excluding Patients with CKD or transplanted kidneys and in whom IVC couldn’t be measured. Demographic data, baseline vital signs, investigations, ongoing inotrope dosage and duration were noted. Maximum and minimum IVC diameters were measured by 3.5 MHz ultrasound probe in M-mode in the transthoracic subxiphoid view and IVC collapsibility index was calculated. Daily urine output and serum creatinine values were collected up to 7 days. The AKI was diagnosed by KDIGO criteria. Multivariate logistic regression analysis was done with AKI as independent variable and age, gender, APACHE II score on admission, vasopressor use and number of vasopressor at admission and the collapsibility index as possible predictors.
Results: 78% of the patients developed AKI by the 7^th day of ICU stay. Only APACHE II score at admission was significantly associated with AKI.
Discussion: The IVC collapsibility index and vasopressor use were not predictive of AKI. Vasopressor use in our sample was only 22%. It is possible that collapsibility index at admission to ICU is not a good indicator of pre-ICU volume status. Future studies should concentrate on volume status estimation and resuscitation in the wards before ICU transfer.

Background: A common nephrotic syndrome finding is the presence of hyperlipidemia. Total cholesterol, LDL, VLDL, and low or normal HDL levels have all increased. Typically, hyperlipidemia is seen when the disease is active and goes away when the proteinuria goes away. However, it may recur and raise the risk of developing atherosclerosis in later life in recurrent cases. We in the current study tried to correlate the severity of nephrotic syndrome and dyslipidemia in pediatric cases presenting to our hospital.
Methods: A pre-validated proforma was used to record the information from the person. Following the parental agreement, clinical information was gathered and recorded in the proforma, including the patient's age, sex, presenting complaints, pharmacological history, and type of nephrotic syndrome (episode, recurrence, SDNS, SRNS, or remission). Blood samples for the patients' lipid profiles and serum albumin were taken after obtaining their medical histories and performing a clinical examination.
Results: The lipid profile of the cases of nephrotic syndrome in the study showed total cholesterol, LDL, VLDL, and Triglycerides were significantly higher in the cases as compared to controls all the values were (p = <0.05). In cases of first episode nephrotic syndrome after 6 weeks of steroid treatment, there was a significant reduction in the levels of lipids from the pre-treatment mean total cholesterol reduced to 213.0 ± 33.18 mg/dl. Similarly, the LDL-C levels were reduced to mean levels of 124.76 ± 22.60 mg/dl. The VLDL levels were reduced to 42.61 ± 5.27 mg/dl. The HDL levels were increased to 48.23 ± 3.02 mg/dl. The levels of triglycerides were reduced to 104.19 ± 31.8 mg/dl.
Conclusion: In pediatric nephrotic syndrome cases there is a significantly increased serum lipid profile. The lipid profile parameters were negatively correlated with serum albumin levels except HDL with weak positive correlation. After 6 weeks of steroid treatment in the first episode of nephrotic syndrome, there was a significant reduction in the mean levels of pre-treatment total cholesterol and LDL cholesterol. In the relapse nephrotic syndrome cases at the end of steroid treatment, there was no significant reduction in the mean levels of total cholesterol, LDL-C, VLDL-C, and triglycerides.
 

Background: Postoperative pain is one of the most common concern for people undergoing surgery. Preventing and treating postoperative pain is crucial to the patient's early mobilisation and well-being. Pre-emptive analgesia prevents central sensitization caused by incisional and inflammatory damage during surgery and the early postoperative period and has the potential to be more effective than a similar analgesic treatment started after surgery, reducing immediate postoperative pain and preventing the development of chronic pain by reducing altered central sensory processing^[1].Pregabalin, a GABA analogue, is effective in the treatment of neuropathic pain, incisional injury and inflammatory injury. Perioperative administration of pregabalin is reported to reduce perioperative anxiety, opioid consumption and opioid related side effects^[2]. Amitriptyline inhibits the neuronal reuptake of serotonin and norepinephrine which is an important physiologically to terminate transmitting activity. The inhibition of norepinephrine reuptake increases the levels of norepinephrine in the posterior grey column of spinal cord. This increased levels of norepinephrine increases basal activity of alpha 2 adrenergic receptors which increases GABA transmission among spinal interneurons thereby mediating analgesic effect. Also, the sodium channel blocking effect of amitriptyline contributes to its analgesic activity.^[3]
Aims:To evaluate and compare the pre-emptive analgesic efficacy of oral pregabalin versus oral amitriptyline in patients undergoing elective inguinal hernioplasty surgeries under spinal anaesthesia and to assess the incidence of adverse effects of both drugs.
Materials and Methods: 90 patients of ASA 1 and 2 were randomized into three groups as Group A (Amitriptyline 10mg, n=30) and Group B (Pregabalin 75 mg,n=30)  and Group C (Placebo,n=30). Patients received placebo or either of the study drugs 2 hours before surgery. Demographic data, postoperative pain score, sedation score, time since spinal anaesthesia to requirement of first rescue analgesic, total opioid consumption in 24 hours and side effects were recorded.
Results: Time for first rescue analgesic was longer in Group B as compared to Group A and Group C, although statistically insignificant. There was no significant reduction in mean VAS score and sedation score between the three groups. The three groups were comparable in terms of total postoperative opioid consumption. Side effects were negligible with both the drugs.
Conclusion: Single preemptive oral pregabalin 75 mg and oral amitriptyline 10 mg is ineffective in reducing the severity of postoperative pain as compared to placebo in patients undergoing inguinal hernioplasty.

Introduction: Preeclampsia is linked to maternal morbidity and death, as well as short- and long-term effects on the unborn child. Preeclampsia has become more common, and the incidence of recurring preeclampsia has not decreased. The current study's objective was to determine risk variables for recurrent preeclampsia in women who had previously experienced the condition.
Materials and methods: Case control analytical study was conducted among 60 preeclampsia case and 60 control at tertiary care hospital of Gujarat.
Results: As per univariate analysis, preeclampsia was found to be substantially correlated with advance age and poor education of mother as well as family head, obesity, family history of preeclampsia, hypertension, and personal history of DM. Obstetric history such as  early menarche age (11–12 years), primiparity, inter pregnancy interval less than 3 years were significantly associated with development of pre eclampsia. On multivariate analysis, it was found that obesity, primiparity, interpregnancy interval less than 3 years, personal history of DM, family history of pre eclampsia and hypertension were independent risk factors of Preeclampsia.
Conclusion: Obesity, primiparity, interpregnancy interval less than 3 years, personal history of DM, family history of preeclampsia and hypertension are significant predictor for development of Preeclampsia. Most of these factors are non-modifiable, but can be used to screen women dursing antenatal visits to identify those at higher risk of Preeclampsia.

Aim: To assess the Knowledge and Awareness regarding Breastfeeding and COVID-19 vaccination among Pregnant and Lactating Mothers attending OPD in a Service Hospital during COVID-19 Pandemic.
Material and Methods: Hospital based cross sectional study. Sample size of 380 Pregnant and Lactating Mothers attending OPD antenatally or postnatally were included in the study. Ethics committee approval was taken. A peer reviewed predesigned questionnaire was used to obtain information after taking consent. Demographic data and Knowledge of Mothers regarding Breastfeeding and COVID-19 Vaccination data was collected and analyzed.
Results: Our Study revealed knowledge and awareness regarding Breastfeeding and COVID-19 Vaccination in Pregnant and Lactating Mothers during COVID-19 Pandemic in a Service Hospital to be 53% and 57% respectively. Our Study also found a significant correlation between Age and Education of Mothers and their Knowledge regarding Breastfeeding in Pregnant and Lactating Mothers during COVID-19 Pandemic. A significant Correlation was found between Education of Mothers and their Knowledge regarding COVID-19 Vaccine in Pregnant and Lactating Mothers during COVID-19 Pandemic.
Conclusion: This study emphasizes the need to focus on promotion of breast feeding and COVID-19 Vaccination in Pregnant and Lactating during COVID-19 Pandemic. These simple steps may contribute in lowering Neonatal and Infant Mortality rates. Breastfeeding must continue after Maternal COVID-19 vaccination

The first case of penile  fracture was documented 10 centuries  back by Abul Kasen.[1] Penile fracture is defined as traumatic rupture of corpora cavernosa. It can involve corpora spongiosum and urethra. [2]
Penile fracture occurs commonly after slipping of the erect penis from vagina and hitting the pubis or perineum during sexual intercourse. [3]. The various other causes include over enthusiastic masturbation, falling or rolling onto erect penis and practice of bending erect penis for changing shape or size of penis called as taqaanadan.[4]
The circumstances lead on to the presenting chief complaint of sudden loss of erection with pop up sound, swelling and discoloration with typical eggplant deformity. However, the feeling of embarrassment and social stigma prevents patient from seeking early treatment.                                          
The shaft of penis is composed of three erectile tissues, a pair of corpora cavernosa and one corpus    spongiosum. Tunica albuginea composes of outer longitudinal and inner circular layer, it can resist the rupture until intra-covernous pressure rise to more the 1500mm Hg.[5].Ventrally corpus spongiosum is adjusted in the groove formed by tunica albugina. [6]
The tributaries from the internal pudendal artery are chief supplier of blood to penis. The cavernous artery supplies the erectile tissues of the penis. The venous blood from cavernous spaces is drained by the deep dorsal veins. The superficial group of inguinal nodes drains the lymph from the penial skin, whereas the lymph from intermediate and proximal cavernous drains in the internal iliac nodes and the deep inguinal lymph nodes drains the glans of the penis. [7]

Vagina is generally distinguished by relationships between Lactobacillus acidophilus and the metabolic by products of endogenous flora, oestrogen, vaginal pH and glycogen. L. acidophilus keeps the vaginal pH acidic by producing hydrogen peroxide, which is harmful to the pathogens. [1]
The species of Candida are found commonly in the healthy vagina in lesser amount. When any imbalance happens, like change in pH of vagina, hormonal balance, there is multiplication of Candida.[2]
After bacterial vaginosis, the next most common cause of vaginal infection is vulvovaginal candidiasis. Around 75% female face minimal single episode of vulvovaginal candidiasis in their period of fertility. [3]
The most common cause of vulvovaginal candidiasis is Candida albicans (85-90%) and other causes include Candida glabrata, Candida guilliermondii, Candida krusei and Candida tropicalis.[4]
Around 21-32% of healthy women are carriers of asymptomatic vaginal infection. Pregnant females, females treated with antibiotics previously and females with diabetes mellitus showed increased rates of colonisation. [5] In immunodeficient females, Candidiasis was found to be the most familiar opportunistic fungal infection. [6]

Background: Supraclavicular approach of brachial plexus block has been popular technique in delivery of anesthesia in patients undergoing upper limb surgeries. Of various local anesthetics, bupivacaine is used most frequently for brachial plexus block. Any adjuvant to the local anesthetics for brachial plexus block prolongs its analgesic effect. Hence the present study was undertaken to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine in supraclavicular nerve block for upper limb surgeries. Methods: A total 100 patients of ASA grade I and II were enrolled and randomly divided into two equal groups. Group A received 25-30mL of 0.5% Bupivacaine + 50μg Fentanyl and group B received 25-30mL of 0.5% Bupivacaine + 50μg Dexmedetomidine. The onset time and duration of sensory and motor blockade were recorded. Hemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. Results: The onset of sensory and motor block was significantly faster, and duration of sensory and motor block was significantly prolonged in group B as compared to group A (p<0.05). Rescue analgesic requirements were significantly less in group B compared to group A (p<0.05). Hemodynamic variables did not differ between groups in the post-operative period, except the pulse rate which was found to be on the higher side for fentanyl group. Conclusion: Addition of 50μg dexmedetomidine to 25-30ml bupivacaine 0.5% in supraclavicular brachial plexus block was more effective in prolongation of sensory and motor duration as well as providing adequate intra-operative analgesia when compared to 50μg fentanyl with 25-30ml bupivacaine 0.5%, without producing any adverse events.

INTRODUCTION: The curriculum for medical graduates proposed by the MCI, has undergone significant changes. The new curriculum identifies essential skills, describes methods and contexts of teaching, and recognizes standardized measurement of competencies¹. It focuses on learning critical competencies needed for success in clinical practice and provides standards and a framework for measuring performance². It allows for self, objective, and multisource assessments with mandates to improve the quality of health care and enhance patient safety ^3,4
OBJECTIVE: To develop a cost-effective upper limb mannequin for training students in the skill of parental injection techniques to be assessed using objective structured practical examination (OSPE).
MATERIALS AND METHODS: Cost effective upper limb was prepared for parenteral drug administration. Each student was able to practice individually. A study questionnaire was given covering aspects of Perception and feedback of the students regarding the mannequins.
RESULTS: A Huge percentage (96.87%) of students concurred that simulation is a useful learning method. A large percentage of students agreed that it made the topic interesting and provided a semi-realistic experience.  Feedback obtained showed that over half of the students agreed that the mannequins were good.   
CONCLUSION: The simulation technique provided self-learning of a variety of skills with confidence in a safe and controlled environment without fear of harming patients. Students were able to enhance clinical competence by repeatedly doing the procedure & correcting their mistakes.

Idiopathic inflammatory polymyositis is a disorder characterised by progressive muscle weakness, extra muscular manifestations , elevated serum levels of muscle enzymes , Electromyographic (EMG) abnormalities, inflammatory infiltrates in muscle biopsy . Extra muscular involvement such as pulmonary , cardiac and gastrointestinal involvement is correlated with increased mortality and morbidity in patients. Here we report a case of idiopathic inflammatory polymyositis.

INTRODUCTION: Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disorder of unknown aetiology that may affect many tissues and organs In the previous years, various authors have studied the association between disease activity of RA and these haematological parameters separately. The current study intended to find out the association of DAS 28-score of RA with platelet count, MPV and Hb level so that an assessment of disease activity of RA can be done by these haematological parameters in addition to conventional serological markers so that a better management of the patients of RA can be done.
MATERIAL AND METHODS; patients of rheumatiod arthritis attending rheumatology opd were randomly selected and detail history and examination done. Lab investigation like CBC, ESR, CRP, S.ferritin done. 
RESULT: rheumatiod arthritis was more common in female  with rheumatiod factor positivity in 80% and  prevelance of anemia was 73.3%. Anemia is very well correlated with rheumatoid factor positivity, disease activity (das 28 score),duration of disease and ESR.
CONCLUSION: The anemia is the one of the indicator of disease severity and anemia incidence is more in our Population. It was also observed that thrombocytosis and eosinophilia also the indicators of disease severity which positively correlated with DAS 28 score

BACKGROUND
More than 95% of people with diabetes have type 2 diabetes. Apart from the micro and macrovascular complications people with diabetes especially patients with long standing diabetes have new complication with degenerative muscle disease called as sarcopenia. The prevalence of sarcopenia is more in diabetics and sarcopenia itself is a risk factor for diabetes mellitus. It’s a controversial bidirectional association.
OBJECTIVES / AIMS
To study the clinical profiles and association of sarcopenia and non-sarcopenic patients with T2DM
MATERIALS AND METHODS
It is a cross sectional observational study done in RIMS hospital, Raichur. All the patients aged above 18 years and have been diagnosed with type II diabetes for the last 1 year had been included in the study. Patients were subjected to anthropometric measurements and we measured hand grip strength (HGS) using a medical handgrip dynamometer. Based on the observation we categorised them to sarcopenic group and non sarcopenic group. The clinical profile of both groups were then compared and statistically analysed.
RESULTS
A total of 100 patients were included in the study who met inclusion and exclusion criteria. Among them, 30 patients had sarcopenia. Mean age of presentation was 66.3 Years. Males were more in sarcopenic group. The mean BMI in sarcopenic patients group was 21.3 which were far less compared to non sarcopenic patients group (28.5).
CONCLUSION
Sarcopenia is common in adults over the age of 70 years and in males. BMI is a strong predictor of skeletal muscle mass. There is significant association with type 2 diabetes mellitus and sarcopenia especially when the patients are having long standing diabetes and associated complications.

Background: Medical audit forms a component of quality assurance and quality improvement in health care delivery.It is very important for a transfusion service to know exactly how many blood products it issues, as well as the disposition of every unit. In many countries, it is a legal mandate for the transfusion service to be able to account for every unit that it issues, from donor to recipient.
Objective: To evaluate ongoing transfusion services at a tertiary care centre.
Methodology: We have conducted an audit over a period of 12 months from oct 2020 to Sept  2021. The Data obtained, regarding the utilization of 5034  units of various blood components i.e. red cell concentrate, whole blood, platelets and frozen plasma (FFP) during that period, was compiled and analyzed further to evaluate the transfusion services, the pattern of blood component request and utilization.
Results: Maximum demand was received from Intensive care unit (n= 2500) followed by the department of Medicine(n=590) and followed by Surgery (n=587) Maximum  utilization of blood units was noticed in the Medicine unit with C/T ratio 1.10:1 Of total 1995 units demand for FFP & platelets, FFP demand was 56.44% (n= 1126) and platelets demand was 43.56% (n= 869). 1206 units demand for FFP resulted in transfusion in 1084 patients (average 1.11 units/ patient) with maximum demand from ICU (26.36%) followed by the department of Medicine (12.46%) .Total 869 units of platelet were transfused and the most common indication was thrombocytopenia.
Conclusion: Every health care institute must develop distinct transfusion guidelines based on the nature of emergency & routine services and the subsequent implementation of such guidelines, through the institutional transfusion committee to assure effective blood utilization is must. The Transfusion practice of the Blood bank is 100% Blood component .The practice of whole blood transfusion is abandoned.

Hyponatremia is the most common, electrolyte abnormality out of all in critically ill neurological patients. TBM is a common cause of sub-acute and chronic meningitis in developing countries like India. It is an important cause of stroke in young individuals in India. Hyponatremia in TBM is multifactorial and may be due to anorexia, nausea, vomiting, poor intake of sodium, diarrhoea, drugs and associated comorbidities.
Method: This study was a six-month cross-sectional study of consenting patients admitted with a diagnosis of TBM at our hospital. Patients were labelled as having hyponatremia, SIADH and CSWS as per operational definitions. The findings were noted in the Performa along with other demographic Patients were classified as per BMRC stage I/II/III and duration of symptoms.
Results: A total of 135 patients were admitted with the diagnosis of Tubercular Meningitis. Out of 135 patients with TBM, 48.88% (n=66) had hyponatremia. It was found that 13.33% (n=29) had SIADH and 19.26% (n=37) had CSWS. The age range of the patients was from 22 years to 60 years with mean age of 43.78±2.64. There were 61.48% (n=83) male and 38.51% (n=52) were female. Maximum number of patients were in age group 51 – 60 years with 31.19% (n=42). The most common presenting complaint of the patients was fever followed by headache, vomiting, and altered sensorium. It is observed that occurrence of hyponatremia was not dependent on age group (p-value=0.47), gender (p-value=0.106) and Grade of disease (p-value=0.188).
CONCLUSION: Electrolyte disturbance adds to morbidity and mortality in TBM patients. It is thus important to investigate serum electrolytes early in such patients and to differentiate the cause of hyponatremia., so that electrolyte imbalance can be detected early and proper management can be initiated to prevent morbidity and mortality due to electrolyte imbalance.

Background & Method: The aim of this study is to Study the Clinico - etiological profile of urinary tract infection among children in outpatient and inpatient department. We had enrolled all the patients of Paediatric department who had either symptoms of UTI of 3months to 15years of age duringOctober 2019 to March 2021 with positive Urine R/M or Urine C/S History, clinical features, investigations and treatment given will be recorded as per Performa.
Result: Patients according to presenting complaints. Fever  was  seen  in  176  (88%)  patients,  vomiting  in  143  (71.5%) patients, abdominal pain in 137 (68.5%) patients, dysuria in 134 (67%) patients, constipation in 127 (63.5%) patients, frequency of urination in 122 (61%) patients, failure to thrive in 42 (21%) patients, urgency in 14 (7.0%) patients, hematuria in 9 (4.5%) patients, lethargy / dullness in 7 (3.5%) patients, enuresis in 3 (1.5%) patients and incontinence in 2 (1%) patients. Fever, vomiting, abdominal pain, dysuria, constipation and frequency of urination were the most common presenting complaints.
Conclusion: Fever was seen in (n 176) (88%) patients, vomiting in 71.5% (n 143 ) patients, abdominal pain in 68.5%(n 137 ) patients, followed by dysuria in 67%(n 134 ) patients, Fever, vomiting, abdominal pain, dysuria, constipation and frequency of urination were the most common presenting complaints. Renal abnormalities were seen in 8.5% (n 17 ) patients, neuromuscular problems was seen in 2.5%(n5 ) patients and voiding dysfunction was seen in 2%(n 4) patients.

Introduction: Many Gram negative bacteria are multi resistant as they produce ESBLs which breaks down the ring in the antibiotics there by rendering them ineffective. Infections caused by ESBL can be of great consequences even with common infections like urinary tract infections. Timely detection of drug resistant bacteria is of outmost importance as it plays a role in treatment approach and fatality. 
Materials and methods: 5ml of Clear midline stream urine was collected from 164 patients. The urine samples were careened for bacterial isolates and the presence of ESBL producers were confirmed by combination disc method and tested for antibiotic sensitivity and resistance.
Results: A total of 164 urine samples from 82 males and females were collected. We found that 58 females and 32 males had recurrent UTI. 43 and 38 isolates of ESBL producing bacteria were found by combination disc method in urine samples of females and males respectively. Out of 81 isolates of ESBL producers 43 were from E coli and 20 were from K pneumoniae.    
Conclusion: We found that E coli is the largest producer of ESBL in urine samples of patients with diabetes. ESBL isolates were found more in female urine samples than in males. There was a strong positive association of levels of diabetes with ESBL production. The ESBL were highly sensitive to amaikacin and nitrofurantoin but resistant to 3rd generation cephalosporin. 

Aim: The purpose of the present research was to assess the co-relation between stress and hypertension.
Methodology: In this correlation study 30 individuals were selected. Basic demographic data was collected and were asked to fill up the Perceived stress scale. Blood pressure was measured at the brachial artery three times and average of the three was taken. To study the relation between stress score and BP, correlation was done. As data were not normally distributed, Spearman correlation test was done (P < 0.001).
Results: According to the analysis done, PSS shows moderate correlation with SBP while DBP shows weak correlation with r values 0.47 and 0.202 respectively and p values 0.806 and 0.283 respectively.
Conclusion: Stress is significantly related to hypertension and is an independent risk factor for hypertension.

Background: To evaluate the Bilateral Asymmetry in the Humerus of Human Skeletal Specimen.
Materials & methods: A total of 100 sets of skeletons, both female and male, of different ages and geographical origins were enrolled. Weight of humerus bone was assessed on a weighing balance.  Humerus length was determined by using an osteometric board. Mid-Shaft Circumference was assessed using a millimeter graph paper at the level of the apex of the deltoid V. All the dimensions were recorded in Microsoft excel sheet and were quantified. All the results were recorded and analysed using SPSS software.
Results: Among the males, mean weight of left and right humerus was 118.3 grams and 117.2 grams. Mean length of left and right Humerus was 32.91 cm and 32.83 cm respectively.Mean mid-shaft circumference of left and right Humerus was 5.95 cm and 5.72 cm respectively. Among the females, mean weight of left and right humerus was 103.5 grams and 103.1 grams. Mean length of left and right Humerus was 31.12 cm and 30.99 cm respectively.Mean mid-shaft circumference of left and right Humerus was 5.62 cm and 5.49 cm respectively.
Conclusion: Bilateral asymmetries do exist in the humerus with more asymmetry observed in the male compared with the female.

Introduction: This term describes implantation within the myometrium of a prior cesarean delivery scar. Its incidence approximates 1 in 2000 normal pregnancies and has increased along with the cesarean delivery rate. It is rarest of all ectopic pregnancies. It is a life threatening condition, causes excessive haemorrhage and risk of uterine rupture.
Case Summary: A 35 year old female, presented to OBG Department with complaints of Per Vaginal spotting since 3 days (with less than half pad soaked) and lower abdominal pain since 3 days, UPT was positive. Her obstetric score was Gravida 4 Para 2 Living 2 Abortion 1 with 6 weeks of amenorrhea. On eliciting her obstetric history, her married life was 10 years. She had history of one spontaneous abortion at 2 months of gestation for which a dilatation & evacuation was done. She had 2 previous Caesarian sections indicated because of low lying placenta and previous caesarean respectively. On Per abdomen examination, previous LSCS scar was seen and on palpation abdomen was soft and non tender with no scar tenderness. On per speculum examination minimal bleed was seen on the cervical os. On per Vaginal examination - uterus was normal in size, retroverted and bilateral fornices were free and non tender. An urgent USG OBS was advised, which showed- A gestational sac in the lower uterine segment along the anterior wall, with thinning of anterior myometrial wall. Adjacent to the sac, an heterogenous echogenicity was seen - likely previous LSCS scar. Hysteroscope port with camera was put into the cervix, a gestational sac with clots adjacent to it was seen over the anterior uterine wall over the lower segment of uterus. Curetting was done and products were removed. Patient was discharged within 8 hours and was asked to follow up after 1 week with an USG abdomen pelvis which was normal, and showed no RPOC or any other significant abnormality.

Background: Salivary gland tumors are rare head-and-neck neoplasms. They demonstrate dual cell differentiation and morphologic overlap. Dual cell differentiation requires histomorphological study and immunohistochemistry to diagnose. p63 is a selective  immunohistochemical marker expressed in nuclei of myoepithelial cells and basal duct cells in normal salivary glands and aid in the diagnosis of of salivary gland tumors by highlightining the biphasic nature of the tumors. Extent of p63 positivity can be a useful predictor of clinical outcome and could help in the aggressive mode of treatment in certain types of salivary glands tumors.To study the role of p63 in the diagnosis of salivary gland tumors.
Material and Methods: The present study was conducted at Malla Reddy Institute of Medical Sciences in the Department of Pathology on the surgically resected salivary gland specimens received for routine histopathological evaluation. A total of 60 cases of salivary gland tumors were included in the study. It is a retrospective study carried out from January 2018 to December 2021, on surgically resected salivary gland tumor specimens and Immunohistochemical analysis with p63.
Results: A Total of 60 Salivary gland tumors were studied with different cytomorphology and mixed architectural patterns. In the present study, most frequent age groups were between 40 and 60 years.. All tumors except Warthin's were female-predominant. The parotid gland was the most common site, with adenoid cystic carcinoma mostly seen in smaller salivary glands. Pleomorphic adenoma and Mucoepidermoid carcinoma were frequent tumors seen. Standard techniques of IHC with p63 antibody were carried out on all the 60 Salivary gland tumors. All the benign tumors were positive for p63. Malignant tumors with basal cell involvement, such as Adenoid cystic carcinoma 6/7 cases showed p63 positivity with varying intensities. Clear, intermediate and squamous cells of all Mucoepidermoid carcinoma were p63 positive. p63 was negative in  Acinic cell carcinoma. Differential localization of p63 in various neoplasms was observed which has given information on myoepithelial cells.
Conclusion: P63 is an important Immunohistochemical marker which aids in diagnosis of salivary gland tumors and also helps in localization of myoepithelial cells by differential expression in various salivary gland tumors.

Coccydynia is a common condition that is often self-limited and mild. Although the vast majority of patients who seek medical attention respond to conservative treatments, some patients require more aggressive treatments. In these cases, the etiology of the coccydynia may be complex and multifactorial. A multidisciplinary approach employing physical therapy, ergonomic adaptations, medications (NSAIDs), injections, and, possibly, psychotherapy leads to the greatest chance of success in these patients. Surgical coccygectomy generally is not recommended, and although different surgical techniques are emerging, more research is needed before their efficacy can be established.

Introduction: A key diagnostic material for aerobic growth and susceptibility testing in the microbiology laboratory is pus. It is crucial to periodically conduct investigations to ascertain the evaluate the safety of microorganisms since the rate of emergence of resistance in bacterial isolates considerably outpaces the frequency of subsequent drug discovery and development.
Aim: This investigation was done to assess the evolving pattern of antibiotic resistance in different pus specimens.
Materials and Methods: Pus specimen was obtainedfrom several Department of Microbiology, MGM Medical college n Lion’s Seva Kendra, Kishanganjover the course of six months using an aseptic approach, and they were processed right away in the lab using conventional antimicrobial techniques. Motility tests, Gram staining, and biochemical processes were used to microbes. All specimens underwent Kirby Bauer's disc diffusion method antibiotics susceptibility testing on Muller Hinton agar, with results interpreted in accordance with CLSI recommendations.
Results: 120 pus specimens were analysed, and the results revealed that surgeries departments (32.42%) contributed the most to the 93.26% culture positive. One of most prevalent organism was Pseudomonas, followed by Staphylococcus aureus (22.51%). Gram negative bacilli were responsive to Imipenem (87.09%), Piperacillin (61.28%), and Gentamicin (48.38%) while Gram positive cocci were susceptible to Linezolid (94.86%), Vancomycin (92.30%), and Imipenem (92.30%).
Conclusions: As per regions and growing multi-resistant bacteria, the shifting patterns of antibiotic sensitivity in isolated strains from pus might be a useful tool for doctors to begin empiric therapy of patients as soon as possible

Background: Gallbladder disease is known to affect a substantial number of people throughout the world. In India, the disease prevalence is on the rise, largely attributable to dietary & lifestyle changes, thus causing a significant disease burden. The purpose of this study is to evaluate the varied histological manifestations of gallbladder pathology and their association with cholelithiasis.
Materials & methods: This retrospective study was conducted in a tertiary medical centre in Patna from January 2020 to December 2020. The clinical data and the histopathological changes were evaluated.
Results: Of the 156 cases which were studied, 120 cases (77%) had gallstones. The mean age was 47 years. Females had a slight preponderance for gallbladder diseases with the Male: Female ratio being 1:2. 138 cases (88.5%) were diagnosed as chronic cholecystitis. 1.92% cases were diagnosed to have invasive malignancies.
Conclusion: A diverse spectrum of diseases affect the gallbladder encompassing inflammatory conditions, parasitic infections, pseudoneoplastic lesions and neoplasms. Routine cholecystectomy specimens should be evaluated meticulously as incidental findingss and diagnosis can be transformative.

Background: Chronic dacryocystitis is the most prevalent adnexal illness encountered in routine treatment and is a major cause of ocular morbidity in India.
Methodology: This cross-sectional study comprised 200 consecutive individuals with persistent dacryocystitis. All subjects had baseline examination after providing signed informed consent. By applying pressure to the lacrimal sac and allowing the regurgitant material to reflux via the lacrimal puncta, or by irrigating the lacrimal drainage system with sterile saline and collecting the sample from the refluxing material, sample fluid was collected. Gram staining and culture were performed on the samples, which were delivered to the microbiology department. The Kirby Baur disc diffusion test was used to assess antibiotic sensitivity in cultured bacterial growth.
Results: Chronic dacryocystitis is most common in the fifth decade of life. Females are more likely than males to develop chronic dacryocystitis. The left eye was more affected than the right. The majority of patients developed mucopurulent discharge. When compared to cases with serous discharge, the percentage of samples yielding positive growth on culture was higher in cases with mucopurulent and purulent discharge. On culture, the majority of patients with serous discharge exhibited no growth. The majority of individuals had epiphora with mucopurulent or purulent discharge. The most common nasal association was a deviated nasal septum. Microorganisms were found in 58.7% of the samples cultivated.
Conclusion: Knowledge of the bacteriology of chronic dacryocystitis aids in the selection of prophylactic antimicrobial drugs that act precisely on the pathogenic organism and also helps to prevent antibiotic resistance induced by injudicious antibiotic usage.

Background: The normal mechanical function of the hip is substantially altered by a variety of disorders. The surgical treatment of such conditions, particularly by hip replacement offers an opportunity not only to replace the articular surface of joint, but also to improve the long term mechanical function by decreasing the load on the joint. Objective: To evaluate short term outcome of large diameter head in uncemented total hip arthroplasty.
Materials and Methods: This study was done in the outpatien and emergency Department of Orthopaedics, Pt. B.D.S.  P.G.I.M.S. Rohtak.  Duration of study period was from January 2010 to June 2020.
Results: 14 cases (58.33%) had avascular necrosis of head of femur, 5 cases (20.83%) had osteoarthritis, one patient had rheumatoid arthritis. 15 patients (60%) were operated on left side, while 8 (32%) were operated on right side and 1 (8%) case was operated on both sides. Metal-on-metal THR was done in 8 cases (32%), Metal-on-polyethylene THR was done in 17 cases (68%) and Ceramic-on-ceramic was done in none. Postoperative pain was absent in 15 patients (60%), mild pain was seen in 9 patients (36%) and moderate pain in one patient (4%).
Conclusion: Total hip arthroplasty continues to be an ideal procedure for achieving painless, mobile, stable hip in cases with advanced hip disorders.

Introduction: Fluid resuscitation is essential to treat hypovolemia and restore organ perfusion. Respiratory variation in arterial pulse pressure is a reliable predictor of fluid responsiveness in mechanically ventilated patients with circulatory failure.  Respiratory variation in arterial pulse pressure is a reliable predictor of fluid responsiveness in mechanically ventilated patients. Respiratory variations in Pulse Oximetry Plethysmographic waveform peaks also correlate with pulse pressure variability in similar settings.
Aim and objective: The purpose of this study was to assess the relationship between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ICU patients of a tertiary care hospital in south India.
Methodology: A hospital-based prospective observational study was done at MDICU Department of Anaesthesiology, College Hospital, Trivandrum, s tertiary care hospital for a period of 1 year and 6 months. A total of 77 participants were included in this study. 
Result: The correlation between Pulse Pressure and Pulse Oximetry Plethysmography was statistically not significant.
Conclusion: The Large variability of ∆POP and poor agreement between ∆PP and ∆POP limit the calculation of POP as a potential non-invasive tool for fluid responsiveness in ICU patients. The same analysis should be done with a non-processed plethysmographic signal before ruling out ∆POP as a surrogate of ∆PP.

The aim of this study was to investigate the accuracy of the Nuchal translucency (NT) measurement between 11 and 13 weeks and 6 days of gestation as a marker to screen for congenital heart defects (CHD). 100 pregnant female patients who had come for routine antenatal scan were studied in a time period of 6 months in their later first trimester (12 to 14 weeks) and the nuchal translucency was measured. NT measurement was performed using philips affinity 70g  machine in the first trimester examination. The cases were followed up to one month postpartum to assess the presence of CHD.A progressive increase in the prevalence of CHD according to the NT values obtained in the examination was observed. The relationship between NT size and major cardiac defects was analyzed, and it was found that the incidence of cardiac defects increased along with NT size. In  sample, the use of NT as a screening method for CHD showed a low sensitivity –of 20% when the 95th percentile was used as the cut-off point. However, the specificity of the method was high - 99.4% for the 4.0 mm cut-off point. The negative predictive value was always above 99% at the different cut-off points. Evaluation of the nuchal translucency should be considered during the first trimester ultrasound as increased NT is associated with a spectrum of fetal abnormalities and chromosomal defects.

A total of 26 patients with average age of 45 years was treated with fully threaded cannulated cancellous screws. Out of the 26, 20 (77%) were males and 6 (23%) were females. The average timing of surgery 32.6 hrs following the incident ( range 32.6 +/- 11.34hrs) with a range of 18 to 76 hrs . There was no significant limb length discrepancy noted in immediate postop and follow up period. Incidence of infection non-union avascular necrosis was comparable with partially threaded group in previous studies. Harris Hip Scores was found to be fair to excellent except in 5 cases (3 had non-union neck of femur and other 2 with avascular necrosis of femoral head). Average femoral neck shortening was 3.6+/_ 3.06 mm and 1.98+/- 1.68 mm respectively which was significantly less as compared to  partially threaded groups.

Candida Auris is an emerging multi-drug-resistant fungus with catastrophic consequences. It is rapidly spreading worldwide in healthcare settings and immunocompromised patients are much at risk. Large outbreaks have been reported worldwide and this phenomenon is mainly associated with the increasing rate of invasive procedures, extensive use of broad-spectrum antimicrobials, and more frequent immunocompromised status of critically ill patients. High mortality rates have been associated with therapeutic failure mainly related to Azole Resistance. Difficulty in microbiological identification, high virulence, multi-drug resistance profile, and rapid global spread with several reported outbreaks make C. Auris as one of the serious emerging pathogens that physicians should be aware of. Our Study retrospectively analyzed the Epidemiology, clinical profile, and sensitivity pattern of Candida Auris infection at Max Super specialty Hospital I.P. Extension, Delhi a tertiary care center in North India.

Introduction: Dermatoglyphics is the scientific study of finger prints from palms, fingers, soles and toes of humans and animals. The uniqueness is it reflects DNA hence does not change & correlated with genetic abnormalities and are useful in biomedical studies. Vitiligo is the commonest heritable acquired progressive pigmentory disorder of skin. Altered dermatoglyphics pattern is well established as a early diagnostic aid in such disorder.
Material and Methods: Patients suffering from vitiligo 100 of them  (38 males and 62 females)visiting the dermatology OPD at Vydehi Institute of Medical College and Research Center, Bangalore,  were considered as cases in the study. Controls were hospital staff & medical students from the same institute. Dermatoglyphic prints were taken by the ink method & analysed with the help of magnifying hand lens.
Results: The whorl pattern in vitiligo was the commonest, mean value  was more in males than females, frequency of left hand fingers more than right in both male & female cases, Whorl pattern showed higher ratio in males in all left fingers except ring finger, in females was in left thumb, index, ring fingers. The arch pattern in vitiligo was least, mean value showed females more than males, showed in males more frequency of  left hand fingers, in females right hand fingers compared to other hand. Arch pattern showed higher frequency in males in left thumb & little finger, absent in index, ring finger, in females it was more in right fingers & absent in index finger. The loop pattern was 2^nd commonest , mean value was more in males vitiligo & showed right more than left hand fingers both in males & females, Loop ratios were higher in males in all the digits except ring finger & in females showed higher ratio left hand in thumb, middle & little finger. The Total finger ridge count mean value in vitiligo showed males more than females & there was significant difference between male vitiligo & control group.
Conclusion: This concluded from our study that difference observed between vitiligo & control may be result of genetic abnormality or influence of some intrauterine environment factors. The study of dermatoglyphic pattern serves as aid to diagnose and may indicate an increasing tendency to develop the disease

Disorders of sex development (DSD) are rare disorders occurring when there is a discordance between chromosomal, gonadal, or phenotypic sex. These occur in the presence of genetic mutations that affect one of the two major processes in sex determination or sex differentiation, sex development. In sex determination, the biopotential gonad is genetically programmed based on the sex chromosome complement to become either a testis or ovary. Sex differentiation occurs in the presence of a formed testis or ovary, and is dependent upon the ability of the gonad to produce hormonal factors and/or the presence of the appropriate receptors in extragonadal tissues.

Background - Continuous spinal anesthesia (CSA) offers considerable advantages over “singleshot” spinal or epidural anesthesia since it allows administration of well-controlled anesthesia using small doses of local anesthetics and a definite end point with less failure rate. The combined spinal–epidural technique (CSE) involves intentional subarachnoid blockade and epidural catheter placement during the same procedure. CSE allows a rapid onset of neuraxial blockade, which can subsequently be prolonged or modified. Study detail - Here we planned a prospective randomized study on continuous spinal anesthesia versus combined spinal epidural block for abdominal oncological surgery. Informed consent was obtained from the subjects and institutional approval was obtained before random and prospective studies of 50 patients who were scheduled for abdominal oncological surgery. Results and outcome - Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. CSA provided better cardiovascular stability with a smaller dose of local anaesthetic and shorter onset time, and without failures. We used epidural needle for CSA as it is cost effective and the technique is easy

Background: Postoperative sore throat (POST) is a well-recognized complication that remains unresolved in patients undergoing endotracheal intubation for general anesthesia. The wide variation in these figures is presumably due to different skills and techniques among anesthetists and to differences between patients in the definition of sore throat. Objective: The main aim is to study the attenuating effect of Magnesium sulphate nebulization on the incidence of postoperative sore throat. Materials and Methods: This is a prospective, comparative and observational study conducted in the Department of Anaesthesia and Intensive care unit, NC Medical College and Hospital over 1 year. 90 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologists (ASA) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation. Patients in Group N were nebulized with 3 ml of normal saline and the patients in Group M were nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min. The incidence of POST at rest and on swallowing at 0, 2, 4, 12, and 24 h in the postoperative period was evaluated. Results: There was no significant difference in POST at rest, at 0th, 2nd, and 4th h between normal saline and MgSO4. The significant difference was seen at 24th h, where MgSO4 lessened POST. There is no significant difference in POST on swallowing at 0th and 2nd h between normal saline and MgSO4. The significant difference was seen at 4th h, where MgSO4 lessened POST. Conclusion: POST is common in patients undergoing GA with a tracheal tube for routine surgical cases for up to 24 hr. We conclude that the use of magnesium sulphate in the form of nebulization as a pre-medication agent significantly reduces the incidence of POST compared to normal saline and it was found to be safe, simple, and effective in preventing the occurrence of postoperative sore throat.

Background: To comparethe main inguinal hernia repair using a pure tissue-based approach to the traditional Lichtenstein repair.
Material and Methods: 170 cases were divided into 2 groups for our study. Lichtenstein denoted asgroup L had 87 patients, whereas Desardagroup D had 83 patients. Early (within 1 year) inguinal hernia recurrence was the main factor in the outcome. Treatment time from surgical intervention to skin closure was a secondary outcome factor. Visual analogue scale scores for postoperative pain were calculated. It was calculated how long it would take to resume routine activities at home. Postoperative problems included cord oedema, groin pain, seroma, fever, wound infections, persistent pain, etc.
Results: One recurrence is detected in each arm after a 15-month mean follow-up period (P=1). In Lichtenstein, the operational time was 73.89+12.63 min, whereas the repair time was 72.60+13.89 min (P=0.508). When compared to the Lichtenstein group, postoperative pain was significantly lower in the group's first seven post-operative days (P=0.09). The amount of time needed to resume routine activities at home and in the group was significantly lower (P = 0.001). Between the two trial arms, there was no statistically significant difference in the rates of post-operative complications.
Conclusion: The outcomes of the Desarda approach for treating inguinal hernias are comparable to those of conventional Lichtenstein surgeries. The Desarda method does not employ a mesh. Patients who undergo Desarda's surgical treatment recover from it more quickly than those who receive the traditional Lichtenstein mesh repair. Less postoperative pain, same consequences to method standardisation. The Desarda procedure may increase the selection of tissue-based groyne hernia treatment options.

Background: To compare post-operative discomfort, residual abscess, and percutaneous suction drainage methods for treating breast abscesses. Length of stay in the hospital, Time needed for full recovery, appearance of a scar. The traditional approach of breast abscess incision and drainage has gradually changed from invasive to minimally invasive approach, using percutaneous placement of a suction drain as an option.
Material and Methods: For prospective trial from June 2021 to July 2022, 60 patients were admitted to the Ayaan Institute of Medical Sciences in Moinabad, Telangana, India. Total 60 patients with a primary diagnosis of puerperal breast abscess were enrolled. Thirty patients received I&D, and another thirty underwent percutaneous suction drain insertion.
Results: Compared to the I and D group, all patients who had percutaneous drain placement (VAS G1 and G2) experienced very little post-operative pain (G4 and G5). Two cases in the PDP group and one instance in the I and D groups had residual abscesses that were treated with incision and drainage. The average hospital stay in the I and D groups was 4-6 days, while it was 4-6 days in the PDP group. Complete healing took 4.2+1.2 weeks for I and D patients and 1.7+0.5 weeks for PDP patients. In contrast to patients who had the usual procedure, patients who underwent PDP had a small, unsightly scar at the entry and exit sites.
Conclusion: In comparison to the typical approach, percutaneous implantation of a suction drain in a puerperal breast abscess is less intrusive (painful), more likely to resolve quickly, heal with less scarring, and has a lower risk of complications.

Background: The aim of the present study is to the comparison of viral load suppression and increase in CD4 count in the HIV reactive patients by the new regimen (TLE) within shorter period compared to the old regimen (TLD).
Material and Methods: The study includes newly diagnosed100 HIV patients. The data collected included age, sex, regimen used by the HIV patients, CD4 count and Viral Load count. Out of these 100 patients 50 of them were initiated on old ART regimen (TLE) and other 50 of them were initiated on new ART regimen (TLD). The CD4 count was estimated using Flowcytometry (BD FACS Count^TM) and Viral Load count was estimated by RT-PCR technique (Abbott HIV-1 Assay).
Results: After 6 months out of 50 patients who were on TLE (old regimen),40 of them showed CD4 count,>560 cells/mm³ and Viral Load target not detected and 10 of them showed CD4 count >460 cells/mm³ and Viral Load 300 copies/ml. and out of 50 patients on TLD (new regimen), 45 of them showed CD4 count, >650 cells/mm³and Viral Load target not detected and 5 of them showed CD4 count >500 cells/mm³ and Viral Load 150 copies/ml. After 12^th month out of 50 patients who were on TLE (old regimen), showed CD4 Count > 680 cells/mm³ and 45 of patients showed viral load target not detected and 10 showed 210 copies/ml. After out of 50 patients who were on TLD (new regimen) showed CD4 Count > 800 cells/mm³ and Viral load target not detected.
Conclusion: Present study concluded that, the new regimen (TLD) is well- tolerated and more efficient in viral suppression than old regimen (TLE).The immunological monitoring is essential for the overall success of treating, monitoring and control of HIV.

Background: Dengue virus is the most common Arbovirus in India. It is transmitted by female mosquito -Aedes aegypti. It is a major public health problem world-wide, especially in tropical and sub-tropical areas. Approximately 100-400 million dengue cases occur every year according to World Health Organization (WHO). Hence early diagnosis of dengue is essential to prevent complications and mortality.
Material and Methods: A total of 94 cases with clinically suspicious of dengue fever were included. Blood samples from the OP/IP patients with <9 days fever were collected under aseptic conditions. Serum was separated by centrifugation and subjected to detection of dengue NS1 antigen and IgM antibodies by ELISA.
Results: Out of 94 samples, 23 were positive for dengue infection.  Out of 23, NS1 antigen was present in 7(30.4%) samples, IgM antibody was present in 4 (17.4%) samples, and both NS1 & IgM antibody were present in 12 (52.2%) samples. The sensitivity and specificity of NS1 antigen - 87.5%&82.5%, for IgM - 80%&79.7%, for NS1 antigen + IgM antibody - 92.3% and 87.6% respectively.
Conclusion: NS1 ELISA test method is an effective method for early detection of dengue fever. Early detection will help in treatment at appropriate time to prevent complications.  However, the combination of NS1 Ag test and IgM Ab test by ELISA detected high sensitivity and specificity which provides strong evidence for detection of clinically suspected dengue infection.

Background: COVID-19 is an acute viral illness caused by severe acute respiratory syndrome corona virus 2(SARS-CoV-2). Since the onset of the SARS-CoV-2 pandemic, multiple new variants of concern have emerged which are associated with enhanced transmissibility and increased virulence? It also highlights the role of the clinical interprofessional teams, public health agencies, and community participation in improving patientcare. An analysis of genomic sequencing variants of SARS-CoV-2 in symptomatic patients during 2nd and 3rd wave of pandemic by next-generation sequencing (NGS).
Material and Methods: A total of 200 symptomatic patients, throat/nasopharyngeal swab were collected for real-time reverse transcription-polymerase chain reactions (RT-PCR) at tertiary care hospital, Ongole. The specimens were transported under cold chain according to guidelines to Centre for Cellular & Molecular biology (CCMB), Hyderabad, for genome sequence analysis by next generation sequencing (NGS). Study period – 2ndwave i.e., MARCH 2021 –NOVEMBER 2021 & 3rdwave i.e., DECEMBER 2021 –MARCH 2022 according to WHO.
Results: Out of 200 samples analysed, 132 samples of 2nd wave & 68 samples in 3rd wave. Out of 132 samples, 57 Delta (B.1.617.2), 75 Delta sub-lineages. Out of 68 samples 41 Omicron (B.1.1.529), 11 Omicron lineages (BA.1), 16 Omicron (BA.2).
Conclusion: During the 2ndwave the symptomatic patients were detected with more delta and delta sub lineages showing high mortality rate. During 3rdwave omicron and omicron sub lineages were detected more than delta showing very high transmissibility and less mortality. Continuous monitoring and analysis of the sequence variants to understand the genetic heterogenicity.

Background: Pulmonary tuberculosis is a major communicable disease worldwide. Tuberculosis and HIV is a major health problem in many parts of world. The National Tuberculosis and Leprosy Program annual report indicates that about 7% of all TB notified cases had co-infection with HIV. The incidence of Tuberculosis HIV co-infection increasing gradually.
Materials and Methods: The study is a Retrospective study conducted on 200 HIV reactive patients at ART center in a tertiary care hospital GGH Ongole. Data was analyzed for incidence of tuberculosis in HIV infected patients with CD4 counts and their association between them.
Results: Out of 200 HIV infected, 40 were detected with tuberculosis, of them 32 were pulmonary TB and 8 were extra pulmonary TB. In present study 26 (65%) of patients with CD4 count < 200 cells/μ l developed Tuberculosis, 9 (22.5%) of patients with CD4 count 200-400 cells/μl and 5 (12.5%) of patients with CD4 count > 400 cells/μl shows less number of pulmonary and Extra pulmonary TB.
Conclusion: There is a strong association between Tuberculosis and HIV. Incidence of TB is more when CD4 count less than 200 cells/μl. So it is essential to screen HIV reactive patients for TB along with CD4 count to prevent complications and mortality. This study showed that incidence of Tuberculosis pulmonary and extra pulmonary in HIV infective patients is significantly higher with CD4 count < 200 cells/µl.

Background: In this study, we wanted to study the role of triphasic contrast multi detector computed tomography (MDCT) scan in diagnosis of focal hepatic lesions and enhancement patterns of various focal hepatic lesions on triphasic contrast MDCT scan.
Methods: This was a hospital based prospective study conducted among 96 patients who presented with suspected focal hepatic lesions or those suspected or diagnosed with other imaging modalities to the Department of Radiology, Adesh Medical College and Hospital, Mohri, over a period of 6 months from 1^st March 2022 to 31^st August 2022 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.
Results:  Male preponderance (57.2 %) was seen compared to females (42.8 %) with a sex ratio of 1.3 : 1. 57 (59.3 %) were malignant and 39 (40.7 %) were benign. 47.4 % of the hemangiomas were seen in age group of 30 - 39 years, out of the total 19 cases. Male preponderance was seen in hepatocellular carcinoma (HCC) (85.7 %), metastases (55 %), cholangiocarcinoma (66.7 %), simple hepatic cyst (53.8 %) and abscess (60 %). Female preponderance was seen in haemangioma (63.2 %). Out of the total 345 lesions, 213 were hypo vascular lesions accounting for 61.8 % of the cases and 132 were hyper vascular lesions accounting for 38.2 % of the lesions. Out of the 213 hypo vascular lesions, benign lesions included cysts (28.6 %), abscess (5.7 %) and haemangioma (3.8 %). Malignant hypo vascular lesions included metastases (61.9 %). Out of the 132 hyper vascular lesions, benign lesions included haemangioma (47.8 %). Malignant lesions included HCC (50 %) and intrahepatic cholangiocarcinoma (2.2 %). The most common primary site for hepatic metastases was gall bladder (50 %) followed by lung (25 %) and colorectal carcinoma (7.5 %). No visible enhancement was seen in simple hepatic cysts on hepatic arterial phase (HAP, PVP) and delayed phase and the lesions remained hypo dense in all the phases.

Background: To study and compare tacrolimus ointment (0.1%) and clobetasol propionate cream (0.05%) in the management of localised vitiligo. To know the common types of vitiligo, age and sex distribution and to know the percentage of regimentation and adverse effects encountered with tacrolimus ointments (0.1%) and clobetasol propionate cream (0.05%).
Material and Methods:The present prospective study includes 50 cases of clinically diagnosed vitiligo attending the outpatient department of DVL, ACSR, Government General Hospital, Nellore from 01/06/2021 to 30/05/2022 over a period of 12 months. In this study patient with focal, local, segmental, lip-tip, mucosal and acrofacial vitiligo were included. Generalized and universal vitiligo (vitiligo vulgaris) were excluded in this study.
Results: In the present study 50 cases of vitiligo divided into two equal group treated with either tacrolimus ointment (0.1%) or clobetasol propionate cream (0.05%) were included. In this study the peak incidence of vitiligo is the age group of 21-30 years, with slight female preponderance (58%). Focal form of vitiligo in common (36%), response to clobetasol propionate cream (0.05%) 36 % whereas with tacrolimus ointment (0.1 %) it is 64 %. Adverse effects in clobetasol propionate cream (0.05%) were seen in 7 patients (28 %) and with tacrolimus in one patient (4 %).
Conclusion: In the present study clinical efficacy of tacrolimus ointment (0.1%) was almost equal to clobetasol propionate cream (0.05%) and tacrolimus ointment (0.1%) had fewer side effects than clobetasol propionate cream (0.05%) but the compliance was found to be better with clobetasol propionate cream (0.05%) due to its cost effectiveness.

Since India is an agriculture-based country, organophosphates (OP) still remain the main agent for crop protection and pest control and therefore harm people who are overexposed accidentally while handling the pesticides. Organophosphate compounds are widely used as pesticides in agricultural parts of the world. Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year.  Due to their easy availability and low cost, organophosphates are one of the most common causes of poisoning in the world from agricultural, unintentional, or suicidal exposure. The initial management of acute OP poisoning includes cardio respiratory stabilization, decontamination (removal of clothes for possible source of continued exposure in occupational intoxication), irrigation of skin and eyes as well as gastric lavage and activated charcoal to minimize absorption of the OP compound.

Background: To evaluate the serum ferritin levels in patients with acute myocardial infarction. To inspect normal healthy individuals with non-cardiac chest pain for serum ferritin levels. To distinguish ferritin levels persisting in both the study population. Comparing serum ferritin levels to the probability of developing acute myocardial infarction. To study relevance of serum ferritin level to acute myocardial infarction.
Material and Methods: A case controlled study was held by Department of General Medicine, Government General Hospital, Suryapet, Telangana, India from December 2021 to September 2022. The study consisted of male patients with myocardial infarction for determining the association of serum ferritin to acute myocardial infarction.
Results: The statistical analysis data for the evaluation of study details for different diagnostic test between cases and control group and determines significance between them. Comorbidities associated with cases and control shows that evidence of diabetes mellitus. The comparison of ferritin and lipid profile no significance existed. On differentiating ferritin administrated value to that of day 3 shows statistical significance. While comparing ferritin and glycaemic control, correlation prevailed. A mixed results were obtained from performed study that proved insufficient to correlated ferritin with myocardial infarction.
Conclusion: The study contradicted the hypothesis. Neither of the tested iron biomarkers confirmed the iron hypothesis, based on the meta-analysis. These finding suggest that the evidence is not robust enough to support the connection among iron and cardiovascular disease. This discrepancy in results could be due to the study's use of different iron markers. Despite the large amount of data that has been published to far, the importance of iron in CVD is still up for debate.

Background: Wrist discomfort is frequent in Orthopedic OPD. Computers, phones, laptops, and other electronics aggravate wrist pain. Treatment requires accurate diagnosis. Diagnostic imaging confirms. Ultrasound, MRI, and X-ray are employed. Critical imaging. Sonography and physical exam solve diagnostic problems. Real-time ultrasound is cost-effective for wrist imaging. Ultrasound imaging has improved for wrist joint diseases. It's cheaper than other methods. Cost and availability make wrist ultrasonography significant in our country. Ultrasound is the primary line of imaging for a patient with wrist joint pain. Use ultrasound along with X-rays and clinical exam to aid in speedy and decisive diagnosis, avoiding expensive investigative modalities. To describe USG image interpretation problems.
Material and Methods: In our study, a prospective analysis of 100 individuals who had wrist pain was included. Additionally, a pre-written consent is obtained. All patients got a complete clinical examination, a USG of the affected wrist with comparison to the other side, and an X-ray (PA & Lateral) of the affected wrist
Results: A wide range of pathologies, including anomalies of the local bones, joints, and soft-tissue structures including tendons, can cause the clinical manifestation of wrist pain. US can help identify the precise source of wrist pain.
Conclusion: For a case of wrist pain, a USG examination can be performed as the initial line of inquiry because it is affordable, real-time, and enables comparison with the contralateral side.

Background: The nutrient foramina of the clavicle have extensive clinical importance as these are involved in the repair of clavicular fracture. Therefore, the aim of the present study was to evaluate the morphometry and topography of nutrient foramen in clavicle.
Material and Methods: This study was conducted in department of Anatomy. In this study we were included total 60 dried human clavicle bones. The duration of study was over a period of one year.
Results: The result of this study was revealed that one foramen was present in 65% bone. While, two nutrient foramen present in 26.7% clavicle bones & three nutrient foramen present in 8.4% clavicle bone. Which were found macroscopically.
Conclusion: This study concludes that from all the findings that the nutrient artery should be preserved carefully while doing surgical procedure like internal fixation and vascularised bone graft.

Objective:  One of the most common and potential life threatening complications of pregnancy is pregnancy induced hypertension. This cross-sectional study aimed to investigate the relationship between platelet count and pregnancy induced hypertension.
Materials and Methods: This is a present cross-sectional study was carried out in the Department of Medicine and Obstetrics and Gynecology, Maheshwara Medical College & Hospital over a period of 1 year among 60 subjects. The subjects for this cross-sectional study included consecutively - recruited Normotensive (n = 130) serve as a control, Non-Sever Pre-eclamptic (N = 35) and Severe pre-eclamptic (n = 35). All consenting, adult (≥ 18 years) pregnant women who were confirmed to have pregnancy induced hypertension by an Obstetrician constituted the subjects for these subjects.
Results: A total of 200 pregnant women were included in the study. Platelet count and platelet crit levels tend to decrease as pre-eclampsia becomes more severe. In this study, no statistically significant differences were observed between the three groups in age, residence, number of pregnancies (gravidity), number of deliveries (parity), gestational age, and BMI, but there was a significant difference between the three studied groups with regards to SBP, DBP and MAP which increased with severity of preeclampsia (P<0.001). The value of PLT accounts 180(97–352) ×103/μl for pre-eclamptic women and 260(139–445) ×103/μl for normotensive pregnant women (p<0.001).
Conclusion: Platelet indices, including platelet count, mean platelet volume, platelet distribution width, and Platelet crit, have been identified as promising candidate markers for predicting preeclampsia in pregnant women. In the future, a serial examination of these indicators during several trimesters of pregnancy should be conducted.

Background: Paroxysmal symptoms are brief (lasting seconds to minutes) stereotyped symptoms occurring suddenly and many times a day, for days up to a few months. Objective: to study the prevalence of paroxysmal symptoms in multiple sclerosis patients and their correlation with the demographic data of the patient, type of MS, duration of the illness, severity of the disease, radiological findings and disease modifying therapies. Method: A cross-sectional survey enrolled (100) patients with multiple sclerosis, conducted in the Multiple Sclerosis Clinic in Dr. Saad Al-Witri Neurosciences Hospital - Baghdad during June 2019 - December 2019. Results: (29%) of the participants had reported paroxysmal attacks of various types. Betaferon^® and Rebif^® were found to be significantly correlated with absence of PS. Patients with paroxysmal attacks had longer duration of disease. Patients with PS had significantly lower EDSS score. Highest proportion of patients had paroxysmal paresthesia (34.48%). Conclusions: Paroxysmal symptoms are common presentations in multiple sclerosis initially or during the course of the disease, with paroxysmal paresthesia being the most common among them. Betaferon^® or Rebif^® might be a good choice for patients who are experiencing paroxysmal symptoms. Paroxysmal symptoms tend to occur with the least disabled MS patients and longer disease duration.

BACKGROUND:RDS is usually defined by the presence of acute respiratory distress with disturbed gas exchange in a preterm infant with a typical clinical course or x-ray.The main risk  factor for RDS,by far,is prematurity.The central feature of RDS is surfactant deficiency due to lung immaturity,commonly due to prematurity.Surfactant replacement therapy reduces mortality and several aspects of morbidity in babies with RDS.
METHODS:Newborns with RDS were intubated with endotracheal tube and surfactant was administered.The first dose of surfactant was given as early as possible to the preterm infants requiring MV for RDS then extubated and connected to nasal CPAP.The mortality,morbidities were compared.
RESULTS:Among the 150 preterms who were recruited in this study, outcomes of surfactant therapy is discussed in correlation with the time of presenation,hour of installation of surfactant,birth weight,gestational age,size for gestational age, severity of RDS,surfactant doses,length of hospital stay,type of assisted ventilation,duration of assisted ventilation,duration of supplemental oxygen,complications with surfactant therapy.We found that surfactant replacement therapy has a beneficial effect.
CONCLUSION:Out of 150 preterms with RDS who are more than 31 weeks of gestation,more than 1500 grams,appropriate for gestational age,Singleton neonates,mild and moderate respiratory distress,and who received single dose of surfactant with RDS, had better outcome and discharged.45.3% of the preterm new born who were given surfactant had fatal outcome.Only 54.7% of preterm newborns who were given surfactant have discharged.

Introduction: Proximal humerus fracture patterns being mainly distributed bimodally differentiating between young male and elderly female patients due to high energy trauma like vehicle accident and osteoporosis respectively. The broad majority of proximal humeral fractures are handled non-operatively but few critical fractures need surgery. The purpose of this study was to describe a modified deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures and to assess its clinical outcomes.
Material And method: Forty consecutive patients with proximal humeral fractures were treated with by using a modified deltoid splitting approach with axillary nerve bundle mobilization. Among forty patient five patients were lost to follow up, thirty-five patients were reviewed in our department and had regular follow up.
Results: The mean age of the study population was (53.97±11.80 years). One patient had clinically detectable sensory deficits in the axillary nerve later improved by physiotherapy. Two patients had implant failure for which revision was done and one patient had superficial infection improved by antibiotic coverage according to culture sensitivity report and one patient had deep infection improved by debridement and higher intravenous antibiotic coverage according to culture sensitivity report. Major complications, such as avascular necrosis of the humeral head and varus collapse at the fracture site, were not observed. The mean visual analog score for patient satisfaction was 9.1 (range, 6–10), and the mean neer scores were 83.46±7.11. Distribution of cases as per neer’s score we have found that most of the cases i.e. 45% belong to good followed by 35% belong to excellent and 7.5% belong to fair outcome.
Conclusion: The use of a modified deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures yielded excellent outcomes. This approach is a useful alternative to the deltopectoral approach.

Dengue fever is a tropical, vector-borne infection caused by Flaviviridae, transmitted by the bite of Aedes mosquito. Dengue fever is predominantly asymptomatic but common clinical manifestations include fever with thrombocytopenia induced bleeding tendency, myalgia, arthralgia. Renal involvement in dengue is attributed to pre-renal Acute Kidney Injury. Dengue fever induced thrombotic microangiopathy is very rare. We present a case of Dengue fever induced Thrombotic microangiopathy.

Laryngeal involvement in lupus erythematosus is very rare and exceptionally revealing. The clinical manifestations could be quite varied. Vocal cord palsy (VCP) is a rare CNS involvement in the clinical course of SLE. We report a 51-year-old female who was admitted for acute onset inability to speak for 3 days and nasal regurgitation. Her ANA by IF showed a 3+ homogenous pattern. Anti – ds DNA, anti – SS A and SS B and anti-Ro 52 antibodies were also positive. Video Laryngoscopy (VDL) showed paralysis of the left vocal cord. The patient was treated with systemic corticosteroid with complete recovery with no residual vocal cord palsy.

Background: Portal hypertensive gastropathy (PHG) is known but under detected complication of cirrhosis of liver. Patients with stable liver disease are more prone to internal bleeding due to portal hypertension. Thrombocytopenia is a common complication associated with chronic liver disease and it is associated with poor prognosis.
Aim: The aim of this study is to find out the association between correlation between severity of thrombocytopenia and portal hypertensive gastropathy in patients with chronic liver disease.
Materials and Methods: This cross-sectional analytical study was conducted in a tertiary care centre at Saveetha Medical College Hospital and Research Centre. A total of 80 consecutive subjects were included in this study. All adult patients admitted with diagnosis chronic liver disease underwent upper GI endoscopy; those with portal hypertensive gastropathy(PHG) were included. Platelet count was estimated and severity of gastropathy was classified. Correlation of thrombocytopenia and severity of gastropathy was studied. Statistical analysis was done using SPSS 21. Statistical analysis was done by t test and chi-square test.
Results: Patients withmild PHG category had normal platelet count between 1.5-4.5 lakhs/mm3. But in patients with severe PHG, almost 80% of patients had thrombocytopenia, in which 8% had severe thrombocytopenia <50,000 cells/mm3. The inverse relationship between the platelet count and the severity of PHG was statistically significant.
Conclusion: The severity of thrombocytopenia increased with the increasing grade of portal hypertensive gastropathy. Hence platelet count can serve as the prognostic marker of chronic liver disease induced portal hypertensive gastropathy.

Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas are exceptional cystic exocrine tumour of the pancreas with low incidence rate. It is most prevalent in young women  between 30 and 40 years of age [1]. It is also known as a Frantz or Hamoudi tumour. SPEN has very  low-grade malignant potential, with only 5% of patients developing metastases but it is more aggressive and locally invasive  in men. Early detection of this tumour of this tumour is important as , it usually has a good prognosis following surgical resection but poor prognosis factors are male sex, vascular or local invasion, size >5 cm, and necrosis or cellular atypia[2] . SPEN can present similar to other pancreatic tumours.  This case report aims to describe the clinical and pathological findings in a patient diagnosed with SPEN and present the treatment and its outcome.

Cardiovascular disease is the leading cause of mortality in the world. There are several risk factors for cardiovascular disease, such hypertension, dyslipidemia, obesity, diabetes mellitus and cigarette smoking. However, these classic risk factors do not entirely explain for future cardiovascular disease. As a result, many newer risk factors such as estimated glomerular filtration rate (eGFR), microalbuminuria, C-reactive protein (CRP), homocysteine have been evaluated as potential predictive factors. Microalbuminuria is gaining recognition as simple marker of atherogenic risk. Positive albuminuria is considered not only marker of renal damage but also signify systemic vascular damage since.  In this study we want to evaluate the association between albuminuria and coronary atherosclerosis using angiography in cases with type 2diabetes mellitus by estimating urinary albumin excretion. Materials and methods: It is a cross sectional, observational study of association between increased Albuminuria and Coronary Atherosclerosis in 100 patients with Type 2 diabetes mellitus. We exclude the patients with Gestational diabetes mellitus,type 1 diabetes mellitus and urinary tract infection. Results: Prevalence rates for microalbuminuria in the present study were 31%. 41-50 years showed maximum of microalbuminurics followed by 51-60 years group had maximum of macroalbiminuria cases. Most of the patients were detected with microalbuminuria and in the first few years of the disease. Patients falling in the overweight category showed maximum number of micro and macroalbuminurics. Lipid Profile abnormalities showed negative correlation with microalbuminuria but positive with Serum Triglyceride levels. Due to CAD examination, Microalbuminuria cases were higher as 54.8% among those with DVD. Conclusion: Microalbuminuria in itself being a predictor of diabetic nephropathy however it shows negative association with diabetic neuropathy and diabetic retinopathy. Microalbuminuria showed positive association with CAD cases in the present study. Hypertension and dyslipidemia being a cardiovascular risk factor showed a significant association with microalbuminuria

Introduction: Fractures of humerus are no exception. Fractures of the humeral diaphysis constitute  3% of all fractures. It is the most challenging fracture of upper limb to be treated.  Severe damages can occur if fractures are not evaluated and treated properly. The humerus is enveloped by a sleeve of  muscles and has rich blood supply which helps in fracture union. As the limb does not  take part in weight bearing or ambulation, some amount of shortening is functionally  acceptable. But rotational deformity is not tolerated well.Traditionally humerus shaft fractures have been managed with hanging cast or brace

Contraception is a personal choice. Working and educated women are often well versed with various methods of contraception but the woman residing in shanty towns, rural areas or semi urban areas are either unfamiliar of these methods or if familiar , still hesitate to use them correctly. Contraception is a vital component for a woman’s health as a woman who can plan the frequency and interval of childbirths can easily rule her home and workplace more efficiently and confidently. Historically, various contraceptive methods and practices have been used throughout the world and woman had little choice in planning pregnancies.¹When we look upon the history of birth control we come across a key figure Margaret Sanger (1879-1966), she was educated as a nurse, well known and highly controversial proponent of contraception. She was credited with developing the term “Birth control”². When we look at Indian experience about birth control, in 1952 the family planning program was the first national level program with focus on population stabilization

Background: Excision of skin tumours is one of the most common procedure in surgical department. And excision of skin tumours produce skin and soft tissue defect depending upon the size and extent of the skin tumour. Flaps are a better choice when tissue “bulk” is needed to fill contour defect and usually produce better results from a cosmetic stand point because they can provide a better match for skin tone and texture. The merits of the flaps are definitely higher compared to primary closure or skin grafting. Flap technique produce excellent results in facial reconstruction after skin cancer excision.
Material and methods: Patients admitted in IPD of department of surgery, ENT, plastic surgery in PMCH, Patna.  were considered for the study considering the exclusion and inclusion criteria. A detailed workup was made according to proforma. Patients having skin and soft tissue defects following skin tumour excision were included. Details of cases were recorded including history and clinical examination. Routine and specific preoperative investigations were performed in all patients. Details of reconstructive surgery recorded. Rotational, transposition and advancement flaps were used to reconstruct the defect. A follow-up of patients was done to know the complications and outcome of adjacent flap.
Results: 07 patients with small to medium-sized defects (1-6cm) following excision of skin tumours were treated. The age of patients ranged from 30 to 75 years. Of these 07 patients, 04 were men (57.14%) and 03 were women (42.86%). 05 patients had basal cell carcinoma and 02 patients had squamous cell carcinoma. The tumours were located on the face in all the patients. All the flaps survived. We had no complications and the functional and aesthetic outcomes were good. No recurrence of malignant skin tumour was observed.
Conclusion: Patients presenting with skin defects following excision of skin tumours were treated with adjacent flap (local flap). The adjacent flap provided a better cosmetic appearance, less scarring, superior aesthetic results and functional normalcy. The complications associated with defect closure with local flap were nil in our study and the flap uptake was 100% in all the cases.

Background: Hypertrophic scars are unique human dermal fibroproliferative disorder of injured skin, associated with ugliness, pain, itching and functional limitation. we compare the efficacy of these two treatment modalities for Hypertrophic scars.
Material and Methods: The settings of this study is at Patna Medical College and Hospital (PMCH), Patna. This is the largest referral hospital in Bihar. Study duration of Three years. The patients coming in Department of plastic surgery, PMCH for treatment of Hypertrophic scars. Selection of patients is from the point first seen at O.P.D and further proceed to respective ward prior to intervention.
Conclusion:  This safe & feasible application together with low morbidity, makes the fat grafting a valuable new tool in the treatment of Hypertrophic scars. Although our results are encouraging, We suggest that further research is warranted to asses adipose cell properties, extracelluar  matrix composition and the essential requisites for routine clinical applications.    This safe, & feasible application, together with low morbidity makes it a valuable new tool in the repertoire of every plastic surgeon.

Background: The present day thinking in management of lower extremity damage is surgeries shifted from the concept of amputation of unwanted lower extremity to making it a functional lower extremity. We had conducted a comparative study on perforator flaps and free flaps and their use in lower extremity reconstruction and to compare the perforator flap and free flap in reconstruction of lower leg and foot defects in various advantages and disadvantages of these procedures.
Materials and methods: The present study was a prospective and comparative study that was done between the use of perforator flaps and free flaps in the reconstruction of leg and foot defects on patients who were admitted with leg and foot defects in PMCH, Patna. Study duration of Two Years. Those who were willing were evaluated thoroughly by a team of plastic surgeons who met a consensus on the procedure chosen and the timing of the flap surgery. Results: 50 -60 years constituted 33.33 %. The males comprised 73% (22 cases)   Heel lesions seen in 30 % Between the two groups difference duration of surgery, expenditure for the procedure was statistically significant with a   p value <0.0001 , was lesser for the free flap Secondary Procedures were done in 23.33% ,STSG was done in 3 cases 10% Between the two groups the complications for the procedure was no statistically significant with a p value 1. We had Flap Necrosis in 4 case major loss in tow, tip loss in 1 and partial loss in 12 case.
Conclusion: In the present study we concluded that flap reconstruction is a useful technique that restores the function and to an extent the cosmesis in lower limb tissue loss.

Background: Mandible is also known as lower jaw or jaw bone. It is the largest and the strongest bone of our facial skeleton. It also holds the lower row of teeth in oral cavity. It is the only movable skull bone.
Objectives: If the patient is very sick due to trauma or due to other way, we prefer to do IMF only. But if the patient is stable one then we do IMF followed by ORIF in the same case. Material and Methods: we observed the patients with mandible fractures admitted through emergency and opd PMCH, Patna. Study duration of Two Years. Our study is focussed on the patients with history of   RTA or assault or fall down with facial injury involving subcondylar fracture of mandible. The aforesaid patients undergo either conservative or operative management on random selection basis. These patients usually come from Patna as well as all districts of Bihar.
Conclusion: When we talk about the conservative approach it is only partially reliable for fractures of sub condyle of mandible. If the fracture is displaced or with dislocated TM Joint of that side, we should approach via operative one, while in un displaced simple fractures conservative is enough.

Background: The purpose of this study was to evaluate speed, safety and efficacy of negative pressure wound therapy (NPWT) compared with moist gauge dressings (MGD) to treat foot ulcers in diabetic patients.
Materials and methods : The cases presented in this study are those patients admitted on in patient basis from general surgical wards, plastic surgery and patients with surgery reference for diabetic foot care from all other departments like medicine, orthopaedics in PMCH Patna. Study duration of Two Years. This is a prospective interventional study. In this study 30 randomly selected patients were assigned to the study group (topical negative pressure) based on their willingness for undergoing topical negative pressure dressings and 30 patients to the control group (moist gauze dressings).
Results: The 60 patients admitted for the study were divided into two equal and comparable groups of 30 patients each. All the patients in the study were suffering from diabetes of varying duration, with some on regular treatment and the others on irregular treatment. In Vacuum assisted closure/Topical negative pressure therapy maximum patients of 11 were found in the age group 41-50yrs with 36.7% and in Moist gauze dressing group also same result but the age group being 61-70. Female patients were more in VAC group, compared to male in MGD. Conclusion: Application of Topical Negative Pressure increased the rate of formation of granulation tissue and had better graft uptake, faster wound healing. It also lessen the length of hospital stay thereby improving final clinical outcome than the patients who underwent a conventional dressing for diabetic foot wounds.

INTRODUCTION : Immunization is one of the most effective and efficient way of preventing various childhood infections. It is important to assess the current immunization status of children and various factors affecting it in order to plan interventions and strategies to improve the outcome of immunization programme.
AIMS AND OBJECTIVES : 1.To study the coverage of primary immunization and IFA(Iron and Folic acid supplementation) in urban slums and rural areas. 2.To assess the influence of socio-demographic factors on immunization. 3.To know the sources of immunization. 4.To assess the knowledge of mothers regarding necessity of immunization.
MATERIALS AND METHODS : A community based cross-sectional study was done in the rural and urban slums of a district among 150 children aged 12-23 months over a period of 2 months.Simple random sampling was used to select the children and data was collected through house visits using a predesigned semi-structured questionnaire. Data was entered into MS Excel and data analysis was done through proportions,percentages and Chi-square test using  Epi-Info software.
RESULTS : Among the study population of 150 children,108 children (72%) were fully immunized,41 children (27.33%) were partially immunized and only 1 child(0.6%) was unimmunized.Almost half of the children(45%) were receiving IFA(Iron and Folic Acid)supplementation twice a week.Maternal age,eduactional status of mother,knowledge of mother or caregiver regarding immunisation was significantly associated with immunisation status of children.Majority of the children(76%) were availing immunisation services only from government facilities.
CONCLUSION :  There were more children in urban areas who were fully immunized(72%) compared to children who were fully immunised in rural areas(65%).Socio-demographic factors were found to be associated with partial immunised or unimmunised status of children.

The current study aims at bacterial and fungal etiology of Cholesteatoma in patients attending tertiary care hospital. Cholesteatoma is an abnormal, noncancerous skin growth that can develop in the middle section of ear, behind the eardrum. It is a complication of chronic suppurative otitis media. With the informed consent, 70 patients with Cholesteatoma were included; 42 (60%) were male and 28 (40%) were female, and the mean age was 11-50 years. Materials and methods- Cholesteatoma sac and 2 preoperative swabs were collected from ENT OPD patients complaining of earache and discharge. Results- Out of 70 patients, 28 were sterile samples, 40 (41.7%) showed aerobic bacteria and 2 (1.3%) had fungal etiologies. Conclusion- Gram negative pathogen forms most aural swabs and Cholesteatoma sacs. Pseudomonas aeruginosa was the predominant isolate 18(25.7%), followed by Staphylococcus aureus
11(15.7%) and their antimicrobial susceptibility testing was done. Though the treatment of Cholesteatoma is surgery but to avoid recurrence, the use of proper antibiotics by knowing the antibiogram will lead to a decrease in the prevalence of microbial growth and recurrence of Cholesteatoma.

 Relaxants of muscle are a varied group of drugs.They are structurally and pharmacologically different. Skeletal muscle relaxants(SMR’s) are used as adjunct therapy when initial treatment fails. They are commonly used to treat fibromyalgia, low back pain, neck pain, head ache, myofascial pain and muscle spasm. Increased muscle tone is a common feature of anxiety states in humans and may contribute to the aches and pains including head ache that often trouble anxious patients.This study was carried out to evaluate the muscle relaxant property of nitrazepam and diazepam by rota rod test. It was found that both the drugs demonstrated muscle relaxant action. But diazepam produced more muscle relaxant property as compared to nitrazepam for every concentration and increases relaxant property with increase in dose

Introduction: Back ground: Chronic suppurative otitis media (CSOM) is one of the most common childhood infectious diseases worldwide and is a leading cause of hearing impairment in resource-limited settings. It is less frequently seen in resource-rich settings. It is characterized by chronic drainage from the middle ear associated with tympanic membrane (TM) perforation. CSOM is usually preceded by an episode of acute otitis media (AOM).
Aim and Objective of the study. The aim and objectives of the study is to evaluate the surgical outcomes chronic suppurative otitis media.
 Materials and Methods: Informed consent was obtained from all patients included in the study. The study was approved by institutional ethical committee. The data were collected by the active participation of the patients’ interview by the preformed proforma of data collection sheet and then data were gathered and tabulated. Detail history, physical examination and relevant investigations were done pre-operatively and post-operatively. Post-operative follow up after 1month, 2 months and 3 months were done.
Results and Discussion: In the present study, we included a total of 80 patients with CSOM who underwent surgical intervention. The aim and objectives of the study is to evaluate the surgical outcomes chronic suppurative otitis media. The number of subjects in the age group of 5-10 years were 3, 11-20 years were 20, 21-30 years were 15, 31-40 years were 22 and 41-50 years were 20. The number of males were 62% and females were 38%. It is evident from the table 2 that 100% presented with discharge, 22.5% with granulation tissue, 21.25% with aural polyp, 55% with attic perforation and 35% with postero-superior marginal perforation. It is evident from table 3 that 52.5% had dry ear, 15% had discharging ear and 1.25% had granulation tissue at 1^st month. Similarly, that 55% had dry ear, 10% had discharging ear and none of the subjects had granulation tissue at 3^rd month. It is evident from table 4 that 3.75 % had deterioration, 8.75% had unchanged and 87.5% had improvement in hearing.
Conclusion: Hearing loss arising from COM is a matter of serious concern because of its long-term effects on communication, language development and educational process. Early diagnosis and intervention by skilled Otologist is recommended to regain hearing as well as to prevent disability and complications.

Background: Breast cancer incidence in India is increasing and has now become the most common cancer among women. Preoperative pathology diagnosis and mammography (using breast imaging reporting and data system (BI-RADS) scoring system) constitute an essential part of the workup of breast lesions. The present study was aimed to compare the diagnostic accuracy    of BI-RADS score with histopathological finding in diagnosis of benign and malignant lesions of breast.
Methods: This is a cross-sectional study with study duration of 1.5 year (January 2021- June 2022) The present study was conducted on 100 randomly selected newly diagnosed cases of breast  masses.
Results: Considering histopathological examination as gold standard, the sensitivity and specificity of BI-RADS score is 93.9% and 82.8% respectively. The positive predictive value, negative predictive value and diagnostic accuracy of BI-RADS score is 91.04% and 87.8 % respectively.
Conclusions: The inference derived from the present study is that BIRADS is a very useful tool specially owing to the fact that it is noninvasive, which leads to lesser trauma and faster report however the tissue diagnosis using H&E and other stains remains the gold standard and should always be restored to before undertaking surgery.

Background: Chronic obstructive pulmonary disease (COPD) is a prominent cause of illness and mortality on
a global scale. In 2019, it was predicted to rank as the sixth largest cause of mortality. COPD is one of the
most prevalent non-communicable illnesses in the field of pulmonology. The DECAF score
(Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation) is a risk stratification tool for
patients with AECOPD that can be used at the bedside to guide treatment, such as hospital at home for
low-risk patients. The purpose of this study is to predict the in-hospital mortality in acute exacerbation of
COPD patients with modified DECAF scores. Modified DECAF score includes Dyspnea,
Eosinopenia, Consolidation, Acidemia and Frequency of Hospitalization.
Material and Methods: A total of 50 patients attending Emergency Medicine Department with Acute
Exacerbation of COPD were recruited to this hospital based observational study. This study was conducted
at the Department of Emergency medicine & Pulmonary medicine, at APOLLO GLENEAGLES HOSPITALS, Kolkata.
Results: COPD was more prevalent in the age groups of 41-50 years (28%) and 61-70 years (28%) followed
by those having age between 51-60 years (22%). Majority of the COPD patients were males (88%) compared
to (12%) females. Majority of the COPD patients were males (88%) compared to (12%) females.
Most common co-morbid condition associated with COPD washypertension (16%) followed by
IHD (8%), pulmonary hypertension (6%) and diabetes mellitus (4%). Out of 50 patients with COPD,
11 (22%) had previous history of AECOPD, 38 (76%) were regular user of inhaler, 33 (66%) had
history of influenza vaccination, 16 (32%) had Pneumococcal Vaccination and 2 (4%) patients had
COVID-19 pneumonia. Out of 50 patients, 24 (48%) had Dyspnea (eMRCD) score
of 5a whereas 26 (52%) had Dyspnea (eMRCD) score of 5b as well as 7 (14%) had Eosinopenia
 (<50 cells/mm3) and 20 (40%) had Consolidation.
Conclusion: We conclude that the Modified DECAF score is both sensitive and specific in predicting
in-hospital mortality in AECOPD patients. Modified DECAF is a simple tool that predicts mortality
that incorporates routinely available indices. It effectively stratifies COPD patients admitted with
acute exacerbations into mortality risk categories.

Background: Physiologically calcium plays a critical role in function of smooth muscle and its deficiency can cause increased blood pressure. Magnesium is a cofactor in several enzymes, cause vasodilatation and helps in neurochemical transmission. Besides magnesium and calcium, hyperuricemia may induce hypertension by impairing nitric oxide generation
Objective: To compare serum calcium, magnesium and uric acid levels in women with pre-eclampsia and normal pregnancy
Methods: Hospital based Comparative Cross sectional study was carried out among 60 (30 pre-eclampsia and 30 normal pregnant women) aged 18-35 years between 20 weeks till term gestation for 18 months. Proteinuria, serum Calcium, Serum Magnesium, and serum Uric acid were measured using standard procedures.
Results: Majority were (40%) 25-29 years, (53.3%) were overweight, 46.6% had 36-38 weeks of gestation. 56.67% were Primi. 60% had severe preeclampsia. Proteinuria was seen in all with 46.67% had 2+. Pulse rate, SBP and DBP were significantly higher among the cases compared to controls.  Serum calcium was significantly lower among preeclampsia women and serum uric acid was significantly higher.  However there was no statistically significant difference between serum magnesium levels among preeclampsia and normal pregnant women. There was no statistically significant difference between pulse rates. Systolic and diastolic blood pressure were significantly higher in severe preeclampsia group. Serum Calcium and magnesium were significantly lower in severe preeclampsia group.
Conclusion: Preeclampsia was found to be associated with low calcium levels and higher serum uric acid levels. But it was not found to be associated with the serum magnesium levels.

Pterygium, a word derived from Greek “pterygos” meaning wing. Pterygium is defined as a degenerative ocular surface disorder with wing‑shaped fibrovascular growth of the conjunctival tissue encroaching on the cornea. ^[1] Pterygium is a disease of tropical areas and it has worldwide prevalence. The incidence is high in geographic areas with high ultraviolet radiation, hot, dry, windy, dusty and smoky environments. The prevalence rate of primary pterygium varies between 0.3% – 29% in various populations around the world.

Gallstone disease is extremely common in Western societies, with cholecystectomy being the standard treatment for patients with symptomatic gallstones. The incidence of common bile duct stones (CBD) with concomitant gallstones increases with age from 8 to 15% in patients younger than 60 years and up to 60% in the elderly. There are only a few reports of gallstones after cholecystectomy in the literature. Most of these reports describe the presence of stones in the gallbladder/cystic duct remnant or secondary to migration of the surgical clips. We report a single unique case of primary bile duct stones 7 years after open cholecystectomy.

Objectives: To study the angiogenic activity in giant cell tumor of  bone, by means of VEGF expression, in the endothelial cells using immunohistochemical staining.
 Material and methods: A cross sectional study was conducted from March 2020 to April 2022. 50 cases of GCT of bone were included in this study. Tissue sections that were retrieved from archived tissue blocks were stained with immunohistochemical stain for VEGF protein.
Results: Our study revealed that thirty nine of the cases showed a positive staining for VEGF in the tumor cells (72.2 %). There was a significant association between the expression of VEGF in the tumor cells with tumor stage (p=0.003). There was also a significant association between the expressions of VEGF in the tumor cells with the presence of pulmonary metastases (p=0.015).
Conclusion:  GCT of bone is frequently hypervascular; VEGF secreted by tumor cells elicits angiogenesis, which significantly contribute to the development of pulmonary metastasis. This provided confirmation for the prognostic significance of VEGF in predicting the behavior of GCT of bone and also the basis for therapeutics strategy targeting angiogenesis.

The prevention of nosocomial infections and surgical site infections is a major focus of the discipline of infection control. Any method can be used to propagate an infection, including blood, oral fluid, other fluids, surfaces, tools, air, etc. Air is the most abstract way of disease transfer. 99.97% of all particles larger than 0.3 microns in diameter may be removed by the HEPA (High-efficiency particulate air filter). However, it takes time for the HEPA filter to start lowering the microbial load in the air in the room. In this study, we examined the amount of time the HEPA filter needs to operate in order to prevent any development on a culture plate. We were able to stop any development on the culture plate after 30 minutes, highlighting the need of turning on the HEPA filter 30 minutes before surgery for the greatest benefits in preventing surgical site infections.

Background: Laparoscopic renal surgery (LRS), either via the retroperitoneal or transperitoneal approach, is a popular method for renal therapy. The present study assessed efficacy of analgesia with QLB in unilateral laparoscopic renal surgeries.
Materials & Methods: 50 patients of unilateral laparoscopic renal surgeries of both genders were divided into 2 groups of 25 each. Group I received QLB and group II received no block at the end of surgery. Morphine was administered in patient-controlled analgesia pump with a bolus of 1 mg and a lockout interval of 10 min (min). The total morphine consumption was recorded. The pain was assessed by a Visual Analogue Scale (VAS).
Results: Group I had 15 males and 10 females and group II had 12 males and 13 females. The mean age was 38.5 years in group I and 42.5 years in group II, height was 165.2 cm in group I and 164.4 cm in group II, weight was 70.4 kgs in group I and 72.1 kgs in group II, duration of surgery was 46.3 minutes in group I and 45.2 minutes in group II, ASA grade I was seen in 13 in group I and 15 in group II, grade II in 10 and 9 in group I and I and grade III in 3 and 1 in group I and II respectively. Total morphine consumption was 3.6 mg in group I and 9.1 mg in group II and duration of post- operative analgesia was 1124.3 minutes in group I and 147.6 minutes in group II. The difference was non- significant (p> 0.05).
Conclusion: There was less consumption of opioids following laparoscopic renal surgeries using Ultrasound-guided QLB.

Objectives and Aim: The aim of this study was to determine Haematological profile of Sickle cell disease (SCD) from Karimnagar Region, Telangana, India
Methods: This Prospective Cross-Sectional Study was conduct­ed in the Department of Paediatrics, Prathima institute of medical sciences, Karimnagar India, between June 2019-Feb 2020.37 children between the age of 6 years to 15 years
Results: A total of 37 children’s homozygous (SS) (mean age 11.6±3.4 years) for sickle cell anaemia was studied for their haematological parameters. Out of the total SS subjects, 26 were males and 11 were females
Conclusion: We conclude that moderate to severe anaemia with, low MCV and high HbF dominate the haematological profile

Objectives:1) To determine the Vitamin D in children up to age of 18 years
Methods: A prospective observational study was done from June 2019-Feb 2020 from 0 to 18 years of children’s
Results: Severe Vitamin D deficiency may cause rickets in infants and children However, subclinical vitamin D deficiency is more prevalent, and it is associated with falls or frac­tures. It has been observed that maximum children with rickets were breastfed, breast milk contains less vitamin D
Conclusion: Vitamin D is an essential nutrient not only important in bone health but also beneficial to many other systems. Therefore, Pediatricians should provide information to patients who are at higher risk for vitamin D deficiency on how to get sufficient dietary or supplemental vitamin D.

Background: Visible varicose veins of the leg affect approximately 25–30 per cent of adult women and 15 per cent of men. The present study assessed outcome of management of varicose veins.
Materials & Methods: 84 cases of varicose veins of both genderscomprises of conservative (Group I) and surgical procedures (Group II). Venous clinical severity score [VCSS] and venous disability score [VDS] were assessed.
Results: Out of 84 patients, males were 44 and females were 40. Side involved was left was 15, right side in 16 and both in 10 cases in group I and 11, 18 and 12 in group II. Duration of hospital stay was 5-10 days in 41, 10-15 days in 0, 15-20 days in 0 in group I and in 34, 4 and 3 days in group II. VCSS was mild in 14, moderate in 16 and severe in 11 cases in group I and 10, 22 and 9 in group II. VRS was mild in 15, moderate in 14 and severe in 12 patients in group I and 11, 16 and 14 in group II respectively. The difference was significant (P< 0.05). Aching was absent in 16 in group I and 21 in group II, heaviness in 18 in group I and 23 in group II, itching 19 in group I and 25 in group II and swelling 17 in group I and 28 in group II. The difference was significant (P< 0.05).
Conclusion: Surgical management found to be effective as compared to conservative management in patients with varicose veins. 

Introduction: India is a rapidly developing country and automobiles plying on roads are increasing each day. This has led to an increase in petrol pump stations and petrol pump workers and also exposure of petrol pump workers to vapours of petrol and gases from exhaust of automobiles. Petrol vapours and gases from automobile exhaust have a deleterious effect on the respiratory system. In the present study an attempt has been made to study the effect of inhalation of petrol vapour and gases from automobile exhaust on lung functions of petrol pump workers.
 
Materials and Methods: This is a prospective, descriptive and observational study conducted in the Department of Physiology, Index Medical College, Hospital and Research center Indore from Period of study from January 2021 to December 2022. They are 3 groups in our study: Group-I normal health individual-(N=50), Group-II  fuel filling workers-(N=50) andGroup-III construction workers-(N=50).
 
Results: In our study, the most of workers age group is 18-30 years i.e., 19 out of 50, followed by 31-40 years, i.e., 17 out of 50 in Group I and in Group II 18-30 years i.e., 18 out of 50, followed by 31-40 years, i.e., 17 out of 50. In Group III 18-30 years i.e., 20 out of 50, followed by 31-40 years, i.e., 12 out of 50. Group I out of 50, 39 subjects were male and 11 were female subjects. In Group II 36 were male and 14 were female subjects. In Group III 39 subjects were male and 11 were female subjects. The Mean Working hours of participants of Group I is 8.10±0.37 and Group II is 8.10±0.37 Group III in 8.10±0.37. All the parameters of Pulmonary Function Test were significantly difference among 3 groups.
Conclusion: The present study adds evidence that cement dust adversely affects the respiratory functions and this impairment is association with duration of exposure to cement dust. It also suggests that the workers must undergo pre-employment and periodic medical examination including lung function test. Thus, this study showed existing changes in pulmonary function related to dust exposure, and generated evidence to integrate primary prevention methods towards dust- related morbidity and mortality.

Background:
A prospective study to determine effectiveness of Ponseti method in correcting clubfoot in children aged 2-10 years and failed or recurrent clubfoot in older aged children was done at Department of Orthopaedics&Traumatology.
Two patients had pressure ulcer on talar headOne patient had allergy to plaster material.The plaster breakage was common complication in the older children.
The correction rate with ponseti method is over 90% can accomplished in about two to three months without extensive surgery. It has also been demonstrated that the ponseti method can be successful in clubfeet that recurs after extensive surgery.

Globally the most common indication for thyroid operation is a solitary nodule with the possibility of malignancy. Thyroid nodules are common in clinical practice. This study was carried out to estimate the incidence of benign and malignant thyroid lesions among the thyroid swellings after histopathological examinations following thyroidectomy.
Materials and Methods: This cross-sectional follow-up study was done among patients undergoing thyroidectomy between July 2017 to June 2019 by the Department of General Surgery, Institute Base Hospital, Delhi Cantt. The patients were selected consequently as and when they presented during the study period with thyroid swelling considering inclusion and exclusion criteria. A total of 50 patients were selected for the study. The selected patients were examined clinically. Among routine investigation, their reports of FNAC and histopathogical examination after excision were collected and used for analysis in the current study.
Results: FNAC findings of 50 cases showed that 39 were benign and rest 11 cases were malignant lesions, hence approximately benign and malignant ratio came to 3.55:1. Among the benign lesions, the most common lesion is multinodular or colloid goiter. Out of 11 malignant cases of FNAC finding, majority were papillary carcinoma. On histopathological examination of the excised mass, out of 11 cases that showed malignancy on FNAC, 7 cases (14%) were found to be malignant.
Conclusion: To conclude, it is not unusual to have a diagnosis of thyroid malignancy in a clinically benign thyroid swelling. Incidence of such malignancies is significant. Hence, the patients being treated conservatively for benign thyroid diseases should be followed-up regularly. Patients who opt out of surgery should be put on diligent screening of the swelling and any suspicious change in the swelling has to be tackled aggressively.

Background and Aims: Low blood gas solubility coefficients of desflurane and sevoflurane enable a quick recovery from anaesthesia. Desflurane, meanwhile, has a strong smell and might irritate the airways. While employing the ProSealTM laryngeal mask airway, we examined the effects of desflurane and sevoflurane on recuperation and the occurrence of adverse airway reactions in patients who were breathing on their own (LMA). Methods: In 94 adult patients who received hysteroscopic operations, sevoflurane (S) or desflurane (D) groups were created. Fentanyl 1 g/kg and midazolam 0.03 mg/kg were used as premedicators on the subjects. Adverse airway reactions, such as coughing, hiccups, laryngospasm, and breath holding, were observed after propofol 2.0-2.5 mg/kg was used to induce anaesthesia and a ProSealTM LMA was inserted. Time to awakening, verbal command response, orientation, the capacity to sit with support, and the Aldrete score for the recovery area were all noted during the post-operative interval. Results: Three patients in group S (6.4%) and six patients (13.3%) in Group D had adverse airway events. The mean time to eye opening (Group S-10.75 ± 7.54 min, Group D-4.94 ± 1.74 min), obeying verbal commands (Group S-13.13 ± 8.75 min, Group D-6.55 ± 1.75 min), orientation (Group S-15.42 ± 8.46 min, Group D-6.23 ± 2.4 min) and to sit with support (Group S-36.09 ± 12.68 min, Group D-14.35 ± 3.75 min) were found to be lesser with desflurane than with sevoflurane (P < 0.001). The mean time to recovery was delayed in Group S-46.00 ± 12.86 min compared to Group D-26.44 ± 5.33 min (P < 0.001). Conclusion: Desflurane, when combined with propofol and fentanyl while spontaneous breathing with a Pro^SealTM LMA, exhibits faster awakening qualities than sevoflurane without a rise in adverse airway outcomes.