Background: Aspiration pneumonitis is a syndrome resulting from the ingestion of gastric contents. The incidence in obstetric anesthesia has fallen, largely due to improved anesthetic techniques and the increased use of regional anesthesia at caesarean section. However, aspiration pneumonitis is still a cause of maternal morbidity and mortality, and it is important to use effective prophylaxis, 0.3M sodium citrate has been shown to elevate gastric pH when given as a single dose prior to induction and thereby minimizing the risk of aspiration. Aims & Objectives: aim of this study was to determine the effectiveness of 0.3M  sodium citrate, a non-particulate antacid, in neutralizing secreted gastric acid as prevention of aspiration pneumonia. To assess the ph of the gastric aspirate after induction and at the time of extubation in the study and control groups. To assess the change in gastric ph before and after giving 0.3M sodium citrate. Materials and Methods: 50 patients selected and evaluated were randomized by simple random sampling into two groups of 25 patients each. Group A-25 received 30 mL of test solution A. Group B-25 received 30 mL of Control Solution B. Both solutions were stored in identical amber bottles. 25 patients who received 30 mL of 0.3M sodium citrate were categorized into group A or study group. The remaining 25 patients who received 30 ml of distilled water were categorized into group B or control group. Conclusion: We conclude that the non-particulate antacid 0.3M sodium citrate, given orally about 20 min before induction of anesthesia, is an effective and safe antacid for prophylaxis against aspiration pneumonitis in all elective obstetric surgeries without producing any side effects.

DOI: 10.5281/zenodo.

Background: Pre eclampsia and eclampsia are responsible for more than 50,000 maternal fatalities worldwide. Controlling convulsions is the first rule in the treatment of eclampsia. Magnesium sulphate is the anticonvulsant medication of choice for both preventing and treating eclampsia, but its toxicities are dose-related, which is a serious issue. In many low-income nations, the medicine is only sometimes used due to unwarranted concern over these risks. Reducing the toxicity of magnesium sulphate without sacrificing its effectiveness in preventing seizures and reducing mortality rates is still a difficult task. Aim of the study: To study the effectiveness of low dose Magnesium sulphate Regimen- Dhaka Regimen in Eclampsia and to compare the effects of Standard regimen (Pritchard) to low dose regimen (Dhaka). Materials & Methods: This was a Prospective Clinical Study, Government Maternity Hospital attached to SVMC, Tirupati done in 200 pregnant women with severe pre-eclampsia, imminent eclampsia & eclampsia attending to Govt Maternity Hospital, Tirupati for a period of one year. Results: Unbooked cases of Pritchard regimen group were 94% and Dhaka regimen were 89%. Most of the cases were primigravida (67.5%). 44% were above 37 weeks. Level of consciousness of the patients in the 2 groups not differs significantly. No significant differences between 2 groups in number of convulsions before admission. Majority of the cases in both groups have SBP >160 mm Hg and Majority of the cases have DBP of 100-110 mm Hg. Out of 100 cases in Dhaka regimen group, 17 cases were augmented with oxytocin, 19 cases with PGE2, 57 cases with misoprostol. Conclusion: In women with eclampsia, magnesium sulphate is the anticonvulsant medication of choice. For smaller women, the Dhaka Regimen at a low dose appears to effectively regulate and avoid seizures. The current study offers more convincing evidence in favor of using magnesium sulphate frequently to treat eclampsia convulsions. Clinical surveillance seems suitable as long as there is enough urine output. There is no difference between the two magnesium sulphate regimens in terms of maternal mortality, perinatal death, maternal morbidity, or caesarean section rates.

DOI: 10.5281/zenodo.

Background: Hoarseness of voice, characterized by changes in the pitch, volume, and quality of the voice, is a common clinical symptom that can significantly impact an individual’s communication abilities and quality of life. Aim and Objectives: to analyze the clinical profile, incidence of common etiological factors and the association of common predisposing factors for hoarseness of voice. Materials and Method: This prospective clinical study was conducted in the Department of Otolaryngology at Aayan Institute of Medical Sciences, Hyderabad over a period of 1 year. The study population comprised 80 patients who presented with complaints of hoarseness of voice after following inclusion and exclusion criteria and after getting informed consent. Results: The majority of patients (47.5%) are between 41 and 60 years old, males (53.75%) were more than females, most common occupations are labourers (37.5%), most common habits are smoking (30%). Laryngeal malignancy most common aetiology, affecting 32.5% of patients. The most common finding, observed in 45% of patients observed Squamous cell carcinoma (keratin pearls). Conclusion: Laryngeal malignancy (squamous cell carcinoma) was found to be the most common cause of hoarseness of voice. Smoking was found to be the most common etiological factor for squamous cell carcinoma of Larynx (22%).

DOI: 10.5281/zenodo.

Background: The Blood bank Services play a crucial role in the healthcare system, annually saving numerous lives worldwide. All blood banks encounter the issue of a scarcity of blood donors. Significant number of donors is disqualified from donating blood, either temporarily or permanently, due to various reasons that vary among different blood banks. Materials and Methods: The study was carried out on 1900 donors who came for donation of blood. Results: Total 104 donors were deferred out of 1900 registered donors due to different reasons; anaemia was the most common reason of deferral followed by low weight. Conclusion: In the current study, the donor deferral rate was 5.47%. Understanding the reasons behind donor deferrals is crucial for blood donation centers to maintain a healthy and sustainable donor pool.

DOI: 10.5281/zenodo.

Background: Insulin Resistance can induce an imbalance in glucose metabolism that generates chronic hyperglycemia, which in turn triggers oxidative stress and causes an inflammatory response leading to cellular damage. Triglyceride Glucose index (TyG) index is a novel comprehensive marker composed of fasting blood glucose and fasting triglyceride levels with better predictive value, cost effective and easier to calculate in routine clinical practice. Therefore, the present study aims to determine the relationship between the TyG index and echocardiographic parameters which can be used to evaluate cardiac function and possibly predict the future cardiovascular risk. Method: Seventy patients in the age group 18-75 years were included in the study. TyG index was calculated by using formula Log (Fasting triglyceride (mg/dl) × fasting glucose (mg/dl)]/2). Echocardiographic parameters including LV parameters (IVSTd, LVIDd, LVPWd), ejection fraction, LA Size were measured. LVM was calculated using ASE (American Society of Echocardiography) approved cube formula as follows: LVM = 1.04 x ([IVSTd + LVIDd + LVPWTd]³ – LVIDd³) x 0.8 +0.6. Result: Study showed higher TyG index was associated with elevated LV mass. Also Diabetics were found to have higher mean TyG and thus LV mass than non-diabetics. Conclusion: TyG index is a simple indicator of insulin resistance which reflects cardiac remodelling and dysfunction and in near future could be a potential therapeutic strategy to reduce cardiovascular mortality.

DOI: 10.5281/zenodo.

Background: Spinal anaesthesia with hyperbaric Bupivacaine hydrochloride is popular for longer procedures due to its prolonged duration. With the addition of opioids, we can intensify and increase the duration of sensory blockade without increasing the intensity and duration of motor blockade, thus prolonging the duration of postoperative analgesia. This study aimed to compare the onset, duration, and recovery of sensory and motor blockade, perioperative hemodynamic parameters, level of sedation, and time to first rescue analgesia, side effects, and complications in the perioperative period. Material and Methods: In this comparative, observational, and prospective study, a total of 60 patients were enrolled undergoing lower limb surgery under spinal anaesthesia, divided into two groups. Group-F received 0.5% bupivacaine heavy 3 ml (15 mg) + fentanyl 0.5 ml (25 μg) intrathecally, and Group-T received 0.5% bupivacaine heavy 3 ml (15 mg) + tramadol 0.5 ml (25 mg) intrathecally. Both groups were observed for characteristics of motor and sensory blockade, hemodynamic parameters, and perioperative complications. Patients were monitored for a Ramsay score for sedation, a VAS score for pain, and the time required for post-operative analgesia. Result: The time to onset of sensory block at T10 level was statistically not significant between the two groups, while the time for regression of sensory blockade to the S2 dermatome was prolonged in group F as compared to group T. The mean time to achieve motor block was statistically not significant, while the time for regression of motor block from grade 3 to 0 was prolonged in group F as compared to group T. There was no significant difference in hemodynamic parameters between the two groups. The time required for first-rescue analgesia was longer in group F than in group T. Conclusion: Intrathecal 0.5% hyperbaric bupivacaine with 25 μg fentanyl significantly prolonged both sensory and motor block as well as time for the 1^st rescue analgesic when compared with 25 mg tramadol as adjuvant. Fentanyl also produces perioperative sedation.

DOI: 10.5281/zenodo.

Introduction: Organophosphorus poisoning (OPP) stands out as the predominant medical toxic emergency in India. This study aims to assess the severity of organophosphorus (OP) compound poisoning clinically through Peradeniya scale (PS). Methods: It was a prospective research conducted in the department of general Medicine, Prathima Institute of Medical sciences, Nagunoor. The study protocol was approved by the Institutional Ethics committee. Non cooperative individuals, those taken atropine treatment, doubtful OPP, mixed poisoning, those with chronic infections, known drug hypersensitive individuals were not considered in this research. A comprehensive clinical examination, focusing on vital signs, pupil size, and assessment of the central nervous, respiratory, and cardiovascular systems, was conducted following a prescribed format. The PS was administered to all, categorizing the severity of OPP. The study population were managed with decontamination, atropinisation, Pralidoxime chloride administration as per the protocol. Chisquare test were used for statistical analysis. P < 0.05 was considered statistically significant. Results: Total 60 (100%) members were included in this study.  As per the PS, 39 were mild, 20 moderate and 1 severe. Whereas, as per the consumption, it was 31m 21 and 8, respectively in <30, 31 – 50 and >50 ml consumption; statistically there was significant difference. In mild category, 33 members didn’t require ventilator support (VS) whereas 13 in moderate and 1 in sever category required; statistically there was significant difference. Conclusion: The PS proves to be a valuable tool for assessing severity and forecasting outcomes in individuals exposed to OPP. This simple and cost-effective tool holds promise in predicting the requirement for VS upon admission.

DOI: 10.5281/zenodo.

Objectives: To determine fetomaternal outcome in postdated and post term pregnancy. Material and Methods: It is data analysis of postdated and post term patients who delivered at C.U. Shah medical college over a period of 1 year (1st August 2022 to 31st July 2023). Only 195 patients fulfilled the criteria. Their detailed data was obtained from the department. Results: In the present study, total of 1660 patients were studied over a span of 1 year, i.e. 1st August 2022 to 31st July 2023.Out of these 164 deliveries were postdated and 31 deliveries were post term. Most of the patients were illiterate, unbooked and belonged to rural area. There were increased chances of instrumental delivery, failure of induction and chances of caesarean section increases with postdatism and post term pregnancies. Neonates belonging to the same group also required NICU admission with adverse outcomes. Conclusion: Maternal and fetal morbidity and mortality can be reduced by electively inducing pregnant women at 40+0 weeks as allowing them to continue beyond this gestational age has shown adverse fetal-maternal outcomes. This can be achieved by appropriate ANC care and counseling. CTG reading and partograph charting are required to reduce the neonatal adverse outcome and fetal mortality after time of induction.

DOI: 10.5281/zenodo.

Background: Diffuse axonal injury is also known as traumatic axonal injury, a severe form of traumatic brain injury and known for its severe consequences. The definitive diagnosis of DAI, especially in its early stage, is difficult. DAI represents approximately one-half of all intra axial traumatic lesions. The lesion is the most significant cause of morbidity in patients with traumatic brain injuries, which most commonly result from high-speed motor vehicle accidents, any patient with a closed head injury who will experience extensive loss of consciousness and neurological deficits warrants neuro imaging. DAI typically consists of several focal white matter lesions measuring 1 – 15 mm in a characteristic distribution. Aim: Aimof the study is to study the incidence of Diffuse Axonal Injury in Head Injuries; analyze the morbidity and mortality in DAI; predict the outcome concerning Glasgow Scale, CT, and MRI findings. Methodology: This is a prospective study consisting of 69 cases of DAI studied over a period from October 2021 to December 2023 in the Department of Neurosurgery, Guntur Medical College / Government General Hospital, Guntur. All the patients were admitted to the acute neurosurgical care unit and a variety of clinical / imaging data were collected and analyzed concerning Mode of injury, Incidence among various age groups, Sex distribution, Post resuscitative Glasgow Coma Scale (After optimization of SBP, SPO2, GRBs.), Findings on CT Scan, MRI grading, The outcome of the patient at discharge and follow up by Glasgow Outcome Scale. The mortality and morbidity were analyzed concerning GCS and CT & MRI. Scan findings. Results and Conclusion: DAI constitutes 2.98% of total head injury admissions and 27.70%in severe head injury. MRI is more sensitive compared to CT. Mortality in our series is 40.58%. Most of DAI are due to Road Traffic Accidents. Second and third decade populations are more in DAI (62.32%). Most of them sustained RTA under alcohol influence (77.41% i.e., 48 out of 62 patients). Neurological deficits improved almost completely (over the 1 ½ year to 2 years) and early recovery seen in younger age groups compared to elder age groups. In 27.5% of cases recovery is good as per GCS. The prognosis, morbidity, mortality in DAI can be predicted with GCS and CT scan and MRI findings.

DOI: 10.5281/zenodo.

Background: Dengue fever remains one of the most prevalent outbreaks caused by arboviruses, with reports emerging from various regions worldwide. As outbreaks continue to occur in diverse geographic areas, recent studies have highlighted varying clinical manifestations. This study aims to document the diverse clinical presentations and hematological parameters observed in dengue patients at a tertiary care center. Methods: This observational study included a total of 80 cases of dengue patients who tested positive for NS1 antigen, IgM card test, or IgM ELISA. Clinical and hematological parameters were recorded and subjected to statistical analysis. Results: Group A (Dengue without Warning Signs): This group, comprising 67.5% (54 patients), displayed typical dengue symptoms. Group B (Dengue with Warning Signs): Including 22 patients (27.5%), this group exhibited dengue fever alongside symptoms indicating potential progression to severe dengue. Group C (Severe Dengue): Only 4 patients (5.0%) had severe dengue, characterized by critical symptoms such as plasma leakage and organ impairment. The majority (67.5%) had mild symptoms, while 27.5% showed warning signs. A small proportion (5.0%) progressed to severe dengue. Conclusions: Fever and headache are predominant features of dengue fever; however, clinicians should remain vigilant for atypical presentations to facilitate timely diagnosis and intervention. Early identification of complications and prompt intervention are crucial for the effective management of dengue cases.

DOI: 10.5281/zenodo.

Background and Objectives: Postoperative wound complications are of common occurrence. The incidence of postoperative wound infections ranging from <2% to 38%. Based on NNIS (National Nosocomial Infections Surveillance) system reports, surgical site infections are the third most frequently reported nosocomial infections among hospitalized patient. Comparison of complications of laparotomy wound in elective and emergency surgery and various determinants affecting it. Materials and Methods: It is a prospective randomized study of 72 patients undergoing emergency and elective laparotomy. Postoperative wound complications and various factors affecting it are compared between emergency and elective surgery. Conclusion: In conclusion, laparotomy wound complications are multifactorial, this study demonstrated the increase in incidence of postoperative tissue and wound complications in emergency surgery (25%) than elective surgery (14%). It mainly depends on higher ASA score, anemia and higher wound class who are more likely to be associated with development of wound complications.

DOI: 10.5281/zenodo.

Background and Objectives: Acute cholecystitis is a common surgical problem and was usually treated with conservative management followed by a delayed laparoscopic cholecystectomy after an interval of 6 to 8 weeks. Our aim was to compare the efficacy of immediate laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (LLC) in patients of acute cholecystitis, and also to assess the complications between the two. Materials and Methods: This is  prospective Study randomized controlled trial in NMCH Jamuhar Sasaram. Study duration of Two years. that was conducted on 50 consecutive patients diagnosed to have acute cholecystitis. 25 patients underwent immediate laparoscopic cholecystectomy within 24-72 hours of admission and 25 patients underwent a delayed laparoscopic cholecystectomy after 6- 8 weeks of the initial episode. Conclusion: Early laparoscopic surgery had similar intraoperative and postoperative complications compared to delayed surgery in acute cholecystitis, but was associated with a shorter surgery and lesser stay in hospital.

DOI: 10.5281/zenodo.

Introduction: Scalp nerve block involves blocking nerves supplying the surgical area on the scalp to reduce sensation during surgery. The aim of this study was to assess the analgesic efficacy of scalp block (SB) with 0.25% Bupivacaine vs pre incisional local infiltration with 0.25% Bupivacaine with Adrenaline (1:400,000) in patients undergoing elective craniotomy. Methods: A prospective study was conducted at the Department of Anaesthesiology, KIMS, Amalapuram, from October 2023 to March 2024. Patients aged 18-65 years, ASA I & II, Mallampati scores I & II, and BMI <30 kg/m² were included. Group A received SB with 0.25% Bupivacaine, while group B had pre-incisional infiltration with 0.25% Bupivacaine with 1:400,000 Adrenaline. Intraoperative hemodynamics and postoperative pain were assessed. Statistical analysis included descriptive statistics and inferential tests using SPSS version 20.0, with a significance level of P<0.05. Results indicated significant differences in intraoperative parameters and postoperative pain scores between the groups. Results: Total 60 members were included, 30 in each group. Statistically there was no significant difference in the mean HR, systolic blood pressure. The mean diastolic blood pressure and MAP showed no significant difference. Group S significantly lower VAS scores compared for the first 6 hours postoperatively; afterwards, no significant differences were observed between the groups. Conclusion: Our study suggests that both scalp block with 0.25% Bupivacaine and pre-incisional local infiltration with 0.25% Bupivacaine with adrenaline are effective options for pain management in craniotomy patients.

DOI: 10.5281/zenodo.

Background: Globally, there are an approximate 171 million diabetics, and by 2030, that number is projected to reach 366 million. Without accounting for its role in cardiovascular death, the major cause of death among early diabetics, diabetes mellitus ranks as the seventh major cause of mortality as a direct cause. The traditional approach has been saline-moistened gauze, but it has been challenging to consistently maintain a wound that is moist with these dressings. The primary Negative Pressure on the wound’s surface can be changed thanks to a connection between the wound dressing and a control unit via a set of suction tubes. Negative pressure between 80 and 125mmHg is most frequently applied, either constantly or in cycles. The control unit’s container holds the wound fluid that has been suctioned into it. Aim: Aim of the study is to compare negative pressure wound therapies with conventional dressing in the treatment of diabetic foot ulcer in terms of Rate of growth of granulation tissue; Change in size and depth of the ulcer; Duration to achieve complete healing by surgery or grafting; Duration of hospital stay of patients. Materials and Methods: After taking the written informed consent, subjects were divided into two groups based on computer generated random numbers. Group NPT (negative pressure therapy) included 50 subjects and group CGD (conventional gauze dressing) included 50 cases. All participants were assessed for the demographic and clinical presentation by the principal investigator using a pre structured proforma. Following which the principal investigator assessed the detailed history of the participants and clinically examined the patients. Results and Conclusion: We infer that negative pressure wound dressing is superior to conventional gauze dressing in terms of rate of growth of granulation tissue formation as percentage of ulcer surface area, reduction in size and depth of the ulcer during treatment, duration to achieve complete healing and duration of hospital stay of the patients.

DOI: 10.5281/zenodo.

Purpose: To evaluate the change in central corneal thickness in patients with vernal keratoconjunctivitis (VKC). Method: The study was conducted in Department of Ophthalmology, at tertiary health care Centre. The study group included 100 eyes of 50 patients with vernal kerato-conjuctivitis and 100 eyes of 50 age and sex matched normal subjects were selected as a control group. The central corneal thickness was measured with (ZEISS Cirrus HD-OCT 500) Machine. Result: In the study group, out of 50 patients, 36 were males and 14 were females. Majority were in the age group of 5-10 years. The mean central corneal thickness was 490.9±20.7 µm in the study group and 545.30±30.20μm in the control group, and the difference was statistically significant. Conclusion: The central corneal thickness in patients with Vernal Keratoconjunctivitis (VKC) is low as compared to age and sex matched control population. Evaluation of corneal thickness is important in situations such as corneal refractive surgery and contact lens use, and is an essential parameter in a wide range of ocular disorders, including glaucoma and keratoconus. Therefore, ophthalmologists should be aware of the low central corneal thickness in patients with Vernal Keratoconjunctivitis.

DOI: 10.5281/zenodo.

Objective: To evaluate the benefits and harms of different inguinal and femoral hernia repair techniques in adults, specifically comparing closure with mesh versus without mesh. Methods: This prospective study included 100 patients with hernias who were divided into two groups: Group A (n=50) underwent hernia repair with mesh, and Group B (n=50) underwent hernia repair without mesh. Complications and outcomes assessed included hernia recurrence, complications (neurovascular or visceral injury, hematoma, seroma, testicular injury, infection, postoperative pain), mortality, postoperative hospital stay, and time to return to activities of daily living. The data were analyzed using appropriate statistical methods. Results: In Group A, none of the patients experienced hernia recurrence, indicating a successful outcome. However, 8% of patients developed wound infections, 2% experienced neurovascular injuries, and 6% had seroma formation. Additionally, 1% of patients had hinoma formation and Scotals Valley complication. In contrast, 6% of patients in Group B experienced hernia recurrence, while wound infection occurred in 2% of patients. Neurovascular injuries were observed in 6% of patients, and hinoma formation was observed in 4% of patients. No cases of seroma formation were reported in Group B. Similar to Group A, 6% of patients in Group B had Scotals Valley complications. Conclusion: The use of mesh in hernia repair procedures was associated with a lower recurrence rate compared to repairs performed without mesh. However, both groups experienced complications, including wound infections, neurovascular injuries, hinoma formation, seroma formation, and Scotals Valley complications. Careful consideration of patient-specific factors, surgical technique, and postoperative management are crucial to optimize outcomes and minimize complications. Further research is needed to validate these findings and explore long-term durability and patient satisfaction.

DOI: 10.5281/zenodo.

Depression is a widespread mental illness, mental health which affects million people globally with a significant prevalence in India. The condition’s multifaceted nature and unpredictable course underscore the need for tailored interventions and support systems. Depression manifests in emotional and physical symptoms, including unhappiness, cognitive deficits, and suicidal tendencies. Its impact is significant, with 264 million sufferers globally. In India, 15% of adults require mental health intervention, with women at higher risk. Moreover, it is important to emphasize that, despite all these clinical manifestations, this review also highlights the severe negative effects of depression on various functions: both cognitive impairments and social isolation and the tendency to develop comorbid conditions, including anxiety and addiction, are assumed. Based on this background, evidence-based interventions including pharmacotherapy; psychotherapy and new modalities such as TMS and ketamine infusion are considered. Particular focus is paid to the new personalized medicine field that offers the possible treatment for every specific case.

DOI: 10.5281/zenodo.

Background: Iron deficiency anemia (IDA) is a common complication of pregnancy, necessitating effective management to prevent adverse maternal and fetal outcomes. Intravenous (IV) iron supplementation is recommended when oral iron therapy is insufficient or intolerable. However, comparative data on the efficacy and safety of different IV iron formulations in pregnancy are limited. Aims and Objective: To compare the efficacy and safety of IV iron sucrose versus ferric carboxymaltose in pregnant women with IDA. Materials and Methods: A prospective, randomized controlled trial was conducted at GMERS Medical College and Hospital, Junagadh, involving 100 pregnant women diagnosed with IDA (50 in each treatment group). Participants received either iron sucrose (IS) (Group I) or ferric carboxymaltose (FCM) (Group F) according to standard dosing regimens. Primary outcomes included changes in hemoglobin, hematocrit, and serum ferritin levels from baseline to 4 weeks post-treatment. Adverse effects were recorded as the secondary outcomes. Results: Ferric carboxymaltose led to a greater increase in hemoglobin levels after 4 weeks compared to IS (FCM: 2.0 g/dL, IS: 1.5 g/dL; p < 0.05). FCM also resulted in a more significant rise in mean corpuscular volume (MCV) (FCM: 6.2 fL, IS: 4.5 fL; p < 0.05) and serum ferritin levels (FCM: 35.8 ng/mL, IS: 28.6 ng/mL; p < 0.05) after 4 weeks. Adverse reactions were less common with FCM, with lower incidences of headache, nausea, vomiting, diarrhea, rigor, fever, pain at the injection site, tingling sensation, itching, and anaphylactic reactions compared to IS (p < 0.05). These findings support FCM’s superiority over IS in managing iron deficiency anemia during pregnancy. Conclusion: Ferric carboxymaltose is superior to IS in the management of iron deficiency anemia (IDA) during pregnancy. FCM treatment resulted in a greater increase in hemoglobin levels, MCV, and serum ferritin levels after 4 weeks compared to IS. Additionally, FCM was associated with a lower incidence of adverse reactions.

DOI: 10.5281/zenodo.

Two relatively selective electrodes were fabricated for determination Ranitidine hydrochloride (RNH); first was modified coated graphite electrode (MCGE) and second one was polyvinyl chloride electrode (PVC). Both MCGE and PVC electrodes were based on Ranitidine hydrochloride-phosphomolybdic (RNH-PMA) ion pair and plasticized with di-butyl phthalate (DBP). Both electrodes experience satisfactory sensitivity towards RNH within concentration range of (1.0×10^–6 – 1.0×10^-1 and 1.0×10^-5 – 1.0×10^-1 M), pH range (3-6 and 3-5) and detection limit (4.6920×10^-7 and 4.8044×10^-6 M), Nernstian slope (57.48 and 55.158) mV/decade for MCGE and PVC electrode, respectively. The electrodes can be applied for the determination of RNH in pure solution, pharmaceutical preparation and human fluids (serum and urine) with high accuracy and precision. The methodology (using two electrodes) was fast, simple and economical compared to the rest of the established methods.

DOI: 10.5281/zenodo.

Several polyherbal remedies (PHR) are used in the treatment of various diseases, but there is dearth of information about their safety. This study assessed the toxicological impact of a PHR on haematological, biochemical and organs histology. Acute toxicity test was done using the Up and Down procedure. In repeated toxicity test, the PHR was administered to the test animals intraperitoneally at low dose (258.3 mg/kg), medium dose (516.6 mg/kg) and high dose (1033.3 mg/kg). The control group received the vehicle (5 ml/kg). At the end of administration, animals were fasted overnight, sacrificed and samples were collected for haematological, biochemical and histological analyses using standard methods. Acute toxicity test revealed no death at 5000 mg/kg (an indication that LD₅₀>5000 mg/kg). There was no significant alteration (p>0.05) in body weight and organs weight, except significant (p<0.05) increase in liver and kidney weight at medium dose. There was a significant reduction in hemoglobin at the three dose levels, and significant increase in platelet count at medium and high doses. The PHR posed no deleterious effects on lipid profile, antioxidant parameters, electrolytes, blood glucose, body weight, and histology of the liver, heart, pancreas, spleen, testes, and lung. Only slight distortion in kidney histology was observed at high dose when compared to control group. The results of the study revealed that the PHR is safe following single dose administration, but double of therapeutic dose, as well as repeated administration above the 2 weeks may cause platelet aggregation.

DOI: 10.5281/zenodo.

Background: Complementary and alternative medicine (CAM) is defined as a group of diverse medical and health-care systems, practices, and products that are not generally considered part of conventional modern medicine or Western medicine. Aim and Objectives: To assess the extent of use of CAM among patients. To determine their perception and attitude towards CAM among patients. Methods: The study was conducted among 240 patients attending the Outpatient Department of the government general hospital, Nalgonda, Telangana. Results & Conclusion: Out of 240 patients 96(40%) patients were using homeopathy, 68(28%) patients were using the ayurveda, 40(16%) patients were utilized local healers and 20(8%) were using yoga therapy.

DOI: 10.5281/zenodo.

Background: Diarrhoea is a prevalent clinical condition seen in medical practice, contributing significantly to child mortality rates in India, with an estimated 1.5 million deaths annually. Prompt recognition of heightened clinical suspicion and a comprehensive understanding of dehydration types are vital in averting fatalities. This study aims to explore the biochemical alterations and electrolyte imbalances in pediatric acute diarrhoea cases. Methods: A two-year prospective study, with ethical approval, was conducted at a tertiary care Medical college. Children exhibiting signs of moderate to severe dehydration were included. Clinical data and pertinent biochemical investigations, including serum electrolytes, were collected and analyzed. Results: A total of 90 cases of pediatric diarrhoea were included in the study. Children under 5 years old constituted the most prevalent age group (33.33%), The common clinical symptoms were increased stool frequency (diarrhea) was universal (100%). Vomiting (71.11%), fever (47.78%), dehydration symptoms (increased thirst, dry tongue), and signs of circulatory compromise (tachycardia) were frequently observed.  Over half the patients (58.89%) had normal nutritional status. Electrolyte imbalances were prevalent (80% of cases). Hyponatremia (low sodium), either alone or combined with hypokalemia (low potassium), was the most frequent disturbance. Conclusions: This study highlights the diverse clinical presentations of pediatric diarrhoea. Beyond increased stool frequency, various symptoms, dehydration signs, and potential associations with malnutrition and electrolyte imbalances were identified. Among the electrolyte abnormalities commonly observed in diarrhoeal cases, hyponatremia, hypokalemia, and their combination are significant.

DOI: 10.5281/zenodo.

Background: The incidence of intertrochanteric femur fractures has risen markedly in recent decades, due to demographic changes within the Indian population. Conservative management of these fractures, which has been associated with higher mortality and morbidity, has largely been phased out. Rigid internal fixation and early mobilization have become the standard treatment approaches. The current study aimed to evaluate the outcomes of proximal femur nails compared to the dynamic hip screw device, and to assess their impact on the ultimate functional outcome for the patient. Methods: A total of 30 cases of intertrochanteric fractures of the femur reported to our hospital were included in the study. They were allotted into two groups treated with proximal femoral nail (PFN) and Dynamic Hip Screw (DHS) based on the type of fractures. The operations were done as per standard protocol and the patients were followed up to 1 year postoperatively and functional outcome was recorded in each category. Results: In our study, the average duration of hospital stay was 19.33 days.  Overall, patients who received PFN implants seemed to have slightly better outcomes.  Excellent: 8 patients (53.33%) in the PFN group achieved excellent results compared to 4 patients (26.66%) in the DHS group. Both groups had similar proportions of patients in the Good (26.66%) and Fair (DHS: 26.66%, PFN: 13.33%) categories. The DHS group had a higher percentage of patients with Poor outcomes (20%) compared to the PFN group (6.66%). The PFN fixation is associated with a higher rate of excellent functional outcomes p-value is (<0.006) in patients with intertrochanteric fractures treated with PFN as compared to patients treated with DHF. Conclusion: Our findings suggest that PFN fixation offers comparable outcomes to DHS in stable fractures but emerges as the preferred option for managing unstable intertrochanteric fractures due to its superior biomechanical properties and versatility. Further research with larger patient cohorts could solidify these observations.

DOI: 10.5281/zenodo.

Introduction: Parkinson’s disease (PD) is a common neurodegenerative disorder affecting patients in large numbers throughout the world. The prevalence of PD among the north Indian population is 67.71 per 100,000 individuals. Parkinson’s disease (PD) is associated with autonomic nervous system dysfunction resulting in complications such as diabetes, obesity and hypertension. The objective of the present study was to assess such cardiac autonomic functions in PD patients and their subsequent comparison with healthy controls subjects via Time domain and Frequency domain parameters of heart rate variability analysis. Methodology: The present study was conducted in the Department of Physiology, SMS Medical College, Jaipur wherein 40 PD patients (both males and females) were recruited from the Department of Neurology, SMS Medical College, Jaipur and 40 age- and gender-matched healthy subjects were selected from the hospital staff. Cardiac Autonomic functions were assessed by Time domain and Frequency domain of heart rate variability (HRV). Results: Values of LF (ms²), HF (ms²) and Total power were significantly lower, whereas LF/HF Ratio was non significantly increased in cases as compared to controls.  Time domain parameters (SDNN, RMSSD, Mean RR, and pNN50) decreased highly significantly in Parkinson’s disease patients as compared to the healthy controls. Statistical Analysis: Unpaired ‘t’ test was applied for statistical analysis of data of both groups where P valve <0.05 was considered as statistically significant. Conclusions: Our study indicated that patients with Parkinson’s disease (PD) have blunted autonomic activity as evidenced by decreased values of both frequency and time domain parameters than healthy age and sex matched controls.

DOI: 10.5281/zenodo.

Background: Cataract surgery in diabetic patients may impact macular morphology, particularly regarding diabetic macular edema (DME), but this remains poorly understood. Optical coherence tomography (OCT) offers precise assessment of macular changes, yet the influence of diabetic characteristics on post-operative outcomes is unclear. Objective: To evaluate cataract surgery’s impact on macular morphology in diabetic patients using OCT. Methods: A prospective observational study enrolled 57 diabetic cataract patients undergoing surgery between June 2019 and June 2020. Exclusion criteria included severe non-proliferative or proliferative diabetic retinopathy. Preoperative and post-operative assessments included demographic data, medical history, best-corrected visual acuity (BCVA), and macular assessment via OCT. Results: Predominantly female (61.4%) and aged over 60 (42.1%), most were non-insulin dependent (66.7%) with diabetes duration exceeding 10 years (56.1%). Preoperatively, BCVA averaged 0.50 logMAR (20/50). Surgery led to increased foveal thickness at 4 weeks (mean difference: 45.7 µm, P-value = 0.006) and 12 weeks (mean difference: 47.0 µm, P-value = 0.001) postoperatively. BCVA improved, reaching 0.31 logMAR (20/40) at 1 month and 0.24 logMAR (20/30) at 3 months. Associations were found between diabetic characteristics and post-operative foveal thickening, with insulin dependence, longer diabetes duration (>10 years), and worse pre-operative retinopathy severity correlating with greater thickening effects. Conclusion: Cataract surgery in diabetic patients was associated with increased foveal thickness and assess visual function. Associations between diabetic characteristics and post-operative thickening warrant further investigation. Larger studies are needed to validate these findings and elucidate underlying mechanisms.

DOI: 10.5281/zenodo.

Introduction: Effectively monitoring the spread of   Human Immunodeficiency Virus (HIV) within a population is essential for both prevention efforts and strategic resource allocation. A study was conducted to find the correlation between various demographic factors and HIV status around the newly formed Rajamahendrawaram district, Andhra Pradesh. Methods: It was a prospective, a cross-sectional research conducted in the department of Physiology, GSL Medical College, Rajamahendravaram. The research was conducted from January to May 2016. Individuals of both gender aged > 18 years, those were HIV infected as per the National AIDS Control (NACO) guidelines were included in the study. Non cooperative individuals, pregnant women were not considered in the research. After this initial work, physical examination was carried and all the findings were recorded. The sociodemographic parameters such as age, gender, economic status, and so on were recorded in the study proforma. Then blood sample was collected following the universal safety precautions. HIV status was evaluated as per the NACO guidelines. Statistics such as mean, Standard deviation were used. P < 0.05 was considered statistically significant. Results: Total 164 members were included in the research; gender wise, 95 (57.9%) were female and 69 (42.1%) were male. Majority (42.1%; 69) were in 31 – 40 years. Most (52%) of the study members belong to lower socio economic state it was followed by upper (28%) and middle income (20%) groups. Conclusion: HIV prevalence is notable among males, with the most vulnerable age group being around 40 years. The infection is frequently identified within the low socioeconomic strata.

DOI: 10.5281/zenodo.

Background: Inguinal hernia repair surgeries hinge on effective skin incision methods. This prospective comparative study, conducted from January 2020 to June 2021 at Geetanjali Medical College & Hospital, Udaipur, meticulously compares the outcomes of diathermy-assisted and conventional scalpel skin incisions. Methods: Adult patients undergoing inguinal hernia surgery were randomly assigned to traditional scalpel (Group I) or diathermy (Group II) skin incisions. Parameters assessed included intraoperative bleeding, postoperative pain, surgical site infection incidence, and scar formation at 1-month and 3-month intervals. Robust statistical analysis employed SPSS software (version 24.0). Results: Diathermy exhibited notable advantages, significantly reducing blood loss compared to scalpel incisions (p < 0.05). Postoperative pain was markedly lower in the diathermy group, aligning with efficient wound healing. Scar formation was significantly reduced with diathermy at both 1 month (p = 0.01) and 3 months (p = 0.005). Biochemical parameters remained within normal ranges in both groups, emphasizing the safety profile. Conclusion: The study underscores the transformative impact of diathermy-assisted skin incisions in inguinal hernia repair surgeries. Noteworthy reductions in blood loss, postoperative pain, and improved scar formation establish diathermy as a superior choice compared to conventional scalpel incisions. Despite acknowledged limitations, including sample size and single-center focus, the consistent patterns observed advocate for the incorporation of diathermy in optimizing surgical experiences. This evidence positions diathermy as a promising method for enhancing outcomes in inguinal hernia repair surgeries. Future research, particularly larger multicenter studies, is essential to further validate and extrapolate these findings across diverse surgical contexts and patient populations.

DOI: 10.5281/zenodo.

Background: Stem cell research needs to be studied to understand the premise of research and its latest developments. As there was no literature, it was of interest to find out in the last 10 years the stem cell research articles published. Methods: After exemption from the ethics committee (EC), a stem cell research and therapy journal site was selected and the search term used was “all articles” and volumes from (1/01/2011 to 1/01/2021) were downloaded. Only original research articles were selected and analysed. The variables used were the source of stem cells, therapy area, category of research, indication, type of research(preclinical/clinical), country of research/Institute/Stem cell research committee approval or EC approval mentioned or not. The variables were analysed using descriptive statistics using SPSS 26 software. Results: The total number of original articles analysed was 1846/2476. The most common source of stem cells was Bone marrow. Musculoskeletal therapy was the most common therapy area. The majority of the studies were preclinical. Adult stem cells are the most common cell line used. Institutes in China and the USA are commonly doing studies and the majority were collaborative. Stem cell research committee approval is not mentioned in any of the articles but EC approval is mentioned in all clinical studies. Institutional Animal Ethics Committee (IAEC) approval was mentioned in all preclinical studies. Conclusion: Developed countries are at the forefront doing the majority of stem cell research which is preclinical and the common area is musculoskeletal.

DOI: 10.5281/zenodo.

Introduction: The surge in coronary heart diseases (CHD) underscores the need for early intervention, considering the fetal origins of these conditions. This study aims to measure cholesterol, triglycerides, HDL, and LDL in cord blood of term and preterm, appropriate for gestational age (AGA) and small for gestational age (SGA) neonates, seeking to identify early markers of cardiovascular risk. Methods: A case-control study conducted at Maharajah’s Institute of Medical Sciences, Vijayanagaram, over three years from 2016 to 2019. Institutional Ethics committee approval and parental consent were obtained. Random sampling included newborns from low socioeconomic backgrounds, whose mothers were on iron-folic acid supplements. Exclusions comprised congenital malformations and maternal health conditions. Clinical assessments, gestational age determination, anthropometric measurements, and cord blood collection were performed. Lipid profiles were analyzed enzymatically. Statistical analysis utilized SPSS, employing chi-square test, t-test, and contingency coefficient analysis with p < 0.05 significance level. Results: Lipid profiles differed significantly between SGA and AGA newborn, with higher triglycerides and lower HDL in SGA. Preterm infants had elevated triglycerides, LDL, and VLDL compared to term infants. Total cholesterol showed no significant difference between groups. Conclusion: Our study reveals notable lipid profile variations between preterm and term neonates, emphasizing the need for early assessment in neonatal care. Limited by a small sample size and single-center design, broader multicenter studies are needed to confirm these findings and delve into additional factors influencing neonatal lipid metabolism.

DOI: 10.5281/zenodo.

Introduction: In the past, scrotal assessment relied on palpation, transillumination, and other methods. Today, advanced techniques like high-frequency ultrasound and color Doppler offer detailed imaging, aiding in diagnosis. This study aims to explore sonographic features of scrotal lesions using these modalities, enhancing understanding and informing clinical management strategies. Methods: This cross-sectional study, conducted at GSL Medical College, Rajahmundry, included patients with scrotal pain and swelling. High-resolution grey scale and Doppler imaging were used with specified ultrasound equipment. Patient information was gathered, and thorough physical examinations were conducted before ultrasound. Scanning covered various scrotal planes and included dynamic maneuvers. Results: Out of the 100 study participants, primarily aged 31-40 years (28%). Scrotal swelling with pain (32%) was predominant, followed by swelling alone (28%) and scrotal pain (10%). Inflammatory conditions exhibited hypoechoic patterns on ultrasound. Increased vascularity was common, with chronic epididymo-orchitis prevailing (31.1%), followed by hydrocele (35%) and varicocele (27.5%). Spermatocele was least common (5%). Conclusion: our findings underscore the utility of high-frequency ultrasound and color doppler in diagnosing scrotal pathologies. Early detection of conditions like epididymitis and orchitis aids in timely intervention, mitigating complications. Future research should explore larger cohorts and prospective designs for more robust conclusions.

DOI: 10.5281/zenodo.

Background: Choledocholitiasis develops in about 10–15% of patients with gallbladder stones. For patients with cholelithiasis and choledocholithiasis open exploration of the bile duct was the principal treatment for almost 100 years. But with advancement in endoscopic instrumentation and expertise, endoscopic retrograde cholangiopancreatography has evolved as the primary choice of treatment for biliary stones and it is successful in more than 90% of patients. Currently, the most accepted protocol in these cases involves endoscopic clearance of CBD followed at a later date by laparoscopic cholecystectomy. But there is no consensus regarding the exact time gap between these two procedures. Faced with the frequent problem of a ‘difficult’ laparoscopic cholecystectomy in these cases, the current study was undertaken to attempt to define the ideal time gap between the two procedures for the best possible outcome. Methods: In this study, 30 patients underwent ERCP with or without sphincterotomy followed at various intervals by elective laparoscopic cholecystectomy. According to these intervals, the patient’s data were assigned to one of the two groups : group A (<3 weeks) or group B (>3 weeks). A prospective comparative study was conducted to compare intra-operative parameters and post-operative outcomes of laparoscopic cholecystectomy done at different intervals after endoscopic retrograde cholangiopancreatography to decide upon the optimal timing for the surgery. Results: Overall rate of partial or subtotal cholecystectomy including all patients was 16.7% with significantly higher in delayed group B. Need for a drain was significantly higher as the interval between ERCP and LC progressed (p value 0.014). The mean duration of surgery for group A was 91.75 min and for group B was 127.78 min and this difference was statistically significant at p value < 0.05. A lower incidence of post-operative jaundice, bleeding, bile leak and wound infection was observed in group A than in the group B. Overall, statistically significant higher complication rates were observed in late period group B than in the early period group A. Patients in group B had more prolonged post-operative hospital stay with a mean of 5.0 days (SD 3.08). Conclusion: We recommend early laparoscopic cholecystectomy after ERCP for common bile duct disease could well be an answer in reducing rate of subtotal or partial cholecystectomy, duration of surgery, post-operative complications and post-operative hospital stay.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the association between the newly proposed echocardiographic LVFP parameter, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, and clinical outcomes of HFpEF. Methods: This was a retrospective observational study that assessed the VMT score and clinical outcomes in patients with HFpEF in the Department of  Cardiology, IGIMS, PATNA, Bihar, India. 200 patients were included in the study. Results: Out of 200 patients, 36 patients were under VMT0, 130 in VMT1 and 34 in VMT 2 or 3. While LV volume was increased in patients with VMT 2/3, LV wall thickness and EF were similar among the groups, resulting in greater LV mass index and stroke volume in this group. Mitral E wave velocity, E/A, LA volume index, TR pressure gradient, and E/e0 were increased, and the deceleration time of the E wave and LV isovolumic relaxation time were shortened in accordance with the VMT score, resulting in the higher prevalence of elevated LVFP judged by the 2016 ASE/EACVI recommendations in VMT 2/3. There was an increase in the prevalence of significant mitral regurgitation in the higher VMT scores. RV dimensions and RA volume were also increased with the VMT score which could be associated with a higher prevalence of significant TR in VMT 2/3. While RV systolic function was similar between the groups, the VMT 2/3 was characterized by a larger IVC diameter and lower its respiratory change. Conclusion: In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it could also predict clinical outcomes in HFpEF patients with AF.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical profile of hypoglycemia in newborn and to determine the prevalence of hypoglycemia among neonates admitted in NICU. Methods: This study was conducted as a prospective observational study, among newborns with hypoglycemia admitted in NICU, Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India after obtaining informed consent. Sample size was 200 cases with hypoglycemia. Results: 60% were male as compared to females and 70% were preterm babies. 40% were babied delivered by NVD and 92% had singleton babies. 60% belonged to pimipara and 80% had low birth weight. 85% had maternal risk factors and 15% had no maternal risk factors. 27% had IDM co-morbidity in neonatal. Out of 200 children with hypoglycemia 121 (60.5%) were asymptomatic and 79 (39.5%) presented with symptoms. The common symptoms were poor feeding, lethargy, jitteriness, convulsions, irritability, hypotonia and cyanosis. We found prematurity and IUGR the most associated neonatal risk factors for neonatal hypoglycaemia. Significantly low Sugar levels (p value <0.005) were noticed in symptomatic hypoglycemic babies when compared to asymptomatic hypoglycemic babies. Conclusion: Hypoglycemia in neonates can have variable presentations indicating the need for detailed and thorough examination for evidence of hypoglycemia. Identification of risk factors of hypoglycemia and proper monitoring blood glucose levels should be done to plan early treatment and prevent neurological damage.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the morbidity profile among Deaf mute children attending organizations in Bihar and to determine their nutritional status among them. Methods: The study design was institutional based cross-sectional study and 50 deaf-mute children were selected using a convenient sampling technique. Results: Most common morbidity that deaf mute children facing was dental problems (76%) including dental caries and yellowing of teeth followed by diseases of digestive system 72% (constipation, heart burn, gastro esophageal reflux disease, irritable bowel syndrome). Respiratory diseases were found in more than two thirds (70%) including asthma, pneumonia. In thyroid disorders, majority had hypothyroidism and was on medications for that. Ear discharge and otitis media were found in slightly more than one fourth (26%). Association between gender and dental caries found that higher proportions of female deaf- mute children had dental caries 26 females compared to 9 in males though it was not significant statistically (p=0.1). The prevalence of undernutrition among the study population was 14% and the prevalence of overnutrition (overweight and obese) was 24%. The prevalence of undernutrition was more among boys and the prevalence of overnutrition was slightly more among girls though it was not statistically significant (p=0.7). Conclusion: The present study showed a high proportion of deaf-mute children developing nutritional deficiencies and morbidities; hence an effective collaboration and coordination between these organizations and integrated child development services (ICDS) Anganwadi centres is required for the improvement of Nutritional status. Regular health check- ups and proper treatment need to be ensured along with appropriate measures of health education for the children and caregivers.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the association between serum bilirubin levels and coronary artery disease in comparison with controls without coronary artery disease. Methods: The cross-sectional study was conducted for a period of a one year in Ford hospital and research centre Pvt. Ltd, Patna, Bihar, India.  The entire study subjects were divided into two groups of 50 cases (with CVD) and 50 controls. Results: It was seen from the table that majority of the subjects were in the age group between 55 and 65 years. The minimum age was 43 and the maximum age was 75 years. The most common risk factors for CVD like diabetes, hypertension, smoking, obesity and family history of CVD was found to be slightly higher among the cases than the control groups but it was not found to be statistically significant and it proves that the controls were matched for almost all the risk factors for CVD except for dyslipidemia which was found to be significantly higher among the CVD patients than the controls. The duration of CVD among the cases varied from 2 years to 9 years with majority of the subjects’ duration was between 3 and 5 years and the mean duration was 4.4 years. The various liver function test parameters were compared between the cases and controls it was found that the serum bilirubin levels which includes total bilirubin, direct bilirubin and indirect bilirubin was found to be lower among the case group compared to the control group and this difference was found to be statistically significant. Conclusion: This study showed a significant association between the reduced serum bilirubin levels and the occurrence of CAD; therefore, bilirubin level can serve as a predictive factor, together with other influential factors for identifying a person at risk of developing coronary artery disease.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the fracture distal end of radius treated with percuteneous multiple k-wire. Methods: This was a prospective, comparative observational study was conducted in the Department of Orthopaedics, PMCH, Patna. About 75 patients with Distal Radial Fractures presented to PMCH, Patna, Bihar, India All 50 patients, who fulfilled the inclusion criteria, were included in the study. Results: The majority was men (64%). Majority of the patients (70%) sustained the injury due to fall. The side of involvement was nearly equal and that there was no predominance of the either sides. Majority of the patients (80%) did not have associated injuries. In our study, according to AO classification, 29 cases were of Type A, 15 were of Type B and 6 were of Type C. In  our  study,  70%  of  the  cases  showed  ―Excellent, 24% of the cases showed ―Good, 4% cases showed―Fair and only 2% cases showed ―Poor result. At final follow-up by the Gartland & Werley Criteria for Functional Outcome 35 (70%) patients had―Excellent  result,  12   (24%)   had   ―Good  result,  2 (4%) had ―Fair result and 1 (2%) had a ―Poor result. There were no major complication noted except for pin site infection in 8 (16%) cases and pin loosening in 2 (4%) cases. Conclusion: This study demonstrated that percutaneous Kirschner wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical fracture reduction. It does not required highly skilled personnel or sophisticated tools for application. It is a suitable method for fixation of displaced Colles fracture with minimal intra-articular involvement. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

DOI: 10.5281/zenodo.

Aim: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This was a single-center retrospective study conducted at Anugrah Narayan Magadh medical College and Hospital Gaya, Bihar, India from March 2020 to February 2021. A total of 70 patients were included in the study, divided into two groups, percutaneous needle aspiration (n=35) and pigtail catheter drainage (n=35). Results: In presenting study the age group of the patients ranged from the 20-68 years. Highest incidence (60%) was found in 30-39 years age group. In this study 62 patients were male and 8 patients were female. 63 patients were from rural and 7 were from urban population and the incidence of alcohol consumption was 74.28%. It was observed that fever was present in needle aspiration and catheter drainage 94% and 92% respectively. There was 100% anorexia, pain and tenderness in right upper quadrant and hypochondrium in needle aspiration and catheter drainage respectively. It was observed that leukocytosis was 80% and 100% in needle syringe and catheter drainage. The patients in PCD group showed earlier clinical improvement and 50% decrease in abscess cavity volume as compared to those who underwent PNA. However, there was no significant difference between the duration of hospital stay or the time required for total or near-total resolution of cavity. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

DOI: 10.5281/zenodo.

Aim: Research on the alterations in blood pressure between postmenopausal and premenopausal women. Materials and Methods: The physiology department of SKMCH in Muzaffarpur, Bihar, India, conducted this cross-sectional research. Women of a comparable height and weight who were either postmenopausal or premenopausal were surveyed for this study. Fifty women who had gone through menopause and fifty women who were still in their menstrual periods were chosen after extensive medical histories were taken in accordance with the inclusion and exclusion criteria. A convenience sample was used. Fifty naturally menopausal women, ranging in age from 50 to 55, with a healthy weight (60 to 65 kg) and a height (155 to 157.5 cm), were chosen for the study. Fifty healthy, premenopausal women (35–40 years old) with normal weight and height were chosen for the study. All of the ladies had regular menstrual cycles. Results: The postmenopausal group had a resting pulse rate of 83.16 ±1.45 beats/min, whereas the premenopausal group had 80.76 ± 2.32 beat Resting pulse rate differed more across groups statistically. The postmenopausal group had a systolic blood pressure of 120.54 ± 2.56 mm Hg, whereas the premenopausal group had 118.45 ± 3.23 The postmenopausal group had a diastolic blood pressure of 81.65 ± 2.23 mm Hg, whereas the premenopausal group had 80.34 ± 4.02 Systolic and diastolic blood pressure differences were higher between groups. Postmenopausal women had greater pulse rate (bpm) (83.16 ±1.45), systolic blood pressure (120.54 ± 2.56), and diastolic blood pressure (81.65 ± 2.23). Conclusion: Systolic and diastolic blood pressure were significantly greater in postmenopausal women than in premenopausal women, perhaps owing to reduced oestrogen levels that upregulate the RAS and increase plasma renin activity.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate and compare the efficacy and hemodynamic stability of ketamine / fentanyl along with propofol and also assess recovery profile, post-operative analgesia and complications in patients undergoing Dilatation and Curettage. Methods: The present study was carried out in the Department of Anaesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya , Bihar, India from December 2019 to November 2020 the study was conducted in 100 patients, aged 18-35 years of ASA Grade 1&2 scheduled for Dilatation and Curettage procedures lasting up to 30 minutes. Results: Pre-induction heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, spo2 were comparable in both the groups with a statistically no significant difference between them (p<0.05). Conclusion: It may be concluded from our present study that propofol with ketamine as an adjuvant in the dose of 0.75 mg/kg compared to propofol with fentanyl as adjuvant in the dose of 2 mcg/kg provides deep sedation. But propofol-ketamine group is more efficacious and provides better peri-operative hemodynamic stability during anaesthesia as compared to propofol-fentanyl group. Also the propofol-ketamine combination produces good analgesia with less requirement of rescue drug in post-operative period with fewer peri- operative complications than propofol-fentanyl combination. We have not encountered any psychotomimetic effects of injection Ketamine in the 0.75mg/kg dose. Hence propofol-ketamine combination is a better choice especially when hemodynamic stability is of great importance in patients undergoing dilatation and curettage.

DOI: 10.5281/zenodo.

Aim: To determine the functional outcome resulting from changes in the carrying angle after supracondylar humeral fractures in children. Material and Methods: This retrospective study was conducted in the Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India for six months. 21 children aged more than 5 years to 12 years old, having supracondylar humeral closed fractures within one week from the injury and treated by closed reduction and fixed by two percutaneous K-wires applied from the lateral side, had change of elbow carrying angle in contrast to the other side at the end of minimum follow up period (twelve months after fixation of the fracture) were included in this study. All patients were subjected to clinical assessment, physical examination, and radiological evaluation. All patients had treatment utilizing a closed reduction and two Kirschner wires inserted from the side. Results: The study involved 21 patients with an average age of 6.81 years (SD ± 1.60 years). The majority were boys (57.14%) compared to girls (42.86%). Fractures were predominantly on the right side (61.90%), and all patients were right-handed. Most fractures were of the extension type (90.48%), commonly caused by a fall on an outstretched hand (FOOSH) at ground level (90.48%). Surgical fixation occurred mostly on the first day of the fracture (57.14%), with some on the second (38.10%) or third day (4.76%). The mean operative time was 54.52 minutes (SD ± 6.87). Patients typically wore splints for 4.10 weeks (SD ± 0.44) and had pins removed on average after 2.62 weeks (SD ± 0.50). Regarding elbow changes post-treatment: Carrying Angle Change: Most patients (80.95%) had a change of 0-5 degrees, indicating minimal deviation. Elbow Flexion Change: The majority (76.19%) experienced an improvement of 0-5 degrees. Elbow Extension Change: Similarly, 71.43% showed improvement of 0-5 degrees in extension. Conclusions: The carrying angle changes following supracondylar humeral fractures managed by closed reduction and K-wires fixation are resulting in satisfactory outcomes represented in good functional outcomes.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the efficacy and safety of 25 mcg intravaginal misoprostol vs 50 mcg misoprostol for induction of labor. Methods: This study was conducted in the Department of Obstetrics and Gynecology at AIIMS, New Delhi, India. This study group consisted of 200 cases of low-risk singleton pregnancies attending at Aiims or admitted to the antenatal ward. Results: Both groups had most instances between 20 and 25. In both categories, 82% and 79% of cases are booked. The 25-mcg group had 65% term pregnancies while the 50-mcg group 54% postdated. The groups needed equivalent oxytocin supplementation. 25 mcg (74%), compared to 50 mcg (51%), increases vaginal deliveries. Caesarean section rate is 39% higher with 50 mcg. In this research, 50 mcg misoprostol induction administration intervals were fewer than 12 hours in 62 instances (62%) and 33 cases (33%). Most single-dose 50 mcg instances delivered vaginally within 12 hours. Failure to advance caused most induction failures. In the 50-mcg group, 39 of 100 patients failed induction, or 39%. Fetal discomfort caused most induction failures. Side effects were 26% in the 50-mcg misoprostol group and 14% in the 25-mcg group. Only the 50-mcg group had tachysystole and hyperstimulation. Conclusion: Locally applying misoprostol to the posterior fornix is simpler. Compared to other prostaglandins, misoprostol is cheaper and more stable. Both groups had excellent Bishop’s score changes, although 50 mcg is statistically superior for cervical ripening. Induction delivery period is much shorter for 50 mcg (9.45 hrs) than 25 mcg (14.5 hours).

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the prevalence and severity of anemia in pregnant women. Methods: A descriptive cross-sectional study was conducted in the Department of Pathology, DMCH, Darbhanga, Bihar, India over a period of 2 years. In considering the inclusion and exclusion criteria, the pregnant mothers were selected in the study. A total sample comprised of 50 pregnant women who were interviewed by using self-structured questionnaire for data collection, and classification of anemia was performed according to Indian Council of Medical Research (ICMR). Results: 14 (28%) were in between the 20-25 yrs of age group, 12 (24%) were in between 26 and 30 yrs of age group, 24 (48%) were in between 31 and 35 yrs of age group, 28 (56%) antenatal women were from rural area. 24 (44%) women belong to nuclear family, 28 (56%) belong to joint family, 15 (28%) were employed, and 37 (71%) were unemployed. 18 (36%) were having no children, 19 (38%) were single child, and 13 (26%) were ≥2 no. of children. 18 (36%) were vegetarian, and 32 (64%) were nonvegetarian category of dietary practices. 17 (34%) were primigravida, and 33 (66%) were multigravida. 01 (02%) were nullipara, 22 (44%) were primipara, and 27 (54%) were multipara woman. The contributing factors leading to anemia in antenatal women, 30 (60%) were not having any H/O abortion, 20 (40%) were having H/O abortion, 40 (80%) were not having any H/O infection, 11 (22%) were having history of infection, 8 (16%) were having H/O chronic malaria, 42 (84%) were not having any H/O chronic malaria, 14 (28%) were having H/O hook worm, 36 (72%) were not having any H/O hook worm infection, 13 (26%) had low menstruation flow, 32 (64%) were moderate, 5 (10%) were high, 20 (40%) attended <4 antenatal visit, 30 (60%) attended ≥4 antenatal visit, 32 (64%) were taking iron supplement, 17 (34%) were having previous H/O anemia, 33 (66%) were not having previous H/O anemia. Conclusion: The study implies that the prevalence rate of Anemia is high. Spacing between pregnancy and H/O infection plays a significant role in considering anemia in pregnant women, which eventually affects both maternal and fetal condition.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the use of Relaxation Techniques in Reducing Stress Levels by Measuring Heart Rate Variability at tertiary health care center. Methods: This was a retrospective study carried out in the apparently normal individuals to study the effect of various relaxation techniques like Breath focus, Body scan, Guided imagery, Mindfulness meditation, Yoga, Taichi, and qigong, Repetitive prayer etc. on heart rate variability in the Department of Physiology, Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India . There were 100 individuals who given written consent to be part of the study. Results: The average age in both the age group was 36± 3.97 and 34± 4.26 was not statistically significant (p>0.05). The baseline parameters in both the groups were comparable (p>0.05) but the HRV after 12 weeks therapy High Frequency HRV increased in Group A as compared to Group B was significant (P<0.05); The Low frequency waves increased in Group B as compared to Group A (p<0.05) decreased Low frequency HRV and LF/HF ration after 12 weeks intervention was statistically significant (P<0.05). Conclusion: It can be concluded from our study that after 12 weeks training with various relaxations techniques the autonomic function measured by HRV i.e. High frequency Increased and low frequency decreased hence the parasympathetic dominance increased with the relaxations techniques.

DOI: 10.5281/zenodo.

Aim: The Purpose of the study was to assess the Radiological outcome of Total Hip Arthroplasty in Displaced fracture Neck of femur. Methods: The present study was conducted in the Department of Orthopaedics, ESICMCH, Bihta, Bihar, India for 2 years, Total 200 patients were treated with total hip replacement. Results: Total 200 patients treated with total hip replacement for displaced fracture neck of were included in this study. Out of 200, 144 patients were male and 56 female, most of the patients in were above 50 year and followed by 40-50 year. Majority of the patients had involved right side 64% as compared to left side 36%. Patients scored 55% excellent, 26% good, 9% fair and 10% patients scored poor according to Harris hip score. Acetabular cup inclination is an important component of radiological evaluation. The results in our study were as follows: Normal (30-45 degrees) – 148 (74%), Vertical (> 45 degrees) – 32 (16%), Horizontal cup (<30 degrees) – 20 (10%). The ideal position of stem of femoral component is central. In this study we had 72% central, 16% each in valgus and 12% varus position. Conclusion: The results from this study showed that Total Hip Arthroplasty gave better results in displaced Intracapsular Neck of femur Fracture radiologically. Also there was no loosening of Acetabular component or migration of acetabular cup and cup position was normal in 75% cases. Femoral stem position was Neutral in 72% of cases with no vertical subsidence and no femoral component loosening.

DOI: 10.5281/zenodo.

Aim: To compare the effectiveness of intravenous esmolol and intravenous magnesium sulphate in reducing the physiological reaction to laryngoscopy and endotracheal intubation. Materials and Methods: This study was conducted in the Department of Anesthesia, Patna Medical College and Hospital, Patna, Bihar, India for 18 months. The total sample size for the study 120, each group contain 40 patients (Total Population = 120) In patient with Informed written consent, ASA grade I and II posted for elective surgery under general anesthesia, Age group 18 -60 years and Weight 45-65 kg were included in this study. Group N: Patients were given single bolus dose of normal saline 10 ml intravenously before laryngoscopy and intubation. Group M: Patients were given single bolus dose of Magnesium sulphate 50 mg/kg body weight (making total volume 10 ml by adding normal saline) intravenously before laryngoscopy and intubation. Group E: Patients were given single bolus dose of Esmolol 2 mg/kg body weight (making total volume 10 ml by adding normal saline) intravenously before laryngoscopy and intubation. Results: There were Statistically no significant difference among the groups according to given HR, with p – value {p > 0.05} and When the computed F–ratio is less than the tabulated F– ratio (critical ration) = 3.07}.Then there were statistically significant difference among the groups according to given HR, with p – value {p < 0.05}. Baseline SBP Was Comparable in all the three groups (> 0.05). SBP declined in group M and Group E, but statistically not significant (>0.05). SBP was More in Group N compared rest of two groups (<0.05). After 10 minutes SBP became comparable in all the three groups. Baseline value of mean diastolic blood pressure was comparable in all the three groups. After giving the study drugs, all the value were comparable (>0.05). At 1 minute of intubation, mean diastolic blood pressures were maximum in all the groups (<0.05). Rise in Diastolic Blood pressure was minimal in Group E as compared to Group M and Group N. Mean diastolic blood pressure reached near baseline at 10 minutes in Group N and Group M. Whereas Mean diastolic blood pressures were less at various interval compared to baseline value in Group E. Conclusion: Our study confirms that IV esmolol (2mg/ Kg) is more effective than IV magnesium sulfate (50 mg/Kg) in controlling the hemodynamic stress response to laryngoscopy and endotracheal intubation.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the efficacy of intravenous Clonidine 1 µg/kg in attenuation of hemodynamic response to orotracheal intubation and laryngoscopy and observe. Methods: The retrospective study was conducted at Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India for 12 months. Written informed valid consent was obtained from all patients participating in the study. 100 patients of either sex, between 20-60 years of age of ASA Grade I and II scheduled for surgery under General Anesthesia were studied. Results: Thus there was a statistically significant increase in HR (P=0.000) compared to baseline value. There was statistically significant increase in SBP at 0 minute, 1 minute, 3 minutes and 5 minutes whereas negligible decrease after 10 minutes compared to baseline value. After intubation there was statistically significant increase in DBP (P<0.01) compared to baseline value. Conclusion: Clonidine at a dose of 1 μg/kg body weight diluted in 10 ml Normal saline given 10 minutes before induction significantly attenuates the hemodynamic responses to laryngoscopy and orotracheal intubation with minimal side effects like bradycardia. However, the study has to be done on a larger population and in high risk patients for further evaluation.

DOI: 10.5281/zenodo.

Aim: To determine the surgical procedure for cataract removal and its complications in patients diagnosed with pseudo exfoliation syndrome. Materials and Methods: This study was conducted in the department of Ophthalmology, Patna medical college and hospital, Patna, Bihar, India for nine months. Cases of 225 eyes (80 eyes with pseudo exfoliation and 145 eyes without pseudo exfoliation as the control group) that underwent phacoemulsification cataract surgery and IOL implantation were analyzed retrospectively. All patients were given detailed information about their diagnosis and surgical procedures to be applied, and written informed consent was obtained. Patients with previous ocular surgery or trauma, uveitis, glaucoma, IOP ≥ 21 mmhg or corneal pathology were excluded from the study. All cataract surgeries were performed using quick chop technique by the same surgeon. Patients’ age, gender, anterior segment and fundus findings in both eyes, presence of pseudo exfoliative material, preoperative and postoperative day 1 IOP, and surgical notes were evaluated. Results: There were 51 (34.7%) males and 29 (38.6%) females among the PEX cataract patients, and 98 (65.3%) male and 47 (61.8%) female controls. The incidence of pseudo exfoliation was similar in women (38.2%) and men (34.7%) (p=0.660). There was no statistically significant effect of gender on pseudo exfoliation frequency. The mean age was 74.64±6.8 in the PEX group and 68.95±7.5 in the control group. Mean age was significantly higher in the PEX group compared to controls. Poor pupil dilation was observed intraoperatively in 60 (75%) of the patients with pseudo exfoliation and 17 (11.7%) of the control patients. Frequency of poor intraoperative pupillary dilation was significantly higher in the PEX group compared to controls (p<0.001, Table 3). Intraoperative posterior capsule rupture occurred in 10 (12.5%) PEX patients and 5 (3.4%) controls. The incidence of intraoperative posterior capsule rupture was statistically significantly higher in the PEX group compared to the control group (p=0.012, Table 4). Intraoperative vitreous loss occurred in 7 (8.8%) PEX patients and 5 (3.4%) controls. Despite the fact that more PEX patients developing vitreous loss than controls, the difference was statistically insignificant. Conclusion: Cataract patients considering surgery should be evaluated preoperatively for pseudo exfoliation. Surgeons should be aware of the possibility of poor pupillary dilation and the complications that can arise in patients with PEX during cataract surgery. Caution should be taken during every stage of surgery to avoid these complications, and surgeons should be knowledgeable and skilled in complication management should they occur.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the Functional outcome of Intramedullary Interlocking Nail and Minimally Invasive Plate Osteosynthesis. Methods: The present study was conducted in the Department of Orthopaedics, Shri Ramkrishna Institute of Medical Sciences and Sanaka Hospitals, Durgapur, West Bengal, India and 100 patients with confirmed Extra articular distal tibial fractures were included in the study. Results: The age of the patients ranged from 19 to 74 years with a mean of 42.3 years and standard deviation (SD) of 15.4 years. Majority of the patients belonged to 36-45 years of age and 60% were male. 48% had transverse fracture followed by 44% oblique. 58% underwent nailing and 42% underwent 42%. 48% had transverse fracture followed by 44% oblique. 58% underwent nailing and 42% underwent 42%. The average time for full weight bearing was 10.09 ± 1.41 weeks which was statistically significant (P < 0.0001). The average time of union was 18.26 ± 2.49 weeks (range 15–24 weeks) which comes out to be very significant (P < 0.0001). Conclusion: Both ILN and MIPO are reliable methods of fixation and are helpful in maintaining most of the osseous vascularity, fracture hematoma which are most useful in providing biological repair. Both are less invasive and in both soft tissue dissection is less.

DOI: 10.5281/zenodo.