Background: Heart rate variability (HRV) is considered an indicator of cardiovascular health. Women generally show a lower risk of coronary heart disease and serious arrhythmias compared to men, with a significant delay in the incidence of sudden death. This disparity suggests potential gender differences in autonomic modulation. We in the current study aimed to evaluate the Heart rate variability in young adult male and female students of our institute. Methods: The study involved 120 participants (60 males and 60 females). We measured anthropometric parameters such as age, height, weight, and BMI. Baseline characteristics, including resting heart rate and systolic and diastolic blood pressure, were recorded during five minutes of supine rest. HRV parameters like total power, low frequency, low frequency normalized units, high frequency, high frequency normalized units, and low frequency/high-frequency ratio were analyzed using ECG recordings. Results: Males have a significantly higher LF power in milliseconds squared (ms²) compared to females (p=0.023). This suggests greater sympathetic activity or response to stress in males. While the average normalized LF power (nu) is also higher in males, the p-value (0.051) is borderline significant. It suggests a possible trend but needs further investigation. Females have a significantly higher HF power in ms² compared to males (p=0.019). Conclusion: Our study shows that there are possible gender differences in heart rate variability (HRV) among young healthy individuals. Males were more likely to have low frequencies which might be being regulated sympathetically. This corresponds to the previous findings that sympathetic dominance might be related to the cardiovascular disease risk.

DOI: 10.5281/zenodo.

Introduction: Lymphadenopathy, often known as the swelling of lymph nodes, is a common illness that is often encountered in clinical settings. FNAC has become an essential diagnostic technique for identifying the root causes of lymphadenopathies. A new category approach for the classification and reporting of lymph node cytopathology was presented at the 20th International Congress of Cytology in Sydney in May 2019, bringing about a significant transformation in the discipline. Materials and Methods: This retrospective study was carried out at a single center over the course of two years, and it involved the review of slides from cytology and histopathology by two pathologists with extensive experience. The objective of the study was to assess the performance of the Sydney system in terms of its diagnostic accuracy and clinical utility for reporting lymph node cytopathology. Results: The findings showed that the majority of cases (41 cases) were discovered in patients between the ages of 11 and 20. There were 127 cases of lymphadenopathy in the cervical region, which was the region with the highest number of cases. The majority of instances, which totaled 143, were deemed to be benign. It is important to note that the Sydney method has a high diagnostic accuracy, as evidenced by the fact that the study discovered a Risk of Malignancy (ROM) of 100% in categories IV and V, 50% in category III, and 3.8% in category II. Conclusion: This study demonstrates that FNAC is a safe, cost-effective procedure for diagnosing lymph node lesions. Furthermore, the Sydney system provides an effective framework for classifying and reporting lymph node cytopathology, aiding in patient management and treatment decisions.

DOI: 10.5281/zenodo.

Background: Coronaviruses are RNA viruses that are phenotypically and genotypically myriad. In this Review, we light on the basic virological concept of SARS-CoV-2, including genomic attributes and receptor use, highlighting its role key variance from previously known coronaviruses. The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which is also called, as the 2019 novel coronavirus (2019-nCoV) was rapidly spreaded from its origin in Wuhan City of Hubei Province of China to all parts and became a cosmopolitan problem for world. Around 704,539,018 cases of coronavirus disease 2019 (COVID-19), 7,008,958 deaths and 675,395,611 have been reported till 31/ 03/2024 in the world. India has reported 45,034,136 cases, and 533,547 deaths till 31/ 03/2024. But the future course of this virus is unknown. Coronaviruses are known to be associated with a variety of diseases in humans and domestic animals. It has been postulated that the proximity of humans to wild animals might have led to animal pathogens jumping across species from animals to humans, and become the causative pathogen in the latter. It is important to determine whether there is an animal reservoir, as breaking transmission of the virus may be more difficult and a recurrence of the disease is more likely. The clinical manifestations of COVID-19 are found myraid, ranging from asymptomatic state to acute respiratory distress syndrome and multi organ dysfunction. Common characteristics wasclude fever,  cough, sore throat, headache, fatigue, headache, myalgia and breathlessness. Conjunctivitis has also been described. Thus, they are indistinguishable from other respiratory infections. In a subset of patients, by the end of the first week the disease can progress to pneumonia, respiratory failure and death. This progression is associated with extreme rise in inflammatory cytokines including IL2, IL7, IL10, GCSF, IP10, MCP1, MIP1A, and TNFα. This finding suggests that receptor usage may not be the only factor that determines the severity of HCoV infection. Dipeptidyl peptidase 4 (DPP4, also known as CD26), the receptor for MERS-CoV, is a multifunctional cellsurface protein widely expressed on epithelial cells in kidney, small intestine, liver and prostate and on activated leukocytes. DPP4 is expressed in the upper respiratory tract epithelium of camels. In the human respiratory tract, DPP4 is mainly expressed in alveoli rather than the nasal cavity or conducting airways. DPP4 is a key factor in the activation of T cells and immune response costimulatory signals in T cells, which could indicate a possible manipulation of the host immune system. Human aminopeptidase N (CD13), a cell-surface metalloprotease on intestinal, lung and kidney epithelial cells, has been identified as the receptor for hCoV229E. The receptor for HCoV-OC43 is 9-O-acetylated sialic acid. Currently, the receptor for HCoV-HKU1 has not been identified. Aim: This article may try to gives a blue eye view about this new virus. Since knowledge about this virus is rapidly updating and evolving, readers are urged to update themselves regularly. Discussion: Current understanding of the pathogenesis of HCoVs infection is still limited. However, several significant differences in the pathogenesis exist among SARS-CoV, MERS-CoV and the other HCoVs. Cell entry and receptors. The critical first step for HCoV infection is entry into the susceptible host cells by combining with a specific receptor. Spike proteins (S proteins) of HCoVs are a surface-located trimeric glycoprotein consisting of two subunits: the N-terminal S1 subunit and the C-terminal S2 subunit. The S1 subunit specializes in recognizing and binding to the host cell receptor while the S2 region is responsible for membrane fusion. To date, a wide range of diverse cellular receptors specifically recognized by the S1 domains have been identified for all HCoVs except HCoV-HKU1. ACE2, the receptor for SARS-CoV and HCoVNL63. is a surface molecule localized on arterial and venous endothelial cells, arterial smooth muscle cells, epithelia of the small intestine and the respiratory tract. In the respiratory tract, ACE2 is expressed on the epithelial cells of alveoli, trachea, and bronchi, bronchial serous glands, and alveolar monocytes and macrophages. Conclusion: The 2019 novel coronavirus (2019-nCoV) outbreak is a major challenge for clinicians, and social, economic & public health prosperity to almost whole world. In India the economic progress and prosperity sturdily challenged and affected. The clinical course of patients remains to be fully characterized, little data are available that describe the disease pathogenesis, and no pharmacological therapies of proven efficacy yet exist.

DOI: 10.5281/zenodo.

Background and Objectives: Antiretrovirals, as most other chronically administered drugs, are reported to have adverse reactions, and particularly higher occurrences are seen at the beginning of ART. The main aim of this study is to gain knowledge on the profile of early onset ADRs associated with antiretroviral drugs, the burden of ADRs of ART in this setup with the ultimate goal of improving the patients’ compliance and effectiveness of treatment. Methods: An observational longitudinal study conducted at ART Centre of Tertiary care hospital of Eastern Gujarat. Data was collected through active pharmacovigilance and ADRs were recorded through ADR reporting forms. ADR causalities were assessed through WHO and Naranjo’s causality scale, Severity was assessed through Modified Hartwig and Siegel Scale and Preventability was assessed through Modified Shumock and Thorton criteria. Results: A total of 431 patients were interrogated in 6 months, of which 93 patients (21.58%) reported a total of 141 ADRs. ADRs were associated more with TDF+3TC+EFV Regimen. Most common system involved was gastrointestinal system (41.13%) followed by nervous system (34.04%) and the most frequently reported ADRs were of Nausea (17.73%) and Dizziness/Vertigo (17.02%). Majority of ADRs observed under Mild (83.69%) category. Causality assessment of suspected drug using WHO and Naranjo’s scale revealed maximum ADRs were Possible (94.33% and 79.43%). Maximum ADRs were not preventable (59.57%). Interpretation & Conclusion: We can improve the quality of care to patients living with HIV by providing an ADR profile, thus enabling a direct approach for the early detection and subsequent treatment of adverse drug reactions. To optimize adherence and hence effectiveness of treatment, clinicians must focus on preventing adverse effects whenever possible and distinguishing between self-limited and easily treatable ones from the potentially serious ones.

DOI: 10.5281/zenodo.

Introduction: The severity of symptoms of Dengue patients depends upon their nutritional status. Therefore, study on relation of vitamin D deficiency with severity of dengue patients needed attention. Vitamin D plays a crucial role in regulating bone metabolism and maintaining calcium and phosphorus levels in the body. It has been found to be associated with autoimmune diseases, metabolic syndromes, cardiovascular disease, cancers, and all-cause mortality. There is an increasing interest in the potential role of vitamin D in Dengue viral infection. Dengue patients had major complain of severe bodyache, fatigue when other symptoms are absent, which is variable in different patients. Aim: To identify a possible association between low levels of systemic 25-(OH) D and the likelihood of developing severe dengue fever. Materials and Methods: This was a single-center, cross-sectional study conducted in the Department of Medicine, Dr. RMLIMS, Lucknow, Total 156 Dengue patients were taken after confirmation from NS1 Ag and IgM positive reports. Serum vitamin D levels were measured at the time of admission in all patients. MS Excel and R-4.3.2 statistical software were used for statistical analysis. A p-value < 0.05 was considered significant. All statistical tests were two-sided. Results: The results reflected mean age of 36 years with SD of 14.428 and low Serum Vitamin D < 20 ng/ml (P-value 0.944). Out of total (n= 156), 47.4% (n=74) were females and 52.6% (n=82) were males. The levels of vitamin D ranges between 5 and 109 ng/ml. Serum vitamin D was found deficient in 66.7% (n=102) of total Dengue patients. The prevalence of Dengue without warning signs, Dengue with warning signs and severe Dengue fever (according to the latest classification of WHO- 2021, for Dengue) was found to be 69.5%, 75% and 89% respectively in low vitamin D patients. Studies were also done for various demographic characteristics and clinical features in dengue patients with vitamin D deficiency. Conclusion: The study concludes that severity of Dengue patients was directly related and more in low vitamin D patients. The present study revealed that serum vitamin D may contribute in the pathogenesis of dengue infection; thus, vitamin D levels might serve as useful prognostic marker for predicting disease progression.

DOI: 10.5281/zenodo.

Background: Ansa cervacalis is a nerve loop which gives branches to innervate the infrahyoid group of   muscles.  Any injury to these muscles would cause disturbance in phonation.  The Ansa cervicalis nerve loop is formed by superior root i.e arise from the cervical spinal nerves (C1-C2) inferior root is descending from C2-C3 .In the present study, We aim to document anatomical variations of Ansa cervicalis and can be important acknowledgment in specific surgeries of the neck region and its clinical implications. Materials & Methods: During routine dissection of adult cadavers of age 30-60 years old at department of anatomy, Rangaraya Medical College, Kakinada. while performing neck dissection, location and level of ansa cervicalis are  observed in 25 cadavers on both sides of neck (50 hemineck dissections). Results: Among 50 hemineck dissections (In 25 cadavers ), 1 hemineck dissection on right side of neck showing abnormal location of ansa cervicalis i.e inside to the carotid sheath and in remaining 49 hemineck dissections ansa cervicalis is located on anterior aspect of carotid sheath intermediate level ansa seen in 40 hemineck dissections, low level ansa seen in 10 hemineck dissections but high level ansa not observed in any hemineck dissection. Conclusion: Knowledge regarding the location & level of ansa cervicalis is very useful to ENT Surgeons ,Head and neck surgeons, Onco surgeons to minimize the complications like paralysis of infrahyoid muscles while performing surgeries over the neck.

DOI: 10.5281/zenodo.

Background: The supraclavicular block provides effective anesthesia for the brachial plexus for surgical procedures at or below the elbow level. Traditionally, the landmark technique has been used, but this blind method often necessitates multiple needle attempts through trial and error, leading to prolonged procedure times, associated pain, discomfort, and potentially severe complications. Peripheral nerve locator, a newer technique, offers advantages such as reduced procedure time, less pain, and discomfort, and fewer complications. This study aimed to compare two techniques in terms of the time required for the procedure, the onset and duration of sensory and motor blockade, and the overall effectiveness of the block. Methods: Surgeries involving upper limbs. Patients belonging to the American Society of Anesthesiologists Grade I & II. Patients of either sex, aged between 15-70 years. In one group (Group C, n=30), the conventional subclavian perivascular technique was employed, while in the other group (Group NS, n=30), the supraclavicular nerve block was administered under peripheral nerve locator guidance. In both groups, the block consisted of 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with 1:200,000 adrenaline. Results: The nerve locator technique was quicker (average time: 5.66 minutes) than the conventional method (8.7 minutes), potentially due to simpler procedures in the latter. The nerve locator approach significantly accelerated the onset of both sensory and motor blocks (p<0.005), likely because of direct nerve stimulation and more precise injections. It also prolonged the duration of these blocks (p<0.005) and achieved a higher success rate, with 97% complete block compared to 73% in the conventional group. Both methods exhibited low complication rates, which might be attributed to the use of short needles and correct techniques. Conclusion: Our study reveals that among the available anesthesia techniques to be utilized for the supraclavicular blocks during upper limb surgeries, locating a nerve with a nerve locator results in an early onset of both sensory and motor blockade and a prolonged blockade duration and a decreased need of analgesics both during and after surgery. Furthermore, this technique is seen to have a relatively higher success rate and fewer complications.

DOI: 10.5281/zenodo.

Background and Aim: Clinical profile of patients having tachypnoea in tertiary care hospitals reflects the burden in the community and identifying the risk factors for mortality and morbidity in the children between 2months to 60 months, will help proper utilization of available resources and ensure adequate management of these children. Aim of this study was to identify the various causes of tachypnoea among 2months to 60 months old and to analyze various factors influencing morbidity and mortality patterns among them. Material and Methods: Present Descriptive observational study was conducted at Paediatric ward in a tertiary care hospital in All Indoor patients between 2 months to 5 years for the duration of 6 months. A structured proforma was prepared, after taking consent from the parents, detailed history with presenting complaints and detailed general and systemic examination was done. Nutritional status assessed using WHO Z score weight for Age. WHO weight for age less than -2 Z score is considered as a risk factor in this study. Details regarding immunization were taken from parents and immunization cards. Results: Out of 846 total admissions, 145 children (2 months – 5years of age) had Tachypnea, overall occurrence of Tachypnea was 17.13%. Occurrence of tachypnea among 2 months – 12 months (Infants) was 24.53% and 13 months to 60 months was 11.13%, more number of infants was suffering from tachypnea owing to the infantile respiratory anatomy they have. More deaths were observed in infantile age group. 54 children admitted with tachypnea had longer hospital stay (>7 days) out of which 28 were suffering from pneumonia, 6 were suffering from underlying CNS disease and 5 had septic shock. Conclusion: Prevention of anemia and malnutrition will significantly improve the less than 5 morbidity and mortality. Strengthening of immunization is still required even in urban areas. Introduction of pneumococcal vaccine and flu vaccine will help to improve less than 5 morbidity and mortality.

DOI: 10.5281/zenodo.

Background: Epidural administration of ropivacaine offers effective analgesia, minimal motor blockade, and cardiac stability. The incorporation of adjuncts such as dexmedetomidine extends the duration of analgesia, prolongs motor blockade, and ensures sufficient sedation. Our research directly compares the effects of ropivacaine alone versus ropivacaine combined with dexmedetomidine on block characteristics, postoperative pain relief, and sedation levels. Methods: A total of 60 cases were identified and included in the study during the duration of the study. They were equally and randomly allotted by a computer-generated random number into one of the two groups.  Group I (n=30) received 15 ml of 0.75% ropivacaine (Ropivacaine 0.75% preservative-free 0.75% 20 ml ampoules.  Group RD (Number of patient-50) 15ml of 0.75% ropivacaine + 0.6µg/kg of dexmedetomidine (inj.1ml = 100µg, 1ml ampoule). Results:  There were no significant differences between the two groups regarding age, sex, height, weight, or body mass index. On average, Group II achieved a slightly higher level of sensory block, but the difference wasn’t statistically significant.  Group I experienced a more complete motor block (no leg movement) compared to Group II. Patients in Group II had deeper sedation levels compared to Group I. The sensory and motor blocks lasted significantly longer in Group II compared to Group I. Group II experienced a significantly faster onset of both sensory and motor blocks compared to Group I. Overall, the findings suggest that adding Dexmedetomidine to Ropivacaine (Group II) might lead to deeper sedation but result in a less complete motor block compared to using Ropivacaine alone (Group I). Conclusion: The Dexmedetomidine group exhibited a rapid onset of action, prolonged duration of sensory and motor block, improved sedation scores, and a more pronounced motor block. No difference was noted in the maximal dermatomal level of analgesia, and any associated side effects such as bradycardia and hypotension did not pose significant challenges to the hemodynamic profile.

DOI: 10.5281/zenodo.

Objective: To determine the prevalence of vitamin D deficiency in Indian children hospitalized with diarrhea and evaluates the association between vitamin D status and severity of diarrhea. Methods: A hospital-based cross-sectional study was conducted from June 2023 to March 2024 in Nalanda Medical College and Hospital in the state of Bihar, India. Infants and young children aged 6–60 months hospitalized with diarrhea were recruited. Serum blood samples were collected on admission and analyzed for total serum 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 concentrations using liquid chromatography-tandem mass spectrometry. Vitamin D deficiency was defined as a level of serum vitamin D <50 nmol/L. The association between vitamin D deficiency and severity of hospitalized diarrhea patients according to WHO criteria, including the presence of danger signs, signs of severe dehydration, shock, duration of hospitalization, and admission to Intensive Care Unit (ICU), was analyzed using logistic regression. Results: 133 children with WHO-defined diarrhea were enrolled in the study and 127 (96%) had their vitamin D status determined. The mean vitamin D concentration was 56 (± 18 SD) nmol/L and 30.7% of participants were vitamin D deficient. Age younger than 12 months was associated with prolonged hospitalization (> 5 days) and low birth weight and poor nutritional status on admission were risk factors for severe dehydration. However, vitamin D status was not associated with the presence of danger signs, duration of hospitalization, or severe dehydration. Conclusions: One in every three children hospitalized with diarrhea was vitamin D deficient. Vitamin D status was not associated with the severity of diarrhea.

DOI: 10.5281/zenodo.

Introduction: Aedes aegypti mosquitoes are common carriers of dengue virus (DENV) and CHIK virus (CHIKV). At times where both viruses coexist, they can spread simultaneously. There are extremely few investigations on the dengue-chikungunya coinfection, which results in the difficulty in treatment aspects. Methodology: In the present study 200 suspected samples were subjected to the presence of antibodies sensitive to DENV for detection of NS1 antigen and Dengue IgM and the Chikungunya IgM was used for diagnosis of chikungunya. Results: A total of 200 samples from suspected patients for dengue infection, 29 (14.5%) samples were positive for DENV NS1. While 21 (10.5%) were tested positive for DENV IgM, 11 (5.5%) samples were positive for CHIK IgM antibodies. A total of 7 (3.5%) patients showed dengue chikungunya coinfection. Conclusion: The rise in the rate of Dengue and Chikungunya illnesses, as well as their cocirculation, is an important health issue that necessitates intensive prevention and control strategies.

DOI: 10.5281/zenodo.

Background: Infectious diseases significantly contribute to morbidity and mortality in our country, with tuberculosis, falciparum malaria, and leptospirosis being common causes of death. This study aims to investigate the causes, clinical features, and associated organ dysfunction in patients with acute febrile illnesses and acute renal failure. Methods: This cross-sectional study was conducted in the Department of General Medicine, Government Medical College, and Hospital, Wanaparthy, Telangana State. Patients over 18 years old with an acute febrile illness and a platelet count below 150,000/mm³, who have acute kidney injury due to Dengue, Malaria, Leptospira infection, Rickettsial fever, Typhoid, or Chikungunya, confirmed by laboratory tests. AKI was diagnosed based on the recent KDIGO AKI Guidelines. Results: A variety of AFI diagnoses were identified, with Dengue being the most frequent, followed by Malaria, Scrub Typhus, Leptospirosis, and unspecified causes. The majority of patients (64.0%) presented with mild thrombocytopenia. A significant proportion also had moderate (18.0%) and severe thrombocytopenia (18.0%). Dengue appeared to be associated with a higher risk of moderate and severe thrombocytopenia compared to other diagnoses. A significant proportion of patients (50.0%) developed AKI during their AFI illness. Dengue and Leptospirosis were associated with a higher prevalence of AKI compared to other diagnoses. The severity of AKI also differed based on the diagnosis. Dengue and Leptospirosis had a wider range of AKI stages, while Scrub Typhus and Malaria had mostly less severe stages. Conclusion: This study highlights the complex clinical picture associated with AFI and thrombocytopenia. While Dengue appears to be the most common diagnosis, other infectious agents can also contribute. The presence of thrombocytopenia is a frequent finding, with Dengue potentially leading to more severe cases. The study also emphasizes the significant risk of AKI in this patient population, particularly with Dengue and Leptospirosis.

DOI: 10.5281/zenodo.

Introduction: Snakebite envenomation represents a persistent health challenge, particularly in regions like India, where it exacts a considerable toll in terms of morbidity and mortality. Despite efforts to address this issue, gaps persist in understanding the treatment patterns and outcomes associated with snakebite incidents. In this study, we aim to investigate the patterns of snakebite envenomation treatment and its outcomes, focusing on factors such as treatment timing, anti-snake venom administration, complications, and mortality rates. Material and Methods: This prospective observational study, conducted over an eight-month period at a tertiary care center in Mumbai, aimed to investigate the time interval between snake bite incidents and the administration of anti-snake venom (ASV) as a prognostic indicator of patient outcomes in snake bite envenomation cases. Patients presenting with confirmed snake bite envenomation were included, and detailed clinical assessments, including history, physical examination, and laboratory investigations, were conducted. ASV administration and clinical outcomes were closely monitored, with data analyzed to assess the association between treatment timing and patient outcomes. The study underscores the importance of timely intervention in snake bite management to improve patient prognosis. Results: In our study involving 80 patients treated for snake bite envenomation, significant findings emerged regarding demographics, treatment timing, complications, and outcomes. A notable gender disparity was observed, with males comprising 58.75% of cases, and individuals aged 19-30 years represented 22.5% of the cohort. Kraits were the most common snake species encountered (41.25%), followed by Vipers (25.0%) and Cobras (18.75%), with 15.0% of cases involving unidentified species. Most patients received anti-snake venom within 6 hours of the bite (47.5%), and the distribution of ASV vials varied significantly, with 37.5% receiving 5 vials and 25.0% receiving 20 vials. Complications, predominantly cellulitis (56.25%) and acute kidney injury (37.5%), were observed, alongside an overall mortality rate of 8.75%. Notably, associations were found between treatment timing, vial administration, and mortality rates, emphasizing the critical importance of timely intervention and appropriate management strategies in snake bite cases (p<0.05). Conclusion: Our study highlights key associations in snakebite management, revealing that prompt anti-snake venom administration within 6 hours correlates with increased vial usage and longer hospital stays. Additionally, higher vial usage is linked to higher mortality rates, emphasizing the critical importance of timely intervention in improving patient outcomes.

DOI: 10.5281/zenodo.

Introduction: Quality control is important in a laboratory to detect errors and to reduce false rejections. Sigma measures how far a given process deviates from perfection. Sigmametrics can be applied wherever an outcome of a process has to be measured. A poor outcome is counted as an error or defect. Sigma metrics shall be calculated from CV, percentage bias and total allowable error for the parameters by the following formula: sigma= (TEa- bias%) / CV%. The quality goal index (QGI) ratio represents the relative extent to which both bias and precision meet their respective quality goals. Aims and Objectives: 1. To understand the value of Six Sigma performance and apply it to quantify our laboratory performance on Sigma metrics. 2. To estimate the quality goal index of the biochemical parameters. Materials and Methods: The study was conducted in the central biochemistry laboratory at ACSR Government medical college Nellore. We run internal quality control level 1 and level 2 daily. We participate CMC VELLORE EQAS program for chemistry II parameters. In this study the control data for a period of six months from January to June 2020 on nine parameters were studied for sigmametrics. Inclusion criteria: Only those parameters enrolled for external quality control (i.e Chemistry II) were included in the study. Institutional ethical committee clearance was obtained. Results & Discussion: In our study sigma values for nine biochemical parameters were calculated from both internal quality and external quality control values as sigma calculation requires C.V, Bias and TEa values.  Quality Goal index calculation in our study revealed that 37 values were due to imprecision, 36 values showed inaccuracy and 11 values were due to both imprecision and inaccuracy and 24 values showed six sigma (N=108). Sigma metric analysis helps to improve the quality of lab performance by giving a scope for thorough root cause analysis. Conclusion: In our laboratory world class performance was obtained for analytes uric acid, bilirubin, albumin and triacylglycerol. Application of sigmametrics helps to reduce number of control measurements and control limits. Calculation of Quality Goal Index helps to identify whether the error was due to imprecision or inaccuracy or both.

DOI: 10.5281/zenodo.

Adenoid basal cell carcinoma [BCC] is a rare histological subtype of basal cell carcinoma, which is the most prevalent form of skin cancer. This variant is distinguished by unique histopathological features that can make it challenging to differentiate it from other similar lesions, such as adenoid cystic carcinoma. Typically presenting in sun-exposed areas of the body, adenoid BCC highlights the significant role of ultraviolet [UV] radiation in its development.

DOI: 10.5281/zenodo.

Background: Cesarean section (CS) is one of the most common obstetric procedures worldwide, and an increased rate of cesarean section has been observed in recent studies. Maternal mortality and morbidities associated with repeat cesarean section is a significant health problem worldwide. It can save the life of the mother and newborn but is also known to have the typical complications of any major surgery: hemorrhage, infection, venous thromboembolism and complications of anesthesia, sometimes leading to maternal death. Aims and Objectives: To study the types and frequencies of intra-operative surgical complications and immediate maternal and perinatal outcomes associated with repeat cesarean sections, which will help identify the magnitude of problems and improve feto-maternal care. Methodology: This is a prospective study conducted in the Department of Obstetrics   and Gynaecology, in SV medical College during the period from October 2022 to June 2023. One hundred women with pregnancies randomly selected those meeting the inclusion. All women in this study who underwent a repeat cesarean section are divided into two groups based on the number of previous sections. Results:  The incidence of placenta previa and placenta accrete was 14.8% and 3.7%, respectively. Adhesions in women with previous one cesarean section (45.2%), dense adhesions in previous two or more cesarean sections (51.8%) than in women, TLUS was in 51.8% women, Scar Dehiscence in 33.3%. Excessive Blood Loss complication was in 33.3%.low birth weight, low Apgar, preterm delivery was more common in previous sections. Conclusion: In conclusion, fetomaternal complications are increased in multiple repeat cesarean sections. Risk reduction may be possible by managing in tertiary centres, following strict indications in first CS, regular antenatal checkups, and prior anticipation and preparedness for complications.

DOI: 10.5281/zenodo.

Background and Aim: Video laryngoscope (VL) is currently introduced Intubating device with high resolution CMOS camera. The primary aim of this study was to compare the efficiency of video laryngoscope with direct laryngoscope regarding their usefulness for tracheal intubation for elective surgical procedure. We compare suitability of video laryngoscope with direct laryngoscope in terms of glottic exposure time, tube insertion time, total duration of intubation, Number of attempts, Cormack and Lehane grading, optimization Maneuvers, Complications and hemodynamic changes. Materials and Methods: After taking written informed consent, patients between age of 18-60 years of both gender and ASA grade I and II scheduled to undergo elective general surgery were included. Patients with oral pathology, needing rapid sequence intubation and not willing were excluded. The patients were randomly assigned into Group V (video laryngoscope) and Group-M (Macintosh laryngoscope) using sealed envelope method. Glottic exposure time, tube insertion time, total duration of intubation, Number of attempts, Cormack and Lehane grading and optimization Maneuvers were recorded at the time of intubation. Haemodynamic and complications were recorded perioperatively. Results: Attempts of intubation, optimization maneuvers and complications were comparable amongst both the groups. Glottic exposure time and total duration of intubation time was more and quality of glottic visualization was better with video laryngoscope than with Macintosh Laryngoscope. Hemodynamic parameters were better in group V than in group M. Conclusion: Video laryngoscope takes short time to achieve successful intubation, offer hemodynamic stability and better quality of glottic view than Macintosh during intubation. Video laryngoscope less frequently need assist maneuvers, so facilitates intubation with less complication. Both devices are useful for routine intubation in adult patients.

DOI: 10.5281/zenodo.

Purpose: To evaluate the presence of COVID-19 viral RNA in conjunctival secretions of moderate to severely ill hospitalized patients with COVID-19 and to find its association with clinical and laboratory characteristics of patients. Methods: Total of 98 subjects from the COVID-19 admission unit with laboratory-confirmed SARS-CoV-2 infection was included. Presence of any ocular manifestations were noted and asked for via a questionnaire and RT-PCR conjunctival swab testing for Corona virus was done by on duty ophthalmologist. Results: 51(52.04%) out of 98 subjects were males. 11 patients (11.2%) had viral RNA detected by RT-PCR, 4(4.08%) patients had inconclusive results and remaining were negative. In the positive group males significantly outnumbered females [p=.008], 5(45.45%) had some co-morbid condition, 2(18.18%) of them had conjunctivitis and the TLC (total leukocyte count) and NLR (neutrophil lymphocyte ratio) were significantly lower in this group [p=.01]. Mortality rate in conjunctival swab positive patients was 54.54% (6 out of 11), while it was 24.13% (21 out of 87) in swab negative patients. Conclusion: Lower TLC and NLR along with appreciably higher mortality rates in the positive group tells us that the severity of the disease cannot only be judged by the laboratory parameters but also by the wide dissemination of the virus in other tissues like conjunctiva and thus conjunctival swab testing can be used as an additive tool and serve as a marker of prognostic value.

DOI: 10.5281/zenodo.

Introduction: Peripheral venous cannulation and propofol infusion can induce preoperative pain, impacting postoperative discomfort. Understanding this link aids in tailored pain management. This study assesses preoperative pain’s predictive value for postoperative pain, aiming to enhance perioperative care guidelines and improve surgical patient outcomes. Methods: Before surgery, patients underwent pre-anesthetic evaluation, including history-taking, vital signs assessment, and basic tests. They were instructed on using a VAS slide ruler to rate pain. Oral medications were administered, and a research investigator cannulated a vein, recording pain levels. Anesthesia comprised propofol, fentanyl, and vecuronium bromide for laparoscopic cholecystectomy. Postoperatively, pain severity was monitored, with fentanyl administered as needed. Results:  The study comprised 130 members, with a mean age of 36.15 ± 11.13 years and 28.5% males. ASA grade distribution was 46.9% grade I and 53.1% grade II. Mean intraoperative fentanyl dose was 114.08 ± 29.64 mg. Preoperative VAS scores varied between venous cannulation and propofol injection. Postoperative fentanyl dosing and timing varied, with significant differences observed in VAS scores. Conclusion: Preoperative assessment of pain during venous cannulation and propofol infusion is vital. Tailored pain management is crucial, aiming to maintain postoperative pain below 4.0 VAS units. Reduced pain threshold during these procedures correlates with lower likelihood of postoperative discomfort. Preoperative pain assessment can be easily conducted at the bedside, potentially improving patient outcomes.

DOI: 10.5281/zenodo.

Introduction: The escalating prevalence of obesity and hypertension in adolescents aged 11 to 15 years is a global health concern. This study aims to assess their prevalence and potential correlations, crucial for informing interventions to mitigate long-term health risks and promote healthier lifestyles in this vulnerable population. Methods: This cross-sectional study took place at the Department of Pediatrics, District Government General Hospital, Vijayanagaram. Ethical approval was obtained, and written consent from parents was secured. A sample size of 2854 children, aged 11-15, from Vijayanagaram town, excluding those with chronic illnesses, underwent data collection and analysis using SPSS version 19, employing chi-square test and logistic regression. Results: Government schools exhibited a higher proportion of male students (18.4%), contrasting with private schools where females predominated (22.6%). Gender distribution disparities were significant. Among 2854 children, 47.5% were above the poverty line, and 55.9% were uneducated. Mean BMI was 17.76 ± 3.013, with 1.9% classified as obese, notably higher in government schools (1.1%). Significant differences were observed between obesity and economic status. Conclusion: The study highlights the concerning prevalence of obesity and hypertension among adolescents, emphasizing the urgent need for intervention strategies. Disparities in gender distribution, school type, and economic status underscore the multifaceted nature of these health issues.

DOI: 10.5281/zenodo.

Introduction: Chronic kidney disease (CKD) complicates lipid metabolism and diabetes mellitus (DM), contributing to dyslipidemia and increased cardiovascular risk. This study aims to explore the association between serum lipid levels and diabetes in CKD patients, informing tailored management strategies for mitigating cardiovascular complications in this challenging patient population. Methods: A prospective study conducted at NRI Medical College, Andhra Pradesh, spanning 18 months, aimed to investigate the association between serum lipid levels and diabetes in CKD patients. Ethical approval was obtained, and informed consent was obtained from participants. Physical examinations and detailed clinical histories were conducted. Blood samples were collected after an overnight fast, processed for lipid estimation, and analyzed using SPSS version 17.0. Statistical analysis included the student t-test, with significance set at p < 0.05. Results: Statistical analysis revealed higher total cholesterol (TC), triglyceride (TG), very low density lipoprotein levels, and lower low density lipoprotein levels in DM individuals compared to non-DM counterparts. HDL levels were slightly lower in DM patients. These findings indicate an association between DM and altered lipid profiles, with dyslipidemia more pronounced in diabetic individuals, suggesting potential cardiovascular risk. Conclusion: This study highlights the complex interaction between dyslipidemia, DM, and CKD. Elevated TG levels were observed in both DM and CKD, while DM individuals displayed higher TC and TG levels. Comprehensive lipid management strategies are crucial in mitigating cardiovascular complications in these populations.

DOI: 10.5281/zenodo.

Introduction: Severe acute pancreatitis (SAP) requires accurate severity prediction. Studies show mixed results on BISAP and Ranson’s scores. While some favor BISAP’s early prediction, others find comparable accuracy. The debate continues, balancing BISAP’s simplicity with Ranson’s comprehensiveness. Future research aims to refine scoring systems and incorporate advanced diagnostic tools. Methods: Demographic, clinical, and biochemical data were collected at baseline and 48 hours post-admission. Ranson’s and BISAP scores were assigned to each patient and compared with the revised Atlanta classification for acute pancreatitis (AP). Parameters evaluated included age, gender, etiology, and various biochemical markers, among others, with data tabulated and graphically presented. Results: Among 101 patients, BISAP scores distribution was: 5.94% scored 0, 24.75% scored 1, 34.65% scored 2, 18.81% scored 3, 10.89% scored 4, and 4.95% scored 5; mean score was 2.18±1.23. SAP was observed in 27.72% of patients, with 6.93% mortality. Ranson’s score ≥3 was in 36% of patients. BISAP score demonstrated higher predictive ability for SAP (OR=2.67, P=0.0003) than Ranson’s (OR=1.47). Conclusion: Our study provides evidence supporting the superior predictive capability of the BISAP score compared to Ranson’s criteria in identifying SAP cases. Early risk stratification using the BISAP score can aid clinicians in optimizing patient management and improving outcomes in AP.

DOI: 10.5281/zenodo.

Introduction: Pancreatitis is a significant medical concern, characterized by inflammation of the pancreas and presenting as acute or chronic forms. Understanding its severity and classifying complications is crucial for effective management. Diagnostic modalities such as ultrasound (USG) and computed tomography (CT) play vital roles in assessing pancreatitis. While USG offers non-invasive imaging, CT provides precise lesion definition. This study aims to evaluate the efficacy of USG in diagnosing pancreatitis and compare findings with CT. Materials and Methods: Study was conducted at Agartala Government Medical College, this observational study included 50 patients over two years. Ethical clearance was obtained, and written consent was acquired. Patients underwent both USG and CT examinations using appropriate equipment. Data analysis employed statistical tools for comparison and presentation. Results: Among the 50 patients, the majority fell within the 30-to-50-year age group, with a higher prevalence in males. USG visualized the pancreas in 88% of cases, predominantly showing hypoechoic patterns and duct dilatation. CT successfully visualized the pancreas in all cases, detecting hypodensity in 98% and duct dilatation in 12%. Extra-pancreatic findings were observed in 26% of cases, including fluid collections, ascites, and pleural effusions. Conclusion: In diagnosing pancreatitis, both USG and CT are valuable tools, with CT offering superior visualization and assessment of pancreatic pathologies. While USG remains non-invasive and widely available, CT provides more detailed information, particularly in detecting extra-pancreatic complications. A combination of both modalities enhances diagnostic accuracy and patient care.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the usefulness of patient education and if AR control was affected by different methods of teaching of nasal spray usage. Methods: The Present study was conducted in the Outpatient Department of ENT-HNS in a tertiary care teaching hospital in Northern India. All patients aged 18 years and above with clinical symptoms suggestive of mild persistent or moderate-severe persistent AR (ARIA guidelines 2008) were recruited in the study. Total 100 patients were included in the study. Results: Patients were between 18 to 60 years old (mean=32.4 years) and among them 40 (40%) were male patients and 60 (60%) were female patients. Based on the 2008 ARIA guidelines, 88 (88%) patients were diagnosed with moderate-severe persistent (MSP) AR, 4 (4%) had moderate- severe intermittent (MSI) AR while 8 (8%) had mild persistent (MP) AR. Assessment on the techniques during the 2nd (visit 2) showed that most of the participants were unable to show a correct technique on the usage of INCS. During the 3rd visit despite re-education, only 26% of participants were able to show the correct techniques. There was statistically significant association between ARIA classification and severity of TNSS during V1-V3. Majority of patients with moderate- severe persistent AR had severe TNSS during V1 and subsequently improved to moderate symptoms during V2 and mild/very mild during V3. Conclusion: Our study showed the importance of educating patient regarding the proper use of INCS. Assessment of improvement after each method of patient education showed statistically significant outcome.

DOI: 10.5281/zenodo.

Introduction: Thalassemia is a group of hereditary single gene disorders of haemoglobin chains. Excess iron in vital organs is known to cause impaired organ function and increased rates of morbidity and mortality. The regulation of iron by hepcidin is of clinical importance in thalassemia patients, as anemia often occurs along with iron overload. Our aim was to determine serum hepcidin level in beta thalassemia patients and healthy controls and to compare serum hepcidin level in beta thalassemia major patients and healthy controls. Material & Methods: This was a case–control study. Total 35 diagnosed patients of β-thalassemia major were taken as cases, and 35 healthy, age and sex matched individuals were included as controls after taking informed consent. Samples were taken for determination of serum Hepcidin levels along with serum iron, serum ferritin and total iron binding capacity. Observation and Results: 35 beta thalassemia major patients and 35 age and sex matched healthy controls were included in the study. Both groups comprised of 21 boys and 14 girls. Serum hepcidin level was found significantly low in Thalassemia patients as compared to the controls. Discussion: Iron overload in β‑thalassemia patients is a major cause of mortality and morbidity leading to a marked cellular damage and organ dysfunction. The increase in serum ferritin in β‑thalassemia patients is mainly due to the suppression of hepcidin caused by ineffective erythropoiesis which then increases iron absorption. Conclusion: Determination of hepcidin concentration is a useful indicator for high risk of iron toxicity in patients of beta thalassemia.

DOI: 10.5281/zenodo.

Objective: To compare oral nifedipine with topical nifedipine in the management of anal fissure. Patients and Methods: In this prospective randomized controlled study, a total of 120 patients ~ anal fissure were selected through surgical outpatient department and divided randomly into 2 equal groups. Group A received oral nifedipine 10 mg TDS and group B were given 0.2% nifedipine ointment for local application TDS. Both groups were compared in terms of pain relief and wound healing at 1^st week, 3^rd week and 2^nd month after starting the treatment. Results: Mean age of the patients was 39.11±10.85 years. In the follow-up visits, there was significant improvement in VAS scores in both the groups. Oral and topical applications of nifedipine were comparable in terms of pain relief. On comparing oral nifedipine with topical nifedipine, improved healing rates were observed in patients who received the topical application, but the results were statistically insignificant. Conclusion : Both oral and topical nifedipine significantly improve pain relief and healing rate in patients with anal fissure and are comparable in terms of efficacy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the role of maternal serum ferritin as a predictive marker in intrauterine growth restriction. Methods: This was a prospective study conducted in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College, Bihta, Patna, India. Total 250 antenatal women visiting the antenatal clinic were enrolled in the study at 25th week. Results: The difference between mean ages of both groups was not significant statistically. The difference in mean birth weight between two group was statistically significant (P<0.05). There was statistically significant difference between mean ferritin value of two group (P=0.03). The mean hemoglobin in group A was 10.46 gm% and in group B was 11.91%, the difference between two was statistically significant (P<0.05). The analysis was statistically significant P<0.0001 for asymmetrical growth restriction as an outcome and P<0.05 for symmetrical growth restriction as an outcome). The serum ferritin value at 20.2 ng/ml was associated with highest Yuden’s index which means that it can be taken as a cut off for screening antenatal patients for development of fetal growth restriction with 61.5% sensitivity and 80.1% specificity. Conclusion: In our study negative correlation was found between the value of serum ferritin and neonatal birth weight. In future large randomized control trial is needed to found association between maternal serum ferritin and IUGR.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the prevalence of febrile seizures in children in DMCH. Methods: The present study was conducted at Pediatric Department of Nalanda Medical College and Hospital, Patna, Bihar, India. Total 200 children were studied for various demographic characteristics like age and sex, type of febrile seizure, risk factors of febrile seizures like family history of febrile seizure, associated infection and length of hospital stay. Results: Of the 200 children 110 (55%) were boys and 90 (45%) were girls. 36 (18%) were in below 1 years of age, 60 (30%) were in 1-2 years of age, 70 (35%) were in 2- 3 years of age and 34 (17%) were in 3-5 years of age. Mean age of occurrence was 2.2 years (±1.5 years). In this study, 80% (160) of the patients had simple and 20% (40) had the complex form of febrile seizure. In our study, 60% (120) of affected children had positive family history of febrile seizure. Acute gastroenteritis (AGE) (24%) followed by upper respiratory tract infection (URTI) (20%) was the most common co- morbidity. 48% children were hospitalized for 1-3 days, 32% for 4-7 days and 20% for more than 7 days. Conclusion: Most of the children had a positive family history and the most common causative factor was acute gastroenteritis – morbidities/risk factors in the form of URTI, LRTI, AGE etc. are associated with febrile convulsion and these diseases can be managed effectively thereby reducing the occurrence of febrile convulsion.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyse the CCT trends amongst three study groups: Normal subjects; Primary Open Angle Glaucoma subjects; and Ocular Hypertension subjects. Methods: The present study was conducted in the Department of Ophthalmology, Narayan Medical College and Hospital, Sasaram, Bihar and total of 120 patients, 40 in each group. Results: Mean CCT in normal subjects is 555.42+ 16.64 µm, mean CCT in glaucoma subjects is 556.14+ 15.35 µm and mean CCT in OHTN subjects is 569.15+ 31.54 µm. Applying the described correction factor for corneal thickness, 40% of eyes with ocular hypertension were found to have a corrected IOP of 21mmHg or less. Conclusion: Increased corneal thickness in ocular hypertension may lead to an overestimation of IOP in 39% of cases. Measurement of central corneal thickness is advisable when the clinical findings do not correlate with the applanation IOP.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to detect left ventricular hypertrophy in hypertensive patients using Electrocardiography and echocardiography. Methods: The study was conducted in the Department of Medicine of Ford hospital and research centre Pvt. Ltd, Patna, Bihar, India . Sample size calculated by purposive sampling method was one hundred. Results: The mean age of the study population was 59.65 ± 12.34 years. Mean duration of hypertension in the study population was 4.72 ± 3.2 years. Mean pulse rate was 77±9.54 beat per minute. Similarly mean systolic and diastolic blood pressure of the study population was 137± 15.42 mmHg and 84±10.5 mmHg respectively. Around 46% of the study population had family history of hypertension and 4% of them were found to have hypertension for the first time. Out of 100 study population, 20 of them had left ventricular hypertrophy on ECG as defined by Sokolow-Lyon criteria, and 15 had left ventricular hypertrophy on ECG as per Cornell Voltage criteria. On combining both Sokolow-Lyon and Cornell Voltage criteria, 10 were found to have left ventricular hypertrophy on ECG (either by Sokolow-Lyon or Cornell Voltage criteria). On echocardiography 22 of study population were found to have left ventricular hypertrophy. The sensitivity of ECG to detect LVH by Sokolow- Lyon criteria was 47% and specificity was 98.8%. Similarly Positive Predictive Value (PPV) and Negative predictive Value (NPV) for the same criteria was 96.6% and 70.8% respectively. Conclusion: Electrocardiography is less sensitive tool to diagnose left ventricular hypertrophy in hypertensive people. The sensitivity of ECG to find left ventricular hypertrophy by Cornell Voltage criteria is 40.5% and by Sokolow-Lyon criteria is 47%. On combining both criteria sensitivity of ECG increased to 53.2%. Specificity of both criteria is high (>95%). Due to its low sensitivity, ECG can’t be considered as screening method to detect LVH in hypertensive people. Investigation of choice to detect LVH in hypertensive population is still the echocardiography.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures. Methods: The present prospective study was conducted in the Department of Orthopaedics, PMCH, Patna for a period of 3 years. In the present study conducted at a tertiary care hospital for two years a total of 50 cases who fulfilled the inclusion criteria were enrolled. Results: 46% of the cases were between 41-60 years with 32% between <18-40 years and 22% of cases >60 years of age. The age range was from 19 to 68 years with a mean age of 48.2 years. 52% of cases were females and 48% were males. 64% of the cases sustained fracture on the left side and 36% on right side. 84% of fractures were of closed type and 16% were open. As per Neer’s type of fracture classification, the most common type of fracture observed in our study cases was two-part fracture accounting to 40% of cases followed in order by three part (26%), four part observed in 24% of cases. 5 cases (10%) had fracture dislocation. Road traffic injury was the most common mechanism for injury in 60% of cases and next was a history of fall in 32% of cases and one case was electric shock and other was hit by an iron rod. 23 cases (46%) were managed by open reduction and internal fixation with locking compression plate using 4.5 mm cortical screw plates and 6.5 mm cancellous screws. Percutaneous pinning was done in 10 cases (20%). Open reduction with K-wire was done in 6 cases (12%) and open reduction with K-wire and cancellous screws in 3 cases (6%). Closed reduction with intramedullary nailing was done in 4 cases (8%). The mean scores observed on Neer’s score were pain (34.6 units), function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units). Conclusion: The present study concluded that good surgical skills, surgeons experience in selection of the type of surgery depending upon the factors like type of fracture are necessary to achieve correct and best outcome. Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures.

DOI: 10.5281/zenodo.

Aim: The aim of this study was to determine the prevalence of anxiety and depression in women with PCOS and to find the association of various demographic and socio-economic factors with anxiety and depression. Methods: This was a single-center cross-sectional study conducted at a pmch for the period of 2 years and 100 patients were included in the study. Results: The mean age of all the participants was 25.5 ± 6.4 and the mean body mass index (BMI) was 27.6 ± 5.7. Out of these 100 cases, 62 (62%) were married. Level of education was postgraduate or master’s degree in 28 (28%) cases, followed by undergraduate or bachelor’s degree in 32 (32%) cases. Housewife was the most common employment status that was observed in 33 (44.6%) participants, followed by students, which comprised 32 (32%) cases. The length of diagnosis of PCOS was more than one year in 54 (54%) cases, and family history of PCOS was present in 24 (24%) cases. The presence of PCOS-related symptoms was assessed, and all 100 (100%) cases reported experiencing one or more of these symptoms. The most common symptom was menstrual cycle abnormalities, which was present in 76 (76%) cases. Weight gain was experienced by 66 (66%) cases and hirsutism by 55 (55%) cases. The presence of depression and anxiety was assessed using HADS. The mean HADS score was 7 ± 3.8 for depression and 8 ± 3.7 for anxiety. Depression was diagnosed in 18 (18%) cases (score ≥ 11), whereas another 17 (17%) cases were found to be in the borderline range for depression (score: 8-10). Anxiety was diagnosed in 15 (20.3%) cases (score ≥ 11), whereas another 20 (20%) cases were found to be in the borderline range for anxiety (score: 8-10). Conclusion: Anxiety and depression are common in patients with PCOS. These psychological conditions are associated with various demographic and socio-economic factors such as BMI, level of education, monthly household income, employment status, and pregnancy. It is recommended to involve a multidisciplinary team while managing patients with PCOS to timely identify and treat these psychological conditions in these patients.

DOI: 10.5281/zenodo.

Background and Objectives: The surgical procedures like right hemicolectomy and appendicectomy on the caecum and appendix demands a precise knowledge of vascular anatomy of ileocolic region. The aim of this study is to study the arterial supply of the caecum and appendix, findings of which may reveal more anatomical facts about the arteries of caecum and appendix and their variations. Methods: Total 32 specimens of caecum and appendix with their arteries intact were collected, cleaned and dissected. The ileocolic artery and its branches to the caecum, appendix and ileum were traced carefully and observations were recorded. Results: The ileocolic artery arises independently from superior mesenteric artery in 96.88% of cases and ends by dividing into superior and inferior division in 93.76% of cases. The anterior and posterior caecal arteries arise by a common trunk in 56.25%. The appendicular artery arises from inferior division in 46.88%, ileal branch 28.13%, ileocolic artery 18.75% and from arterial arcade in 6.25% of cases. 21.87% of cases showed additional appendicular artery. Conclusion: The ileocolic artery arises from the superior mesenteric artery independently in 96.88% and terminates into superior and inferior division in 93.76% of cases. Common caecal artery seen in 56.25% of cases, arises from inferior division (43.75%), superior division (9.38%) and ileocolic artery (3.12%).

DOI: 10.5281/zenodo.

Aim: To compare the heart rate variability between male heavy smokers and non-smokers. Materials and Methods: The SKMCH Department of Physiology at Muzaffarpur, Bihar, India, performed this case-control research. The Smoking Index: The index was developed by multiplying the average daily cigarette consumption by the years smoked. The amount of cigarettes is the average daily consumption during the last week. Light (Smoking index1-100), moderate (101-200), and heavy (>201) smokers were considered. This research comprised 50 healthy male heavy smokers and 50 non-smokers aged 20-50. Results: Resting pulse rate and blood pressure were significantly greater in smokers compared to non-smokers (p<0.05). Smokers had significantly lower levels of high frequency power in normalised unit values compared to non-smokers (p<0.05) in terms of total power (ms2) and high frequency power (ms2). Smokers had greater LH/HF ratios compared to non-smokers, with a significant difference (p<0.05). Smokers had significantly lower SDNN and RMSSD values compared to non-smokers (p<0.05). Conclusion: Compared to non-smokers, those who smoke have less parasympathetic activity and more sympathetic activity. Therefore, they are more prone to cardiovascular disorders caused by autonomic dysfunction, namely sympathetic overactivity, which is caused by smoking. Measurement of HRV may therefore serve as a screening tool for the early detection of ANS changes prior to the onset of clinical symptoms.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was aimed to evaluate the effect of adding 1 ug/kg of dexmedetomidine to lignocaine 2% and adrenaline during ear surgeries and assess the patients comparatively in terms of analgesia, hemodynamic stability and sedation. Methods: The present study was single-center, prospective, randomized study, conducted in Department of Anaesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India from Jan 2020  to December 2020. Results: Both groups were comparable in terms of age, gender and type of surgery and no statistical significance was noted. The preoperative vitals were comparable in both the groups and were statistically significant. The present study found that for first 10 mins vital parameters i.e. pulse rate, systolic blood pressure, diastolic blood pressure etc. increased and from 15 mins it started decreasing whereas grade of bleeding and sedation score were increasing. As compared between group A and group D the parameters were at a higher range in group A as compared to group D, majority of parameters had statistical significance. Rescue analgesia was required among group A at mean 25.54±11.55 min. No rescue analgesia was used among group D. Effect of analgesia was more among group D (548.6 ± 64.72) as compared to group A (258.2 ± 56.54), statistical significance was seen. Conclusion: In dexmedetomidine group pulse rate, systolic blood pressure, diastolic blood pressure, respiratory rate all the vital parameters were maintained at the lower range as compared to control group. In dexmedetomidine group, VAS score was also good, no rescue analgesia was needed, grade of bleeding and sedation score both were at lower range. The present study concluded that use of dexmedetomidine shows good results in terms of hemodynamic stability, analgesia, sedation and can be used in day to day ear surgeries.

DOI: 10.5281/zenodo.

Aim: To compare the effectiveness of local corticosteroid injection with dry needling in treating Lateral Epicondylitis. Material and Methods: This prospective randomized control trial was conducted in the Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India for eight months. A total of 42 patients between the ages of clinically diagnosed with LE utilizing provocative tests and point tenderness at the insertion of the ECRB at the lateral epicondyle. A minimum of three weeks of abstinence from the offending activity along with analgesic medication were given to the study participants before the start of the study. The inclusion criteria were, patients who had pain at lateral epicondyle for more than 3 months, patients not getting any benefit from 1 line treatment of lateral epicondylitis and patients who had pain during forced forearm supination, forced wrist extension, and forced third finger extension for more than 3 months. The patients who had other co-morbidities than the pain at lateral epicondyle, patients who have high RBS and patients having osteochondritis, dissecans, or osteonecrosis were excluded from the study. Results: The mean age of the patients was 39.9 years in group A and 43.8 years in group B. There were 18 (42.86 %) males and 24 (57.14 %) females in the study group. 16 (38 %) patients of the study group suffered LE in their dominant arms. The age distribution and sex distribution between the groups were almost comparable. In group A (DN group), the mean PRTEE score before the start of therapy, at the 4th week and 8-weeks follow-up was 68.96±6.89, 44.13±5.23 and 37.18±5.81 respectively. In group B (corticosteroid group), the mean PRTEE score before the injection, at the 4th week and 8-weeks follow-up was 65.23±4.82, 51.08±6.32 and 43.72±4.12 respectively. Conclusion: Both the techniques have proven good results at defined intervals at regular follow ups. But as the PRTEE score we found both the treatment are equally effective. But due to less complications we preferred dry injection over local steroids. More Comparative studies should be conducted to compare dry needling with other treatment modalities.

DOI: 10.5281/zenodo.

Aim: This study was undertaken to study the various histopathological patterns of ovarian lesions, their classification and relative distribution of these lesions. Methods: The study was undertaken as a retrospective systematic study using existing patient data retrieved from the records of the Department of obstetrics and Gynecology, AIIMS, New Delhi, India . 200 ovarian mass specimens were received for evaluation, either as solitary specimens, or as part of total abdominal hysterectomy (TAH) specimens. Results: Most patients were 10-39 years old. 20 (15%) instances were bilateral and 170 (85%) unilateral. 39 were symptomless. Hysterectomy specimens with salpingo-oophorectomy have associated findings. Leiomyoma and adenomyosis were most prevalent. Hydrosalpinx, chronic cervicitis, carcinoma endometrium, and carcinoma cervix were also found. Cystic follicle (14 instances), Follicular cyst, Par ovarian cyst (6 cases), hemorrhagic cyst, ectopic pregnancy, Torsion ovary, Inclusion cyst, and oophoritis did not cause cancer. Conclusion:  Several types of ovarian lesions have comparable clinical, radiological, and gross characteristics. Histopathology is the basis for diagnosing and classifying these lesions.

DOI: 10.5281/zenodo.

Background and Objective: The aortic and pulmonary valves are formed from endocardial cushions and become populated by neural crest cells, in addition to endocardial and pharyngeal derived mesenchyme. To estimate the mean of morphometric values of human aortic valve in the population of Bihar. The morphometric variables include mean area and the circumference of the human aortic valve of both genders. Materials and Methods: The present study was carried out on 30 adult cadaveric hearts in the department of Anatomy at NMCH, Jamuhar Sasaram, Rohtas. And Peripheral medical college. Heart and aortic arch were dissected according to standard dissection techniques. The aortic orifice and valves were exposed; pictures were taken keeping a plastic ruler alongside the periphery of the valve. The pictures were analyzed using Image J software (64 Bit Java 1.8.0V) to calculate circumference and area of the aortic valve. Results were analyzed using unpaired t test. Results: The mean circumference of aortic valve was 8.827 cm in males and 8.179 cm in females. The mean area of male aortic valve was 5.365cm² and female aortic valve is 4.641cm². The circumference results were found to be significant whereas the area results were not significant. Conclusion: The size of the aortic valve in the Bihar region was found to be more as compared to other studies. The present study might help the cardiothoracic surgeons as well as the prosthetic valve manufacturing companies for the rough estimation of the aortic valve size.

DOI: 10.5281/zenodo.

Background: The femur is the long bone of the lower extremity, there are no published studies on the anthropometry of the distal femur in the Indian population. Hence the results obtained from this study would provide valuable data on the average dimensions of the distal femur which can serve as guidelines for designing a suitable femoral component of total knee prostheses for this population. Methods: After applying inclusion and exclusion criteria 41 dried femur of each side (total 82) of unknown age and sex will be selected for present study. The maximum anteroposterior distance & maximum transverse distance of lateral femoral condyle, maximum anteroposterior distance & maximum transverse distance of medial femoral condyle width was measured. Results: In the present study the mean AP diameter of the medial condyle on right side was 54.55±6.88 mm and on left side was 54.36±3.56 mm, The mean Transverse diameter of the medial condyle was 27.33±3.09 mm and 25.03±1.99 mm on right and left side respectively. In AP diameter parameters no statistically significant difference found between right and left side because p value was >.05 for both parameters. But in Transverse diameter parameters are statistically significant found between right and left side because p value was <0.05. Conclusion: On comparison between right and left side measurements, no significant difference was found between values of parameters of right and left sided femur. This information will be useful to negate the need of side specific measurements for implant.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the prophylactic use of antibiotic coated intramedullary nail in treatment of open tibia fractures. Methods: This prospective study was conducted in the Department of Orthopaedics, ESICMCH, Bihta, Bihar, India. 50 patients were treated over a period of 24 months with gentamicin coated tibia interlocking nail after taking written and informed consent. Results: All 50 patients (42 males and 8 females) were followed up for minimum of six months duration. Males were 84% against females 16%. The radiological Union was assessed using RUST Score and maximum patients had score 8. Time taken in wound healing in majority of patients was less than 5 weeks (52%). Average duration of hospital stay was 16 days. Large numbers of patients had fair outcome- 54%. Conclusion: Antibiotic coated tibia interlocking nail is a good treatment option for open tibial fractures, yields good functional outcome with less complications in these fractures and should be used whenever indicated.

DOI: 10.5281/zenodo.

Background and Objectives: Adipose tissue surrounds a pair of bean-shaped kidneys that are located posteriorly below the peritoneum, one on either side of the spinal column. The average kidney is 11 cm long, 6 cm wide, and 3 cm thick anteroposteriorly. Lower poles of the kidney are associated with the third lumbar vertebra, whereas upper poles are located at the level of the 12th thoracic vertebra. Because of its proximity to the right lobe of the liver, the right kidney is slightly lower than the left. The left kidney is located closer to the median plane than the right kidney and is a tiny bit longer and narrower. The anterior and posterior aspects that are typically characterized are, in fact, anterolateral and posteromedial because the long axis of each kidney is pointed inferolaterally and the transverse axis posteromedially. Morphological and stereological parameters of developmental anatomy of kidneys are directly related to manifestations of renal disorders. In the present study, the morphological data denoting the various embryonic developmental stages of human fetal kidney were collected and tried to establish the correlation of the same with the gestational age of the fetus and further the histogenesis of the human fetal kidney was also studied in the Indian population. Fetal dissection of human kidney morphological analysis. This study provides autopsy standards for body weight, body dimensions, and fresh organ weights for non-macerated fetuses. Material and Method: This study was carried out in the Department of Surgery in NMCH, Patna. The abortus/fetus used in this study were gathered from the Department of Surgery and Obstetrics and Gynecology. 40 fetuses between the ages of 14 and 40 weeks were gathered. For the benefit of the parents and close relatives, the consent form was written in both Hindi and English. Once we receive information from sister-in-charge of labor room about availability of fetus, we immediately rushed to the labor room. Conclusion: It was concluded that in the present study that fetal weight in the population is lower than the same from Nepal as well as Eastern India. Up to second trimester end, the Gujarati fetuses were found to be heavier than the American fetuses. At terms, the Dennis, the Australian and the Gujarati fetuses were comparable in weight. In the last trimester, fetuses of Gujarati population weigh lighter than the same from the French.

DOI: 10.5281/zenodo.

Background: As Coronary artery disease is one of the most common heart diseases and also the major cause of death in developing countries. The aim of the present study is to evaluate the coronary dominance pattern which will help the cardiac physicians and surgeons for better diagnosis and management of coronary artery diseases. Methods: The study was planned on 30 heart subjects. These selected hearts are without any obvious pathology referred with cardiac conditions was enrolled into the study in NMCH, Patna. The coronary arteries were dissected and analysed for the origin of sinoatrial Nodal artery and Observations were noted. The hearts identified with the congenital anomalies were excluded from study. Conclusion: From the above study it can be concluded that the most common is the right coronary dominance compared to left and balanced dominance as seen in this study. The present study is in comparison with the data generated by previous authors. This knowledge of normal anatomy and variations of coronary dominance will help interventional cardiologist, cardio-thoracic surgeons and radiologist to plan and provide proper management to patients.

DOI: 10.5281/zenodo.

Background and Objectives: Hypertensive pregnancy may be responsible for vascular damage, enhanced systemic inflammation and insulin resistance in the placenta as oxygen and nutrient transfer is impaired and oxidative stress is generated affecting the placental growth and development. Placental growth pattern in hypertensive pregnancies shows a variable pattern owing to placental insufficiency. Method: The study was carried out on 80 sets placentae, mothers and their babies. The placentae were collected from Obstetrics & Gynecology Department of NMCH, Patna. Out of 80 placentae, 40 were from normal pregnant mothers and 40 from pregnancies complicated by PIH in previously normotensive women, serial number of placentae, mother and baby were same. placentae were collected soon after the normal vaginal delivery or caesarian section along with 10 cm long stump of umbilical cord. The aim of this study was to determine whether maternal PIH would affect the morphology and histology of placenta and compare this with that of normotensive mothers. It was a cross-sectional comparative study carried out at the maternity ward and anatomy department of NMCH, Patna. Histological findings were cytotrophoblastic cellular proliferation, syncitial knot formation, fibrin plaque formation. In 20 percent cases, villi were hypovascular. The hypovascular villi have abundance of syncitial knots, usually lack vasculosyncitial membrane and increased stromal collagen. Conclusion: PIH adversely affect both morphology and histology of placenta. Conclusion: From the above study it can be concluded that the most common is the right coronary dominance compared to left and balanced dominance as seen in this study. The present study is in comparison with the data generated by previous authors. This knowledge of normal anatomy and variations of coronary dominance will help interventional cardiologist, cardio-thoracic surgeons and radiologist to plan and provide proper management to patients.

DOI: 10.5281/zenodo.

Aim: To investigate the plasma lipid profile parameters and their internal ratios in psoriasis patients who have been clinically grouped. Material and Methods: This study was conducted Department of Dermatology, GMCH, Purnia, Bihar, India for one year. Detailed history, regarding the illness, duration of disease, the drugs taken as well as food habits was collected. The normal control subjects were taken from the employees of Medical College and affiliated hospitals. Psoriasis patients are clinically sub-grouped into Mild, Moderate and Severe depending on their PASI Scores. A fasting heparinized blood sample (5-7ml) was collected from selected psoriasis patients as well as from chosen normal control subjects after obtaining an informed consent. The blood samples were centrifuged at 3500 rpm for ten minutes. The separated plasma was employed for estimation of Total Cholesterol,  Triacylglycerols and HDL Cholesterol. Results: It is evident that TC/HDLC, TC/LDLC, TAG/HDLC, TAG/LDLC are significantly elevated in psoriasis patients as compared to normal control subjects whereas the ratios TC/TAG, TC/VLDLC, HDLC/LDLC, HDLC/VLDLC and LDLC/VLDLC are significantly lowered in psoriasis patients as compared to normal control subjects. The elevation in TAG/ HDLC is much significant (1.86 ± 0.28 in normal controls against 5.42 ± 0.78 in psoriasis patients) indicating the possibility that this ratio may be employed as a cardiovascular disease marker in Psoriasis. It is seen from the table that there is parallel rise in the ratios of TC/ HDLC, TAG/HDLC, TAG/LDLC with the severity of disease whereas a significant parallel decrease in the ratios of TC/TAG, TC/VLDLC, HDLC/LDLC, HDLC/VLDLC and LDLC/ VLDLC with the severity of disease. Further the rise in the ratio of TAG/HDLC is so profound with the severity of psoriasis disease that it is possible to use this ratio as a marker of psoriasis disease severity. Conclusion: It can be concluded from the results obtained in the present study that psoriasis patients are vulnerable group for the dyslipidemia induced cardiovascular complications and the ratio TAG/HDLC is quite promising marker of the cardiovascular complications in psoriasis.

DOI: 10.5281/zenodo.

Background: Septal deviations are extremely common and may develop at any of septal articulation and spurs may also be found where the quadrilateral cartilage sends small process between the ethmoid and vomer. Method: The present study, carried out in the Department of ENT (Otorhinolaryngology), DMCH, Laheriasarai, Darbhanga. a total of 100 patients with clinical evidence of chronic rhinosinusitis were evaluated with Nasal endoscopy and CT scan PNS coronal view from Study duration is Two years. Results: DNS was observed unilaterally in all cases with no bilateral DNS. Among the unilateral DNS left sided DNS showed predominance. Majority of cases had mucoid bilateral nasal discharge (80%) in group Band 76% in group A Inferior turbinate hypertrophy was observed in 70 % group B and 20 % in group A. Middle turbinate was found to be 24% in group B and 10% group A. Conclusion: Endoscopic septoplasty allow accurate, conservative repair of obstructive nasal septal deviations, with fewer complications and better functional results compared to conventional septoplasty however, the endoscope has its own limitations which include loss of binocular vision , need for frequent cleaning of the tip of endoscope especially when there is more bleeding and lastly by endoscopic approach to septoplasty complex deformities with caudal deflections could not be corrected. Residual deviation and spur was not seen in any case undergoing endoscopic septoplasty.

DOI: 10.5281/zenodo.

Background: The distinctive morphology of human skeleton and its clear sexual dimorphism make it of interests from anatomical, forensic, obstetrical, radiological and anthropological point of view. The hip bone is considered as an ideal bone for sex determination as it provides the highest accuracy levels. Many workers have studied various metric parameters for sexing of hip bone. Methods: The present study was done with an aim to find out the sex of hip bone using various parameters of greater sciatic notch. For this purpose, 100 dry hip bones were collected from the Department of Anatomy. At MMC, Madhubani, Bihar. Seven different parameters of the greater sciatic notch were used for the study: Maximum width, Maximum depth, Posterior segment, Index I, Index II, Total angle and Posterior angle. Results: All the parameters (especially posterior segment, posterior angle and index II) were found to be highly indicative of sex hip bone by t- test (p<0.005) except the depth. Conclusion: By the present study it was concluded that the width and depth of the greater sciatic notch were a less useful criteria for sexing purposes while the posterior angle was found to be the best parameter, which identified 75% of left and 88% of right male hip bones and 92% of left and 100% of right female bones. Length of the posterior segment and Index II also assigned sex to a high percentage of hip bones, specially to the female ones (95-97%), these results suggests that the widening of the greater sciatic notch found in females has occurred mainly in its posterior part.

DOI: 10.5281/zenodo.

Background and Objectives: The supracondylar spur of the humerus is a hook-like, bony spine that protrudes distally from the humerus’s antero-medial surface. It is located around 5 cm from the medial epicondyle. Its length ranges between 2 and 20 mm. Ligament of Struthers may be used to connect the supracondylar spur to the medial epicondyle in some circumstances. The brachial artery and the median nerve may travel beneath the band, making it prone to compression. The goal of this study was to see how common supracondylar spur is in North Indian dry humeri, as it can help with the differential diagnosis of supracondylar syndrome. Materials and Methods: 224 dried humeri from tertiary healthcare centres in North India were studied for the period of three years in the departments of Anatomy and Forensic Medicine, DMCH Laheriasarai, Darbhanga. including 106 from the right side and 118 from the left. The bones were thoroughly inspected for the presence of a supracondylar spur. A digital calliper was used to collect measurements after the findings. Results: Only two left-sided humeri out of 224 dried humeri studied had a supracondylar spur, which was triangular in shape and projected forwards and medially from the anteromedial surface. The spur protruded 0.4 cm from the surface, with a vertical length of 1 cm and a width of 0.8 cm. The medial epicondyle was 5.2 cm away from the spur. Conclusion: The supracondylar spur is a natural anatomical variation rather than a chronic disease of the bone. Compression of the median nerve and claudication of the brachial artery are possible side effects.

DOI: 10.5281/zenodo.

Background and Objectives: Nutrient artery enters the bone obliquely through the nutrient foramen, which is directed away as a rule from the growing end, to locate and describe as well as to observe any variation in the number and the position of nutrient foramen of fibula. Material and Method: Present study was done on 189 human dried fibulae collected from Madhubani medical college Madhubani, Bihar. In this study we used magnifying hand lens and a thin stiff wire to confirm the number and direction of nutrient foramen. Results: Out of 189 fibulae examined, 168 (88.88%) showed a single foramen while 17 (8.99%) possessed double foramina and 4 (2.11%) are having no nutrient foramen. Of the total 202 foramina, 197 (97.5%) existed in the middle third, 3 (1.5%) in upper third and 2 (0.99%) were in the lower third of the shaft. Conclusion: This study has provided information on the morphology and topography of nutrient foramen in fibulae. This knowledge of nutrient foramen is useful in certain surgical procedures to preserve the circulation.

DOI: 10.5281/zenodo.

Background: Mucormycosis emerged as catastrophe in an already devastatating scenario of COVID-19. Rhino-orbito-cerebral form was found to be most common, combined with heavy corticosteroid use and coexisting diabetes mellitus, it posed a difficult and novel situation to clinicians and surgeons worldwide. Looking back and reassesing clinical and surgical practices was needed to prepare better for such scenarios in future. Methods: A retrospective observational study was done at Department of ENT, AIIMS Patna assessing patients admitted  for COVID associated Mucormycosis during May 2021 to July 2021. Data was collected via a google form extracting clinical records of patients and was analysed in a descriptive format using simple statistics. Results: A total of 130 patients were analysed, diabetes mellitus being the most common comorbidity. Maxillary sinus was the most common subsite involved, most of them needed open surgical debridement, craniotomy was done for 3 patients. An endoscopic approach was used in 44 patients. Orbital exentration was needed in 8 patients. Corticosteroid use was seen to be significantly associated with development of the disease. Conclusion: COVID associated mucormycosis posed a unique and serious challenge to ENT surgeons, use of corticosteroids in managing COVID-19 further complicated the disease progression. Both open and endoscopic surgical debridement were appropriate and helpful in reducing disease burden and better penetration of antifungal drugs.

DOI: 10.5281/zenodo.

Objective: To assess the role of tinnitus retraining therapy and hearing aid use in management of patients presenting with tinnitus and presbycusis. Materials and Methods: A retrospective observational study was done at Department of ENT, Aiims Patna. A total of 75 patients aged 50 years or more who had attended OPD with complaints of hearing loss and tinnitus and were given TRT sessions with or without hearing aid were included in the study. Data was collected from hospital records and analysed using SPSS version 2.0. Results: Of the 75 patients, 54(72%) were males and 21 (28%) were females. The mean age of male patients was 60.74 years and female patients was 54.29 years. 56 patients (74.7%) had bilateral (B/L) and 19 patients (25.3%) had unilateral (U/l) tinnitus. A mean 18.03±3.09 TRT sessions were administered to patients. A total of 52 patients were prescribed and used digital hearing aids. All patients except for one experienced an improvement in tinnitus. Conclusion: Tinnitus retraining therapy is an effective tool in the management of symptoms related to this condition to a large extent. Hearing aid plays a significant role in alleviating hearing loss and tinnitus in such patients.

DOI: 10.5281/zenodo.