Background: Intrathecal opiods enhance analgesia from subtherapeutic dose of local anesthetic and make it possible to achieve successful spinal anaesthesia using otherwise inadequate doses of local anesthetic. Hence the aim of the present study was to evaluate the effects of fentanyl and clonidine added to Bupivacaine, for caesarean section in spinal Anaesthesia. Materials & Methods: Patients were randomly allocated into 3 groups of 80 each.  A- Control Group – Injection (0.5%) Bupivacaine 1.8 ml + 0.4 ml NS, B- Study group 1 inj. (0.5%) Bupivacaine 1.8 ml + Clonidine 30 μg) + 0.2 ml NS, C- Study group 2 Inj (0.5%) Bupivacaine 1.8 ml + Clonidine (30 μg) +fentanyl (10μg). Total duration of analgesia was taken as the period from the time of giving subarachnoid block till the patient’s first requirement of analgesic medication. Results: The pain free time between the groups were compared in the table 1. The means of three groups were 131.5 ± 25.5, 182.6 ± 18.3 and 224.2 ± 29.2 respectively. They were significantly differed between them. The sedation levels of three groups were associated in the above table 2. The sedation level 1 was associated with groups A and B. The sedation level 2 was associated with group C. The above associations were statistically very highly significant. Conclusion: The above study bears out the following facts. Intrathecal clonidine and the clonidine fentanyl combination, both improved quality of Intra Operative analgesia. Combination of clonidine with fentanyl increased the intra operative analgesic efficacy and significantly prolonged postoperative analgesia compared with clonidine alone.

Background: To assess the existing knowledge about palliative care among physicians and to assess the existing awareness about palliative care practices among physicians. Methods: Cross-sectional, anonymous, self-administered questionnaire survey was done with a group of 100 conveniently sampled physicians. This study used psychometric methods, including item response theory, intraclass correlation coefficients, and known-group validity. included 20 items across the following 4 domains: (1) palliative care, (2) Hospise (3) Terminal illness (4) Pain control . There was a significant difference in the scores between palliative care specialists and other physicians. Results: Most of the physicians have heard about palliative care in their residency/ post graduation days and are aware that it is mainly for all terminally ill patients. None have received any formal education or training in palliative care. Almost 30% didn’t know that the main aim of palliative care is to improve quality of life. Most physicians came to know about palliative care and hospice through their friends and internet. All physicians believe that patients should be taken care of at home or in hospice and there should be judicious use of opioids with spiritual councelling. Most of them were not aware about the Narcotic Drugs and Psychotropic Substances Amendment Act 2014 or WHO ladder of pain .Most only knew about VAS scoring system of pain and didn’t know about other pain scores. Conclusion: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Amongst doctors of various departments, there is a lack of training and awareness in palliative care. Almost all are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care.

Background: Psychiatric illnesses are one of the major causes of morbidity nowadays. Mental and behavioral disorders are universal across all regions, societies and countries not exclusively limited to any special group. Prescription of psychotropic drugs are increasing day by day which results increase health care cost of person and country, occurrence of number of adverse drug reactions (ADRs), noncompliance, discontinuation of therapy and prolong hospitalization. In developing countries like India, various factors like cost and availability of drugs, local paradigms, decision of physician, and social and culture-specific barriers play important role in prescription of psychotropic drugs. Material and Methods: A prospective cross sectional drug utilization study was carried out in 600 patients visiting psychiatric outpatient department after approval from institutional ethics committee. Drug use indicators and adverse drug reactions (ADRs) due to psychotropic drugs were analyzed as per study criteria. Results: Major depressive disorder (34.66%) and schizophrenia (30%) accounts highest morbidity among observed psychiatric illnesses. Most of the psychiatric illnesses were found in the age group of 35-44 years in both sexes. Out of the 600 patients surveyed, 299(49.83%) and 301(50.16%) belonged to male and female respectively. Around 93.33% drugs are prescribed by generic name among the prescribed drugs. 42.85% drugs are prescribed from WHO Essential drug list (2017) and National Essential drug list (2015). Atypical antipsychotics were more prescribed than typical antipsychotics in schizophrenia. Anticholinergic drug was co-prescribed in schizophrenic encounters parallel to antipsychotic drugs suggest its overuse and irrational use. Prescribing frequency of selective serotonin reuptake inhibitors (SSRI) was found greater than tricyclic antidepressant in major depression. Lithium (36.73%) and sodium valproate (35.71%) were prescribed in bipolar mood disorders in decreasing order. Average cost for psychotropic drugs per encounter was 60.54 INR per month. 64 patients (10.66%) from the total of 600 patients developed ADR. ADRs were observed most commonly in age group of 25-34 years according to preferred term (PT), tremor (21.87%) followed by salivation (12.5%) and rigidity (9.375%) were most commonly reported reactions. Risperidone was responsible for most of the ADR (37.5%) followed by lithium (14.06%) and fluoxetine (12.5%). Conclusion: Major depressive disorder was the most common psychiatric illness followed by schizophrenia, bipolar mood disorder and schizoaffective disorder. Females were more affected with depressive disorder while males with schizophrenia, bipolar mood disorder. Most of the psychiatric illnesses were found in the age group of 35-44 years in both sexes. Atypical antipsychotics were more prescribed than typical antipsychotics in schizophrenia. Prescribing frequency of selective serotonin reuptake inhibitors (SSRI) was found greater than tricyclic antidepressant in major depression. Lithium and sodium valproate were prescribed in bipolar mood disorders in decreasing order.

Aims: The present study evaluates the antidiabetic activity of Piper Betle leaves extract on the blood glucose level of streptozotocin induced diabetic rat models. Objective: To study the antidiabetic activity of aqueous extract of Piper betle in streptozotocin induced diabetes in albino rats. ii) To compare the antidiabetic activity of Piper Betle extracts with that of standard drug glibenclamide used in the treatment of type 2 diabetes mellitus. Materials and Methods: In the present study 24 male albino wistar rats divided into 6 groups with 6 animals were taken. One group as control was given normal saline for 15 days daily. Other 3 groups were induced diabetes. Standard and test groups were fed with glibenclamide (0.5mg/kg) and aqueous extract (50, 100, 150mg/kg) daily for 15 days respectively caused a significant (P<0.01) reduction in blood glucose levels in diabetic rats. The body weight of diabetic animals was also improved after daily administration of extracts. The extract also improved other altered biochemical parameters associated with diabetes. Result: The results were analysed with student t-test.

Background: Adjuvants are added to 0.5% heavy bupivacaine to improve the quality of spinal anesthesia and prolong the duration of motor and sensory blockade. Tramadol, a centrally acting opioid analgesic, has minimal respiratory depressant effect as it has 6000-fold less affinity for µ receptors compared to morphine whereas midazolam occupies benzodiazepine receptor that modulates γ-amino butyric acid (GABA), a major inhibitory neurotransmitter in the brain. Methodology: A prospective randomized study was conducted among 70 patients who were posted for various elective infraumbilical surgical procedures. They were randomly divided by the closed envelope method into two groups of 35 patients each, Group M (Midazolam) and Group T (Tramadol). Subarachnoid block was performed using a 27-gauge Quincke spinal needle with intrathecal hyperbaric bupivacaine with adjuvants. Onset and duration of the sensory and motor blockade along with post-operative analgesia were assessed. Results: The onset of sensory and motor blockade was comparable as there was no statistical significance. There was a statistically significant difference in sensory blockade prolongation in the tramadol group, whereas motor blockade was significantly less in the tramadol group than in midazolam. Both the groups had stable hemodynamics both intraoperatively and postoperatively. The midazolam group shows sedation as a significant side effect. Conclusion: We conclude that adjuvant tramadol is better than midazolam when used along with intrathecal bupivacaine.

Background: Carcinoma esophagus is one of the least studied and deadliest cancers worldwide because of its extremely aggressive nature and poor survival rate. Overall, at the time of presentation, more than 50% of patients had metastatic disease, near 30% had locally advanced disease and less than 20% had a localized stage that could be cured. Aims and Objectives: To document and analyse: (1) Various modalities of treatment in esophageal carcinoma. (2) Surgical interventions with particular emphasis on postoperative events and their outcomes. Materials and Methods: All patients with esophageal carcinoma presented to the surgical wards of KRH Mysuru from January 2019 to June 2020 for 18 months with clinical / pathological / radiological endoscopic / CT / MRI features of esophageal carcinoma. A total of 33 patients were included in the study and had undergone curative resection. This was a hospital-based cross-sectional study. Routine blood investigation, x-ray chest, abdominal pelvic ultrasound, upper GI endoscopy, HPE of biopsy, CT chest and abdomen done and patient planned accordingly into primary surgery or CTRT. Postoperative complications were identified promptly and managed accordingly. Patients after recovery were followed on an OPD basis and examined thoroughly for complications. Results: The incidence of carcinoma esophagus in our institution by our study was 33/645 (5.1%). The most common age group was 51 to 60 years and males outnumbered females (5.6:1). The most common location was in the middle 3^rd and squamous cell carcinoma was the most common histological variant. Out of 33 cases, 14 (42%) cases were early cancer and 19 (56%) were locally advanced cancer. And 7 cases (21%) underwent NACT, and 26 cases (78%) underwent primary surgery. 21 cases (63%) got discharged within 10 days of hospital stay. 15 cases (45%) had respiratory complications. The number of postop mortality was 4 cases. Gastroesophageal reflux and dysphagia were the commonest complications during follow-up.

Background: Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi. Most commonly it affects male population and involves the mucous membranes of the nostrils, nasopharynx and eyes. Involvement of cutaneous locations including lid and cheek has been seldom given account of. Here we are presenting a case series of ten cases of Rhinosporidiosis over cutaneous sites. The disease responds well to wide local surgical excision and follow up treatment with Dapsone. Material and Method: In this case series we have included all the cases of cutaneous rhinosporidiosis which were observed in the past three years in tertiary medical health care centres of Chhattisgarh. Results: Although rare, it is not so uncommon to find Rhinosporidium seeberi on cutaneous sites. Chhattisgarh is primarily a tribal area and due to lack of sanitation and clean water facilities cutaneous rhinosporidiosis was diagnosed in ten patients in this study. In our study the age ranged from 2^nd -6^th decade. It was found to be more common in male population which may be attributed to their more outdoor activities than females. The male to female ratio was 7:3. The most common cutaneous site of rhinosporidiosis in our study is ocular region followed by parotid region, cheek, chin and extremities. In one of the patients multiple site involvement with recurrence was also noted. Conclusion: Although the commonest site of rhinosporidiosis is mucosa, still in rare instances it can also present as cutaneous lesions. It is more common especially in backward and tribal areas due to lack of awareness, poverty and poor hygienic conditions. The disease responded well to wide local surgical excision and follow up treatment with Dapsone.

Introduction: While managing COVID -19 patients, the healthcare professionals are at higher risk for contracting the infection and also could be a potential source of transmitting the disease in the community unknowingly. Therefore awareness [knowledge, attitude, and practice (KAP)] among healthcare professionals becomes of utmost importance. Methods: We conducted this observational cross sectional study to evaluate the knowledge, attitude and perceived practices toward COVID-19 among HCWs  using a self-administered questionnaire at tertiary level healthcare facility in western Rajasthan. The questionnaire was shared with  all the healthcare professionals of the pre identified tertiary care facilities through electronic mail (e-mail) and the responses received were recorded and analyzed. Results: A total of 59 responses were recorded. Out of the total participants, 61% were aware of national COVID-19 helpline numbers, 54.2% answered correctly about Hydroxychloroquine prophylaxis, 13.6% answered appropriately on COVID-19 testing. Almost 96.6% acknowledged to wear a medical mask however only 55.9% participants answered correctly regarding using a face mask. 52.5% responded that ash collection as a ritual may be allowed after funeral (cremation) of the body of a COVID-19 patient. More than 90% of participants acknowledged to clean their hands > 6-10 times in a day. 72.9% of participants admitted to open the MoHFW website to keep themselves updated on COVID-19 in India and 66.1% have ‘Aarogya Setu’ application in their mobile phone. However only 23.7% have ever used central helpline number or email-ID to get information on COVID-19. Conclusion: We concluded that healthcare professionals were aware of the management strategies and treatment protocol however there is significant differences in the KAP of HCW sub groups. It also becomes important to study the KAP in various other populations (general populations, close contacts of COVID-19 etc.) for planning effective intervention strategies for them.

Background: Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide with continuously increasing prevalence. Macroangiopathy, a relatively serious complication of DM. Carotid intima-media thickness (CIMT) is an established marker of atherosclerosis. Left ventricular global longitudinal strain (LVGLS) is an echocardiographic measure of left heart function, which can unmask subclinical left heart abnormalities. However, it is unknown whether increased CIMT and FMD are independently associated with subclinical left heart dysfunction assessed by speckle-tracking echocardiography. Aim: To detect subclinical atherosclerosis and LV Strain and Volume in type 2 diabetes patients. Methods: 100 consecutive adult patients (> 18 years of age) with type 2 diabetes (T2DM) referred for cardiovascular risk assessment as part of regular patient care attending the OPD of the Department of Cardiology, SCBMCH, Cuttack were selected as observational group and subsequently compared with control group of 100 age and gender matched healthy subjects. Results:  Average CIMT was 0.071 ± 0.01cm, higher and statistically significant among the DM cases in comparison to controls (0.043 ± 0.010 cm, p=<0.001). No difference in, septal s’, and lateral a’ between the groups was found. Subjects with diabetes showed a reduced GLS (-17.78 ± 2.86) as compared to controls (- 23.29 ± 1.82) [ p <0.001]. Finally, Pearson correlation coefficient between FMD % and GLS is 0.401 indicating a significant positive weak linear relationship between these two. Conclusion: Adding GLS, the most robust deformation marker, to LVEF increases the accuracy of predicting early ventricular functional decline and future cardiovascular events in the risk population.

Introduction: A treatment to make a woman more comfortable during childbirth is called an epidural anaesthesia. The area of the spine where local anaesthetic is administered is referred to as the “epidural.” It is a local anaesthetic that causes a person’s feet to freeze up to their abdomen. The patient can participate actively in all aspects of the childbirth process while fully awake. Both nonpharmacological and pharmacological analgesic techniques can alter the pain pathways. Assist in the early and second stages of labour with improved pain management. Promote the participation of the expectant mother during labour and delivery. This study looked at how epidural analgesia affected maternal and foetal outcomes in women who were having their induction of labour. Material and Methods: A complete physical examination of 110 low risk primigravida patients who were at term and in labour (>=4 cm) was performed. Physical status ASA 1 individuals received epidural analgesia and acted as cases. Primigravida who met the inclusion criteria and reported in the delivery room or antenatal clinic were given the choice of receiving epidural analgesia. In addition to conducting a clinical examination, a thorough relevant history was acquired. Informed written agreement was obtained from the expectant mother and her family members who agreed to receive epidural analgesia. An anaesthetist placed the epidural catheter in the operating theatre. The CTG (cardiotocography) was used to record baseline variables such heart rate, blood pressure, SpO2, and FHR. Results: The mean Apgar score of neonates at one minute was 9.57±1.54 while mean Apgar score at 5 minutes was 10.2±1.64.In terms of pain relief, the majority of patients 71,( 64.55%) reported no pain, 23 (20.91%) reported mild pain, 11 (10%) reported moderate pain, and 5 (4.55%) reported severe pain. The majority of the patients (n 68, 61.82%), with a mean age of 24.9 ± 2.1 years, were in the 20–25 age range. 59 patients (53.64%) gave birth naturally by vaginal delivery; 6 patients (5.45%) used forceps; 9 patients (8.18%) used ventouse, and 36 patients (32.73%) required a cesarean section (LSCS). Conclusion: Thus, epidural analgesia aims to make labour a pleasant, and pain-free event and offers good pain relief for the majority of the patients. It was not linked to foetal compromise, but it was linked to an enhanced second stage of labour. Consequently, epidural analgesia is among the best and safest methods of pain management.

Aim: This study aims to determine and compare the PEFR values using peak flow meter and digital spirometer. Methodology: This analytical cross-sectional study was conducted at Shri Ramakrishna institute of medical sciences and Sanaka Hospital, Durgapur in the Department of Physiology after obtaining ethical clearance from the Institutional Ethical Committee. For this study, 100 healthy male medical students in the age group of 18–25 years were selected. After taking a detailed personal history, anthropometric parameters such as height and weight were measured using standard methods and from this, body mass index was calculated. General physical and systemic clinical examination was done to rule out any pathology. PEFR and spirometer was recorded in sitting position. All results were expressed as mean ± standard deviation SD. Student’s paired t-test was used to analyze the data using the SPSS software. P < 0.05 was considered as statistically significant. Results: Our study comprised 100 healthy male medical students, aged between 18 and 25 years. The mean height and weight of participants were 160.64 ± 6.3 m and 52.56 ± 7.2 kg, respectively. The mean PEFR measured by peak flow meter and spirometer was 342.8 ± 118.46L/Min and 300.2 ± 130.34 L/Min, respectively. PEFR value is significantly greater when measured by peak flow meter than by spirometer (P < 0.05). Conclusion: Even though the value measured by both instruments varies, still the peak flow meters can be recommended for measuring PEFR in healthy individual and daily monitoring of symptoms in asthma and COPD patients as they are not expensive, easy to handle, and also gives consistent readings.

Aim: To explore the link between Vitamin D and cellular senescence measured with the enzyme telomerase in pre-HTN. Methodology: After obtaining the institute ethics committee clearance from Shri Ramakrishna Institute of Medical Sciences and Sanaka Hospital, volunteers were recruited from medical students. Inclusion criteria for the pre-hypertensive group (pre-HTN) (n = 50) were both genders between 18 and 25 years of age with SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg in apparently healthy individuals. The controls (n = 50) population were healthy individuals with 18–25 years of age with SBP between 100 and 119 mmHg and DBP between 60 and 79 mmHg. The volunteers were asked to not participate in heavy exercises, not drink alcohol and coffee 1 day before the data collection. Baseline, anthropometric parameters were recorded before recording of the BP by sphygmomanometer as per standard protocol. Then, 5 ml of blood was collected, allowed to clot, and subjected to centrifugation to separate the serum. Serum was stored at ‒80°C for processing of Vitamin D and telomerase levels as per the instructions provided in the commercially available kits. Results: The study population included 100 apparently healthy individuals. 50 were pre-hypertensive with the age of 20.65±1.56and the age of controls was 19.98±1.25. Among 50 in each group, 28 males, 22 females in pre-HTN group and 26 males, 24 females in the control group. A significant difference was not found between-group differences in height and waist-hip ratio. Significantly low levels of Vitamin D (P < 0.001) and high telomerase (P < 0.001) were seen in pre-HTN group when compared to controls. Low levels of Vitamin D have no correlation with BMI, waist-hip ratio, DBP, and MAP. However, significant correlation was seen with HR, SBP, PP, RPP, and telomerase. High telomerase levels have correlation with waist-hip ratio, SBP, DBP, MAP, and RPP but no significant correlation was seen with BMI, HR, and PP. Conclusion: From this study, it can be concluded that reduced Vitamin D levels in pre-HTN may cause derangements of cardiovascular homeostatic mechanism, enhance the speed of cellular senescence measured by telomerase.

Aim: To evaluate the morphometry of foramen ovale and its variations in dry skulls of India. Methodology: This present study was undertaken on 50 dry adult human skulls obtained from Department of Anatomy, Santosh Medical College, Ghaziabad, Uttar Pradesh, India . The foramen ovale was observed from the extra cranial view of skull base. Skulls with damaged walls of foramen ovale were not considered. The shape of the foramen ovale was noted by direct inspection as per the classification. Accessory foramen and bony growth around the margins of foramen were also noted. Measurements of foramen ovale were taken by placing a pair of divider on antero-posterior length and transverse diameters of the foramen and then carefully transferred to a meter rule for the readings to be taken. Variation in right and left side in length and breadth was also evaluated. Results: A total of 38 skulls were studied. We found most common shape of foramen ovale was of oval type and was present in 52% cases. The shape of foramen ovale was round in 18% cases, almond in 24% cases and D-Shaped in 6% cases. Out of 50 skulls, spines were present in 4 skulls (8%). The maximum length and width of foramen ovale on the right and left side was 8.08 mm, 5.14 mm and 9.98 mm, 5.26 mm respectively. Minimum length and width of foramen ovale on right and left side was 6.04 mm, 2.92 mm and 5.62 mm, 2.16 mm respectively. Mean length on right and left side was 7.10 mm and 7.66 mm and mean width on right and left side was 4.02 mm and 3.83 mm respectively. Conclusion: Knowledge in variations of morphometry of foramen ovale has various clinical, anatomical and surgical importance. The results of this study will provide an in-depth knowledge about the foramen ovale in dry skulls to the anatomists. This knowledge will also be useful to clinicians and surgeons in planning and executing procedures of the skull base in Indian population.

Introduction: A treatment to make a woman more comfortable during childbirth is called an epidural anaesthesia. The area of the spine where local anaesthetic is administered is referred to as the “epidural.” It is a local anaesthetic that causes a person’s feet to freeze up to their abdomen. The patient can participate actively in all aspects of the childbirth process while fully awake. Both nonpharmacological and pharmacological analgesic techniques can alter the pain pathways. Assist in the early and second stages of labour with improved pain management. Promote the participation of the expectant mother during labour and delivery. This study looked at how epidural analgesia affected maternal and foetal outcomes in women who were having their induction of labour. Material and Methods: A complete physical examination of 110 low risk primigravida patients who were at term and in labour (>=4 cm) was performed. Physical status ASA 1 individuals received epidural analgesia and acted as cases. Primigravida who met the inclusion criteria and reported in the delivery room or antenatal clinic were given the choice of receiving epidural analgesia. In addition to conducting a clinical examination, a thorough relevant history was acquired. Informed written agreement was obtained from the expectant mother and her family members who agreed to receive epidural analgesia. An anaesthetist placed the epidural catheter in the operating theatre. The CTG (cardiotocography) was used to record baseline variables such heart rate, blood pressure, SpO2, and FHR. Results: The mean Apgar score of neonates at one minute was 9.57±1.54 while mean Apgar score at 5 minutes was 10.2±1.64.In terms of pain relief, the majority of patients 71,( 64.55%) reported no pain, 23 (20.91%) reported mild pain, 11 (10%) reported moderate pain, and 5 (4.55%) reported severe pain. The majority of the patients (n 68, 61.82%), with a mean age of 24.9 ± 2.1 years, were in the 20–25 age range. 59 patients (53.64%) gave birth naturally by vaginal delivery; 6 patients (5.45%) used forceps; 9 patients (8.18%) used ventouse, and 36 patients (32.73%) required a cesarean section (LSCS). Conclusion: Thus, epidural analgesia aims to make labour a pleasant, and pain-free event and offers good pain relief for the majority of the patients. It was not linked to foetal compromise, but it was linked to an enhanced second stage of labour. Consequently, epidural analgesia is among the best and safest methods of pain management.

Background: Severe acute respiratory syndrome coronavirus 2 (SARSCoV‐2), was identified as the causative pathogen of pneumonia cases. The vulnerability of pregnant women and their offspring is well established from the results of prior coronavirus outbreaks. Past human coronavirus outbreaks have shown us that pregnant women and their unborn offspring are particularly susceptible to adverse effects. This study was conducted to look for the maternal and neonatal outcome in COVID-positive mothers. Methods: We retrospectively analyzed their medical data. We used the Coronavirus Pneumonia Prevention’s criteria as per guidelines. All of these patients had their throats sampled, and the samples were sent to the lab. Medical records were gathered and independently examined for clinical traits, lab test outcomes, and maternal and neonatal outcomes. Results: Mean age in study group was 26.42±5.26 while in control group was 27.5±7.2 (p=0.3282). in study group complications during pregnancy was 48 (88.89%) while in control group it was 31 (28.18%) (P<0.0001). LSCS was performed in 50 (92.59%) and 85(77.27%) in study group and control group respectively. Preterm delivery was observed in 8(14.81%) in the study group while it was 5(4.55%). Previous morbid conditions were observed in 5(9.26%) in the study group while it was 15(13.64%). “Key neonatal markers, such as gestational age at birth, the APGAR score at five minutes, and intrauterine fetal distress, did not significantly differ between newborns from the cases and controls”. In this study, we looked for evidence that COVID-19 pneumonia among pregnant women who underwent vaginal or caesarean birth causes significant maternal and newborn problems. The results of laboratory tests had the same profile as pregnant women without pneumonia.

Background: The patient of COPD can land into respiratory failure, which could be acute, acute on chronic or chronic. These patients need ventilatory support that could be invasive or non-invasive. CPAP is a safe modality of non-invasive ventilation. These patients may be given bronchodilators, which include methylxanthines, B2 agonists and anticholinergics. Tiotropium is a new anticholinergic, which has shown promising results in the management of COPD. Hence this study was undertaken to assess the role of CPAP by nasal mask and Tiotropium in patients of COPD in acute exacerbation. Material and Methods: The present study was undertaken in a total of 25 patients, who were known cases of COPD diagnosed by history and clinic investigatory methods (later on confirmed by spirometry). After proper selection of patients as per our inclusion criteria, the patients were given a trial of CPAP via a nasal mask along with bronchodilators through nebulization. ABG parameters (like PaO2, PaCO2 and pH), SaO2, RR and dyspnea were compared before and after the intervention with CPAP and Tiotropium. These parameters were analyzed to assess the response of CPAP and Tiotropium in patients of acute exacerbations of COPD. Results: Out of 25 patients, 10 (40.0%) were of the age group 51-60 years followed by 8 (32%) patients of 41-50 years age group. 20 (80%) were males, while the rest 5 were females. 13(52%) cases had moderate impairment in FeV1, while 9 (36%) had severe impairment. Mean PaCo2 of 68.15(±1.95) is seen among GOLD II cases, while 70.89(±4.11) and 76.00(±1.63) were the mean PaCo2 among grades III and IV patients. Conclusion: Intervention with CPAP and bronchodilators are associated with improvements in various parameters like PaCO2, PaO2, pH, SPO2 and RR. Improvement was also seen with subjective parameters like breathlessness, cough and wheezing.

Objective: To evaluate the covid-19 pandemic related anxiety in obstetrics patients admitted in tertiary care centre in  suspected covid wards by using WSAS and HAM-A scales. Methods: A cross- sectional survey of women accessing maternity services was carried out at the local peak of the pandemic. Background data including relevant demographic details, pregnancy and mental health history, concerns, as well as helpful stress-reducing factors reported by women was collected. Depression and anxiety symptomatology was studied using the WSAS and HAM-A scales. Results: The survey results revealed a high prevalence of anxiety and Depressive symptomatology (34.4 and 39.2% respectively), based on WSAS and HAM-A scales. These rates appeared much higher than the reported pre-pandemic prevalence and were not affected by occupation, previous mental health problems or pregnancy complications. Women’s most commonly reported concerns as well as coping factors. Conclusion: Marked increase in anxiety and depressive symptoms during the COVID-19 pandemic, among pregnant and puerperal individuals, who constitute a vulnerable group with respect to mental health morbidity.

Background: A pyogenic liver abscess (PLA) may be defined as solitary or multiple collections of pus within the liver, as a result of bacterial infection. Amoebic liver abscess is caused due to Entamoeba histolytica. Objectives: To study etiopathogenesis, clinical presentations of patients presenting with features of liver abscess. To study various treatment modalities (like conservative, ultrasonography guided aspiration, percutaneous and open surgical drainage). Materials and Methods: This was a descriptive study conducted from January 2019 to June 2020 among 40 cases who were admitted to Krishnarajendra Hospital Mysuru, attached to Mysore Medical College and Research Institute, Mysuru. During this period cases admitted to various surgical units, selected at random were studied in detail. Results: This study found alcohol as the single most consistent etiological factor in all patients with liver abscesses. 57.5% of cases consumed alcohol. Laboratory investigations revealed leucocytosis in 47.5% of cases, anaemia in 25% of cases, and 42.5% of cases were found to be diabetic. 27.5% of cases showed raised urea levels. Hypoalbuminemia was found in 15% of cases and raised SGOT in 7.5% and SGPT in 7.5% of cases. Recurrences were noted in 5/40 (12.5%) cases. Recurrence (12.5%) was the most common complication associated with liver abscess. Mortality in our study was 2.5%. Conclusion: All cases of liver abscesses do not require invasive management. Ultrasound-guided percutaneous aspiration and pigtail catheter drainage procedures are safe and effective methods, particularly percutaneous aspiration had less recurrence than pigtail drainage in our study. Laparotomy and drainage are the standard of care for ruptured liver abscess in the peritoneal cavity. Recurrence was the most common complication associated with liver abscess.

Background: A symptom complex of Vertigo, dizziness, and imbalance occur in patients following concussion. Multiple factors play role in their recovery following rehabilitation. The causes may be peripheral or central. Aim and Objectives: To study the influence of pre-existing diseases on the vestibular dysfunction recovery in patients with head injuries. Objectives were to observe the factors which predispose, promote and perpetuate the rehabilitation of vertigo. The objectives were to record the predisposing and promoting factors of vertigo, undertake bedside equilibrium tests and caloric test for peripheral and central causes of vertigo. Materials: 83 patients with head injuries were included who presented with vertigo. Patients with pre-existing diseases like hypertension, diabetes and thyroid hormone dysfunction were included. All the patients were assessed using a Dizziness handicap index with subscales to assess the physical, functional and emotional aspects. Vestibular rehabilitation was done and DHI scores were evaluated at the end of 12 weeks. Results: Out of 83 patients 61 (73.49%) were males and 22 (26.50%) were females. Male to female ratio was 2.3:1. Patients aged 18 to 27 years were 12 (14.45%), Patients aged 28 to 37 years were 36 (43.37%), Patients aged 38 to 47 years were 21 (25.30%), and Patients aged 48 to 57 years were 14 (16.86%). The mean age was 38.75±3.15 years. The head injury severity as per Head Injury Severity Scale (HISS) was minimal in 24 (28.91%), 26 mild in (31.32%) and 33 moderate in 33 (39.75%) of patients. There were 44 (53.01%) patients with ore-existing diseases and 39 (46.98%) patients without pre-existing diseases. There was no statistical significant predilection of any age group to gender or degree of head trauma (p>0.05). Conclusions: Vertigo after concussion brain injury was common. All the patients responded to vestibular rehabilitation from 3^rd week onwards. By 12^th week the patients without pre-existing diseases with central vestibular dysfunction and fixed peripheral vestibular dysfunction were either resolved or greatly improved. The patients with pre-existing diseases responded rather slowly and the DHI indices/scores were more compared to the patients without pre-existing diseases.

Background: Making a prescribing decision is vital in the prevention of morbidity and mortality. The present study was conducted to evaluate prescription writing skills among undergraduate medical students. Materials and Methods: 200 undergraduate medical students of both genders were enrolled. Prescribing knowledge of students was evaluated based on a questionnaire given to them and also they were asked to prescribe for a common clinical scenario. Their prescriptions were analysed for various parameters like mention of patient’s name, age and gender; date of issuance; the symbol Rx; drug name (generic), dose and dosage schedule; directions for use; the signature of the prescriber, prescriber’s registration number, legible handwriting etc. Results: Out of 200 subjects, males were 90 and females were 110. Prescription writing was previously learnt by 94%, 92% had written prescriptions previously, 83% replied that there were questions in summative assessment regarding prescriptions, 45% replied that clinicians discussed prescription writing but only 25% consider it to be a part of case discussion. 85% replied that undergraduate training had prepared them in prescription writing Also 92% consider the need of reinforcing classes during 3rd and 4th year in prescription writing to refresh their knowledge. 80% consider writing generic names in prescription but only 50 percent have actually written generic names in their prescriptions. On analysis of their prescriptions, patient’s name was written in 99%, gender was mentioned in 95%, age in 92%, weight in 96%, date mentioned in 84%, doctor name mentioned in 89%, address of the doctor in 35%, doctor’s phone number mentioned in 30%, registration number in 57%, patient’s phone number mentioned in 25%, correct drug dose in 78%, dosage form in 85%, duration of treatment  in 90%, generic names written in 50%, follow-up details in 36%, hand writing was legible  in 92%, patient’s  instructions mentioned in 41%. Conclusion: Undergraduate training during 2^nd year and foundation course has definitely trained students in prescription writing as assessed from the quality of their prescriptions. But still there are certain shortcomings that need to be worked upon. There is need for reinforcement sessions during 3^rd and 4^th year in prescription writing to upgrade their skills. Moreover, there is a dire need to train students for prescription writing among special age groups as well as in pregnant and lactating females.

Background: On March 11, 2020, the World Health Organization (WHO) proclaimed Corona-virus Infection 2019 (COVID-19) to be a pandemic. Older subjects and those with underlying medical disorders such hypertension, asthma, diabetes mellitus, chronic lung infection, cardiovascular infections, obesity, and chronic kidney infection have been shown to have a more serious infection course and a greater fatality risk. Aims and Objectives: A study on biochemical parameters of HBV positive individuals suffering from Covid 19 & its effect on their final outcome. Material and Methods: The research was conducted in the Department of Biochemistry L.N. Medical College, Bhopal. 200 subjects who are Covid positive will be included in the research. Category-1 – 60 corona positive subjects who are Hepatitis B virus positive. Category-2 – 140 corona positive subjects. Results: Out of total 200 covid positive cases, 60 individuals were also HBV positive & rest were only having Covid positive status. When we compared for the pathological/ laboratory diagnostic parameters of all the covid cases, Mean White blood cell Count was more in HBV positive individuals. Lymphocyte count was grossly decreased in HBV positive individuals. Neutrophil count, Platelet count, Alanine aminotransferase, Aspartate aminotransferase, Total bilirubin, Gamma-glutamyltransferase, Alkaline phosphatase, Albumin all these were comparatively on higher side in HBV positive individuals. Conclusion: Cholangiocytes have a role in various immune response-related activities of the hepatic, and when their function is disturbed, it can cause hepatobiliary damage due to a cytopathic effect. The hypothesis that cholangiocytes express more ACE2 receptors than other cell types could help to explain why hepatic function is dysregulated.

Background: Perioperative analgesic techniques that are reliable and efficient are crucial for improving postoperative healing. Aims & objectives: For patients undergoing laparoscopic chole-cystectomy, the current research compared the effectiveness of sub-costal TAP block vs. port site infiltration with regard to pain and post-operative respiratory functioning. Material and Methods: The current investigation was a single-center, hospital-based, randomized, observer-blinded, interventional trial that involved patients undergoing laparoscopic chole-cystectomy under general anesthesia who were between the ages of 18 and 60 and had an ASA Grade I or II. Category 1 (Oblique sub-costal TAP block category) and Category 2 were randomly assigned to each of 120 patients undergoing laparoscopic chole-cystectomy (Port site infiltration). Results: The average length of the procedure and the average length of the analgesia were comparable between the categories and statistically insignificant. Peak Expiratory Flow Rate (PEFR) was not significantly different between the two categories at baseline (372.70 55.42 vs. 373.50 56.25 l/min; p>0.05), however Category 2’s PEFR was significantly lower than Category 1’s at 24 hours after surgery (329.42 17.72 vs. 266.42 39.16 l/min; p0.05). Both categories’ VAS scores were equivalent during the shift, however Category 1’s VAS score at the post-operative time intervals (2, 4, 8, 12, and 24 hours) was considerably lower than Category 2. 22 (18.3%) and 4 (3.3%) of the patients in Categories 1 and 2, respectively, needed rescue analgesics. It was shown that substantially fewer patients in Category 1 than in Category 2 required rescue analgesics. In Category 1 and Category 2, respectively, 4 (5%) and 10 (8.3%) patients experienced nausea and vomiting. Conclusion: When compared to the port site infiltration Category, the TAP Categories pain and post-operative respiratory functions, as measured by PEFR following laparoscopic chole-cystectomy and VAS score at post-operative time intervals of 2, 4, 8, 12, and 24 hours, were considerably reduced.

Background: A pyogenic liver abscess (PLA) may be defined as solitary or multiple collections of pus within the liver, as a result of bacterial infection. Amoebic liver abscess is caused due to Entamoeba histolytica. Objectives: To study etiopathogenesis, clinical presentations of patients presenting with features of liver abscess. To study various treatment modalities (like conservative, USG guided aspiration, percutaneous and open surgical drainage). Materials and Methods: This was a descriptive study conducted from January 2019 to June 2020 among 40 cases who were admitted to K.R Hospital Mysuru, attached to Mysore Medical College and Research Institute, Mysuru. During this period cases admitted to various surgical units, selected at random were studied in detail. Results: This study found alcohol as the single most consistent etiological factor in all patients with liver abscesses. 57.5% of cases consumed alcohol. Laboratory investigations revealed leucocytosis in 47.5% of cases, anaemia in 25% of cases, and 42.5% of cases were found to be diabetic. 27.5% of cases showed raised urea levels. Hypoalbuminemia was found in 15% of cases and raised SGOT in 7.5% and SGPT in 7.5% of cases. Recurrences were noted in 5/40 (12.5%) cases. Recurrence (12.5%) was the most common complication associated with liver abscess. Mortality in our study was 2.5%. Conclusion: All cases of liver abscesses do not require invasive management. Ultrasound-guided percutaneous aspiration and pigtail catheter drainage procedures are safe and effective methods, particularly percutaneous aspiration had less recurrence than pigtail drainage in our study. Laparotomy and drainage is the standard of care for ruptured liver abscess in the peritoneal cavity. Recurrence was the most common complication associated with liver abscess.

Background: In this study, we wanted to evaluate the efficacy of MRI in the assessment of important prognostic factors in carcinoma cervix like tumour size, involvement of parametrium, pelvic side wall, adjacent organs and the lymph nodal status and how it alters the plan of management and correlate MRI findings with clinical FIGO staging of carcinoma cervix. Materials and Methods: This was a hospital-based cross-sectional study conducted among histopathologically proven cases of carcinoma cervix presented to the Department of Radiodiagnosis attached to Mysore Medical College and Research Institute for 18 months from January 2020 to June 2021. Results: The most common histopathological type in both newly diagnosed cases and post-treatment cases was squamous cell carcinoma and the remaining was constituted by adenocarcinoma. In our study, there were 18 biopsy-proven new cases, 32 old cases. MRI proved the best in identifying mass better than clinical identification. The accuracy, sensitivity and positive predictive value of MRI in newly diagnosed cases in our study were 83.33%, 88.24%, and 93.75%, respectively. Conclusion: MRI is better at delineating the invasion of adjacent organs. MRI can replace cystoscopy and sigmoidoscopy in identifying bladder and rectal wall invasion. A combination of T2W imaging and diffusion-weighted imaging would be the optimal technique for imaging both new and post-treatment cases. T2W and diffusion-weighted images are the best sequences not only in identifying recurrence, but also in excluding false positives in already treated patients.

Objective: To find demographic, clinical and epidemiological characteristics, comorbidities, outcome and mortality in ICU. Methods: We did a prospective observational study of medical records of critically ill patients admitted to intensive care unit (ICU). The data on demographic, clinical and epidemiological characterstics treatment received and outcomes of patients admitted in ICU was analysed. SOFA score at admission, then at 24 hours and then at 48 hours was done. ARDS was accessed by Berlin criteria. KDIGO Criteria for AKI and diagnostic stratergies for VAP was used for assessment, prognosis and improvement after treatment. Results: By multivariate analysis, predictors of in-hospital mortality were Sepsis-related Organ Failure Assessment (SOFA) score at ICU admission, SOFA score over the first 3 days in the ICU. In our ICU patients are refered from medicine and emergency department (78 %) followed by accident and trauma (18%). Patients of medicine department were of old age and had accompanying comorbidities. Patients with high SOFA score, old age, comorbidities, long ICU stay, and those who needed invasive ventilation had higher morbidity and mortality. Conclusion: Both outcome and mortality were favourable in patients with low sofa score. Mortality was more in patients with comorbidities. We want to be able to understand the characteristic features of patient admitted in ICU and factors associated with the increased mortality. This data can be used in making stratergies and future actions for the betterment of patients and improvement of services of the ICU.

Aim: To compare patient satisfaction between regional anesthesia (RA) and general anesthesia (GA) in patients undergoing upper limb surgeries. Material & Methods: In this open label study, the participants were cross-sectionally assessed to compare patient satisfaction following RA and GA in Department of Anesthesiology, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar, India, over a period of one year. Results: The mean scores of the following items were higher in RA—the kindness shown to them, information provided, feeling of safety, meeting demands, providing attention, and feeling of wellbeing. The GA group had higher scores for postoperative nausea and vomiting and feeling of anxiety items. Conclusion: RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.

Aim: To investigate the PRM is superior to intraperitoneal hydrocortisone instillation as regards postoperative pain reduction in patients who have undergone laparoscopic gynecological surgery. Material & Methods: This is a prospective, randomized, controlled study was conducted in the Department of Anesthesiology, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar, India, during one year time period. Ethical approval from the ethics committee and informed consent was obtained. 90 patients were included (30 in each group) in the study. Results: There was a statistically significant difference between both the hydrocortisone and the pulmonary recruitment groups in comparison with the control group as regards 24 h postoperative total analgesic consumption, P value <0.001. Conclusion: Intraperitoneal hydrocortisone and pulmonary recruitment manoeuvre could both effectively reduce pain after gynecological laparoscopic surgeries, however, intraperitoneal hydrocortisone might give a longer pain-free time.

Background: There has been an unprecedented rise in multiple pregnancy in the last two decades.  An increment of 50% was observed in number of live births from twin deliveries. Naturally 1 out of 80 pregnancies are twin pregnancies, corresponding to 2.6% of all new-borns, the frequency of monozygotic twin births is rather constant worldwide- approximately one set per 250 births, and by large, is independent of race, heredity, age, and parity. Materials & Methods: The present prospective study was conducted from 1/1/2019 to 31/12/2019 for a period of one year on 71 pregnant women with twin pregnancy. All the pregnant women with multifetal gestation admitted to Hospital for delivery in the year 2019 were included and Pregnant women who do not provide written consent were excluded from this study. Aims: To study the maternal and fetal outcomes in twin pregnancy. Results:  Incidence of multifetal gestations is 5.91 per 1000 deliveries, More than half (54.9 %) of them belonged to age group of 21 to 25 years, Most of the study participants (30 out of 71 i.e., 42.3%) were primigravida, Out of 71 pregnant mothers, 44 i.e., 61.9% were of Di-Chorionic Di-Amniotic type, most common maternal complications in case of multifetal gestations and their frequencies among the study participants is Three fourth of the mothers i.e., 74.6% ended up with pre-term labour, Next most common complications were PPROM (22 out of 71 i.e., 31%), Pre-eclampsia (18 out of 71 i.e., 25.4%) and Anaemia (16 out of 71 i.e., 22.5%), Other uncommon complications in the mothers pregnant with multifetal gestation were Polyhydramnios (8.5%), Gestational Hypertension (2.8%) and Gestational Diabetes Mellitus (2.8%). 4 pregnant mothers 71 (5.6%) had history of previous LSCS. 2 out of 71 multifetal gestations i.e., 2.8% ended up in miscarriage. No cases of Antepartum haemorrhage were identified. Most common complication in NICU admitted new-borns was Respiratory distress. In total, 81 new-borns (62.3 %) had respiratory distress, however only 6 of them (4.6 % of the total 130 live-born) were intubated. Two other severe complications observed were intra-ventricular haemorrhage (in 21 babies i.e., 16.2 %) and sepsis (in 9 babies i.e., 6.9 %). Conclusion:  Most common maternal complications in case of multifetal gestations  i.e., 74.6% ended up with pre-term labour, Next most common complications were PPROM (22 out of 71 i.e., 31%), Pre-eclampsia (18 out of 71 i.e., 25.4%) and Anaemia (16 out of 71 i.e., 22.5%),  Most common complication in NICU admitted new-borns was Respiratory distress. In total, 81 new-borns (62.3 %) had respiratory distress, however only 6 of them (4.6 % of the total 130 live-born) were intubated. Two other severe complications observed were intra-ventricular haemorrhage (in 21 babies i.e., 16.2 %) and sepsis (in 9 babies i.e., 6.9 %), emphasizing the need of close antenatal surveillance and need to deliver with good NICU care.

Background: Increasing incidence of resistance to antibiotics is a global concern in the healthcare sector including India. AMPS (antimicrobial stewardship programs) have been recommended to mitigate antimicrobial resistance which is rapidly rising. Aim: The present study aimed to assess the intake of anti-microbials in subjects admitted to ICU at trauma units in India by both DOT (Days of Therapy) and DDD (Defined Daily Dosage) methods. Methods: The present prospective clinical study was done at an Indian center in subjects admitted to ICU (intensive care units) with polytrauma and in subjects admitted to neurosurgical ICUs. Antibiotic intake was gathered manually on daily basis by the practitioners performing the infection controls concerning DDD and DOT. Results: During the study duration, antibiotic intake at ICU for both culture-based therapy and empirical therapy were 460.5 and 531.6 DDD/1000 subjects. The intake of antimicrobials at the ICU for both culture-based therapy and empirical therapy were 426.02 and 489.7 DOT/1000 subjects. Conclusions: The data gathered from the Indian ICU set-up concerning the intake of antimicrobials is helpful in monitoring, evaluating, and establishing the functions of antimicrobial stewardship programs in Indian healthcare settings.

Aim and objectives: The aim of the present study was to assess histopathological features of lesions of prostate and to classify tumours of prostate as per recommendations of WHO and to analyse cases of Adenocarcinoma of prostate according to Modified Gleason grading system. Methods: An observational study conducted in the Department of Pathology for the period of one year and 200 patients were included in the study. Results: All prostatic specimens were broadly classified into benign 180 (90%) and malignant 19 (9.5%). We reported 1 (0.5%) case of Prostatic Intra-epithelial Neoplasia (PIN). Maximum cases of BPH 80 (40%) were seen in the 61-70 years age group. Cases of BPH with co-existing chronic prostatitis were 12 (6%) and that with acute prostatitis were 6 (3%). Less frequent findings were BPH with basal cell hyperplasia 6 (3%) and BPH with squamous metaplasia 2 (1%). We reported 19 cases of adenocarcinoma prostate with modified Gleason Grading system. Conclusion: Maximum number of cases of adenocarcinoma was seen in 61-70 years age group. It is necessary to study all prostate biopsies in order to identify premalignant lesions, proliferative activity and grade of inflammation. Histopathological diagnosis and grading plays a definitive role in the management of prostatic carcinoma.

Aim: The aim of the present study was to discuss the significance of various pulmonary and extrapulmonary abnormalities that may be identified on high-resolution computed tomography (HRCT) chest of systemic sclerosis (SSc) patients. Methods: The present study was a cross-sectional, observational including 50 patients in the Department of Radio-Diagnosis for one year . Patients with clinical diagnosis of SSc having pulmonary involvement were included in the study. Pregnant females and patients having active chest infection or history of pulmonary tuberculosis were excluded. Results: Age ranged from 13 to 61 years (mean 35.5±10.2 years) and most of the patients belonged to 20-30 age group followed by 31-40 age group. All the patients had clinical complaints of skin thickening and tightness, barring a few. Mean duration of skin manifestations was 5.4±5.8 years. Other than skin thickening, dyspnoea and dry cough were the frequently associated symptoms. 36% patients had duration of <6 months. 56% had 61%-80% FEV. Chest radiography was not found to be a sensitive modality in evaluating ILD, particularly in the early stages of the disease. Among them, 56% had right lung involvement and 24% had left lung involvement. Most common chest radiograph finding was fine or coarse reticular opacity. Variable degree of lung volume loss was observed on radiography. Conclusion: Systemic sclerosis commonly occurs in middle aged females; the presenting complaint being diffuse skin thickening over the limbs and face and dyspnoea on exertion with or without dry cough as the primary respiratory symptom. PFT reveals restrictive pattern. The limitations of chest radiography may overcome by HRCT chest. Non-specific interstitial pneumonia pattern is the most common ILD found in SSc.