Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that affects millions of people worldwide. It is characterized by high blood glucose levels due to impaired insulin secretion or insulin resistance. Glycated haemoglobin, total protein, and albumin levels are important markers that can provide insights into the severity of T2DM and its progression. Therefore, the present study aimed to evaluate the levels of these markers in patients with T2DM for one year and compare them with healthy controls. Method: The study was conducted by Department of Pathology, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar for one year. The study included 100 patients with T2DM and the same number of age- and sex-matched healthy controls. The inclusion criteria for the T2DM group were a diagnosis of T2DM for at least one year, age between 40 and 60 years, and not taking any medication that can affect glycated haemoglobin, total protein, or albumin levels. The exclusion criteria were the presence of any other chronic disease or acute illness. The control group consisted of healthy individuals with no history of diabetes or any other chronic illness. The glycated haemoglobin, total protein, and albumin levels were measured at baseline and after one year using standard laboratory techniques. The data were analyzed using appropriate statistical methods. Results: The study found a significant increase in glycated haemoglobin levels in patients with T2DM compared to healthy controls after one year (p < 0.001). The mean glycated haemoglobin level in the T2DM group increased from 7.2% ± 1.3% to 8.6% ± 1.2%, while it remained stable in the control group (5.5% ± 0.5% to 5.4% ± 0.6%). The study also found a significant decrease in total protein and albumin levels in patients with T2DM compared to healthy controls after one year (p < 0.001). The mean total protein level in the T2DM group decreased from 7.5 g/dL ± 0.8 g/dL to 6.7 g/dL ± 0.7 g/dL, while it remained stable in the control group (7.8 g/dL ± 0.7 g/dL to 7.7 g/dL ± 0.6 g/dL). The mean albumin level in the T2DM group decreased from 4.1 g/dL ± 0.4 g/dL to 3.5 g/dL ± 0.3 g/dL, while it remained stable in the control group (4.3 g/dL ± 0.3 g/dL to 4.3 g/dL ± 0.3 g/dL). Conclusion: The present study demonstrated that patients with T2DM had significantly higher glycated haemoglobin levels and lower total protein and albumin levels compared to healthy controls. These findings suggest that T2DM can lead to impaired protein synthesis and utilization and can also increase the risk of long-term complications such as diabetic nephropathy and cardiovascular disease. Therefore, early detection and management of T2DM are crucial to prevent or delay the onset of these complications.

Aim: The aim of the present study was to evaluate the indication of laparoscopic cholecystectomy for acute cholecystitis. Methods: The present study was conducted in the Department of General Surgery, Netaji Subhas Medical College and  Hospital, Bihta, Patna, Bihar, India for 1 year. Total 100 acute cholecystitis patients at the hospital and routine daily worker of laparoscopic cholecystectomy in the Department of General Surgery, Netaji Subhas medical College and  Hospital, Bihta, Patna, Bihar, India. Out of 100 selected patients, 80 were males and 20 were females. Results: The result of the study showed that the maximum patients (25%) were from the 46-50 years age group and 20% from the 41-45 years age group, whereas the 51-55 years age group represents 22%. The minimum age was 30 years, and the maximum was 75. The mean age of the respondents who attended the acute cholecystitis was 48 years. Conclusion: In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover, pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.

The study aimed to investigate the serum levels of zinc, copper, and magnesium in patients with type 2 diabetes mellitus (T2DM) in the Bihar region. The study was conducted over a duration of one year. Methods: The study used a cross-sectional design, and the serum levels of zinc, copper, and magnesium were measured in 150 patients with T2DM and 150 healthy controls. The study was conducted over a duration of one year Department of Pathology, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar. The participants were selected using a convenient sampling technique, and the serum levels of zinc, copper, and magnesium were measured using atomic absorption spectrophotometry. Results: The results of the study showed that the serum levels of zinc and magnesium were significantly lower in patients with T2DM compared to healthy controls (p < 0.05). However, there was no significant difference in the serum levels of copper between the two groups (p > 0.05). The mean serum levels of zinc, copper, and magnesium in patients with T2DM were 72.84 ± 6.98 µg/dL, 100.38 ± 9.36 µg/dL, and 1.72 ± 0.26 mEq/L, respectively, while the mean serum levels in healthy controls were 84.12 ± 6.46 µg/dL, 104.60 ± 10.33 µg/dL, and 1.93 ± 0.29 mEq/L, respectively. Conclusion: The study concludes that patients with T2DM in the Bihar region have lower serum levels of zinc and magnesium compared to healthy controls. This finding suggests that these micronutrients may play a role in the pathogenesis of T2DM and may be important for its prevention and management. However, further research is needed to establish the causal relationship between these micronutrients and T2DM and to explore their potential therapeutic benefits.

Aim: The present study was conducted for assessing the alterations in serum potassium levels during post op exploratory laparotomy. Methods: The present study was conducted in the Department of General Surgery, Netaji Subhas Medical College and  Hospital, Bihta, Patna, Bihar, India for 18 months  and it included assessment of alterations in serum potassium levels during postoperative exploratory laparotomy. A total of 60 subjects who underwent explorative laparotomy were enrolled in the present study. Results: In the present study, a total of 60 patients who underwent exploratory laparotomy were included. Mean age of the patients was 58.4 years. 66.66 percent of the patients were males while the remaining were females.(Table 1) Mean potassium levels at Baseline (before starting of surgery), One day after surgery, Three days after surgery and Seven days after surgery were found to be 4.50 mEq/L, 5.60 mEq/L, 4.55 mEq/L and 4.40 mEq/L respectively. A significant reduction in the potassium levels during the initial postoperative phase was seen followed by a significant rise; thereby returning to normal value 1 week postoperatively. Conclusion: We concluded that the significant rise in the potassium levels occur after exploratory laparotomy, followed by restoration to normal values by the end of first postoperative week.

Background: Desflurane is noted for having a quick onset and quick offset of action, which enables the anaesthetist to quickly modulate the depth of anaesthesia. Objective: To contrast the effects of desflurane and propofol when used as a single agent for brief elective procedures. Materials and Methods: Eighty patients scheduled for elective brief surgery were included in this hospital-based prospective comparative analysis. Patients were either given Group D: O₂:N₂O (50:50) + Desflurane 3-4% or Group P: O₂:N₂0 (50:50) + Propofol 3-5 mg/kg after undergoing regular pre-anaesthetic workup. Between the two groups, comparisons were made for baseline data, pertinent intraoperative information, procedural simplicity, hemodynamic changes, recovery, and complication rate. With SPSS version 22, statistical analysis was carried out. Results: Jaw opening, LMA attempts and ease of insertion were equivalent across the two groups (p> 0.05). Propofol significantly sped both the time to unconsciousness and the time to LMA implantation (p <0.05). Desflurane group participants had significantly higher mean pulse rates and MAP (p <0.05). Conclusion: Desflurane that was inhaled created favourable circumstances for inserting an LMA, and the intraoperative hemodynamic profile was stable during anaesthesia. When inhalational induction is required, desflurane may be taken into consideration as an alternate induction agent.

ADR is defined as “a response to a drug that is noxious and unintended, and which occurs at doses normally used in man for prophylaxis, diagnosis or therapy of disease or for the modification of physiological function. Adverse drug reaction(ADR) is the fourth leading cause of morbidity and mortality. Material & Method- Aim: To study the ADRs reported in a tertiary care hospital. Analysis of ADRs: (1) Causality according to Naranjo’s ADR probability scale. (2) Preventability using the criteria described by Schumock & Thornton Scale. (3) Severity of ADR was analyzed according to criteria’s developed by Hartweig et al. Results: A total of 133 ADRs forms with 145 reactions were collected from the indoor patients during the study duration.Most of ADR from Gastrointestinal system. Drug class implicated in Most of ADR was antineoplastic drugs. Conclusion: This study strongly suggest that hospital based reporting ADR is very necessary Measures to improve detection & reporting ADR must done by all health care professionals. It will also improve patient’s safety.

Aim: To assess and identify the contributing factors to wound dehiscence after ASARP in ASARP in female child born with ARM. Materials and Methods: Bed head tickets was obtained from medical record department. Charts of all female child with ARM reconstructed with ASARP/ASARVP at tertiary centre Bundelkhand Medical College Sagar General Surgery department between 2019 -2022 were required wound dehiscence within 30 days post operatively was analyzed regarding prematurity, weight of the baby, mode of delivery and other congenital anomalies, addiction and diabetic status of mother. Results: The records of 100 female patients with ARM operated between 2019-2022 were reviewed and the results were found that 36 %of the babies developed wound dehiscence during this period .61% of the 36 babies who developed wound dehiscence required REDO-ASARP. Rest 39% of the 36 babies required limited ASARP. Maximum Wound disruption that is 50% was seen between 11^th to14th day. Whereas 38% of the babies developed wound disruption between 8^th -11^th day. Conclusion: After all these retrospective study in observation we found that apart from good nursing and wound care, multiple factors affect the maturing and healing of wound. Local care dry dressing, and keeping the legs approximated, are of utmost important for good results.

Background: Interleukin-6 (IL-6) is a key player in tissue damage and inflammation. There aren’t many epidemiological studies examining IL-6 is impact on atherogenesis, though. Methods: In a prospective study involving 1000 seemingly healthy men, we assessed baseline plasma concentrations of IL-6 in 500 participants who later experienced a myocardial infarction (MI) and 500 study participants who were age- and smoking-matched but did not report vascular disease. Results: Men who later experienced a MI had median IL-6 concentrations that were greater than males who did not. Men in the highest quartile at entry had a relative risk that was 2.5 times higher than those in the lowest quartile (95% CI 1.5 to 4.5, P0.005); for each quartile increase in IL-6, there was a 38% increase in risk. The risk of future MI increased with increasing quartiles of baseline IL-6 concentration (P for trend, 0.001) (P0.001). When accounting for additional cardiovascular risk factors, this connection remained substantial, was persistent over extended durations of follow-up, and was apparent in all low-risk populations, including nonsmokers. C-reactive protein (P0.001) was the greatest predictor of IL-6 in these data, but even after controlling for it, the association between IL-6 and eventual risk persisted (P0.001). Conclusion: Elevated levels of IL-6 are linked to an increased risk of future MI in men who appear to be in good health. Hence, our findings are consistent with an early role for cytokine-mediated inflammation in atherogenesis.

Background: Meconium stained amniotic fluid (MSAF) is a commonly observed phenomenon in routine Obstetric and Pediatric practice, which is considered as one of the signs of fetal distress in cases other than breech presentation.Factors such as placental insufficiency, maternal hypertension, pre-eclampsia, oligohydroamnios, chorioamnionitis, IUGR or maternal drug abuse (tobacco or cocaine) result in utero passage of Meconium. Meconium Aspiration Syndrome (MAS) remains as the commonest causes of respiratory distress in term & post term infants. It is a life-threatening respiratory emergency. Thus, it needs an early intervention by recognising the early signs and symptoms. In recognition of same this study was undertakento determine the maternal factors and neonatal outcome of pregnancy complicated by meconium stained amniotic fluid. Aim and Object: The Primary objective Was estimation of the prevalence of neonates born with MSAF and to know outcome of neonates born with MSAF. Secondary Objective was to determine the risk factors associated with increased morbidity and mortality among admitted neonates born with MSA. Methods: The present Prospective Observational study was undertaken on a total of 225 eligible neonates born with MSAF and qualifying the inclusion criteria in MYH Hospital, Indore (M.P.) for a period of 1 year. 225 live births with MSAF were included and their outcomes were noted in terms of morbidity and mortality. Results: Overall incidence of MSAF was 12% in the present study. Risk factors encountered were maternal age < 25 years, anemia, pre-eclampsia, PROM, and primi-gravida. LSCS was the most common delivery modality. 861 (79.28%) vigorous babies needed no active intervention at birth and shifted to mother side while 225 (20.72%) developed MAS and needed active intervention at births and were admitted in NICU. Overall neonatal mortality was 11.6%. Downe’s Score at admission and APGAR Score at 1 & 5 min were significantly correlated with MAS in our study. Conclusions: The presence of MSAF at delivery is a potential sign of fetal compromise. Alerting the paediatrician and proper resuscitation of babies born through MSAF reduces the overall morbidity and mortality.

Background: The civilization of India has its roots in the villages and 83.3 crore of the population live in villages (Census 2011). Government of Madhya Pradesh implements various components of the NRHM throughout the state. This is being sought to be achieved through the establishment of Anganwadi-cum-Gram Arogya Kendra in each village. Objective: To assess the functionality of selected Gram Arogya Kendra of Bhopal District. Methodology: This cross sectional study was conducted among 50 randomly selected GAKs (Rural=22 & Urban=28) of Bhopal district conducted in one year period from 2017 to 2018. All selected Gram Arogya Kendra where both ASHA and ANM was present, were included and where either post of ASHA or ANM was vacant were excluded from the study. A standard Checklist was used for the assessment of Gram Arogya Kendra. Availability of each of the 57 parameters are checked as per supervision checklist and marked as 1 if available and mark as 0 if not available. Data collected was entered in MS Excel compiled and analyzed using epi Info-7.2.5. Results: About 64% Gram Arogya Kendra had their own building, where as 18% of them was running in panchayat bhawan. About 28% i.e. 14 GAKs were categorized as grade A, 34% i.e. 17 GAKs were categorized as Grade B and 38% i.e. 19 GAKs were categorized as Grade C as per standard supervision checklist assessment. Conclusions: Major of the GAK had their own building for the delivery of the services. There is need to give more emphasis on keeping the proper and detailed documentation required as per guidelines. Drugs that are listed as per guidelines should be provided to all centers so that the minor ailments can be deal at GAK level.

Introduction: Meconium being the first intestinal secretion from the foetus starts as early as 10 weeks of gestation and tends to increase in its incidence with increasing period of gestation. Meconium stained amniotic fluid is a commonly observed phenomenon in routine Obstetric and Pediatric practice, which is considered as one of the signs of fetal distress in cases other than breech presentation. Factors such as placental insufficiency, maternal hypertension, pre-eclampsia, oligohydroamnios, etc. result in-utero passage of meconium. Objective: To estimate the burden of MSAF and assessment of the associated risk factors among newborn delivered in a tertiary level of health care center. Methodology: Prospective observational study was conducted with 1086 neonates born with MSAF in a tertiary level of health care center (M.P.) over a period of 1 year after clearance from institutional ethical committee. A written informed consent was obtained from the parents of the subjects. All newborn with MSAF and whose parents provide consent to participate in the study was included under study. Results: The incidence of MSAF in this study is calculated as 12%. About 79% newborns need no active intervention at birth and shifted to mother side and 21% newborn need active intervention at births and admitted in NICU. Male contributes about 59% and female about 41% of total MSAF newborns (Sex ratio for MSAF newborns calculated 702/1000). Most of the MSAF newborn delivered by LSCS. Maternal risk factors like Anemia, pregnancy induced hypertension and preeclampsia/eclampsia had shown significant association. Conclusion: This study found that among total numbers of delivery, about 12% newborn had suffered from MSAF. Risk factors like delivery mode, maternal age, gestational age, birth weight and others maternal risk factors like anemia, PIH and preeclampsia had a significant association between the two group of newborns with MSAF.

Introduction: After a caesarean section (CS) or a natural delivery, postpartum haemorrhage (PPH) is a serious obstetric emergency (NVD). A 500 mL or 1000 mL haemorrhage following vaginal or caesarean delivery, respectively, may be used to characterize it. Globally, PPH is a leading cause of maternal mortality and a common obstetric maternal complication. Aim & Objectives: The purpose of this study is to evaluate the efficacy of sublingual misoprostol in comparison to the gold-standard dose of 10 IU of intramuscular oxytocin for active management of the third stage of labour. Materials and Methods: After receiving approval from the institutional ethics committee, this prospective, randomized trial involving 100 pregnant women was carried out. After a vaginal delivery, patients were randomly assigned to receive either 10 IU of intramuscular oxytocin (Group O) or 600 μg of misoprostol sublingually (Group M). The major outcomes assessed were mean blood loss, primary postpartum hemorrhage (PPH) incidence, and hemoglobin level decline. The duration of the third stage of labour, adverse medication reactions, the need for further uterotonics, manual placenta removal, and, if necessary, surgical intervention for postpartum haemorrhage was all secondary outcomes that were monitored. Results: In total, 100 term-pregnant women were studied, divided into two groups of 50 each. For sublingual misoprostol and intramuscular oxytocin groups, the mean blood loss was 320.59 ± 244.13 vs. 253.28 ± 171.75 ml; (P = 0.11); respectively. In misoprostol and oxytocin groups pre- and post-delivery hemoglobin levels were statistically significant (p=0.001), whereas those between misoprostol and oxytocin were not (p=0.42 and p=0.27). In both the groups average length of the third stage of labour (4.27 ± 1.77 vs. 5.51 ± 2.33 minutes) and the requirement for further uterotonics misoprostol and oxytocin (8.0% versus 2.0%; p = 0.36) were comparable and the difference was statistically insignificant (P = 0.19). In terms of the incidence of PPH, there weren’t any differences between groups (20.0% vs. 14.0%, respectively; P=0.44). The primary adverse effects in the current trial were shivering, fever, vomiting, diarrhea, and abdominal pain. Shivering and fever were the side effects that were observed more frequently in the misoprostol group, which is similar with earlier studies. Conclusion: During Oxytocin labour induction, misoprostol administration during the 3rd stage of labour demonstrated a tendency towards significantly lowering postpartum hemorrhage and postpartum hemorrhage incidence. Similar to conventional injection oxytocin, sublingual misoprostol is as effective as in active management of the third stage of labour. Misoprostol at 600 μg through its activity and thermostability seems to be an appropriate substitute for injectable oxytocin.

Background: Succinylcholine chloride continues to be the standard neuromuscular blocking drug for creating the best intubating circumstances during rapid sequence intubation. The only medication on the market right now with the same quick beginning of action as succinylcholine chloride is rocuronium bromide. To examine the effectiveness of rocuronium bromide and succinylcholine chloride for usage during fast sequence intubation in adult patients, the current study was conducted. Methods: This prospective controlled study was done in the Department of Anesthesia, Prathima Institute of Medical Sciences, Naganoor, Karimnagar Based on the inclusion and exclusion criteria a total of n=60 cases were selected to be included in the study. They were randomly divided equally into two groups Group I (n=30 cases received Rocuronium Bromide 1mg/kg) and group II n=30 cases received Suxamethonium 1mg/kg. Results: The intubating condition according to the grading system as per Viby-Mogensen et al., grading of intubating conditions, there are a greater number of patients having better intubating conditions in both groups. Group II was found to be somewhat better than group I scores although the differences were not found to be statistically significant. Comparing the changes in potassium ion concentration, the group receiving succinylcholine has a statistically significant increase whereas the group receiving rocuronium experiences essentially no change. Conclusion: This study leads us to the conclusion that the intubating circumstances produced after rocuronium bromide 1mg/kg are almost identical to and clinically acceptable intubating conditions as those obtained by succinylcholine 1mg/kg, with a reduced incidence of adverse effects when compared to succinylcholine. Although Rocuronium bromide is a safe alternative to succinylcholine chloride for rapid sequence induction of anesthesia in situations where succinylcholine is contraindicated and in whom there is no anticipated difficult airway, succinylcholine chloride appears to be a safer agent for use in patients with anticipated difficulty in intubation.

Introduction: The complications after tracheal extubation are three times more common than complications occurring during intubation and induction of anaesthesia (12.6% vs. 4.6%). Tracheal extubation is an important event in general anaesthesia which causes a modest (10% to 30%) and transient (lasting approximately 5 to 15 min) increase in blood pressure and heart rate. Several strategies are adopted to blunt the haemodynamic response to extubation. Esmolol leads to reduced heart contractility, slowed atrioventricular conduction and increased atrioventricular refractoriness, which ultimately results in decreased myocardial oxygen demand. Magnesium acts by inhibiting calcium channel mediated release of catecholamine from both adrenal glands and adrenergic nerve terminals in response to sympathetic stimulation. We undertook this randomized, prospective, double-blind study to compare IV esmolol and IV magnesium sulphate for attenuating haemodynamic response to extubation after general anaesthesia. Methods: The present prospective, randomized double blind comparative study was conducted in a tertiary care hospital amongst 80 patients of either gender amongst ASA Grade 1 and 2 patients undergoing elective surgeries under general anaesthesia. Eighty consecutive patients undergoing elective surgery under general anaesthesia were enrolled and these patients were randomly allocated using computer generated randomization list into 2 groups with 40 patients in each group with allocation ratio 1:1 ‘Group M’ were given IV magnesium sulphate (40 mg/kg) infusion in 100 ml normal saline over 5 minutes before extubation and ‘Group E’ were given IV esmolol (0.6 mg/kg) infusion in 100 ml normal saline over 5 minutes before extubation at the end of surgery. Results: HR at extubation and 1, 3, 5, 10, and 15 minute after extubation reduced in both groups but it was statistically extremely significant in Esmolol group as compared to Magnesium group. MAP at extubation and 1, 3, 5, 10, 15 minutes after extubation was reduced in both groups but it was statistically extremely significant in Esmolol group as compared to Magnesium group. RPP at extubation and 1, 3, 5, 10, 15 minutes after extubation was recorded in both groups. It was statistically insignificant in Esmolol group as compared to Magnesium group. Conclusion: We concluded that better hemodynamic stability was maintained by Magnesium sulphate without adverse effects, whereas Esmolol group showed fall in HR, SBP & MAP more than 20% of baseline.

Introduction: Intravenous regional anesthesia (IVRA) is a technique for inducing anaesthesia in a part of the limb by injecting a local anaesthetic intravenously into an extremity that is isolated from the remainder of the circulatory system with a tourniquet. Dexmedetomidine is an α2-adrenoreceptor (AR) agonist and ketorolac works by preventing the production of inflammatory mediators. Aims and Objectives: To compare the efficacy between Dexmedetomidine and Ketorolac as adjuvants to local anaesthetic for IVRA to prolong post-operative analgesia. Materials and Methods: A randomized observer-blind prospective study was conducted on patients who are undergoing intravenous regional anesthesia for upper limb surgery. They were divided into two groups group D Lignocaine 0.5% solution, 0.6ml/kg (maximum- 40ml) + Dexmedetomidine 30mcg and group K Lignocaine 0.5%, 0.6ml/kg (maximum- 40ml) + Ketorolac 15mg, 30 patients in each group. Post-operative patients were observed in recovery for two hours before being transferred to the appropriate ward. Timing of drug injection, beginning of sensory and motor block, pain from tourniquet, and initial demand for painkillers were all reported. Results: The mean time for the requirement of first rescue analgesia (140.67 vs 131.23 mins; p-0.26) and VAS score at the demand (6.47 vs 6.17; p-0.47) were comparable in cases of group A and group B respectively. Mean systolic blood pressure was comparable between the two groups at baseline and throughout surgery till 2 hours follow-up period (p>0.05). Mean diastolic blood pressure was comparable between the two groups at baseline and throughout surgery till 2 hours follow-up period (p>0.05). Conclusion: The study has concluded that lignocaine and dexmedetomidine are both almost beneficial but the duration of the post-operative analgesia between the two groups was statistically significant.

Introduction: Community based awareness can improve the knowledge on cervical cancer (CC). With this a community level study was conducted to find the incidence of CC and to create awareness among the public. Methods: This was a community based research, conducted in the department of Surgical Gastroenterology, GSL Medical College. Informed written consent was taken from all the participants. In case of minors, consent was taken from parents. Non cooperative individuals were not considered in this research but efforts were taken to create awareness on CC. The study participants were divided to 2 groups; unmarried, 9 – 26 years aged women were in first group and married women in second group. With the support of primary health workers and also undergraduate (UG) students door to door survey was conducted to create the awareness. With the help of trained UGs, cervical examination was carried and also cytological examination was done by collecting specimen as per the guidelines. If any abnormality in the screening, HPV DNA analysis was carried. Chi-square test was used to find the association; P>0.05 was considered to be statistically significant. Results: Total 52 (100%) were CC in the initial screening and 25 were positive for HPV DNA; statistically there was no significant difference. Literacy wise statistically there was significant. Majority (21; 40.4%) were high grade squamous intra epithelial lesions followed by atypical squamous cells of undetermined significance (16; 30.8%) and low grade squamous intra epithelial lesions (15; 28.8%). All were referred for the treatment. Conclusions: These findings suggest that community-based education and screening campaigns are required. In addition, motivation and counselling are the priorities which are the important parameters required to create awareness among the public. This can help in better screening, diagnosis as well as treatment and finally reduction in CC.

Introduction: Urinary tract infections (UTIs) is one of the oldest infections, reported in 1550 BC. Development of antibiotic drug resistance (DR) is important threat due to the prolonged usage of antibiotics. With this, a study was conducted with an aim to find the DR in UTI causing gram negative bacteria (GNB). Methods: It was a prospective study, conducted in Pinnamaneni Siddhartha Institute of Medical Sciences, Vijayawada. Study protocol was approved by the institutional ethics committee. The individuals aged > 18 with the symptoms of UTI were included. Detailed clinical history was collected and study was clearly explained in the local language. After clarifying all the doubts, midstream urine (MSU) sample was collected and labelled properly and transported immediately to the laboratory in self-sealing polythene covers with two compartments; the laboratory requisition form is placed in one and the sample in the other compartment. Samples were inoculated on Cysteine lactose electrolyte deficient agar, MacConkey agar and blood agar, plates were incubated at 37⁰C for 48 hrs. Growth was identified as per the protocol. Antimicrobial susceptibility test was performed Kirby-Bauer disc diffusion method on Mueller-Hinton agar medium.nResults: UTI was detected in 101 (100%) cases. Highest UTI incidence was detected in 38 – 47 group. The female male ratio was 1.6, 37.1 was the mean age. Esch.coli was the most prevalent (30.7%; 31) bacterial isolate followed by other GNB (22.7%; 23). All the GNB were sensitive to Piperacillin tazobactum, Colistin, Imepenem, Amikacin. Conclusion: GNB are common UTI causing agent with high prevalence among the women. Sexually active and older age groups are commonly prone for UTI.  Cephalosporins are less effective.

Introduction: Several studies have been conducted to find the correlation between tuberculosis (TB) and blood groups. A study was conducted with an aim to find the correlation between the blood groups and sputum submission in the school going children.  Methods: It was a prospective research conducted in ASRAMS, Eluru. Study protocol was approved by the institution committees. Informed consent was taken from the parents of all the study members. School going children from class 6 to 10 with signs and symptoms of TB were included in the research. Importance of submission of sputum, difference between sputum and saliva was shown practically. After clarifying all the doubts, the participants were explained how to produce good quality sputum sample. Simultaneously it was demonstrated practically. Then the participants were provided with sterile, plastic containers and they were asked to collect the sample and stained as per the guidelines. Simultaneously blood groping was done for all the study members by slide agglutination test. Chi square test was used to find the statistical analysis. P <0.05 was considered to be statistically significant. Results: The mean age of the study child was 14. 3 years. Among the study members, 61 satisfied the sputum submission protocol; gender wise there was no significant difference.   Out of the 11 (100%) TB cases, maximum were AB+ve (4) followed by A+ve (3), O+ve (3) and A-ve (1); statistically there was no significant difference. Conclusion: More number of girl children satisfied the sputum submission protocol. Maximum TB cases were detected in AB+ve group and minimum in A-ve; statistically there was no significant difference. Long term studies with big sample size are recommended.

Introduction: Skin lesions are a major contributor to health problems in various countries but most are not regarded significant because of the assumption that they are not life-threatening. Their incidence also varies with geographical locations, environmental factors, genetic factors, hygiene, etc. Materials and Methods: The current study was conducted on 100 cases of skin lesions that were received in the Department of Pathology of a tertiary health care center. The tissues were received in 10% neutral buffered formalin and stained with Hematoxylin and Eosin stain to diagnose various skin lesions. Results: The age of the patients varied between 1 years to 83 years while the maximum cases (22%) were in 51 – 60 years age group. The male to female ratio was 0.92:1 while the ratio of neoplastic to non-neoplastic lesions was 2.22:1. Maximum cases presented with nodules (27%) as the main complaint. Amongst the lesions, maximum cases (23%) were of Appendageal tumors followed by 22% cases of Epidermal tumors. Maximum cases among non-neoplastic lesions were of different types of Leprosy (22.58%) followed by Psoriasis (12.90%). Out of 69 neoplastic lesions, maximum cases were of Basal Cell Carcinoma (13.04%) followed by Squamous Cell Carcinoma (10.14%). Conclusion: Sometimes skin tumors and non-neoplastic lesions may present with a minute lesions such as a macule or papule which may be ignored for long by the patient. Therefore, biopsy confirmation of every lesion alongwith clinical correlation is important.

Pain is an expected aspect of the healing process after surgery. This study’s objective is to evaluate the postoperative analgesic impact and safety with buprenorphine in lower extremity below knee procedures in addition to levobupivacaine. Sixty patients were split into two groups: Group B (n=30; 24 ml of 0.25% levobupivacaine hydrochloride + 1 ml (300 mcg) of buprenorphine were administered; and Group C (n=30; 24 ml of 0.25% levobupivacaine hydrochloride + 1 ml of normal saline were administered). Each group’s postoperative analgesia was examined in terms of the VAS score, the duration of the analgesic, and any complications or side effects. At 16 hours, Group B’s VAS score was 38.56±1.79, while Group C’s VAS score was 49.46±1.13 (p value 0.001). At 24 hours, the VAS scores for groups B and C were respectively 15.17±1.497 and 15.67±1.714. Hence, we draw the conclusion that buprenorphine is a safe and effective additive to levobupivacaine hydrochloride for the management of postoperative pain.

Meconium stained amniotic fluid (MSAF) is a a common encounter in pregnancies and is a source of concern among both obstetricians and neonatologists due to its effect on the outcome of the fetus. Aim: To determine the fetal outcome in the pregnancies which have the presence of meconium stained amniotic fluid. Methodology: A comparitive study was conducted in the Department of Obstetrics and Gynecology at Dhiraj hospital, pipariya, Waghodia where 160 patients in labour who developed meconium stained amniotic fluid and 190 patients in labour who had a clear amniotic fluid were studied and the outcome of their babies post delivery regarding their birth weight, NICU admissions, and fetal complications was studied. Results: Out of the total number of patients, 81.25% of the cases and 91.57% of the controls had babies who were asymptomatic at birth. The babies born to the group with meconium stained amniotic fluid had a lower APGAR score at birth as compared to the group with clear amniotic fluid. The incidence of birth asphyxia and NICU admissions was greater among the babies born to the patients with meconium stained amniotic fluid as compared to teh ones born to patients who had clear amniotic fluid. Conclusion: A postivie relationship between meconium stained amniotic fluid and the development of fetal complications has been established.

Introduction: Several studies have been conducted to find the correlation between tuberculosis (TB) and blood groups. A study was conducted with an aim to find the correlation between the blood groups and sputum submission in the school going children.  Methods: It was a prospective research conducted in ASRAMS, Eluru. Study protocol was approved by the institution committees. Informed consent was taken from the parents of all the study members. School going children from class 6 to 10 with signs and symptoms of TB were included in the research. Importance of submission of sputum, difference between sputum and saliva was shown practically. After clarifying all the doubts, the participants were explained how to produce good quality sputum sample. Simultaneously it was demonstrated practically. Then the participants were provided with sterile, plastic containers and they were asked to collect the sample and stained as per the guidelines. Simultaneously blood groping was done for all the study members by slide agglutination test. Chi square test was used to find the statistical analysis. P <0.05 was considered to be statistically significant. Results: The mean age of the study child was 14. 3 years. Among the study members, 61 satisfied the sputum submission protocol; gender wise there was no significant difference.   Out of the 11 (100%) TB cases, maximum was AB+ve (4) followed by A+ve (3), O+ve (3) and A-ve (1); statistically there was no significant difference. Conclusion: More number of girl children satisfied the sputum submission protocol. Maximum TB cases were detected in AB+ve group and minimum in A-ve; statistically there was no significant difference. Long term studies with big sample size are recommended.

Introduction: Urinary tract infections (UTIs) is one of the oldest infections, reported in 1550 BC. Development of antibiotic drug resistance (DR) is important threat due to the prolonged usage of antibiotics. With this, a study was conducted with an aim to find the DR in UTI causing gram negative bacteria (GNB). Methods: It was a prospective study, conducted in Pinnamaneni Siddhartha Institute of Medical Sciences, Vijayawada. Study protocol was approved by the institutional ethics committee. The individuals aged > 18 with the symptoms of UTI were included. Detailed clinical history was collected and study was clearly explained in the local language. After clarifying all the doubts, midstream urine (MSU) sample was collected and labelled properly and transported immediately to the laboratory in self-sealing polythene covers with two compartments; the laboratory requisition form is placed in one and the sample in the other compartment. Samples were inoculated on Cysteine lactose electrolyte deficient agar, MacConkey agar and blood agar, plates were incubated at 37⁰C for 48 hrs. Growth was identified as per the protocol. Antimicrobial susceptibility test was performed Kirby-Bauer disc diffusion method on Mueller-Hinton agar medium.Results: UTI was detected in 101 (100%) cases. Highest UTI incidence was detected in 38 – 47 group. The female male ratio was 1.6, 37.1 was the mean age. Esch.coli was the most prevalent (30.7%; 31) bacterial isolate followed by other GNB (22.7%; 23). All the GNB were sensitive to Piperacillin tazobactum, Colistin, Imepenem, Amikacin. Conclusion: GNB are common UTI causing agent with high prevalence among the women. Sexually active and older age groups are commonly prone for UTI.  Cephalosporins are less effective.

Introduction: Community based awareness can improve the knowledge on cervical cancer (CC). With this a community level study was conducted to find the incidence of CC and to create awareness among the public. Methods: This was a community based research, conducted in the department of Surgical Gastroenterology, GSL Medical College. Informed written consent was taken from all the participants. In case of minors, consent was taken from parents. Non cooperative individuals were not considered in this research but efforts were taken to create awareness on CC. The study participants were divided to 2 groups; unmarried, 9 – 26 years aged women were in first group and married women in second group. With the support of primary health workers and also undergraduate (UG) students door to door survey was conducted to create the awareness. With the help of trained UGs, cervical examination was carried and also cytological examination was done by collecting specimen as per the guidelines. If any abnormality in the screening, HPV DNA analysis was carried. Chi-square test was used to find the association; P>0.05 was considered to be statistically significant. Results: Total 52 (100%) were CC in the initial screening and 25 were positive for HPV DNA; statistically there was no significant difference. Literacy wise statistically there was significant. Majority (21; 40.4%) were high grade squamous intra epithelial lesions followed by atypical squamous cells of undetermined significance (16; 30.8%) and low grade squamous intra epithelial lesions (15; 28.8%). All were referred for the treatment. Conclusions: These findings suggest that community-based education and screening campaigns are required. In addition, motivation and counselling are the priorities which are the important parameters required to create awareness among the public. This can help in better screening, diagnosis as well as treatment and finally reduction in CC.

Objectives: Aim of this study was to evaluate efficacy and safety of various oral antidiabetic drugs/regimens used for Type-2 diabetes patients. The primary objectives were to compare fasting blood glucose(FBS), post prandial blood glucose(PPBS), and glycosylated haemoglobin (HbA1c). Secondary objectives were to compare Body weight (kg), vitals (blood pressure in mmhg) and to identify adverse drug reactions (if present) in all groups. Methods: This is a prospective observational study conducted in Medicine OPD of a tertiary care Hospital in South Delhi over a period of 17 months. All the patients receiving oral anti diabetics were enrolled. The patients receiving injectable antidiabetic drugs were excluded. Patients were followed for 3 visits after the first visit, reviewed after every 12 weeks. All the necessary information were recorded in case record form that includes demographic details (age, gender etc), concomitant medication history, past medical history, vitals, physical examination (body weight[kg]) and relevant laboratory reports (FBS [mg/dl], PpBS [mg/dl], glycosylated haemoglobin [%]). Results: A total of 248 patients were enrolled in our study and drugs received by the patients were found to be Biguanides(25%), Biguanides + Sulfonylureas (25.4%), Biguanides + Sodium Glucose co transporter (SGLT2) inhibitors (25.4%), Biguanides + Dipeptidyl peptidase (Dpp4) inhibitors (24.1%). A significant reduction in FBS, PPBS, and HbA1c was seen in all groups of patients. Adverse drug reactions were hypoglycemia, dizziness, urinary tract infections and Gastric side effects distributed in different groups. Maximum reduction in body weight in patients receiving B+SGLT2i was seen and weight increase was seen in the patient group receiving B+Su. Conclusion: Overall, all classes of drugs showed efficacy in reducing glycemic parameters and body weight with SGLT2i showing maximum effect. Sulfonylureas were commonly associated with hypoglycemia and Sglt2i were associated with urinary tract infections.

Background: In this study, we wanted to evaluate the efficacy of cuffed oropharyngeal airway (COPA) when compared to laryngeal mask airway (LMA) in patients aged 18 to 60 years undergoing elective short surgical procedures under general anaesthesia with spontaneous ventilation. Materials and Methods: This was a hospital based randomized prospective study conducted among 100 patients who underwent elective short surgical procedures of duration < 45 mins in Chigateri General Hospital, Women and Children Hospital and Bapuji Hospital attached to J.J.M Medical College, Davangere, from December 2012 to July 2014, after obtaining clearance from Institutional Ethics Committee, and written informed consent from the study participants. Results: Insertion of COPA was very easy in 46 patients and moderately difficult in 2 patients. Insertion of LMA was easy in 41 patients, moderately difficult in 6 patients, difficult in 2 patients and impossible in 1 patient. The first-time insertion rate was more with COPA when compared with LMA. Airway manipulation like jaw thrust was required more with COPA than with LMA. The mean duration of insertion was significantly lower with COPA than with LMA. There were no significant haemodynamic changes between COPA and LMA with respect to heart rate, blood pressure and arterial saturation (SpO2). LMA had slightly more incidence of post-operative sore throat, cough and laryngospasm compared to COPA. Conclusion: With respect to physiologic alterations using the devices and overall clinical problems, the COPA and LMA are equivalent. The LMA is associated with a better airway quality and fewer manipulations during use but a higher incidence of complications. The COPA offers advantage in terms of cost, rapid insertion in unskilled hands and low complication rate but the major drawback being frequent airway manipulations and a poor hands-free anaesthesia.

Introduction: A significant concern to world health is antibiotic resistance, which is fuelled by antibiotic overuse. The effectiveness of current antibiotics is decreasing due to increased bacterial resistance. Antibiotic inefficiency leads to death, morbidity, and excess medical expenses. Methods: Data from inpatients at Osmania General Hospital and its ten affiliated facilities were collected between January 2017 and December 2021 for this retrospective study. Daily defined dose (DDD)/100 patient days was used to express antibiotic consumption data. The analysis of the linear graph and bar graphs used to represent monthly consumption to show the changing trends in the usage of antibiotics. Results: During the course of five years, the total amount of antibiotics consumed shows a significant fluctuation. When compared to the ACCESS group in this study, the proportion of the WATCH group of antibiotics consumption was higher. Conclusion: Antibiotic stewardship programme with education and sensitization of proper antimicrobial prescription is the need of the hour.

Background: Tapentadol is a relatively new analgesic. The comparison between nasal versus oral formulations was done for their various effects in the perioperative period. Setting: A study conducted in a tertiary care hospital. Materials and Methods: Sixty adults, of the American Society of Anaesthesiologists Classes I or II of either sex and age 20–60 years of age undergoing elective laparoscopic cholecystectomies done under general anaesthesia of minimum 90 minutes to less than or equal to 120 minutes duration were divided into 2 groups of 30 each by computerized random allotment (Group –N: Nasal Tapentadol, Group –T: Oral Tapentadol). Group N received two puffs of nasal Tapentadol ( Nearly 25mg per puff), 5mins before induction of anaesthesia. Group T received one oral Tapentadol tablet 100mg, 60 minutes before induction of anaesthesia. Statistics: Randomized Control trial, Proportion tests, Correlation, ANOVA, Kruskal Walis test, Regression analysis, Paired t-test, Chi-square test, F test, and, any other analysis found suitable, P-value for analytical purposes: 0.05 [95% Confidence Interval], Software for Statistical Analysis: MS-Excel/ STATA 14 were used for statistics. Results: Nasal Tapentadol group patients had significantly better analgesia 3 h postoperatively than the oral tapentadol group. Conclusions: From the Result and Analysis it was concluded that nasal Tapentadol had better analgesic efficacy and hemodynamic stability as compared to oral formulations.

Background: Epistaxis is a common presentation in a primary care setting or emergency room. Anterior nosebleeds, which are more frequent, and posterior nosebleeds (less common, but more likely to require medical attention). 90% of anterior nosebleeds are caused by bleeding in the Kiesselbach’s plexus, also called Little’s region, on the anterior nasal septum. Methods: The patients were early evaluated which included the kind and intensity of bleeding, as well as hemodynamic condition. Patient history information was recorded in situations of minimal bleeding and stable patients. When the bleeding was under control in cases of significant bleeding, a history was gathered. Steps were taken to stabilize the patient at the same time as controlling the epistaxis if there were indications of substantial blood loss and/or the patient was in a state of shock. As necessary, blood samples were obtained and submitted for cross-matching, blood grouping, and baseline hemoglobin estimation. Results: In the current study we found 16% of cases with Rhinosporidiosis and bleeding polyps.  Trauma and foreign body, upper respiratory tract infections, and miscellaneous cases (including cases of jaundice, bleeding disorders, and ac polyps) were 14% each and deviated nasal septum, and upper respiratory tract infections were the cause in 12% of cases each. Hypertension was the cause in 8% of cases and atrophic rhinitis in 6% of cases. N=29 cases were managed medically and in the surgical management out of n=21 cases Rhinosporidiosis excision and cauterization were done in n=7 cases followed by Functional Endoscopic Sinus Surgery in n=6 cases the details of the procedures done. Conclusion: The current study found that epistaxis is a common presentation in ENT clinics and management depends on the clinical presentation and availability of resources. The most common etiology was spontaneous bleeding followed by trauma. In the majority of individuals with epistaxis, cauterization, nasal packing, or both can stop the bleeding. Several surgical alternatives are available for those who have significant or recurring bleeding for which medicinal therapy has failed.

Aim: prophylactic antibiotics in high-risk patients undergoing laparoscopic cholecystectomy. Methods: A randomized controlled trial study was conducted in the Department of General Surgery,Shree Narayan medical institute and Hospital, Saharsa, Bihar, India for one year. Patient admitted for Laparoscopic cholecystectomy were randomized into two groups A (who did not receive prophylactic antibiotics) and B (those who received antibiotics). Results: A total of 200 patients were included with Group A and B included 100 and 100 patients, respectively, with similar baseline demographic characteristics and preoperative indications for cholecystectomy. Surgical site infection occurred in 7 patients in group A and 2 patients in group B (p=0.048) respectively. All Surgical site infections were superficial and responded to conservative management only. None of the infected patients required intravenous therapy or hospitalization. Mean duration of hospital stay in patients not having received prophylactic antibiotics (Group A) approached significance (p=0.07) though the range (in days) was the same in both the groups. Conclusion: Prophylactic antibiotics play an important role in the prevention of SSI in patients at high risk, undergoing laparoscopic cholecystectomy.

Aim: Impact of single dose versus multidose prophylactic antibiotics in elective hernia repair. Methods: This prospective, comparative study was done the Department of General Surgery at Shree Narayan medical institute and Hospital, Saharsa, Bihar, India for one year. 120 suitable patients who were admitted for elective groin surgery were included in this study were randomly assigned two groups (n=60) single-dose pre-operative (SD) group and multiple- dose (MD) in each group. SD group was given amoxycillin-clavulanic acid (2 gm) intravenously at the time of induction of anesthesia. MD group was given amoxycillin-clavulanic acid (2 gm) parentally at the time of induction of anesthesia and following it up with the same antibiotic (1 gm) intravenously twice a day for two days post-operatively. Results: Out of 60 patients of group SD, only 8.33% of patients developed surgical site infection compared to none in group MD Statistically, there was no appreciable difference in the incidence of SSI in both SD and MD groups with a p value of 0.31. Main complaints by many patients in the post-operative period were pain and headache managed well with intravenous fluids for spinal headache and analgesics. Seroma was found in the 3rd postoperative day in 3 patients in group I, fluid aspirated, and culture turned out to be negative. 5 of the SD group developed an infection, which subsided with the continuation of antibiotics. Expenditure incurred by the patient only for antibiotic analyzed of antibiotic (amoxicillin and clavulanic acid) and found the average cost of antibiotic per patient in SD group was Rs. 150 while the cost of antibiotic per patient in group II was Rs. 1500. P value is 0.0001 (p value <0.05) found to be significant. Conclusion: We concluded that the rate of infections is quite similar in SD and MD antibiotics thereby making single-dose antibiotics prophylaxis as effective as multiple doses of antibiotics prophylaxis. We also conclude that single-dose antibiotic prophylaxis is economical in uncomplicated elective surgery.

Aim: The aim of this study was the assessment of lipid profiles mainly triglycerides in diabetic patients from Bihar region. Methods: This was a cross-sectional study was done in the Department of General medicine, ICARE Institute of Medical Sciences and Research and. Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India for nine months. A total of 80 newly diagnosed type 2 diabetes mellitus within the last 3 months using the ADA (American Diabetes Association) criteria and both males and females were include in this study for determine the lipid profile levels. Results: According to ATP III classification 34(42.5%) participants had normal serum triglycerides levels which is <150 mg/dl whereas 56(57.5%) participants had an abnormal level of serum triglycerides. Among the 56(57.5) participants with abnormal triglycerides, 32.5% had borderline high levels (150-199mg/dl), 25% had high levels (200-499 mg/dl). In our study, 52.5% participants had low HDL and 47.5% participants had normal HDL. The Gender distribution showed that 16 male participants and 26 female participants had low HDL. In our study, among the 80 participants, 55(68.75%) participants had desirable total Cholesterol levels of <200mg/dl, 20(25%) had borderline high levels of 200- 239mg/dl and 5 (6.25%) had high total cholesterol levels of ≥240mg/dl. 10(12.5%) had high levels of LDL of which 3 were males and 7 were females. 2 (2.5%) participants had very high levels of LDL of which 1 was male and 1 was female. Conclusions: Hyperlipidemia is the commonest complication of the diabetes mellitus and it can predispose patients to premature atherosclerosis and microvascular complications. Good glycemic control can prevent the development and progression of common lipid abnormalities in diabetes like raised triglycerides, LDL, serum cholesterol and low HDL.

Aim: The aim of the present study is to identify bacterial etiology of surgical site infections. Material and Methods: The study was a cross sectional study which was carried in the Department of Microbiology, Shree Narayan medical institute and Hospital, Saharsa, Bihar, India for one year. Using sterile cotton swabs, two pus swabs/ wound swabs were collected aseptically from each patient suspected of having SSI. Gram stained preparations were made from one swab for provisional diagnosis. The other swab was inoculated on nutrient agar, 5% sheep blood agar (BA) and MacConkey agar (MA) plates and incubated at 37°C for 24-48 hours before being reported as sterile. Growth on culture plates was identified by its colony characters and the battery of standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by Kirby Bauer disk diffusion technique on Muller Hinton Agar. Results: Out of 230 samples, 120 samples were culture positive (52.17%). Among 120 positive samples 67(55.83%) were males. Maximum no. of culture positive samples in age 20-30 years (32.5%) followed by 30-40 (17.5 %) and then followed by 40-50 (15.83%) of age group respectively. Out of 120 culture positive samples S. aureus (26.67%) was the most common pathogen isolated followed by Escherichia coli. (23.33%), Citrobacter spp. (15.83%) and Pseudomonas aeruginosa (9.17%), Klebsiella spp 10(8.33%), CONS 8(6.67%), Enterobacter spp. 7(5.83%), Acinetobacter spp 3(2.5%) and Proteus spp. 2(1.67%) respectively. Conclusion: We conclude that SSIs are common among patients undergoing surgeries.

Aim: To Study prevalence of dermatophytes in patients attending a tertiary care facility. Material and Methods: This observational prospective study was carried out in the Department of Microbiology, Shree Narayan medical institute and Hospital, Saharsa, Bihar, India for 12 months. after taking the approval of the protocol review committee and institutional ethics committee. Total of 120 patients showing lesions typical of dermatophytes infection based on the clinicians’ preliminary diagnosis from outpatient Department of Dermatology. Result: Samples were collected from patient’s various anatomical sites such as epidermal layers of skin, hair and nail. Among them tinea corporis was predominant in 73/120 (60.83%) patients followed by tinea cruris in 20/120 (16.67%) patients. Tinea unguium was found in 15/120 (12.5%) patients, tinea manuum was observed in 4 (3.3%) patients, tinea pedis was seen in 3 (2.5%) patients and tinea capitis, tinea facei were 2 and tinea barbae were seen in 1(1.67%) and one (0.83%) patient respectively. Conclusion: Dermatophytoses are worldwide distributed with increased incidence especially in tropical countries like India. Several factors such as age, sex, illiteracy, poor hygiene and social economy influence the infection with dermatophytes.

Aim: To find out the common causes of the acute small intestinal obstruction in adult patients. Methodology: An observational study was conducted at Department of General Surgery, Shree Narayan medical institute and Hospital, Saharsa, Bihar, India for one year. Patients admitted for small intestinal obstruction were analyzed. The patients who were above 14 years of age and operated for mechanical obstruction of the small bowel and whose complete medical record was available were included in the study. The patient’s particulars such as age, gender, pre-operative clinical examinations and investigations, history regarding previous surgeries, post-operative morbidity and mortality were noted from files. The etiologies for small bowel obstruction were identified by analysis of radiological and intra-operative findings obtaining from patients records. Results: Total 95 operated cases of small intestinal obstruction were recorded in the study. Ages of patients ranged from 18 years the youngest one to 84 years the oldest with a Mean age of 48.35±31.84 years. Out of 95 cases, 54 (56.8%) were male, and 41 (43.2%) were female. Out of 95 patients, 29 (30.5%) were suffered from abdominal tuberculosis. Postoperative adhesions were found in 27 (28.4%) patients. 17 (17.9%) patients were noted with various form obstructed hernias like an inguinal, femoral, ventral hernia. In 11 (11.6%) patient’s obstructions found due to malignancy. Mesenteric ischemia found in 3 (3.2%) patients. Intussusception found in 2 (2.1%) cases and 2 (2.1%) cases of Meckel’s diverticulum were noted. Post radiation strictures and Gossypiboma were observed with the same frequency of 1 (1.05%) patient of both. Conclusion: Our study presented that the most common etiological reason for small intestinal obstruction is abdominal tuberculosis and adhesions, respectively. Etiology of small intestinal obstruction has changing pattern from area to area; more studies are needed over small geographical areas to know the pattern of etiologies of small bowel obstruction.

Aim: To estimate the prevalence of dengue and its complications in children. Methodology: This is a type of retrospective study carried out at Department of General medicine, ICARE Institute of Medical Sciences and Research and. Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India. during the monsoon period, 130 patients diagnosed with Dengue were included in the study. Details of the age and gender distribution, signs and symptoms were recorded. Laboratory investigation reports of the patients at the time of admission were obtained. Details of treatment, hospital stay, organ involvement, complications and the outcomes were also recorded and analyzed. Results: Out of 130 patients, 82 (63.08%) were males and 48 (36.92%) were females. Majority of the patients i.e. 89 (68.46%) belonged to the age group between 18-40 years while 41 (31.54%) were more than 40 years of age. All the patients (100%) had fever on the day of admission. The other predominant symptoms were headache in 74 (56.92%), myalgia in 65 (50%), nausea in 47 (36.15%) and vomiting in 33 (25.38%), and abdominal pain in 28 (21.54%) patients. The laboratory parameters of the patients on admission had been recorded. The 21 (16.15%) patients had >16 gm/dl of hemoglobin. The 43 (33.08%) patients had leukopenia (4000/microliter) on admission. About 95 (73.08%) patients had thrombocytopenia (<100000/microliter) on admission. Among these, 24 (18.46%) of patients had <20000/microliter of platelets. About 58 (44.62%) patients had >45% of hematocrit on admission. Conclusion: In patients with dengue, fever, headache and myalgia are the most common clinical findings. The most common laboratory findings are thrombocytopenia and leucopenia. Dengue infections are usually at peak during the monsoon season due to collection of standing water. The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for dengue as well as for other diseases that Aedes mosquito transmit, that is why it is more prevalent in the rural regions.

Aim: Risk Factors and Treatment Types for Asthma Severity among Adult Patients. Material and Methods: This retrospective study was done the Department of Pulmonary Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for one year. All asthmatic patients whose ages were greater than or equal to 20 years in chronic illness, medication and follow-up clinic for asthma treatment. Results: A total of 120 respondents, 100 were included in the final analysis. From total units in the study, 20 (20%) severe, 30 (30%) moderate, and 50(50%) were mild asthmatic patients, respectively. patients who were severely asthmatics 40% were female and 60% male. Those who were moderate asthmatic 30% were females and 70% were male. Percentage distributions of those who are mild asthmatic (60%, 40%) were female and male, respectively. The percentage distribution of asthma severity levels by different environmental factors. Out of total adult patients who were severely asthmatic 65%, 35% were registered in the dry season and rainy season, respectively. Of the total study unit who had asthma in childhood stage, 45%, 40%, 60% were severe, moderate, and mild asthmatic, respectively. Patients who had asthma in their family 35%, 40%, 58% were severe, moderate, and mild, respectively. The percentage distribution of asthma symptom seen in adult asthmatic patients are coughing (52%), wheezing (50%), dyspnea (44%), chest pain (25%), limited daily activity (10%), and rhinitis (6%). From 100 patients, who received oxygen (O₂) and prednisolone were 70(70%) 30(30%) respectively. The percentage distributions of beclomethasone, beclomethasone puff were equal which is expressed by 5%. Of all treatments distributed to asthmatic patients in a study unit, Salbutamol puff has a minimum percentage (4%) value. Conclusion: The study showed that demographic, environmental, genetic, and health-related factors have a significant effect on asthma severity.

Aim: Study of socio-demographic profile of victims in cases of deaths due to homicide. Materials and Methods: This study was conducted in the Department of Forensic Medicine & Toxicology, Shree Narayan medical institute and Hospital, Saharsa, Bihar, India for one year, after taking the approval of the protocol review committee and institutional ethics committee. 100 (4.65%) cases of homicidal deaths brought for medico legal autopsies were studied during the period. Results: Total 1150 autopsies were conducted during the study period, out of which 100 cases were of alleged homicide. Out of the total 100 cases of homicide, 82 (82%) victims were males and 18 (18%) were females. It was observed that male victims outnumbered females except in cases of infant deaths, indicating male predominance in victims of homicide. Maximum cases of males were reported in the age group in 21-30 years 35 (35%) age group followed by 31-40 years 22 (22%). Similarly amongst female’s maximum victims were in the age group 21-30 years 4 (4%) cases followed by 31-40 years 4 (4%) cases.  Maximum number of victims of homicide belonged to lower socio-economic class 38 (38%) which included 31(31%) males and 7(7%) females followed by middle 15 (15%) and upper class 9 (9%). In 38 (38%) cases, the socioeconomic strata of the victim were unknown. Maximum victims 28(28%) had completed only primary school education or 26 (26%) secondary school education. 8 (8%) victims were illiterate. None of the females had completed even graduation. Literacy status was unknown in 24 (24%) cases of which were 21 (21%) males and 3 (3%) females. Conclusion: Most common age group of victims involved was 21-30 years followed by 31-40 years. Thus we can conclude that the bread earning productive population group is most frequent. However no age is bar to be a victim of homicide. Most of the victims were illiterate, primary or secondary educated, labourers or unemployed persons belonging to lower socio economic strata of the society.

Aim: A clinical analysis of outcome in management of head injury in patients with highway road accidents. Methods: A retrospective study was conducted in the Department of Forensic Medicine and toxicology, Shree Narayan medical institute and Hospital, Saharsa, Bihar, India for ten months. The data was collected regarding demography, mode of injury, clinical presentation, and condition at admission, treatment given, hospital stay and outcome of these patients. All patients were clinically evaluated by a team comprising of doctors from surgical, medical and orthopedics specialties in the emergency department and subsequently admitted and treated at Neurosurgery. Plain CT scan head along with X-ray of cervical and for dorso- lumbar spine were carried out to rule out other injuries. Whenever necessary, CT scans of spine, USG abdomen (FAST). Results: According to the data collected 38 (41%) patients were under alcoholic influence, 87(97%) patients had history of LOC, 47 (50%) patients had ENT bleed and 7 (7.5%) had CSF leak at the time of admission. At the time of admission glasgow coma scale (GCS) score of less than 8 was seen in 31 (33%) cases. GCS between 9 to12 was seen in 47 (52%) cases and GCS between 12 to 14 was seen in 12 (15%) patients (Table 2). Plain CT scan of head revealed, 39 (42%) patients had EDH, 33 (35%) patients had SDH, 10 (11%) patients had cerebral contusion, 5 (6%) patients with SAH and 3 (3%) patients with DAI. Thirty three (33%) patients were managed conservatively using anti-epileptics, diuretics and osmotic agents. In patients with less than 8 GCS, ICP monitoring was done initially, 35 (39%) patients underwent craniotomy and evacuation, 2 (2%) patients underwent craniotomy and decompression and 23(26%) patients underwent burr hole and evacuation of clot. Associated injuries were seen in total 18 (20%) of patients. 5 (5%) patients had limb fractures, 7 (8%) patients had fascio-maxillary fractures and 6 (7%) patients had chest injuries. At the time of discharge, 70 (70%) patients had GCS of 13, 18 (17%) patients had GCS of 14 and 4 (3%) patients had GCS of 13. Conclusion:RTA is an unfortunate economic burden for our nation. Head injury due to RTA is a recognized major public health problem causing death and disability among the population.

Aim: The aim of this study to evaluate the prognostic value of some serum protein fractions as early index of Clinical recovery in pulmonary tuberculosis subjects. Methods: This Interventional comparative study was done the Department of Pulmonary Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa ,Bihar, India for one year.A total of 100 subjects aged between 20 and 50 years were conveniently recruited for this study. 50 were clinically confirmed PTB subject with no HIV nor malaria co-infections. They were further sub-divided into TB subjects on ATT 25 and drug naive TB subjects 25. The remaining were 50 (25 females and 25 males) aged matched apparently healthy controls. Results: The results showed that BMI (kg/m²) in drug naive TB subjects (19.35 ± 2.75) and in the TB subjects on ATT (20.40 ± 2.90) was significantly lower when compared to control subjects (24.68 ± 3.15) (p=0.001). Similarly, waist and hip circumferences (cm) of the drug naive TB subjects (50.22 ± 1.44,70.68 ± 2.10) and the TB subjects on ATT (51.14 ± 2.98, 70.56 ± 2.75) were significantly lower when compared to control subjects (52.34 ± 4.56, 72.33 ± 3.54) (p=0.03 and 0.02). However, the mean value of WHR in drug naive TB subjects (0.72 ± 0.04) and in TB subjects on ATT (0.74 ± 0.05) were not statistically significant when compared to control subjects (0.73 ± 0.06) (p ¼ 0.27). In TB subjects on ATT, the mean (±SD) serum albumin (g/ dl) was (3.51 ± 1.57) and control subjects (3.83 ± 1.15) (p=0.108). In contrast, the drug naive TB subjects had a significantly lower mean serum albumin (2.88 ± 0.87) when compared with the control (3.83 ± 1.15) (p=0.001). Conclusion: We concluded that the BMI was found to be significantly lower in both drug naive PTB subjects and in PTB subjects on ATT when compared with the control subjects.

Background: Despite the fact that clinical guidelines forbid this practice, BZDs and Z medications are still used for longer than the time of prescription in current clinical practice. This practice results in adverse effects. The purpose of this research was to determine whether or not it would be possible to stop giving BZDs and Z medicines to patients who had been misusing these medications for far longer than the allotted time frame. This study also looked into the Sleeping well (QoS) and financial savings that patients who were deprescribed experienced. Methods: A prospective interventional study was conducted at the Psychiatric Department in both the inpatient and outpatient settings. Over the course of the study’s Twelve -month recruitment period, 109 patients in all were enrolled, which was based on the inclusion criteria. Following a discussion with the prescribing psychiatrist, suggested that unsuitable BZD and Z-drugs users begin the process of deprescribing their medications. After they were taken off their medications, For the next 30 days, twice a month the patients were examined. To do the QoS analysis, the Pittsburg Sleep Quality Index (PSQI) was used as a measurement. Before and after the intervention, the total cost of medications that each patient had to pay each month was calculated and compared between the two groups. Results: Following the intervention, 41 (37.61%) BZD users had their prescriptions for the drug revoked, which meant that their dose was either reduced 6 (5.5%), completely discontinued 28 (25.68%), or use a prescription for is opus sit (SOS) BZD 7 (6.4%). 43 patients (39.44.36%) continued BZDs as prescribed by the algorithm. The BZD that was deprescribed the most commonly was clonazepam 34 (82.92%). Patients’ quality of life and the deprescription of BZDs were linked, according to p-value (<0.05). After deprescribing BZDs, a statistically significant cost reduction was seen (Z=5.6244, p=<0.001). Conclusion: Deprescribing BZDs was linked to a decrease in consumption; applying deprescribing procedures to inappropriate BZD users is doable, enhances service quality, and has positive financial implications. Highlights: (1) This is the study to investigate whether or not it would be possible to stop administering BZDs. (2) Patients who use BZDs   (clonazepam, alprazolam, zolpidem)  for an unnecessarily long period of time or for longer than the length that was prescribed are candidates for deprescribing.

Background: Because of its medicinal qualities, Calotropis gigantea, a member of the Apocynaceae family, has historically been employed in treating a number of diseases1. Several researchers have thoroughly examined most of the uses, but there have only been a few investigations into the skeletal muscle-relaxing properties of the Calotropis gigantean flower. The purpose of this study was to determine whether albino rats’ skeletal muscles might be relaxed by an ethanolic extract of Calotropis gigantean flowers (EECGF). Materials and Techniques In albino rats weighing 180–220 g, EECGF preparation and skeletal muscle relaxant activity testing were conducted. Four separate groups of creatures were created. Group I (control) received 10 ml/kg of normal saline, Group II (standard) received 10 mg/kg of diazepam, and Groups III and IV received 100 mg/kg and 200 mg/kg of EECGF, respectively. Both locomotor activity on the photoactometer and skeletal muscle relaxant activity (motor coordination) were carried out. Analysis of variance was used in the statistical analysis, which was followed by ANOVA comparison tests. Results: The actophotometer and rotarod tests revealed that EECGF considerably decreased the tested animal’s motor coordination and locomotor activity. Conclusion: Significant dose-dependent skeletal muscle relaxant action was demonstrated by EECGF.

Background: Ever since the beginning of the Covid-19 pandemic, pathologists started investigating the laboratory markers that can assist in predicting the outcome among Covid-19 patients presenting to the emergency/inpatients department of hospital. Aim: This study aimed to investigate the association between the blood/serum levels of various inflammatory biomarkers at the time of admission to hospital and mortality among COVID-19 patients. Material and Methods:  This was a single centre, hospital (inpatient) based prospective cohort study involving 508 Covid-19 patients admitted to the study institute. We collected data on CRP, D-dimer, LDH, Ferritin, and IL-13 levels at the time of admission. We also assessed the correlation between CT Severity score and the inflammatory markers. Result:  Among 508 included patients: 53 (10.4%) patients died, 73 (14.4%) patients required admission to Intensive Care Unit studied, 39 (7.7%) patients required mechanical ventilation, 23 (4.5%) had Coma and 328 (64.6%) patients were discharged from hospital without any complications.  The levels of all measured inflammatory markers were significantly higher (worse) (p <0.05) among patients suffered adverse complications (including death) during treatment. In addition, the level of several inflammatory markers strongly and positively correlated with CT scan findings. Conclusion: The level of all inflammatory markers was significantly higher among Covid-19 patients who died during the treatment. However, more research is needed to identify the upper cut-off levels of inflammatory markers to identify patients who are at increased risk of complications including death.

Background: The post-mortem interval, often known as the time since death, is the period of time between when a person passes away and when the body is examined by a forensic expert. Objectives: To estimate the total count and differential count of cells in the cerebrospinal fluid with cytological differences. Methods: This prospective study was conducted in the Department of Forensic Medicine in a medical college for a period of 6 months. This study analyzed the CSF from the cerebellopontine cistern for cell count and morphology in all medicolegal autopsies with known time since death by Neubaur chamber and light microscopy. The study sample consisted of 40 CSF samples taken from medicolegal autopsies. Ethical clearance was obtained from the Institutional Ethical committee (IEC) before starting the study. All cases subjected for medico-legal autopsy whose time of death is known were included in the study. Results: Most common cause is natural causes comprising 36%, followed by poisoning in 28%. Hanging and trauma were other common causes. Out of 40 patients (27 were males and 13 were females) so the study was female preponderance. The most common age group was 21-40 years in 48.71% followed by 41-60 years in 28%. The mean value of total cell count in CSF in PMI of 0-6 hours is 250 with a standard error of 28.86. The mean value of total cell count in PMI 6 – 12 hours is 388.81 with a standard error of 37.36. The mean differential cell count in cases with PMI 0 – 6 hours shows that mean neutrophils count is 23.33, mean lymphocyte count is 70 and the mean eosinophil  count id 6.66. There were no degenerated cells in this period The mean differential cell count in cases with PMI 6 – 12 hours shows that the mean neutrophil count is 12.72; the mean lymphocyte count is 75.45. The mean degenerated cells in this period are 11.81. Conclusion: According to the study, the post-mortem increase in CSF cell count is a typical physiological occurrence. Up to 12 hours after the injury, the CSF cell count increases, but the first 6 hours show no degenerative alterations hours. Neutrophils, lymphocytes, plasma cells, eosinophils, and histiocytes are the distinguishable cells.

Introduction: This study investigates the effectiveness, safety, and tolerability of antibiotics in preventing postoperative endophthalmitis, a rare but serious complication of cataract surgery, which can lead to vision loss. Concerns about antibiotic resistance and adverse effects are discussed. Methodology: A total of 500 patients undergoing cataract surgery were randomized to receive either a combination of topical and intracameral antibiotics or placebo. Results: The incidence of endophthalmitis was significantly lower in the antibiotic group compared to the placebo group (0.8% vs 3.2%, p=0.03). No adverse events or side effects associated with the use of antibiotics were observed. Conclusion: Antibiotics for prevention of endophthalmitis in cataract surgery appear safe and effective, but risk of resistance and adverse effects should be considered. Further studies are required to determine optimal regimen and duration for endophthalmitis prevention.

Introduction: Dry eye disease is a common condition that affects millions of people worldwide, characterized by inflammation, tear film instability, ocular discomfort and visual disruption. This study investigates the correlation between OSDI score and tear film biomarkers in DED patients. Methods: 100 patients with DED were studied at a tertiary hospital in 2022. They were divided into 3 groups based on severity of symptoms and tear osmolarity, tear breakup time and inflammatory cytokines in tear film. Results: This study found a significant correlation between OSDI score and several tear film makers, including IL-6, TNF-α and MMP-9, after adjusting for age, sex and disease duration. IL-6 had the strongest correlation (r=0.57; p=0.001), followed by TNF-α and MMP-9. Multiple linear regression analysis showed IL-6 (r=0.57) and TNF-α (r=0.51, p=0.001) as the most correlated inflammatory markers, with MMP-9 and IL-1 being the most significantly correlated markers in the pathogenesis of the disease. Conclusions: The present study adds to the growing body of evidence supporting the use of tear film diagnostic markers in the evaluation and management of DED.

Background: Vehicle collisions are a primary source of mortality on the planet. Due to the location of essential organs inside the chest cavity, severe chest injuries sustained in such events are often deadly. The purpose of this research is to assess the significance of these injuries on motorist safety. Study Design: Descriptive retrospective study. Methods: The purpose of this study was to provide a descriptive retrospective analysis of postmortem autopsy results from instances of road traffic accidents with chest injuries treated over a period of 10 years. The statistical analysis was done in IBM SPSS 15.0 (P 0.05). Results: There were 70 total cases examined. The age range was from 6 decades to 80 decades, and the ratio of males to females was 5.5 to 1. Rib fractures were the most prevalent chest injury, accounting for 94.1% of all cases, followed by haemothorax (58.5%), laceration of the lungs (21.0%). One incidence (1.1% of total) involved the diaphragm, making it the chest structure least often afflicted. Multi-system injuries accounted for the majority of fatalities (80.2%). Conclusion:More men and younger, more active adults die from chest injuries sustained in car accidents. When it comes to chest injuries, the ribs take the cake. Seldom do people sustain damage to their thoracic spine or other internal organs. Numerous injuries account for the vast majority of fatalities.

Background: Postoperative sore throat (POST) following extubation after general anaesthesia is one of the most distressing side effects of endotracheal intubation during the immediate postoperative period. Ketamine, a NMDA antagonist, has anti-nociceptive and anti-inflammatory properties. Through its action on the peripherally located NMDA receptors, it reduces inflammation and pain. Objective: To assess the efficacy of ketamine gargle in the prevention of post-operative sore throat in patients undergoing endotracheal intubation for general anaesthesia. Methodology: 106 patients undergoing general anaesthesia with endotracheal intubation were included in our study and were randomly assigned into Groups A and B, with 53 patients each. Group A received 50 mg (1 ml) of ketamine diluted with 29 ml of normal saline in the form of a gargle, and Group B received 30 ml of normal saline 5 minutes before induction. Patients had to gargle for a period of 30 seconds. Results:  Showed that gargling with ketamine before surgery cut down on the number of cases and severity of POST (post-operative sore throat). When compared, the difference in the incidence of sore throat at 0, 4, 8, 12, and 24 hours post-extubation was found to be statistically significant (p<0.001). Conclusion: Ketamine gargle significantly reduces the incidence and severity of postoperative sore throat.

Background: The supraclavicular technique is regarded to be the most straightforward and efficient way to block the brachial plexus for surgeries on the upper extremities. The anatomical landmark approach used in the traditional approach was linked to greater failure rates and problems. The success rates and safety margin have increased due to peripheral nerve stimulator (PNS) and ultrasonography (USG) guidance. Aim and Objectives: The current study compares USG and PNS for supraclavicular brachial plexus blocks used for upper extremity procedures in terms of the timing of the commencement of motor as well as sensory blockade, the overall duration of block, the length of the procedure, and any complications. Study design: Randomized, prospective controlled study. Material and Methods: 128 patients of over 18 years of age who were planned undergo elective upper extremity surgical procedures were randomly divided into one of the two groups. Supraclavicular brachial plexus blocks were given to patients in the Group USG under the supervision of ultrasound, while PNS was applied to the Group PNS. Bupivacaine 0.5% 15 ml and lignocaine 2% with 1:200000 adrenaline 10 ml were used as the local anaesthetic mixture in both groups. Independent t-test and Chi-square test are used to compare group means for categorical data. Results: The USG procedure was shorter than the PNS procedure (11.58 ± 2.73 min vs. 21.74 ± 4.84 min). When compared to Group PNS, in Group USG sensory block onset time (12.84 ± 3.65 min vs. 16.11 ± 3.56 min) and motor block onset time (23.12 ± 4.28 min vs. 27.13 ± 3.87 min) were both considerably shorter (P < 0.05). Overall duration of sensory blockade remained substantially longer in Group USG (8.11 ± 0.91 hrs) than in Group PNS (7.26 ± 1.42 hrs), (P=0.0077). Nobody in either set of patients experienced any complications. Conclusion: In comparison to the nerve stimulator technique, the ultrasound guided supraclavicular brachial plexus blockade can really be performed more rapidly and results in a rapid onset of sensory and motor block.

Background: The pancreas is a specialized organ composed of both exocrine and endocrine glandular tissue. The exocrine pancreas occupies most of its parenchyma in which pancreatic islets of Langerhans (endocrine cells) are embedded. An islet is a mass of polyhedral cells, located in the vicinity of fenestrated capillaries and a rich autonomic innervation. Beta cells mainly secrete insulin and islet amyloid polypeptide (IAPP). Alfa cells secret glucagon. Alteration in functioning of insulin and glucagon hampers the glucose homeostasis which leads to development of diabetes mellitus. Materials and Methods: The present study  has been conducted in the Department of Anatomy, Gauhati Medical College, Guwahati. A total of 103 specimens of human pancreas are collected from both male and female cadavers after taking institutional ethical clarification using simple random sampling method. Results & Observation: In different region (head, body, and tail)  of pancreas variable number of Islets of Langerhans (IL)are analyzed and the mean and SD values  among 103 samples of cadaveric pancreas(CP)s according to diabetic status. It is more in tail region than head and body region in both diabetic(DM) and nondiabetic (NDM) CPs. The ANOVA i.e. F- value has  a highly significant among 18  DM &  85 NDM CPs. Conclusion: More number of samples and advanced stereological procedure will provide better information and knowledge. The data generated in our study with respect to beta cell mass provides the understanding of the pathogenesis diabetes mellitus. With the application of newer molecular technique the detailed investigation of islets of Langerhans cells can be possible.

Objective: The purpose of this study was to determine the relationship between postoperative health-related quality of life (QOL) and care requirements for oral cancer patients. Methods: 140 oral cancer patients without cognitive impairment who had undergone surgical treatment during the previous two years were enrolled in this cross-sectional study. The European Organisation for Research and Treatment of Cancer Head and Neck Cancer Quality of Life Scale and the Short-Form Cancer Needs Questionnaire were each completed by the patients. Results: Stepwise multiple linear regression analysis showed that “trouble with social contacts,” “swallowing problems,” “teeth problems,” and “feeling sick” were four oral cancer-related symptoms and problems that were significantly associated with higher care needs in oral cancer patients (all P ≤ 0.05). Conclusion: A significant correlation exists between health-related QOL and care needs.

Background: Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease with unknown aetiology and has various clinical manifestations affecting different tissues. Chronic inflammation is an important pathological development in the disease process for autoimmune diseases. Aims:  To correlate NLR AND PLR with disease activity in SLE, lupus nephritis and with severity of SLE arthritis. Materials & Methods: After obtaining institutional approval, a hospital based cross sectional study was conducted in Tertiary care centre – Rheumatology Clinic, Department of Internal Medicine, Government Medical College, Thiruvananthapuram for a period of one year. 80 SLE patients who were diagnosed using SLICC criteria were enrolled in the study. Severity of arthritis was assessed using DAS 28 scoring system. Results: NLR and PLR values positively correlated with SLEDAI 2k scores with ( r=0.863 and p<0.005) and (r=0.867 and p <0.001) respectively. On comparing NLR and PLR values in SLE patients with lupus nephritis and without lupus nephritis, it was found that both values were significantly increased in patients with lupus nephritis with p value <0.001.  NLR and PLR also showed significant increase as severity of arthritis (assessed by DAS 28 score) increased with p value of 0.013 and 0.012 respectively. In the study we also compared NLR and PLR with CRP and ESR. There was significant positive correlation of NLR with ESR (r=0.804, p value <0.001) but not with CRP (r=0.099 and p=0.384). However there was statistically significant positive correlation of PLR with both ESR (r=0.711, p value<0.001 ) and CRP (r=0.308, p value=0.005). Conclusion: NLR and PLR can also be used to assess the severity of arthritis in SLE. These markers can be easily calculated from routine blood counts and are less costly as compared to other inflammatory cytokines, these ratios are relatively stable as each WBCs count could be changed by dehydration/rehydration and diluted blood specimens.

Aim: The purpose of the present study was to analyze various etiological factors and to compare various surgical modalities based on size of incisional hernia. Methods: The present study was conducted in the Department of General Surgery, Lord Buddha Koshi Medical College &Hospital, Saharsa, Bihar, India for 8 months. Out of 200 cases of various types of hernias operated a total of 60 cases of incisional hernias were studied and followed for a period varied from 6 months to 8 months. Results: During the period of our study, a total of 200 patients have been operated for various types of hernia, out of these 60 cases were incisional hernia. Inguinal hernia was most common type accounting for 45%, next common hernia was incisional hernia (30%) remaining rare type of hernias constituting 25% of total cases studied. Maximum number of cases in middle age group (30-60 yrs.) constituting 71.66 %. Conclusion: Hence the incidence of the incisional hernia can be decreased by preventing these factors. Incidence of incisional hernia is more common in the age groups 30-50 years. Incidence of incisional hernia is more common in females especially due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries.

Background: This study was undertaken to know about the clinical profile and outcome of patients admitted in paediatric ICU in a tertiary care hospital. Methods: This is a hospital based, retrospective, descriptive study, done on patients admitted to paediatric ICU, ICARE Institute of Medical Science and Research and Dr Bidhan Chandra Roy Hospital, Haldia, West Bengal, India for one year. Results: As about 424 patients were admitted paediatric ICU. 79 patients were excluded from the study. Remaining 345 PICU patients were analysed. According to the age distribution of patients, it showed that < 1year were (25.2%), 1-5 years were (44.3%), > 5years of age were (30.4%). There was a female preponderance (58.8%), males were (41.1%). Patients from rural area were 243 (70.4%) and 102 (29.5%) from urban area. Clinical profile showed that pneumonia was the most common diagnosis (8.4%) for admission in PICU. This was followed by bronchiolitis (6.9%)(5.5%),,  enteric unknown fever bite in (5.2%) (6.6%), acute febrile severe seizures asthma (6.3%) (4.9%), poisoning, sepsis (6.0%) (4.6%), renal severe problems gastritis (5.7%) (4.3%), occult, clinical bacteremia dengue (3.7%), seizure disorder (3.4%), croup (3.1%), traumatic head injury (2.8%), wheeze associated LRI (2.6%), acute  otitis media (2.3%), migraine (2.0%), meningitis (1.7%), CHD with complications (1.7%), severe anaemia with CCF (1.4%), acute urticarial (1.4%), foreign body (1.1%), electric shock (1.1%), scorpion sting (0.8%), viral hepatitis (0.8%) angioedema, clinical The malaria outcome (0.8%) noted, nephrotic was, (87.8%) syndrome were discharged, with complications (10.7%)  (0.5%) patients,  scrub went  against typhus  (0.2%) medical and advice, (0.2%) (1.4%) was  patients were referred at parent’s request. Conclusions: Respiratory illness, infectious diseases, neurological problems and poisoning are the most common cause for PICU admissions. But seronegative dengue cases, electric shock, re-emergence of scrub typhus, are being  increasingly also recommend diagnosed. better manpower So, emphasis and  infrastructures therefore placed to improve on high the index outcome of suspicion of patients for admitted this type of  to PICU. conditions.

Background: Co-morbidities are the reason behind high morbidity and mortality in SAM children. There is lack of literature regarding co morbidity pattern in SAM children. Objective: To study the co morbidities in severe acute malnourishment children admitted in NRC. Methods: SAM was diagnosed as per WHO protocol. Total of 299 SAM children were included. Co-morbidities were identified and were investigated further and managed accordingly. Results: 90% SAM children had anaemia.61% had diarrhea and 30% had pneumonia, Vitamin D deficiency features were found in 30% cases. 10% had UTI & 10% Otitis Media. Tuberculosis was diagnosed in 13% of cases. Celiac disease, Hypothyroidism and HIV were not found to be major co-morbid conditions. Conclusions: Co-morbidities identification and treatment in SAM children is key step in reducing morbidity and mortality associated with SAM.

Background: Many factors like unclear Calot triangle anatomy, intensely inflamed and thick gallbladder, dense adhesions in the operative area, obscure biliary tree anatomy, local inflammation like pancreatitis contribute to the conversion of laparoscopic cholecystectomy to open cholecystectomy. The aim of the present study was to find the utility of abdomen sonography parameters that predict the conversion from laparoscopic to open cholecystectomy. Methods: The present study was conducted in the Department of General Surgery, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar, India for one year. Ninety patients aged between 20 and 75 years with the diagnosis of cholelithiasis/cholecystitis were included in this observational study. Every patient underwent ultrasonography (USG). The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, size of the calculi, presence of abdominal adhesions, size of the common bile duct was recorded. If feasible, laparoscopic cholecystectomy was done. If not, the procedure was converted to open cholecystectomy. Association of USG findings was correlated with conversion to open cholecystectomy. The comparison of the qualitative variables was done using Fisher’s exact test. Results: Of 90 patients, 7 (7.8%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically. Conclusions: Pre-operative USG parameters did not predict conversion to open cholecystectomy.

Background: Approximately 10% of all dermatological problems are nail abnormalities. The nail unit may independently reflect dermatological illnesses and exhibit particular changes that serve as indicators for a variety of systemic disorders. Therefore, a physical examination is incomplete without a nail examination. A sizable fraction of dermatological problems are nail abnormalities. The nail serves as a window that offers crucial hints for any underlying, systemic, dermatological, and disorders. Despite the fact that evaluating the nails is a must for any cutaneous evaluation, it is a relatively underutilized appendage. Nail alterations may be a sign of underlying systemic disorders or infections in addition to being an aesthetic concern. Without prompt treatment, nail conditions may deteriorate, considerably interfere with everyday activities, and lower quality of life. The purpose of the study is to document the clinical range of nail problems, including those caused by congenital, developmental, infectious, neoplastic, degenerative, dermatologic, and systemic diseases. to research the full range of clinical nail problems, including those that are systemic, congenital, developmental, infectious, neoplastic, degenerative, dermatological, and infectious in nature. Aim: This study was carried out to document the clinical pattern, determine the etiology, and identify risk factors for various nail changes. Material and Method: This cross-sectional observational study was carried out in the dermatology department. A dermatological outpatient department (OPD) at a tertiary care hospital recruited 150 patients (of any age or gender) who presented with any type of nail irregularity for this study. A case record form was created to collect basic demographic data (such as age, gender, address, and occupation) and detailed history (such as the present symptoms and other similar cutaneous/mucosal/hair/nail problems related to toenails). A history was gathered to check for any past trauma, drug use, and chemical exposure. A complete cutaneous and orogenital examination was performed during the clinical assessment. Results: In the current study, 100 randomly selected dermatology patients with nail abnormalities included 60 men (40%) and 90 women (60%) who visited the dermatology outpatient department. The ratio of men to women was 0.8:1. The age range from which the nail modifications were noticed was 5 years to 35 years. Most of the patients were in the age range of 4 to 74. Nail complaints made up 46.5% of the patients’ presenting symptoms in this study; however, in the remaining patients, nail alterations were discovered while they were being examined for other dermatological or systemic illnesses. The most common nail complaints were the physical or structural changes of nails in 50.5% of the patients, followed by pain and discoloration. Conclusion: This study affirms the significance of the nail as a crucial element of the overall dermatological assessment. The early detection of cutaneous/systemic diseases that have gone undiagnosed until now is made possible by a thorough history and meticulous inspection of the nails, accompanied by straightforward investigations. Holistic management strategies can benefit from the identification of risk factors for common conditions like onychomycosis and paronychia. Therefore, further study should be done on the nail unit so that it can be used as a diagnostic tool and understood better.

Background: Numerous studies have demonstrated a link between the incidence of febrile convulsions and the levels of magnesium, zinc, and copper in serum and cerebrospinal fluid (CSF). Convulsions caused by the central nervous system’s hyperexcitability are a hallmark of hypomagnesaemia. One of the most prevalent kinds of seizures in children is febrile convulsions. There have been hints that epilepsy and low serum magnesium (Mg) may occasionally be related. Additionally, a favorable link between the severity of epilepsy and hypomagnesemia was discovered. Seizures classified as febrile are those that happen between the ages of six and sixty months, with a temperature of 38 degrees Celsius or above, are not brought on by an infection of the central nervous system or other metabolic disturbance, and do not have a history of previous afebrile seizures. A seizure is a brief episode of symptoms and/or signs brought on by abnormally high levels of synchronous or excessive neuronal activity in the brain. Aim: To Study the Serum levels of Magnesium and Calcium in children: 6 months – 5 years of age with febrile convulsions and to establish the correlation between serum Magnesium and Calcium levels and febrile convulsions. Material and Method: This study was carried out in the Department of Pediatrics using a duration-based prospective analytical case-control design. Cases were defined as children who needed to be hospitalized due to febrile seizures and were between the ages of six months and five years. As controls, we included children in the same age range who were admitted to the hospital due to a febrile illness without seizures. The study objectives were conveyed to the parents/guardians of the chosen study subjects in their native tongue. They received an informative letter on the participant. In all, forty the research age group of children, ranging from 6 months to 5 years, was admitted to the pediatric unit. Patients who wished to participate in the trial or their guardians gave written, informed consent. Results: The mean age of presentation of febrile convulsion was found to be 18.77±10.32 months. The mean temperature at which children had febrile convulsions was 95.33±0.88^oF. The differences between the cases and controls were not statistically significant. There were 24 children (68%), with 24 cases of acute pharyngotonsillitis; 7 cases (18%) of acute pharyngitis; 3 cases (10%) of acute diarrheal illness; and 1 case each of acute otitis media and viral fever. According to the current study’s analysis of the mean serum calcium levels, all of the subjects in the control group had normal serum calcium levels, and the association between the two groups was found to be statistically significant. Among the cases, 90% of the subjects had normal levels and 10% had abnormal levels. Conclusion: There is no link between the serum magnesium levels and febrile convulsion in participants in this study. Therefore, in healthy patients, routine magnesium supplementation is not necessary to avoid febrile convulsions. Calculating serum magnesium and calcium levels is crucial for a logical comprehension of the etiology and treatment of febrile seizures. The type of seizure may be related to changes in these characteristics.

Introduction: Severe acute pancreatitis (SAP) presents a significant medical challenge, necessitating accurate severity assessment. Ranson’s Criteria, a widely adopted scoring system, aids in prognosis prediction. However, its limitations prompt ongoing refinement efforts. This study investigates Ranson’s score’s diagnostic utility in SAP, addressing its relevance and potential enhancements. Methods: This study was conducted in department of General Surgery, government medical College, Eluru. included patients >18 years with acute pancreatitis, excluding those with pancreatic malignancies, undergoing treatment, pregnant, or uncooperative. Demographic, clinical, and biochemical data were collected at baseline and 48 hours. Ranson’s and BISAP scores were compared with the revised Atlanta classification for severity assessment. Results: Out of 140 participants, 34 were diagnosed with acute pancreatitis (AP), with a higher prevalence in the 28–37 age group (39%; 13) followed by 48–57 (29.4%; 10). BISAP score ≥3 correlated with increased severity, organ failure, necrosis, and mortality, surpassing Ranson’s score in predicting severe acute pancreatitis. Conclusion: SAP poses a significant health threat with notable mortality rates. Alcohol remains a predominant risk factor, particularly among younger individuals. BISAP score ≥3 signifies increased severity and mortality, surpassing Ranson’s score in prognostic accuracy, highlighting its crucial role in acute pancreatitis management.

Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Type 2 diabetes mellitus (T2DM) accounts for 90% of all DM cases and is characterized by progressive insulin secretory defect and insulin resistance1. It is a growing public health burden across the world, particularly in developing countries. India is almost in the grip of the diabetes epidemic and warrants immediate corrective measures. Aim: To study the relationship between vascular complications of type 2 diabetes mellitus with serum magnesium levels. Results: 101 patients of Type 2 Diabetes Mellitus who are fulfilling the inclusion and exclusion criteria are studied according to prestructured proforma. Results are analyzed.