Purpose: The purpose of the study is to determine the cut-off value of SED at the level of the thyrohyoid membrane significant for predicting difficult direct laryngoscopy. Methodology: This cross-sectional study was conducted in the Department of Anaesthesiology at Government Medical College, Idukki, over six months following IEC clearance. The study aimed to determine the cut-off value of sonographically assessed skin to epiglottic distance (SED) at the thyrohyoid membrane for predicting difficult direct laryngoscopy and its association with standard clinical parameters. The inclusion criteria were ASA I, II, and III patients over 18 years undergoing elective surgery under general anesthesia, who consented to participate. Exclusion criteria included patients with skin lesions on the anterior neck, pregnant women, and patients with any mass at the thyrohyoid membrane. A total of 50 participants were selected through consecutive sampling. Result: The study’s analysis of SED and BMI in predicting intubation difficulty provides key insights. For SED, the optimal cutoff value was 18.10 mm, yielding an AUC of 0.444, indicating poor discriminatory ability (p = 0.532). Sensitivity was 46.7%, specificity was 94.3%, PPV was 48.5%, and NPV was 96.0%. Despite the high NPV, the low AUC and PPV suggest limited overall reliability in predicting difficult direct laryngoscopy. The chi-square test showed a significant association between BMI and intubation difficulty (P = 0.03, X² = 7.493), suggesting that higher BMI may correlate with more challenging intubation experiences. Conclusion: The study examined various predictors of difficult intubation, including thyromental distance, mouth opening, temporomandibular joint insinuation, MMPC, skin-to-epiglottis distance (SED), and BMI categories. For SED, the optimal cutoff value was 18.10 mm, with an AUC of 0.444 and poor discriminatory ability (p = 0.532). BMI categories showed a statistically significant association with intubation difficulty (p = 0.03), with higher BMI correlating with more challenging intubation experiences.

DOI: 10.5281/zenodo.

Aim: The present study was planned to find the prevalence of INH and Rifampicin resistance in the treatment naïve new tuberculosis cases. We also tried to find a correlation between sputum grading, sociodemographic factors, and resistance patterns. Methods: It was a cross-sectional study done conducted in the Department of TB and Chest, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for the period of 2 years. 100 patients were included in the study. All Adult patients attending Department of TB and Chest who were diagnosed with new sputum smear-positive tuberculosis and have not received ATT drugs for more than 2 weeks were included in the study after taking informed written consent. Results: A total of 100 newly diagnosed microbiologically confirmed cases of pulmonary tuberculosis were recruited in the study. Most of the patients were male (n=80, 80%) and a mean age of 45.435 (SD ±12.18) years. Based on the Modified Kuppuswamy socioeconomic scale 55% cases belonged to the lower socioeconomic group, whereas 35% belonged to the upper lower group. 20% were smokers and 80% were non-smokers. 85% patients presented with cough as chief complaint followed by Fever in 35%, loss of appetite in 50%, and loss of weight in 45% cases. Among comorbidities, Diabetes mellitus was most common followed by asthma. None of the cases had a previous history of anti-tubercular drug intake. All cases were HIV-Sero-negative. Conclusion: INH resistance was found to be low (5.6%) with negligible MDR in the current study. Regular and large studies are needed to quantify and tackle the problem of primary MDR TB.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess timely initiation of breastfeeding and associated factors among mothers of children less than 12 months old. Methods: The present study was conducted in Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India and mothers who have a child less than 12 months of age were included in the study. Total 1000 mothers were included in the study. Results: In this study, 500 mothers had infants less than 12 months participated in this study making the response rate 98%. The mean age of mothers that participated in this study was 24.96 with the standard deviation of (±0.970). About 700 (70) of respondents were Hindus in their religious affiliation. About 400 (40%) of mothers completed primary school and 750 (75%) of them were housewives. Around 520 (52%), and 480 (48%) of them were females and males respectively. About 900 (90%) of the study participants had exposure to mass media and the majority of respondents. The highest majority, 850 (95) of respondents had received antenatal care (ANC). About 800 (88.88%) of participants started their antenatal care before fifth month of gestation. Majority, 520 (57.77%) had four antennal visits. 586 (65.12%) of the study participants had gotten counseling on breast feeding. 500 (55.55%) were receiving counseling on timely initiation of breastfeeding. 800 (80%) respondents delivered at health institutions and 440 (88%) of them were assisted by health professionals. 860 (86%) of the mothers had spontaneous vaginal delivery. About 34% mothers did not give breast milk within 1 hour after delivery to their infants because of maternal illness. The Bivariate logistic regression analysis yielded that sex of the child, place of delivery for the current child, mode of delivery, exposure to media and family type were statistically associated. Conclusion: Prevalence of timely  initiation of breast feeding experienced by mothers was 80%. Being male infant, living with nuclear family, spontaneous vaginal delivery and counseling on timely initiation of breast feeding during ANC were factors associated with early initiation of breastfeeding.

DOI: 10.5281/zenodo.

Introduction: Thyroid hormone abnormalities frequently coexist with liver diseases, impacting disease progression and treatment outcomes. This study aims to explore the spectrum of thyroid dysfunction in liver diseases, elucidating underlying mechanisms to guide targeted interventions and improve patient care. Methods: The study enrolled eligible inpatients with liver disease, conducting detailed history-taking, clinical examinations, and investigations including thyroid function tests. Symptom duration categorized liver disease as acute or chronic, with ascites and hepatic encephalopathy graded for severity. Institutional ethical approval and informed consent were obtained. Child-Pugh scores assessed chronic liver disease severity. Results: Ninety-six participants were included, 12 with acute liver disease (ALD). Mean ages were 44.83 ± 15.33 for ALD and 46.13 ± 13.99 for chronic liver disease (CLD). Gender distribution: ALD (91.7% male), CLD (20.2% female). Significant associations were found between ALD and CLD in ascites severity and thyroid hormone levels. Conclusion: The study elucidates the diverse presentations and underlying mechanisms of liver diseases, highlighting age and gender disparities, as well as the intricate interplay between liver and thyroid function. These findings underscore the importance of personalized management strategies tailored to individual patient characteristics, optimizing clinical outcomes in liver pathology.

DOI: 10.5281/zenodo.

Introduction: Stroke, a cerebrovascular accident, results from vascular causes, including ischemic or hemorrhagic events. Its diagnosis relies on clinical assessment and imaging studies. With a significant global health burden, stroke ranks among leading causes of morbidity and mortality. Prevention and management strategies, including Mean platelet volume (MPV) association studies, are vital for mitigating its impact. Methods: This cross-sectional study involved thorough clinical assessments using a pre-designed questionnaire and diagnostic tests. Stroke severity was evaluated using the Modified Rankin Scale (MRS), providing insights into disability-adjusted life years (DALY). Statistical analysis utilized a significance level of P< 0.05 to determine meaningful associations. Results: The study involved 92 participants, mean age 60.39 ± 7.75 years, with 53.3% male and 46.7% female. Prevalence rates included hemiplegia (34.8%), altered sensorium (22.8%), headache (19.6%), vomiting (18.5%), convulsions (4.3%), hypertension (47.8%), coronary artery disease (32.6%), dyslipidemia (31.5%), and smoking history (28.3%). Glasgow Coma Scale categorized severity. MPV remained stable across time points. Conclusion: The study underscores the significant impact of stroke, with consistent findings across age, gender distribution, symptomatology, comorbidities like CAD and severity based on GCS scores. Furthermore, it highlights a notable association between MPV and stroke severity.

DOI: 10.5281/zenodo.

Introduction: Bloodstream infections (BSIs) are a leading cause of morbidity and mortality in hospitalized patients. Coagulase negative staphylococcus (CoNS) is the leading cause for the contamination of blood cultures (BCC). With this a study was conducted to find the various pathogens isolated in the blood cultures those with BSIs. Methods: It was a prospective research, conducted in the department of Microbiology, Rangaraya Medical College, Kakinada between March to May 2024. Individuals aged >18 years suspected with BSIs were included, those on antimicrobial treatment were not considered. Two blood samples were collected as per the guidelines and Brain heart infusion (BHI) biphasic media was used for culture. Blood culture, identification were carried as per the guidelines. Results: Total 74 members were included and 22 (30%) blood cultures were positive. Klebsiella (8) was the leading isolate followed by Esch.coli (5), Staph. aureus (4) Acinetobacter baumannii (3) and CoNS (2). Maximum drug resistance (DR) was observed to ampicillin and there was no Vancomycin resistance. Conclusions:  In this study, 30% blood culture were positive. GNRs are the common isolates and Klebsiella was the common isolate. No significant DR was identified. Short duration is the limitation of this research.

DOI: 10.5281/zenodo.

Aim of the Study: To assess the incidence of contrast induced nephropathy, defined as a raise in post-procedural creatinine by >25% over the baseline, in patients undergoing cardiac catheterization studies. Material & Methods: Patients were identified as hypertensives if already diagnosed and on treatment or newly detected with a Blood pressure of 140/90 or more as defined by JNC. Patients with Diabetes mellitus were defined as known diabetics on treatment or patients with a random blood sugar value of >200mg/dl as defined by ADA guidelines. Blood. Results: Results are presented as mean ± SD or a percentage of the total. The significance of difference in means between two groups was calculated by means of Student’s t test and the significance of difference in proportions were compared with Pearson’s χ2 (chi-square) test. Statistical significance was taken to be significant at 1% level when P value was < 0.001, significant at 5% level when P value was between 0.011 to 0.05, and not significant at 5% level when P value was >0.05. Conclusion: It was noted that among the 200 patients followed up in the Department of Cardiology 56 developed CIN (28%). Among the patients who developed CIN, it was noted that common risk factors were increased Age, elevated baseline serum creatinine, low baseline creatinine clearance, and multi-vessel coronary disease. Identification of these risk factors before subjecting the patient to angiogram studies gives us an opportunity to anticipate development of CIN and to use prophylactic measures to prevent CIN.

DOI: 10.5281/zenodo.

Background: Proximal femoral nail antirotation-2 (PFNA-2) has been extensively utilized for treating intertrochanteric fractures, with previous studies reporting varied outcomes. The entry point of the nail is crucial for achieving acceptable reduction, stable fixation, and minimizing implant-related complications. This study aims to determine the optimal greater trochanteric entry point for PFNA-2 in managing unstable intertrochanteric femur fractures. Methods: A retrospective analysis was conducted to assess the outcomes of PFNA II nail fixation in unstable intertrochanteric fractures. The study cohort comprised 20 patients (15 males and 5 females) with a mean age of 58.66 years (range: 35-70 years). Right hip involvement was observed in 12 patients, while the remaining 8 patients sustained fractures in the left hip. The majority of fractures (10) were attributed to low-energy falls. The remaining cases were caused by high-energy mechanisms such as motor vehicle accidents or falls from a significant height. Preoperative radiographs were used to classify the fractures according to the AO classification system, with distribution as follows: 10 (31.A1), 7 (31.A2), and 3 (31.A3). Results: PFNA II nails showed promise for intertrochanteric fractures (n=20). Small (200mm) nails were the most common (50%). Most patients achieved good fracture healing (75%) and alignment (75%). Intraoperative complications were limited (fracture of the greater trochanter in 15%). Postoperative complications were mostly minor (nail mismatch 10%, pain 5%). Functional outcomes were positive, with 80% of patients achieving good or excellent scores on the Harris Hip Score. Conclusion: In conclusion, our study suggests that the PFNA II nail presents a promising option for the surgical management of unstable intertrochanteric fractures. This fixation method offers potential advantages of reduced operative time and a demonstrably low complication rate.

DOI: 10.5281/zenodo.

Background: According to the World Health Organization (WHO), obesity is one of the most common neglected public health problems in both developed and developing countries. Undernutrition due to poverty, dominated in the past is being rapidly replaced by obesity associated with affluence. Aim: To study the prevalence of undernutrition and overnutrition among young medicos. Materials and Methods:  The study was done among young medicos who joined in Ⅰ MBBS in Government Medical College, Ananthapuramu from all over India. A total of 150 students were included in the study. Out of them, 73 were females, 77 were males. Anthropometric measurements of Height and Weight of each student were taken. BMI was calculated. Subjects were categorized based on BMI, as Underweight, Normal, Overweight and Obese. Waist Hip Ratio was measured and calculated. Random blood sugar values were measured to assess the glycemic status. Hemoglobin levels were measured and assessed for the presence of anaemia. Results: Based on BMI, the overall prevalence of Malnutrition in the present study was 38.6 %, Under nourished was 16.6 %, and over nourished was22 %. Based on WHR, prevalence of Obesity is more in females (47%) when compared to males (23.3%). The prevalence of Anaemia was more in males (44.2%) compared to females (41%). In this study, BMI was not significantly related with anaemia. In the present study, all 150 students RBS values were within the normal range. Conclusion:  Overnutrition, incidence is increasing in all ages including adolescence. Hence nutritional evaluation should be done in all ages which will help in giving proper preventive measures like Lifestyle modification thereby prevention of various metabolic and cardiovascular diseases.

DOI: 10.5281/zenodo.

Background: Thalassemia is a genetic disorder marked by reduced or absent globin chain synthesis in haemoglobin. Approximately 15 million people globally suffer from thalassemia, with 240 million carriers of β-thalassemia. In India, 30 million are carriers, and 12,000 infants are born annually with severe forms. This study aim to evaluate serum ionized calcium levels in thalassemia major patients and explore the correlation between serum ferritin and calcium levels. Methods: An observational study (March 2023 – March 2024) at C. U. Shah Hospital, Gujarat, involved 50 children (ages 1-18 years) with transfusion-dependent beta thalassemia. Exclusion criteria included those on calcium, vitamin D supplements, or non-deferasirox iron chelators. Data collection comprised patient’s histories, clinical examinations, and blood tests (serum ferritin and ionized calcium). Pearson correlation test was used for statistical analysis. Results: The majority of patients were in the 5-10 year age group, with a male predominance (64%). Most were from rural backgrounds and the mean age was 8 years. Most children were diagnosed between 6-12 months (52%).A significant negative correlation was found between serum ferritin and serum ionized calcium levels (r = -0.674, p < 0.001). Treatment with deferasirox significantly reduced serum ferritin levels over time. Conclusion: This study shows a significant inverse relationship between serum ferritin and ionized calcium levels in transfusion-dependent beta thalassemia major patients. Regular monitoring and effective use of iron chelators are crucial to prevent complications. Future research should explore combined therapies and genetic mechanisms of iron-induced hypoparathyroidism to optimize care.

DOI: 10.5281/zenodo.