Background and Objectives: Increased preterm baby survival rates were facilitated by improvements in neonatal care, which resulted in a rise in the count of children suffering from retinopathy of prematurity (ROP). This study calculated the occurrence of ROP and assesses all possible risk factors. Study design: Hospital based prospective study. Setting: Ophthalmology department of Government Medical College and Hospital of south India from March 2012 to August 2013. Material and Methods: A total of 72 preterm newborns were screened for retinopathy of prematurity between March 2012 and August 2013 after receiving institutional ethical committee permission and the parents’ informed written consent. Outcome measures: The cumulative incidence of ROP was used as the primary outcome measure, while risk factors linked to ROP were used as the secondary outcome measure. Results: 28 out of the 72 infants who were a part of the study’s sample had ROP in some stage in either one or both of their eyes. In the studied population, ROP had an overall incidence rate of 38.89%. There was no statistically significant difference in occurrence between the genders, as calculated by the Chi-square test (P = 0.263). Statistically significant disparity were observed in terms of mean gestational age (29.54±1.78 weeks) and mean birth weight (1030.11±175.07 grams) in the ROP group and control (No ROP) group (32.30±1.82 weeks) and (1371.36±309.63), (P < 0.0001 and P=0.0005, respectively). NICU admission and respiratory distress syndrome also had a significant correlation with ROP (P≤0.01). Conclusions: Among the population analysed, researchers discovered a striking rate of ROP in this study (38.89%), and the following elements have quite a statistically significant impact on the progress of ROP in its active form: early gestational age, a low birth weight, NICU admission, as well as respiratory distress syndrome (p < 0.05). Ophthalmologist and neonatologist should work together for timely screening and regular follow up to reduce the burden of blindness due to ROP.

Background: Preeclampsia is a pregnancy-related hypertension and multisystem disorder. It is the leading cause of maternal death and illness. Pre-eclamptic mothers have a greater rate for lower segment caesarean section (LSCS). In order to compare the effects of general anaesthesia vs. subarachnoid block upon maternal outcomes in pre-eclamptic patients, we conducted a comparison study. Materials and Methods: One hundred consenting 16 to 32 years old patients with severe pre-eclampsia who were scheduled for elective as well as emergency LSCS were randomly assigned to one of two groups: group GA or group SA, who obtained general anaesthesia or subarachnoid block, respectively. The mother’s Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Systolic Blood Pressure (SBP), & Heart Rate (HR) were measured prior to induction, immediately after induction, 5, 10, 30, and 60 minutes after induction, and 15, 30, 60, 90, and 120 minutes after the surgery was completed. Result: In neither of these two groups is there any evidence of maternal mortality. The GA group experienced hypertension (10%), and pulmonary edema (4%) during surgery as compared to hypotension in SA group (14%). Conclusion:Regarding intraoperative and postoperative morbidities, the subarachnoid block works well as a modality of anaesthesia for LSCS in parturients with severe preeclamptia.

Background: The use of mydriatic and cycloplegic eye drops is a common practice in ophthalmology for various diagnostic and therapeutic procedures like for estimation of refractive error and for thorough fundus examination. The combination of Tropicamide and Phenylephrine has been a subject of debate among ophthalmologists regarding its efficacy and side effects. Aims and Objectives: The aim of this study was to evaluate the efficacy and safety of 1% Tropicamide alone versus a combination of 0.8% Tropicamide and 5% Phenylephrine for mydriasis and cycloplegia. The objectives were to compare the rate of mydriasis and maximal mydriasis after instilling a single drop of each solution and to measure the degree of cycloplegia and amount of residual accommodation at 25 minutes after instillation of the drops. Methods: This was a hospital-based, analytic cross-sectional study conducted on 100 patients between 15 and 35 years of age presenting to the Department of Ophthalmology, Government Medical College and Associated Group of Hospitals, Kota for refraction or fundus examination. Patients were randomly assigned to either the Tropicamide group or the Tropicamide-Phenylephrine group. The study measured the rate of mydriasis, maximal mydriasis after eye drop instillation. Study also measured the degree of cycloplegia and amount of residual accommodation at 25 minutes after instillation of the drop. Results: The combination of Tropicamide and Phenylephrine resulted in a higher rate of mydriasis and maximal mydriasis than Tropicamide alone. Tropicamide alone uncovered significantly higher mean latent error of refraction and had higher cycloplegic effect as compared to combination group. The study also found that increasing age lead to increased cycloplegia and decreased residual accommodation in both groups. It was also found that both groups had a similar safety profile, with no significant adverse effects observed except significant increase in pulse rate after instillation of combination eye drop. Conclusion: The combination of Tropicamide and Phenylephrine is more effective than Tropicamide alone for inducing mydriasis with a similar safety profile except significant change in pulse rate. While Tropicamide alone had better cycloplegic effect.

Background: Diabetes Mellitus (DM) is a chronic metabolic disorder that can lead to various ocular complications, including diabetic retinopathy (DR), a leading cause of blindness in the working-age population. Tear film abnormality, characterized by a disturbance in the balance of the tear film, ocular surface, and lacrimal glands, is a common complaint among patients with DM and has been associated with the development and progression of DR. However, the relationship between tear film abnormality and DR is not well understood. Aims & Objectives: The aims and objectives of this study were to clinically study tear film abnormality and tear film-related ocular surface disorders in diabetic patients, evaluate ocular and systemic risk. Method And Material: This was a cross sectional study involving a sample of 70 diabetic patients attending the outpatient department of ophthalmology in a government medical college in Kota, India, from November 2020 to November 2022. The study participants underwent a general and ocular examination including visual acuity, anterior segment examination, corneal surface evaluation, Corneal sensation test, tear film evaluation, and fundus examination. Results: 64.28% of diabetic patients had tear film abnormality. The results indicated a high occurrence of tear film abnormality, with a significant association between increasing age, HbA1c levels, TBUT, Schirmer’s test and diabetic retinopathy. Conclusion: This study highlights the need for ophthalmologists to monitor tear film abnormalities in patients with diabetes, especially those with uncontrolled diabetes and diabetic retinopathy. Regular eye exams and management of blood glucose levels can help prevent or delay the onset of tear film abnormality in these patients.

Background: Corneal ulcer is a major cause of visual impairment worldwide. The epidemiology and microbiology of corneal ulcer varies in different regions. In this study, we aimed to investigate the clinical and microbiological features of corneal ulcers in a tertiary care hospital in a developing country. Aims & Objectives: The aim of this study was to investigate the common causes, clinical characteristics and microbiological features of infective corneal ulcers in a tertiary care hospital in a developing country. Methods: This was a prospective study conducted over a period of one year. A total of 50 patients with clinical features of corneal ulcer were enrolled. Detailed history and ophthalmic examination were done. Corneal scrapings were obtained for microbiological evaluation, including Gram staining, Giemsa staining, potassium hydroxide (KOH) mounting, and culture. Results: The most affected age group was 60-70 years, with a male predominance. The most common symptom was pain, followed by redness of the eye. Injury or trauma to the eye was the leading cause of corneal ulcer. Fungal corneal ulcer was the most common, followed by bacterial corneal ulcer and mixed pathogens. Aspergillus and Fusarium were the most common fungal isolates, while Staphylococcus and Pseudomonas were the most common bacterial isolates. Most of the patients had poor visual acuity. Conclusion: Corneal ulcer is a common and serious condition, especially in developing countries. The epidemiology and microbiology of corneal ulcer vary in different regions. In our study, we found that fungal corneal ulcer was the most common, followed by bacterial corneal ulcer and mixed pathogens. Early diagnosis and appropriate treatment are essential to prevent visual impairment.

Background: The six-minute walk test (6MWT) is a straightforward functional capacity assessment instrument that is widely used to assess the likelihood of success and efficiency of any therapeutic or medical intervention. However, there are lots of variability in equation derived from Indian population by different researcher. Objective: To Measure 6MWD using 6MWT in adult population and 6MWD in relation to age, Sex, BMI, WHR(waist-hip ratio), Visceral fat, Subcutaneous fat, skeletal muscle mass, Total body fat. Physiological Response of 6MWT is also studied terms of HR, BP, SpO₂, Borg’s Scale. Materials and Methods: 240 voluntarily participating healthy participants. Recruitment criteria included being between the ages of 17 and 50, injury-free, and not having a history of chronic illness or hospitalisation that would limit their ability to exercise. Age, weight, height, and body mass index (BMI), as well as SpO2, HR, BP, and Borg’s Scale, were anthropometric characteristics that were recorded both before and after the test. Results: The statistical analysis of the data makes it abundantly evident that following the 6-minute walk test, all of the metrics, including SpO2, Systolic BP, Diastolic BP, and heart rate, all considerably increase. The mean values of all the measures, including SpO2, systolic blood pressure, diastolic blood pressure, and heart rate, were calculated and compared to the mean values of the same parameters just prior to the 6-minute walk test. Conclusion: With the exception of WHR, the differences in 6MWD between various variables including visceral fat, subcutaneous fat, skeletal muscle mass, total body fat, and BMI were statistically significant. SpO2, Systolic BP, Diastolic BP, and Heart Rate are all statistically significant physiological response metrics before and after the intervention. (P≤0.05).

Background and Aim: Several studies have shown links between high ferritin levels and central obesity, hypertension, dyslipidemia, and elevated fasting insulin and blood glucose. Much less research has been done on the link between high serum ferritin and the metabolic syndrome. The purpose of the current study was to assess the connection between metabolic syndrome and serum ferritin. Material and Methods: The current cross-sectional study was carried out over the course of a year at the Tertiary Care Institute of India’s Department of General Medicine. Patients with metabolic syndrome who were enrolled in the Tertiary care teaching institute of India during the study period and who had been diagnosed according to the NCEP (National Cholesterol Education Program) ATP III (Adult Treatment Panel III) (2001) guidelines were included in the study. 200 patients in all were enrolled in the trial. Results: In the current study, males composed 62% of the study populations while females composed 38%.) In the current study, 98% of participants had waist circumferences greater than 90 cm, while 94% of the female participants had waist circumferences greater than 85 cm. A statistically significant correlation between PPBS and the metabolic syndrome components was found in the current investigation. The mean blood ferritin levels in this study were 124.70 52.10 The p-value was calculated to be 0.05, indicating a statistically significant connection between serum ferritin levels and metabolic syndrome components. Conclusion: The prevalence of the metabolic syndrome is positively correlated with elevated iron reserves as determined by serum ferritin levels. Serum ferritin levels were associated with an increasing number of metabolic syndrome factors.

Background: Pediatric intensive care has evolved in various domains in last two decades. Early recognition of danger signs, adequate stabilisation of sick children and safe referral of critically ill children, appropriate assessment and management of such children in tertiary care centre are key components in saving young lives. Analysing the type of admissions, assessing need of infrastructure, medications, manpower will aid in improving the level of care in sick children admitted in intensive care. Aims and Objectives: Primary objective of this study is to analyse the pattern of admission and outcome of children who were admitted in rural pediatric intensive care unit in south India Analysing the type of admissions, assessing need of infrastructure, medications, manpower will aid in improving the level of care in sick children admitted in intensive care. Methods and Materials: A Retrospective analysis of case record of children between 1 month-12 year admitted in Pediatric intensive care of Governmaent Villupuram Medical College during the periodof January 2018-December 2018 was done. Demographic profile, morbidity pattern and outcome of those children were analysed. Results: Out of 458 cases admitted during the study period 412 were discharged, 26 children expired and 20 left against medical advice. Most common age group admitted was infants 41.9% and male childern were more (63.1%). Out of this 458 children, 71% of children were from lower class as per updated BG Prasad scale. Most common system involved in children admitted was neurological system 33.4% followed by respiratory system 27.9%. Most common disease for which children were admitted was seizure disorder 17.9% followed by pneumonia 17%.76% of ventilated children were successfully discharged. Conclusion: Morbidity pattern is not the same in all intensive care units. Detailed analysis of Morbidity pattern will help the Intensive care team to be prepared to handle sick children and save their lives.

For several lower abdominal surgeries, including caesarean sections post-operatively, ultrasound-guided Transverse Abdominis Block (TAPB) is a safe and effective analgesic technique. To find the most effective analgesic combination, various drug combinations have been tested. Levobupivacaine and adjuvants like dexamethasone added to local anesthetics in TAPB have been shown to lessen postoperative pain intensity during the postoperative period. Our study aimed to assess the efficacy of the addition of Inj. Dexamethasone (8mg) to Inj. Levobupivacaine (0.25%) in USG guided transverses abdominis plane block given in patients who underwent cesarean section. A total of 80 patients (40 per group) posted for elective and emergency caesarean delivery were included in the present study. Grouping of the patient was done by sealed envelope method & divided into two groups:1). Group L: TAP block with 30 ml of Inj. Levobupivacaine 0.25% + 2cc Normal saline total of 32cc.[16 ml on each side],2). Group LD: TAP block with 30 ml of Inj. Levobupivacaine 0.25% + Inj. Dexamethasone 8 mg (2ml) total of 32 ml. [16ml on each side] and the time to first rescue analgesia (Vas score > 4), the total amount of rescue analgesia required in the first 24 h postoperatively were recorded. We observed that the Time to first rescue analgesia was prolonged significantly in the group LD (19.9hrs ± 2.07) compared to group L (10.2hrs ± 2.21) (p <0.0001). Visual analogue scale scores were significantly lower in group LD. The total consumption of Inj. Diclofenac Sodium in 24hrs was significantly lower in the group LD (95.6 ± 33.92) compared to group L(170.6mg ± 50.92) (p<0.0001). Thus in conclusion, In USG-guided TAPB, the addition of dexamethasone (8 mg) to Levobupivacaine (0.25%) considerably lessens post-operative pain and extends the duration of postoperative analgesia, lowering the requirement for overall analgesics consumption.

Background and Aim: Several eye disorders have their beginnings in childhood, and the morbidity may go unrecognized and negatively impact the child’s academic performance as well as produce serious ocular handicap in later life. There is information accessible on the epidemiology of ophthalmologic issues from many different nations, including several regions of India. As a result, our programme is designed to identify the root causes in the formative years and begin the most effective treatments then. Material and Methods: This study, which included schoolchildren aged 5 to 12, was cross-sectional in nature. 1500 children from five schools in rural Gujarat participated in the study. To screen children, a multistage process was designed. School officials were notified about the screening camp and received signed informed consent from parents for screening pupils for various eye illnesses after receiving ethical committee clearance. Study was done on the relationship between ocular diseases, colour vision, and visual acuity. Children that need more evaluation were forwarded to the hospital. Results: Refractive error was the most prevalent eye problem among 1500 students from 5 different schools. 16% of people had myopia-related astigmatism. 75% of the population, of which 125 were against the rule and 55 had astigmatism, which was followed by simple myopia. Simple hypermetropia (16.6%), simple astigmatism (2.5%), simple hypermetropia (5.83%) (6). Twenty-six children, or 1.73%, squinted. 46.15% (12) of the kids had alternate divergent squints, of which 2 had refractive error. Corneal opacity was present in 1.06 %(16), defective color vision was there in 0.9%(14); lids and adnexal disorders 0.8%(13) and cataract 0.7%(11). Conclusion: Refractive error was the most common cause of ocular morbidity. The majority of the reasons might be avoided or treated. Early eye issue detection was made simple and successful by using a school screening. Early diagnosis and treatment slow the disease’s course and can stop visual impairment.

Background: The use of mydriatic and cycloplegic eye drops is a common practice in ophthalmology for various diagnostic and therapeutic procedures like for estimation of refractive error and for thorough fundus examination. The combination of Tropicamide and Phenylephrine has been a subject of debate among ophthalmologists regarding its efficacy and side effects. Aims and Objectives: The aim of this study was to evaluate the efficacy and safety of 1% Tropicamide alone versus a combination of 0.8% Tropicamide and 5% Phenylephrine for mydriasis and cycloplegia. The objectives were to compare the rate of mydriasis and maximal mydriasis after instilling a single drop of each solution and to measure the degree of cycloplegia and amount of residual accommodation at 25 minutes after instillation of the drops. Methods: This was a hospital-based, analytic cross-sectional study conducted on 100 patients between 15 and 35 years of age presenting to the Department of Ophthalmology, Government Medical College and Associated Group of Hospitals, Kota for refraction or fundus examination. Patients were randomly assigned to either the Tropicamide group or the Tropicamide-Phenylephrine group. The study measured the rate of mydriasis, maximal mydriasis after eye drop instillation. Study also measured the degree of cycloplegia and amount of residual accommodation at 25 minutes after instillation of the drop. Results: The combination of Tropicamide and Phenylephrine resulted in a higher rate of mydriasis and maximal mydriasis than Tropicamide alone. Tropicamide alone uncovered significantly higher mean latent error of refraction and had higher cycloplegic effect as compared to combination group. The study also found that increasing age lead to increased cycloplegia and decreased residual accommodation in both groups. It was also found that both groups had a similar safety profile, with no significant adverse effects observed except significant increase in pulse rate after instillation of combination eye drop. Conclusion: The combination of Tropicamide and Phenylephrine is more effective than Tropicamide alone for inducing mydriasis with a similar safety profile except significant change in pulse rate. While Tropicamide alone had better cycloplegic effect.

Introduction: Skin and/or subcutaneous tissue infections are highly diverse with regard to etiology, causative organisms, incidence, clinical features, severity and complications. Necrotising Soft Tissue Infection (NSTI) is a rapidly progressive infection primarily involving the fascia and the subcutaneous tissue. NSTI encompasses necrotising form of cellulitis, fasciitis and myositis depending of the depth of tissue involved. Specific terms are also used when specific sites are involved, such as Fournier’s gangrene for genitourinary tract, Meleney’s ulcer for anterior abdominal wall and Ludwig’s angina for submandibular and sublingual spaces. Aims: To study the influence of clinical features, LRINEC Scoring System, Imaging and Microbiological flora on the outcome of patients with NSTI. Materials and Methods: This prospective observational study was undertaken taking all the patients admitted to the Department of Surgery, SCB Medical College, Cuttack from Nov 2018 to Oct 2020 with a provisional diagnosis of severe skin and soft tissue infection with high degree of suspicion for NSTI as study population. The Skin includes Epidermis and Dermis. The Epidermis consists of five layers. stratum corneum (keratin layer) stratum lucidum (present in soles and palms only) stratum granulosum (granular cell layer) stratum spinosum (prickle cell layer) and stratum basale (keratin layer). Epidermis contains no blood vessels so cells there derive nourishment by diffusion. The venous drainage of the skin is via both valved and unvalved veins. Unvalved veins allow oscillating flow in the subdermal plexus between cutaneous territories, equilibrating flow and pressure. The valved cutaneous veins drain via plexi to the deep veins. Conclusion: NSTI are often fatal, characterized by extensive necrosis of the fascia and subcutaneous tissues. It is perhaps the most severe form of soft tissue infection potentially limb and life threatening. Early diagnosis of necrotizing fasciitis is essential to advocate timely management for the better wellbeing of the patient. LRINEC scoring system has a better positive predictive value in identifying the onset of necrotizing fasciitis and risk strategizing of the patients with severe soft tissue infections.

Background and Aim: The hypersaturation of cholesterol in bile during the nucleation process, a crucial stage in the formation of bile stones, has been the subject of numerous studies conducted in the west to uncover risk factors for biliary lithiasis. The prevalence of gall stones is higher in people with hypothyroidism condition, according to several reasons for a potential relationship between hypothyroidism and lipid metabolism and gall stone development. The current study aims to determine hypothyroidism as a likely cause of biliary stones in Tertiary care teaching institute of India by examining the prevalence of undiagnosed hypothyroidism in patients with cholelithiasis. Material and Methods: In a Tertiary Care Teaching Institute in India, a prospective, hospital-based cross-sectional study was conducted on patients hospitalised for the treatment of gall stone disease in the general surgery department over the course of a year. After initial screening, patients who met the selection criteria provided a thorough history, paying particular attention to symptomatology and risk factors as per the proforma. All patients who qualified had their thyroid function tested. Three groups of patients—euthyroid, subclinical hypothyroid, and clinical hypothyroidism—were created. used statistical analysis. The prevalence of hypothyroidism and subclinical hypothyroidism in all patients included was obtained after determining the percentage of gall stones in different age groups and genders of the study population. Results: Four of the 160 patients were under the age of 20, 48 were between the ages of 21 and 40, 40 were between the ages of 41 and 60, and 56 were between the ages of 61 and 80. Of of 160 patients, 112 had normal thyroid function, 40 had subclinical hypothyroidism, and 8 had hypothyroidism as their official diagnosis. The research population, which had an unknown thyroid function, displayed indications of hypothyroidism. Conclusion: The study showed a considerable frequency of hypothyroidism in cases of cholelithiasis of 29%. 6 percent had clinical hypothyroidism, while 23 percent had subclinical hypothyroidism. According to this study, ladies over 40 years old have a higher prevalence. The study group had hypothyroid symptoms while having unknown thyroid status, which strongly suggests thyroid profile testing prior to surgery.

Background: Colorectal Cancer is one the most prevalent cancers globally and the incidence is increasing especially in developing countries due to the adoption of the western way of life. Several factors such as obesity, sedentary lifestyle, red meat consumption, alcohol, and tobacco are some of the etiological factors. Methods: Histopathologically confirmed cases of colo-rectal carcinoma were included in the study. Each patient was asked to provide a thorough history, with a focus on early symptoms, habitual history, and family history. A comprehensive physical examination was performed to assess the patient’s overall health and clinical symptoms. All patients had digital rectal examinations (DRE). Each patient’s case had a thorough laboratory investigation workup. In all other circumstances outside the emergency, radiographic tests were done. Colonoscopy and abdominal computed tomography (CT) were performed when needed. Results: A total of n=40 cases were included in the study out of which n=28/40(70.0%) were detected with cancer on the left side. Cancer of the rectum accounted for the majority of cases in n=25 (63%) of cases.  Cases were detected with cancer of ascending colon in n=10 instances, sigmoid colon, caecum, hepatic flexure, anal canal, and splenic flexure in n=1 case each respectively. 75% of cases were found with moderately differentiated carcinoma. Curative abdominal resection was carried out in 40% of the cases in the study. Conclusion: there is a likelihood of a large increase in colorectal cancers owing to epidemiological change and the relative scarcity of the complex and expensive treatment methods normally employed to treat the illness making colorectal cancer a significant problem for the Indian healthcare system going forward. A more rigorous study with larger sample size and long-term follow-up must be done to determine how the epidemiology of the illness is being impacted by newly identified risk factors in India, such as a changing diet.

Introduction: Shoulder pain is a common cause of musculoskeletal disability. Shoulder joint pathologies are commonly diagnosed using MRI and arthroscopy1 . Arthroscopy is gold standard diagnostic in-vestigation in obtaining definitive diagnosis of abnormalities but many studies have reported MRI to be sensitive, accurate and noninvasive tool for investigation.7 The aim of study is to compare MRI and arthroscopy in diagnosing shoulder pathologies. Material and Methods: The prospective study included 41 patients between January 2020 and July 2021, presented to our institute with chronic shoulder pain after applying selection criteria. MRI followed by shoulder arthroscopy was performed for all patients. The data was statistically analysed using SPSS v 26. Results: Synovitis (65.9%) was most common pathology. MRI reported high specificity (100%) for full thickness rotator cuff tear, rotator cuff tendinitis, sub acromial bursitis, and Bankart’s Lesion fol-lowed by SLAP lesion (96.6%), and bicep tendinitis (95.8%) while moderate specificity for syn-ovitis (78.6%) and partial rotator cuff tear (66.7%). MRI reported to have high sensitivity for Hill Sachs lesion, sub acromial bursitis and partial thickness rotator cuff tear and Bankart’s lesion and low sensitivity for full thickness rotator cuff tear, synovitis, SLAP lesions and bicep tendinitis. MRI detected subacromial bursitis (0.807), Bankart’s lesion (0.792) and Hill Sachs lesion (0.707) with substantial correlation whereas it detected synovitis (0.064) with only slight correlation. The accuracy of MRI was highest in diagnosing subacromial bursitis (0.90) and Bankart’s lesion (0.90) and lowest for synovitis (0.46). Conclusion: MRI is effective technique for diagnosis of rotator cuff tears, sub acromial bursitis, synovitis and rotator cuff tendinitis, but was less effective in detecting SLAP lesions and less in differentiating the partial or complete rotator cuff tear.

Aim and Objectives: (1) Knowledge of the COVID 19 vaccine among medical students in a tertiary care hospital. (2) Attitude towards the COVID 19 vaccine among medical students in a tertiary care hospital. Methodology: Study Location: Tertiary care hospital facility in Visakhapatnam. Study Period: From August to September 2022 will be the study period. Study Sample Size: 316. Statistics: Data are gathered using google forms, and the spread document is error-checked. Calculations are made for descriptive numbers like frequency and percentage. Results: Sociodemographic details about the participants- There were 316 competitors in total. Men make up about 34.5% (n=109) of the members. Approximately 65.5% of the members (n=207) are female. About 40.5% (n=128) of the participants are first-year students, 39.25% (n=124) are second-year students, 14.5% (n=46) are third-year students, and 5.7% (n=18) are fourth-year students. Conclusions: The majority of medical students’ responses to this research show moderate knowledge of and a favorable outlook towards the COVID 19 vaccine. It also demonstrates that medical students are more knowledgeable and have more optimistic dispositions. Our findings can be applied to interventions that promote public health, particularly for medical students. To dispel the medical students’ fears and misunderstandings regarding the COVID 19 vaccine, there should be seminars, lectures, and instructional videos that are specifically aimed at them.

Background and Aim: There is insufficient data linking hypovitaminosis D with the potential danger to maternal-neonatal pairings, despite mounting evidence that vitamin D shortage and insufficiency are linked to poor pregnancy and newborn outcomes. The purpose of this study was to examine the relationship between maternal and neonatal vitamin D status and see if maternal vitamin D deficiency may increase the risk of low birth weight. Material and Methods: The current study comprised 200 women and was an observational study. The patients that were enrolled were split into two groups: a case group and a control group. Mothers of newborns weighing more than 2500 g will be used as a control group. Mothers of newborns less 2500 g at birth will be counted as cases. Within two hours of birth, 5 ml of the mother’s blood will be drawn, labelled, and submitted to the lab to be tested for serum 25 (OH) vitamin D levels using the 25 hydroxy vitamin d enzyme immunoassay method. Results: The means maternal serum vitamin D level in the included women was found to be 34.79 nmol/L. The Vitamin D deficiency in the included mothers were found in the 45% of the total included population, Vitamin D insufficiency was found in 29% and the normal range of vitamin D level was found in 26% of the included women population. The present study’s data collection revealed that the mean maternal serum vitamin D levels in the group of newborns with low birth weight were considerably lower than those in the group of newborns with normal birth weight. Conclusion: Low birth weight babies and maternal vitamin D insufficiency are significantly correlated.

Introduction: Acute peritoneal dialysis is used for a short duration, after which chances of peritonitis get increase.  While chronic i.e. continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) is used on a long-term basis. Using peritoneal dialysis as a treatment modality, patients are monitored regarding their clinical status. It is widely available and technically easy to perform, large amounts of fluid can be removed in hemodynamically unstable patients, and easy and gradual correction of acid-base and electrolyte imbalance may be performed. Peritoneal dialysis access placement is relatively easy, particularly in children. In the present study, we analyzed the clinical profile of all patients who underwent peritoneal dialysis for various reasons along with their complications and outcome. Methods: The present prospective observational study was carried out in the Pediatric intensive care unit in a tertiary care hospital amongst 48 cases presented as acute renal failure. In this study, we enrolled 48 patients presenting with acute renal failure or uremia. A detailed history was recorded regarding complaints, their onset, duration and progress, past history was noted. The outcome of the procedure was noted as improvement, whether complete or partial or death. Acute peritoneal dialysis was performed manually.   Results: In this study, the most common age group affected was 1 – 4 years (33.33 %). Among 48 patients presenting with acute renal failure, the most common cases were due to urolithiasis (25 %), and patients with chronic renal failure constituted 14.58 % of the total cases. The most common indication of peritoneal dialysis was fluid overload in 66.67 %. In the present study, 18.75 % of patients required peritoneal dialysis for less than 60 hours while 81.25 % of patients underwent dialysis for more than 60 hours. In the present study, catheter malfunction (25.00 %) was the most common complication, followed by hypokalemia (20.83 %). In the present study, 47.92 % of patients had complete improvement, while 37.5 % had partial improvement.   Conclusion: There was a significant reduction in the blood urea and creatinine levels along with normalization of serum potassium levels after the session of peritoneal dialysis. The outcome of pediatric peritoneal dialysis was good with a mortality of 12.5 % in the present study, cause of death mostly related to associated co-morbid systemic disorder.

Background: Eye trauma occurs fairly frequently in developing countries and constitutes a major health problem. It is the cause of blindness or partial loss of vision in more than half a million people worldwide. This prospective study was aimed at describing the risk factors, agents involved, and final visual outcomes of 30 patients who presented with perforating eye injuries. Methods: All patients who presented with perforating eye injuries were selected for this study. Consecutive patients were enrolled and categorized according to many criteria like age, sex, place at which the injury occurred, and causative factors. All patients were examined and followed up for a minimum of three months. The following parameters were noted for all the patients. Visual acuity with a pinhole at presentation. Slit lamp examination to evaluate the extent of the injury. Investigations like plain X-rays in a suspected metallic foreign body. B scan ultrasonography was done in all cases. Results: The visual acuity was assessed in the patients at the time of presentation to the hospital and it was found that the visual acuity was between 1/60 – PL in 40% of cases and it was between 6/36 – 2/60 in 36.67% of cases. 16.67% of cases had visual acuity > 6/12. After the treatment, the visual acuity was recorded at the end of 3 months, and it was found that 50% of cases had visual acuity between 6/36 – 2/60 and 23.23% of cases had visual acuity > 6/12. Visual acuity of 1/60 – PL was in 16.67% of cases and 6/18 – 6/24 visual acuity scores were in 10% of cases. Conclusion: Most perforating eye injuries are potentially preventable. Improvement in farming techniques should be done. Education should be aimed at young individuals. Parental education regarding the danger of sharp toys and air guns should be emphasized. The use of protective eyewear in both works related as well as recreational activities should be the main focus of preventive education. When prevention fails and an eye injury occurs early, an appropriate referral is very essential to preserve vision.

Aim: Use of priming principle in the induction dose requirement of propofol and its hemodynamic stability. Methods: This prospective study was conducted in the Department of Anesthesiology, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for 10 months. 100 patients of age between 18-55 years, come under ASA-I or ASA-II category undergoing surgery which requires general anaesthesia as a mode of anaesthesia chosen to determine effect of priming principle in relation to Propofol. Results: Two groups were comparable to each other with respect to age, weight, ASA physical status. There was no significant difference in baseline pulse rate & baseline SBP, DBP & MAP, oxygen saturation between group S & Group C (p-value > 0.05). The mean induction dose in group S was 80.37 ± 14.82 and in group C it was 112.27 ± 17.68. Thus we observed a 30% reduction in induction dose requirement in group S. The rise in Pulse rate was highly significant at one minute after induction, during intubation, immediately after intubation & 5 minutes later. There was highly significant fall in MAP at one minute after induction, during intubation, immediately after intubation and 5 minutes later. The changes in SBP & DBP followed the same pattern as MAP. There were no statistically significant changes in SP02 in both the groups. Incidence of hypotension was more in group C while post-suxamethonium fasciculation’s was more in group S. Conclusion: The Priming principle when applied for the induction agent like Propofol is associated with significant reduction in total induction dose requirement of Propofol and improved peri-intubation hemodynamic stability.

Aim: To correlate clinical and radiological outcomes of microscopic discectomy in patients with lumbar disc herniation. Methodology: This was a prospective study conducted in the Department of Orthopaedics, Shree Narayan Institute of medical sciences, Saharsa, Bihar, India. during a period of 12 months. 30 patients scheduled for micro lumbar discectomy for lumbar disc herniation. All patients first underwent conservative for the minimum period of three weeks, after which they were counseled for operative option. Those patients were included who had an unremitting sciatica, with or without back pain, and/or a neurological deficit that correlated with appropriate level and side of neural compression revealed on CT or MR imaging. We did not exclude patients who presented with other spinal degenerative conditions such as stenosis or arthritis with herniated disc because their symptoms were suggestive of the herniated disc. Patients with associated bony canal stenosis and spondylolisthesis were excluded. As with all surgical procedures, informed consent, demographic details, and clinical history were obtained and an explanation of risks, alternatives, and benefits was given. Results: Out of 30 patients, majority of the patients were males (66.7%) and 33.3% were females. Average age of the patients was 43.75 years (21-68 years). All surgeries were single level micro discectomy including L3-L4 (10%), L4-L5 (60%), and L5-S1 (30%). All the cases of L4-L5 and L3-L4 discectomy required fenestration of L4 and L3 lamina respectively while only 2 cases of L5-S1 required fenestration of the L5 lamina for the proper exposure of the disc space. Operative time on the average was 79 minutes (range 50 to 150 minutes). 80% of the patients had a stay of less than 5 days in the hospital, while 20% of patients had a stay of more than 5 days in the hospital. Disc sequestration (30%) and disc exclusion (26.7%) were the most commonly seen types of prolapse followed by central disc bulge (20%), disc protrusion (13.3%), and lateral disc bulge (10%). On assessing the outcome in patients in terms of returning to activities of daily living and satisfaction with surgery, 86.7% and 76.7% had score less than 2 respectively, while only 13.3%  and 23.3% patients had a score more than two respectively. Conclusion: Lumbar discectomy with microscopes is very safe and effective means of treating disc herniation related sciatic pain. But conservative management should be done first. If there is no improvement, lumber micro discectomy can act as a gold standard option.

Aim: To study the histopathological features of cervical lesions. Materials and Methods: A retrospective study was done in the Department of Pathology at Shree Narayan Institute of medical sciences, Saharsa, Bihar, India for 12 months. Results: 87.7% (307/350) lesions were Non-neoplastic and majority was inflammatory in nature second most common was benign lesions 25 (7.1%). Invasive lesions occupied only 2.8% (8/350) and pre invasive about 2.2% (10/350) respectively. Conclusion: Histopathology study of cervical biopsy lesions is a valuable diagnostic procedure. Early detection of cervical lesions may provide an opportunity for appropriate interventions to prevent further complications such as progression from benign to malignant conditions. Adequate screening procedure with follow up cervical biopsies helps in early diagnosis and management of premalignant and malignant lesions.

Aim: The present study was carried out to compare the efficacy of continuous epidural infusion of two amide local anesthetics, ropivacaine and bupivacaine with fentanyl for postoperative analgesia in major abdominal surgeries. Material and Methods: A randomized, prospective, study was carried out in Department of Anesthesiology, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for one year .A total of 80 patients scheduled for major abdominal surgery were randomized into two Groups B and R with forty patients in each group. All patients were administered general anesthesia after placing epidural catheter. Patients received continuous epidural infusion of either 0.25% bupivacaine with 1 ug/ml fentanyl (Group B) or of 0.25% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h intraoperatively. Postoperatively, they received 0.125% bupivacaine with 1 ug/ml fentanyl (Group B) or 0.125% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h. Results: Till the end of 120 min, the sensory blockade was comparable in both the groups. After 150 min, however, the number of patients with level above T10 were significantly more in Group B as compared to Group R till the end of 24 h (P = 0.001 at 12 h). Conclusion: Both ropivacaine and bupivacaine in the concentration of 0.125% with fentanyl 1 ug/ml are equally safe, with minimal motor block and are effective in providing postoperative analgesia.

Metformin (MET)(Standard drug) A biguanide, that lowers insulin resistance by triggering AMP-dependent protein kinase (AMPK). In STZ-induced diabetic rat, metformin lowers blood glucose levels through increasing ẞ-endorphin production from the adrenal glands, which stimulates opioid u-receptor linkage and increases GLUT-4 gene expression while decreasing PEPCK gene expression. Lactic acidosis, bloating, nausea, metallic taste, mild diarrhea, exhaustion, and vitamin B12 deficiency are a few of the side effects of metformin.

Streptozotocin is a glucosamine nitrosourea chemical with a glucose molecule and methyl group connected at one end. Its chemical name is 2-deoxy-2(methyl nitrosamine) carbonyl) amino)-D-glucose, and it was produced by the bacterial strain Streptomyces achromogenes in a fermentation broth (gram-positive bacterium). Typically, it is a poisonous glucose analogue that causes experimental diabetes.STZ is an ideal agent to induce experimental type 2 diabetes, it has more advantages than alloxan over sustained hyperglycemia and the development of well characterized diabetic complications with a low incidence of ketosis and mortality. Streptozotocin’s beta cell toxicity is mostly caused by the pancreas’s loss of NAD. Nicotinamide inhibits poly (ADP-ribose) synthetase activity and prevents NAD depletion in pancreatic beta-cells, which reduces the cytotoxicity caused by streptozotocin.

Background: Posterior malleolus fracture quiet commonly occurs due to rotational ankle injury. Management of PM fragment is still controversial but recently operative management is being preffered. Posterolateral approach has become popular nowadays and most surgeons are preffering this approach. Material and Method: A total of 30 patients was taken into study.All patients were operated by posterolateral approach. A total duration of 12-24 months follow up was taken. Result and Conclusion: In order to achieve proper anatomical reduction and to lessen the complication like post-operative osteoarthritis, this operative method of posterolateral approach has become popular. A direct visualisation and anatomic fixation of posterior malleolar fragment is possible, which is by far the major advantage of this approach.

Background: Animal models of osteoarthritis (OA) have shown that sensory nerve fibers innervating the knee are significantly damaged with subchondral bone destruction, and induce neuropathic pain (NP). So, the investigators hypothesized, can drugs used in NP work in OA. Methods: (Animal experimental study) After IAEC permission, Rats were randomly divided into 5 groups of 8 animals as Normal control (NC), MIA 2mg- (DC), Meloxicam 1mg/kg- (PC), Pregabalin 32.4 mg/kg- (TG-1), Pregabalin 16.2 mg/kg + Meloxicam 1mg/kg (TG-2). OA was induced by intraarticular MIA injection on day 0. After taking the baseline values, drugs treated groups were administered with respective drugs once a day subcutaneously for 28 consecutive days. Behavioral tests were compared from baseline, 7^th, 14^th, 21^st & on 28^th day. Histopathology and bone marker levels of COMP & MMP-13 were compared on the 28^th day. ANOVA with post hoc Tukey’s test was used for parametric data. Non-parametric data was analyzed using Kruskal Wallis test with post hoc Dunn’s test. Results: Rota rod, Hot Plate analgesiometer & Grip strength test showed significant results when TG-2 group compared to DC. Tail immersion & Acetone drop test showed significant results when TG-1 group compared to DC. In Histopathology grading, the scores in TG-2 group were significantly reduced compared to DC. MMP -13 & COMP levels in TG-2 group were significantly decreased as compared to the DC (p<0.05). Conclusion: Meloxicam + Pregabalin was found to be chondroprotective & effective for pain relief which suggested OA pain is a combination of inflammatory & NP.

Objective: To study the epidemiology of depression and quality of life in polycystic ovarian syndrome patients diagnosed with depression. Methods: This hospital-based single-centered observational study enrolled 80 women with PCOD based on eligibility criteria The occurrence of depression is prevalent in patients with PCOS, and this study concurs with the guidelines recommending screening such patients for these disorders. Results: The results of this study show that certain symptoms of PCOS are associated with depression. Out of 59 patients with depression; 13 had mild (22.03%); 26 had moderate (44.07%); 20 had severe depression (33.90%). Upon carrying out multivariate logistic regression analysis, it was found that there was no significant association between PCOD with and without Depression among tage group. Similarly, in case of marital status, educational qualifications, occupations, residence, family type and socioeconomic status there was no significant association between patients with PCOD with or without depression. The symptoms of PCOS may change throughout the course of the illness. Conclusion: It is vital that screening for psychiatric morbidity be incorporated as an ongoing process rather than a one‑time assessment. The likelihood of depressive symptomatology was shown higher in PCOD women with depression. However, PCOS subjects also experienced depression due to body image so this may be a sign of psychiatric illness in PCOS, which needs to be treated as a high priority to improve the quality of life of PCOS patients.

Introduction: Crown heel length is the stature of an individual. It is determined by health, nutrition, infancy, childhood and adolescence. Stature is important in defence department and sports. Height helps in establishing identity in unknown human remains. The aim of present study is to estimate stature from length of radius in deceased individuals between 20 and 70 years. Primary objectives: (1) To find out correlation between radius length and stature of an individual. (2) To derive linear regression formula to estimate stature from these dimensions obtained, in males and females separately. Methods: This is a descriptive study done on 250 cases in the age group between 20 and 70 years brought for autopsy in Department of Forensic Medicine, Government Medical College Kottayam. Study tools included semi structured proforma, sliding vernier callipers and measuring scales. Data from total 250 subjects were collected. Stature, length of right and left radius was recorded in centimetres. Data was entered in Microsoft excel and analysed using Statistical Package for Social Sciences (SPSS) soft ware (free version). Results: In the present study, total 250 cases were taken, of which, 212 males comprising 84.8% and 38 females comprising 15.2% of the total population studied. The mean age of study sample was 40.14 years with standard deviation 10.197 years. The mean height and other numericals showed highest value in males. There was significant correlation between height and radial lengths in both males and females. Right radius length in males showed highest correlation with height (correlation coefficient to 0.980). Left radius length in males showed (correlation coefficient r = 0.708) lowest correlation with height. Conclusion: Current study supports previous research that radial length can be used to predict height of an individual. It was concluded that the calculated regression formulae have high reliability and applicability for height estimation in the sample.

Background: 2-5% of newborns and kids with normal neurological development have febrile seizures. After a single incidence, febrile seizures recur 30% of the time, twice as often after two or more episodes, and even more often in infants. In India, the frequency of febrile convulsions is 10–17%, which is greater than the incidence in affluent nations (2 to 7%). Aims and Objectives: This research sought to determine if iron deficiency (ID) was a risk element for febrile convulsions and whether ID anemia was related to febrile seizures. Materials and Methods: In a tertiary care facility in northeastern India, this observational case-control research was carried out and patients with febrile illnesses were chosen as controls (Group C) from comparable age groups and all patients with febrile seizures had been selected as cases (Group S). Children in both groups had their body temperatures recorded. CBC, TIBC, and serum iron blood tests were carried out. Results: The mean ages in groups S and C in the current research were 2.33 years & 2.204 years, respectively. In group S, the mean haemoglobin levels were 8.25±1.0 g/dL, but in group C, they were 9.86±1.49 g/dL, which was significant statistically (p=0.003). Group S had considerably lower serum ferritin levels than the other group. MCV, MCH, and MCHC averages for group S were significantly lower than those for the control group. The current research additionally suggests a connection between febrile seizures and ID. Conclusion: The current study demonstrated that haemoglobin, serum iron levels, serum ferritin, and MCV were substantially reduced in children with febrile convulsions, indicating that a low iron value plays a significant impact in febrile seizure children. Therefore, ID is indicative of febrile convulsions.

Introduction: In spite of the fact that there are epidemiological differences between India and the United States, the AAP 2010 guiding principles are adhered to perform Lumbar Puncture in the first occurrence of febrile seizures, having incidence of 2-5% in >1month old children and most frequently between 6 months to 5 years old children. Aim and Objectives: To determine the prevalence and risk factors for meningitis for the first incidence of febrile seizures among children between the ages of 6 and 18 months. Materials and Methods: In a tertiary care centre in northeastern India, 200 children between the ages of 6 and 18 months who had been admitted with their first episode of FS underwent this cross-sectional research. The lumbar puncture was carried out, and clinical, blood, CSF variables were analyzed by the SPSS version 21.0. Results: Children aged 6 to 18 months who presented with the initial episode of FS had a meningitis prevalence of 16% (n=32). In 3% (n=6) of patients, bacterial meningitis (BM) was seen. Higher Total Leukocyte Count (TLC) i.e. >16500 cells/mm3 with positive C – reactive protein (CRP) were the independent predictors of meningitis. Seven patients (3 of S. pneumoniae, 2 of MRSA, 1 each of K. pneumoniae, and N. meningitidis) had positive blood cultures. In 56.2% (n=18) among the meningitis cases, monocytes were the most prevalent kind of cell to be found. Conclusion: Given that meningitis is more common in kids with initial episodes of FS in India as compared to the USA and that India has a much lower immunization rate for the Haemophilus (Hib) & pneumococcal vaccine (PCV) than the USA; India have to develop its own criteria to perform lumbar puncture in instances with initial occurrence of FS. In patients who have elevated TLC (>16500 cells/mm3) and positive CRP, meningitis might be anticipated.

Objective: To investigate the various clinical manifestations of dilated cardiomyopathy (DCM), correlate echocardiographic findings with different clinical manifestations, and identify the variables that predict poor outcomes. Objectives: The present study was carried out with following aims- (1) To study the different clinical presentations of dilated Cardiomyopathy. (2) To link Echocardiography findings to various clinical presentations. (3) To identify the variables that contribute to poor outcomes. Methods: This prospective study will be carried out in patients admitted with symptoms and signs of heart failure in MKCG Medical college and Hospital. Results: There were 35 (55%) males and 29 (45% females) out of 64 cases, for a male to female ratio of 1.27:1. Out of 64 cases 52 (81 percent) were Idiopathic. In 56 (88 percent) of the cases, dyspnea was the most common presenting clinical feature. In the Echo study, the majority of cases (39%) had an Ejection fraction (EF) in the 36-40% range, and the majority of cases (55%) had severe fractional shortening (FS). Conclusion: DCM is one of the most common causes of heart failure, as well as the most common type of cardiomyopathy in the middle-aged and elderly population. Males are more prone to it. Biventricular failure is the most common clinical presentation, followed by left ventricular failure. It is critical to identify patients early and begin treatment as soon as possible.

Objective: To study the epidemiology of depression and quality of life in polycystic ovarian syndrome patients diagnosed with depression. Methods: This hospital-based single-centered observational study enrolled 80 women with PCOD based on eligibility criteria The occurrence of depression is prevalent in patients with PCOS, and this study concurs with the guidelines recommending screening such patients for these disorders. Results: The results of this study show that certain symptoms of PCOS are associated with depression. Out of 59 patients with depression; 13 had mild (22.03%); 26 had moderate (44.07%); 20 had severe depression (33.90%). Upon carrying out multivariate logistic regression analysis, it was found that there was no significant association between PCOD with and without Depression among age group. Similarly, in case of marital status, educational qualifications, occupations, residence, family type and socioeconomic status there was no significant association between patients with PCOD with or without depression. The symptoms of PCOS may change throughout the course of the illness. Conclusion: It is vital that screening for psychiatric morbidity be incorporated as an ongoing process rather than a one‑time assessment. The likelihood of depressive symptomatology was shown higher in PCOD women with depression. However, PCOS subjects also experienced depression due to body image so this may be a sign of psychiatric illness in PCOS, which needs to be treated as a high priority to improve the quality of life of PCOS patients.

Aims & Objectives: To compare the three techniques of I-Gel placement (standard, rotation and reverse) in terms of insertion characteristics and success rate. To assess & compare mean time of insertion, ease of insertion, first attempt and overall success rate, Oro-pharyngeal Leak Pressure, Manoeuvres required and Ease of placement of Nasogastric Tube among the three groups. To compare and assess complications such as sore throat and blood staining. Methods: After approval of the Institutional Ethics Committee, 102 patients of ASA Grade I & II, aged 18-65 years who were undergoing elective surgery under general anaesthesia were included. After induction of anaesthesia, i-gel was inserted by using the standard, rotation and reverse techniques in Groups I, II, and III, respectively. The primary objective was to determine mean time of insertion. Secondary variables included ease of insertion, first attempt success rate, oropharyngeal leak pressure, manoeuvres required, ease of placement of nasogastric tube, and complications if any. Results: Time taken for insertion was shortest and significantly lower (P < 0.05) for group III in comparison with the other two groups. There were no significant differences in overall success rate, first attempt success rate, manoeuvres required and incidence of complications among the three groups (P >0.05). Baseline haemodynamic parameters were comparable in all three groups at base line, 1, 3, and 5 min after i-gel insertion. Conclusion: Although the time of insertion is shortest when i-gel is inserted using the reverse technique, all techniques are comparable and choice of technique depends upon the comfort and experience of the investigator.

Background and Objectives: Anterior Cruciate Ligament (ACL) damage is a frequent type of knee injury that often requires surgical repair. Hamstring autografts are frequently used in ACL reconstruction (ACLR). The choice of graft is influenced by several factors. There are few studies in the literature that demonstrate a relationship between patients’ anthropometric measures and the dimensions of the hamstring tendon graft used in ACLR. The purpose of present study was to compare both the length and diameter of the graft acquired with anthropometric measures. Material and Methods: The study was conducted as a hospital based prospective observational study at the Department of Orthopedics, Government Medical College and hospital of south India. Forty seven patients of more than 18 years age receiving quadrupled hamstring autograft ACL reconstruction were evaluated after receiving institutional ethical committee permission and the informed written consent. The anthropometric measurements were obtained preoperatively and intraoperative measurements of the length of both gracilis and semitendinosus tendon and diameter of the quadrupled graft were obtained. All the data collected were analyzed using SPSS statistical software version 22. Pearson correlation test was used to find out correlation between graft diameter and graft length and anthropometric parameters. Results: Analysis showed a positive relation between height, thigh length and graft diameter (p=0.045 and p=0.041, respectively). Height showed a positive correlation with both gracilis and semitendinosus length (p<0.001) whereas thigh length showed a positive correlation with semitendinosus length only (p=0.046). Other factors had statistically insignificant association with the graft diameter and length. Conclusion: For determining graft dimensions for ACLR surgery, anthropometric measures are simple measures. When doing ACLR, affirmative correlation variables (height & thigh length) can be used to predict a high-quality graft.

Introduction: Anorectal disorders are among the most common digestive complications among pregnant women. Due to the physical and psychological problems they cause a significant reduction in the quality of the life of those afflicted. In this study, we study the prevalence of Anorectal diseases and the factors influencing it during pregnancy. Materials and Method: This research is an observatory study based on the descriptive and sectional methods. 230 pregnant women reporting to the OPD of obstetric and gynaecology at tertiary centre were selected and history taking, inspection, digital rectal examination and proctoscopy done and final diagnosis made. The examination of pregnant women was done in only one time during pregnancy. Results: Total prevalence of anorectal diseases during pregnancy was 43.48%. There was a significant statistical association seen between 25-30 years age group and development of anorectal diseases, mean±S.D [ 25.72± 3.72 ] [P=0.0314]. There was also a statistical association observed between the socioeconomic status and anorectal diseases. The highest prevalence of anorectal diseases were observed in people which belongs from lower and middle class [p=0.0427 ].The frequency of perianal symptoms during pregnancy, most common symptoms was constipation (37.82%), then bleeding PR(33.91%), then pruritus(25.65%) and last painful defecation(17.39%). A significant statistical association was observed between trimesters and constipation. About 29.13% pregnant women developed constipation during last trimester [p=0.0001]. A significant statistical relationship was also observed between trimesters and prevalence of anorectal diseases[32.17%, p=0.0001], haemorrhoids were most common in last trimesters (29.13%). A statistical relationship was observed between parity (2or>2) and anorectal diseases during pregnancy[ p=0.259]. A significant statistical relationship was observed between type of the previous childbirth and anorectal diseases (p=0.0447). Out of four anorectal diseases, haemorrhoids (60.71%) was found most common which having history of previous vaginal delivery. Conclusion: The total prevalence of anorectal diseases during pregnancy was 43.48%, of them haemorrhoids was most common (37.82%), fissure (5.65%), anorectal polyps (2.17%) and rectal ulcer (0.87%). Haemorrhoids and anal fissures are common during the last trimester of pregnancy. Constipation, past history of peri-anal diseases, the level of parity and previous normal vaginal delivery are independently associated risk factors. Further studies must be performed to evaluate measures to reduce the incidence and prevalance of anorectal diseases during pregnancy.

Background: Higher blood levels of homocysteine are thought to be harmful to the vascular endothelium through the production of free radicals, so hyper homocysteinemia may be a risk factor for diabetic retinopathy that is potentially modifiable. Aim: To identify hyper homocysteinemia’s contribution to diabetic retinopathy. Material and Methods: A total of 80 patients with Type 2 DM who were seen in the outpatient clinics of the Department of Ophthalmology were screened for eligibility to participate in the study. All patients underwent a dilated fundus examination to diagnose diabetic retinopathy as part of their routine clinical evaluation. Patients were equally divided into two groups: one with retinopathy and one without retinopathy. Samples were sent for measuring levels of serum homocysteine along with blood was sent to determine levels. Results: On statistical analysis using a t test, the difference in mean homocysteine levels in both groups was statistically significant. The mean value of homocysteine in cases is higher than the mean of controls. Conclusion: As a result of our study’s findings, which showed that diabetic patients with DR had significantly higher prevalence of hyperhomocysteinaemia and mean plasma homocysteine levels than a matched control group without DR, homocysteine may be a useful biomarker or a novel risk factor for elevated risk of diabetic retinopathy in type 2 diabetic patients.

Background: One in seven people may get acute appendicitis at some point in their lives, making it one of the most common abdominal surgery emergencies. The lifetime risk is 6.7% for women and 8.6% for males; it is lowest at both extremes of age and highest in the twenties and thirties. A clinical examination can be between 70 to 87% accurate in identifying acute appendicitis. In cases of acute appendicitis, many surgeons advocate for immediate surgical surgery to prevent perforation, even if it means accepting a negative appendectomy rate of 15-20%. The purpose of this research was to evaluate the accuracy of the Alvarado scoring system vs the Tzanaki scoring system for identifying cases of acute appendicitis. Methodology: Our tertiary care facility hosted this cross-sectional, prospective, non-randomized investigation. Participants had to be experiencing pain in the right lower abdomen. The appropriate history, physical, and laboratory tests were performed. Patients had open appendicectomy after being scored with the Alvarado and Tzanakis systems. The pathologist’s histology findings formed the basis of the final diagnosis. Both scoring methods were evaluated and compared based on their sensitivity, specificity, PPV, NPV, and diagnostic accuracy. Results: There were a total of 100 participants in this study. Tzanakis scores of 8 or higher were present in 84 individuals. The Alvarado score was 7 or above for 82% of the patients. In 85 percent of cases, appendicitis was confirmed by a histological analysis. The Tzanakis score was as follows: 97% sensitivity, 93% specificity, 98.81% positive predictive value, 87.50% negative predictive value, and 97% accuracy. Sensitivity = 94.12%, specificity = 86.67%, PPV = 97.56%, NPV = 72.22 %, accuracy = 93%; Alvarado score. Conclusion: According to the results of this research, the Tzanakis scoring system is more sensitive, specific, and diagnostically accurate than the Alvarado scoring system. Therefore, Tzanaki’s score is a useful tool for making a correct diagnosis of acute appendicitis and decreasing the number of unnecessary appendicectomy procedures.

Aim and Objectives: (1) Evaluation of data, documents and resources to check performance of systems to meet specified standards. (2) Evaluating the effectiveness of drug therapy. (3) Preventing problems related to medication. (4) Controlling drug cost. (5) Identifications of areas of practice that require further education of practitioners. Study design: The current investigation is a retrospective, observational study conducted at NRIIMS, Visakhapatnam, a tertiary care teaching hospital. Study Sample Size: 245 prescriptions were reviewed. From May 2022 to October 2022, prescription data from in-patient departments of various specialties were analyzed. Calculations are made for descriptive numbers like frequency and percentage. Results: A total of 245 prescriptions were assessed in this study over a six-month period. All prescriptions included the patient’s name and gender, as well as the date the prescription was received. Some of the prescriptions did not include the patient’s weight. Some of the prescriptions did not include generic names. Few prescriptions fail to use capital letters. Polypharmacy and irrational drug use were discovered in 1.2% of prescriptions. Conclusions: There is an urgent need to reduce polypharmacy and raise awareness regarding antibiotic policy. Prescription auditing is a significant technique for enhancing patient care quality. A comprehensive action plan must be developed in order to improve patient care, and greater emphasis should be placed on pharmacological rationale. Various workshops and seminars must be held at the institution to teach 1. medical knowledge on drug rationality (particularly preoperatively and postoperatively), 2. polypharmacy 3. The significance of body weight in dosage calculation, 4. generic names, 5. use uppercase letters, 6. provide a detailed summary of your allergy history.

Background: Recently, India has witnessed an increase in the rates of crimes as well as convictions, resulting in rise in the number of prisoners and prisons. Nonetheless, prison’s occupancy rate is continuously rising beyond capacity. Similarly, there is increasing prevalence of mental disorders among prisoners, of which most common is substance use. Many foreign researchers have studied the prevalence of substance use among prisoners and association of substance use with crime, but surprisingly there is paucity of Indian data. This study was planned to help understand this in order to curb this social menace. Objectives: The objectives of this study were to estimate the prevalence of substance use, type, severity among convicted prison inmates from Khandwa district jail and to find the association between substance use and crime. Materials and Methods: This descriptive, cross-sectional study was conducted in District prison/jail, Khandwa, Madhya Pradesh, India, over a period of nine months from April 2022 to December 2022. Total 119 convicted prisoners were finally enrolled for data collection for our study after applying inclusion and exclusion criteria. Results and Conclusion: Majority of the prison inmates (49.57%) were middle aged from age group 31-50 years, followed by 18-30 years (36.13%). Most of the participants belonged to rural area (81.5%) and lower socio-economic class (66.38%). Majority were married (68.06%). Family history of substance use was reported by 61.34% and criminal history by 21.84%. 73 participants (61.34%) had AUDIT score more than cut off and 21 participants (17.64%) had DAST-10 score more than cut off. Among alcohol users majority (57.53%) were incarcerated for criminal offences and nearly half (53.42%) were repeat offenders, while among drug users, 76.19% were incarcerated for criminal offences and 61.9% were repeat offenders.

Background: Retinopathy of prematurity(ROP)is a vasoproliferative retinopathy that affects developing retinal blood vessels in very low birth weight premature infants (<1500 grams). Premature retina exposed to high concentration of oxygen, followed by abrupt withdrawal, easily undergoes uncontrolled vasculo-fibrotic proliferation and eventually results in retinal detachment. APROP is the most aggressive form of rapidly developing ROP and can cause severe visual impairments in newborns. Aim: To study the clinical profile of APROP. Materials & Methods: This retrospective case-control study was done in the Department of Ophthalmology of a tertiary care hospital of Southern Odisha since 1^st April 2020 to 30^th April 2022. Neonates born at or before 32 weeks of gestation and/or <1500 grams birth weight admitted in neonatal intensive care unit were included in the study along with neonates born after 32 weeks gestation or birth weights between 1.5 kg & 2 kg if they had any unstable neonatal course. 42 babies developing APROP were compared with 42 controls (with ROP not more than zone 2 stage 2) who were matched for gestational age and birth weight and they were evaluated for other risk factors. Results: The mean age among cases was 24.3 whereas that of controls was 24.9. The mean birth weight among cases was 1762 grams whereas that of controls was 1820 grams. The mean gestational age among cases was 31.2 weeks whereas that of controls was 31.4 weeks. 22 (52.38%) of the cases had sepsis (CRP ≥10mg/L) as compared to 8 (19.04%) of the controls with p value < 0.001. 26 (61.90%) of the cases had oxygen exposure ≥5 days as compared to 11 (26.19%) of the controls and with p value < 0.001. 9 (21.43%) of the cases had thrombocytopenia (Platetlet count < 100000/µl) as compared to 2 (4.76%) of the controls with p value = 0.024. Conclusion: Our study thus showed sepsis, oxygen exposure ≥5 days, thrombocytopenia and blood transfusion as significant risk factors for APROP.

Background: The hysterosalpingogram (HSG) is commonly used to evaluate the uterine cavity and the fallopian tubes in the workup of infertile couples. The sonohysterogram (SHG) is getting popularity as part of this evaluation. This study compares HSG to SHG for the detection of polyps, cavitary fibroids, adhesions, and septae in infertile patients. Materials & Methods: The retrospective study was done among 80 patients selected by convenient sampling method, who visited Hi-tech Medical College & Hospital, Bhubaneswar, Odisha, for infertility treatment. HSG and SHG were done by professionals, data was recorded and analyzed using SPSS version 23.0. Results: The sensitivity of HSG and SHG was 57.2% and 80.8%, respectively. The specificity for HSG and SHG was 24.6% and 92.5%. The differences in sensitivity and specificity were both statistically significant. HSG had a general accuracy of 51.5%, while sonohysterography had a significantly higher accuracy of 76.8%. Conclusion: HSG is the basic screening test for detecting intrauterine abnormality but SHG proves to be more specific, sensitive and accurate in finding results.

The existing Research revealed the traditional understanding of medicinal plants used to treat respiratory ailments sicknesses and asthma disease in country via various tribal groups. The current studies are founded on the review from various surceases & it makes accessible all-inclusive knowledge about herbal medicine & their parts used for the treatments of asthma by many tribal groups in India. Traditional-medicinal plants use 95 species with their botanical names, family, and used parts of plants. The mode of administration and distribution of the plants in India were documented by the belonging 85 types from 56 family plants. The current study provides a vision of the use of these plants in the cure of bronchitis by several tribal people in India.

Background: Competency based medical education (CBME) is learner centred and aims to improve student competence and performance with focused student learning, knowledge application, and frequent, formative and output based assessments with inbuilt feedback mechanism. This all requires time & the present curriculum of pharmacology has to be completed in just 11 months which is difficult. To achieve the defined level of competency, 11 months are not sufficient. In some previous studies also, the participants have highlighted the issue that CBME competencies and number of teaching hours are not in accordance with subject priority. Aims & Objective: The objective of this study through a questionnaire-based survey was to understand the views and opinions regarding challenges faced by faculty members across India during implementation of pharmacology curriculum under CBME. Materials and Methods: A questionnaire-based cross-sectional study was conducted among various faculties of pharmacology across India. A total of 7 questions were framed in this survey to assess the opinion and view of various faculties about the implementation of CBME in pharmacology. A “Survey Heart” fill out form was distributed among various faculties after taking their informed consent. Descriptive statistics were used to analyse the data. Results: Majority of the respondents (78.06%) in this study replied that Pharmacology syllabus cannot be completed in 11 months. Most of the respondents (80.61%) replied that it’s too fast to complete the syllabus in 11 months on the teacher’s part. Majority of the faculty members replied that the duration of pharmacology course under new CBME course should be extended to 24 months and examination to be conducted in third phase, to improve competency-based teaching. Conclusion: Our study concluded that the faculty members are facing the challenge regarding shortage of time to complete pharmacology syllabus efficiently under new CBME curriculum. Most of the faculty members are of the opinion that 11 months are not sufficient to teach pharmacology in second MBBS. Also, the majority of faculties suggested to extend the pharmacology course to third phase for better implementation of CBME curriculum in pharmacology.

Introduction: Antiplatelet treatment (APT) is given to patients with ischemic heart disease. Because of this research, we now have a concrete procedure to follow when deciding whether or not to do extractions on patients receiving APT. Substances and Techniques: After gathering extensive background information from each participant, researchers extracted 120 teeth from study participants’ mouths. All patients had their bleeding times evaluated before surgery, and those with normal times were taken up for local anesthetic procedures. After the extraction, local haemostatic measures were used to stop the bleeding. Following the first 30 minutes of in-clinic observation, all patients had a telephone evaluation between 24 and 48 hours post-procedure. Haemostatic measures with local haemostatic drugs were used if there was active oozing from the surgical site at any time. Results: After 1 hour, 17 individuals on mono antiplatelet therapy had bleeding, although this symptom resolved by the 24-48-hour mark. It’s statistically significant, with a P-value of less than 0.001. Twelve patients on dual APT had bleeding during the first hour, three patients within the first 24 hours, and none within the first 48 hours. It’s statistically significant (P 0.001) if you ask me. Discussion: For individuals who need a tooth extraction, the advantages of continuing APT exceed the dangers of postoperative bleeding. Conclusion: Patients at high risk for cardiovascular events including a heart attack, a stroke, or death from a blood clot may benefit from antiplatelet therapy. Normal dental extractions cause modest bleeding, and antiplatelet medications do not significantly reduce this bleeding.

Background: Asterion is a craniometric point corresponding to the location of transverse sinus and closely related to transverse sigmoid junction. Asterion is classified as type I and type II based on the presence or absence of wormian bones respectively. Differences in the occurrence of sutural bones among populations could be attributed to racial, geographical, topographical variations, dietary patterns and genetic inheritance. Aim: To enhance the knowledge of prevelance of types of asterion in Telangana region. Material and Methods: 100 adult human dry skulls (200 asterions) from different medical colleges of Telangana state were studied and the type of asterion on each side was observed and compared with other geographical areas. Result : Study revealed a Prevalence of 21% of type I asterion on right side, 19% on left side and 79% of type II asterion on right side and 81% on left side.The total prevalence of type I was 20% and type II was 80%. Further, bilateral incidence of type I was 6% and type II was 69%. Conclusion: The prevalence of type I asterion ranged from 7.5% to 88.46% and type II asterion 11.56% to 92.5% in different populations, Type II being more common than Type I except for Nepalese and Mexicans. The presence of sutural bones at asterion may complicate the surgical orientation and may be misdiagnosed as fractures of skull bones in medicolegal cases, hence it has important implications in Neuro and Maxillofacial surgeries.

Background: The clinical effectiveness and safety of hyperbaric ropivacaine and hyperbaric bupivacaine as local anaesthetics for spinal anaesthesia were examined in this study. This investigation was conducted in a tertiary care hospital. Materials and Methods: 200 patients with ASA physical status of I and II (18–55), scheduled for lower limb orthopaedic procedures under spinal anaesthesia were divided randomly into two equal groups. Group A received 3ml of hyperbaric bupivacaine (0.5%) intrathecally. Group B received 3ml of hyperbaric ropivacaine (0.75%) intrathecally. In the statistical analysis, ANOVA, Paired t-tests, P-value for analytical purposes: 0.05 [95% Confidence Interval] and Chi-square tests were employed. Software for Statistical Analysis was done by MS-Excel/ SPSS/ STATA 14/ R. Results: The ‘Bupivacaine’ group significantly outlasted the ‘Ropivacaine’ group in terms of spinal anaesthetic time, sensory and motor block length, and the time after which the first rescue analgesia was administered. The Bupivacaine group had a significantly lower post-operative VAS score than the Ropivacaine group at 120 minutes, 240 minutes, and 360 minutes. Conclusions: Intrathecal Inj. of Hyperbaric Ropivacaine (0.75%) 3ml had shorter duration of action than Intrathecal Inj. of Hyperbaric Bupivacaine (0.5%) 3ml but was adequate for the conclusion of the surgery with better perioperative hemodynamic stability than Bupivacaine and could be considered for future use in patients with comorbidities and for early ambulation of post-surgical patients.

Objective: To study the incidence, etiological, clinical profile and prognosis of ventilator associated pneumonia in patients on ventilatory support. Methods: A total of 60 patients who were aged greater than 15 years were studied. Selection criteria for VAP diagnosis based on CPIS results. Demographic data like gender and age were collected along with relevant history and recorded on predesigned and pretested proforma . A thorough clinical examination was conducted and the findings were also recorded. All relevant data from patient’s medical records, bed side flow sheets including gender, age, admission diagnosis were noted. History of pre-existing diseases and previous admission to hospital and present symptomatology was listed and detailed physical examination was done. Details of medical interventions were recorded. Risk Factors for VAP were also studied. Results: It was observed that VAP was found in 28 (46.66%) patients, males were more affected than females. Majority of cases (28.7%) were observed in >70 years age group. Organisms isolated in early VAP were Klebsiella (47.62%), Pseudomonas (37.50%) followed by E coli (4.76%), Staph aureus (4.76%) and Acinetobacter (4.76%). Organisms isolated in late VAP were E. coli (40%), Pseudomonas (30%), Klebsiella (20%) and Staph aureus (10%).100% patients developed VAP with in the first two weeks.50% patients who expired with VAP were of >70 years age group. Mortality in late onset VAP was 61.11% and early onset VAP was 10%. All of the organisms isolated were multidrug resistant isolates. Conclusion: The incidence of patients who are being admitted to ICU and requiring mechanical ventilation is increasing. Knowledge of incidence of VAP, risk factors and their causative microbial flora in a local setting is of paramount importance to ensure more effective utilization of antibiotics and thereby, a better outcome. It would also allow formulation of strategies to decrease the incidence of VAP.

Background: Most splenic injuries result from motor vehicle accidents. Despite being shielded by the bony ribcage, the spleen continues to be the organ most frequently injured in cases of blunt abdominal injuries. It occurs in almost all age groups. The current study aimed to assess the prevalence, etiology of blunt abdominal trauma, clinical manifestations, mortality, and morbidity in all the cases of trauma spleen reporting to our tertiary care teaching Hospital in south India. Methods: Successive cases with suspected spleen injuries were initially admitted to the casualty Department. The abdomen is specifically examined, paying particular attention to discomfort, guarding, stiffness, and bowel sounds. Every time a blunt injury occurs, a plain X-ray of the chest, abdomen, and, if necessary, other body areas, is obtained. An ultrasound with 3.5 Mhz curvilinear transducers while the patient is supine to do an emergency ultrasound of the abdomen and pelvic cavities. Results: The age range of the cases in the study was 19 – 59 years the mean age of the study group was 33.5 ± 8.5 years. The most commonly involved age group was 21 – 30 years with 40.9% of cases followed by 31 – 40 years with 31.81% of all cases. Grade I spleen injuries were found in 36.36% of cases, Grade II spleen injury was found in 45.45% of cases, grade III injuries occurred in 13.63% of cases and grade IV was in 4.5% of cases No case of grade V spleen injury was found in this study. In the present study n=13 cases were managed by surgical methods and n=9 cases were managed by conservative methods. Conclusion: Road traffic accidents were shown to be the most frequent cause of splenic injuries. The majority of splenic injuries occurred in young cases between the ages of 20 and 30. Early diagnosis depends on a thorough physical examination. Physical examinations are complemented by investigation reports. Early hospitalization, improved diagnostic techniques, optimal surgical timing, the availability of blood transfusions, closed clinical surveillance, and nursing care all have a significant role in lowering death rates following acute splenic injuries.

Background: Fractures of clavicles are most commonly managed by conservative method. However, management displaced clavicle fracture is always a dilemma. In our study we are showing results of clavicle fractures managed by k wire fixation. Materials and Methods: This is a prospective study of 20 patients managed by open reduction and internal fixation by k wire by minimal invasive approach. Results: In our study 30 patients male female in a ratio of whom the right side clavicle and left side clavicle fracture. Excellent outcome shown in patients and good results in. No intraoperative compilation and no postoperative complications. All patients had a full range of movements of the ipsilateral shoulder post operatively. Conclusion: we recommend k wire fixation for clavicle fracture in view of results in our study.

Background and Aims: Laparoscopic donor nephrectomy (LDN) causes considerable postoperative discomfort, and no effective analgesic method is identified. Standard dosages of opioids for analgesia are typically insufficient and are linked to a slew of undesirable side effects. The effectiveness of transverse abdominal muscle (TAM) block in a variety of laparoscopic operations has been studied. During laparoscopic colorectal procedures, intrathecal morphine (ITM) has been found to provide high-quality, long-lasting analgesia. Methods: Examining how well a single dose of ITM 5 g/kg works as an analgesic for LDN was the focus of this study. Thirty adult patients having LDN were randomly randomized to receive either IV fentanyl, ultrasound-guided TAP block, or ITM for postoperative analgesia, with the approval of the institutional review board. In this study, we examined 24-hour postoperative fentanyl consumption through patient-controlled analgesia (PCA), fentanyl and muscle relaxant requirements intraoperatively, and visual analog scale (VAS) pain scores. Stata 11.1 software was used to run the necessary statistical tests for the investigation. Results: ITM patients had considerably greater hemodynamic stability during pneumoperitoneum and in the PACU than those who did not get the treatment. The morphine group required considerably less rescue fentanyl both intraoperatively (P = 0.01) and postoperatively (P = 0.000) up to 24 hours. In both the resting and active VAS measures taken after surgery, the morphine group fared better than the control group. Conclusion: “ITM 5 µg/kg provides better intraoperative and postoperative analgesia and reduces postoperative PCA fentanyl requirement in laparoscopic donor nephrectomy compared to TAP block or intravenous fentanyl.

Background and Aims: Laparoscopic donor nephrectomy (LDN) causes considerable postoperative discomfort, and no effective analgesic method is identified. Standard dosages of opioids for analgesia are typically insufficient and are linked to a slew of undesirable side effects. The effectiveness of transverse abdominal muscle (TAM) block in a variety of laparoscopic operations has been studied. During laparoscopic colorectal procedures, intrathecal morphine (ITM) has been found to provide high-quality, long-lasting analgesia. Methods: Examining how well a single dose of ITM 5 g/kg works as an analgesic for LDN was the focus of this study. Thirty adult patients having LDN were randomly randomized to receive either IV fentanyl, ultrasound-guided TAP block, or ITM for postoperative analgesia, with the approval of the institutional review board. In this study, we examined 24-hour postoperative fentanyl consumption through patient-controlled analgesia (PCA), fentanyl and muscle relaxant requirements intraoperatively, and visual analog scale (VAS) pain scores. Stata 11.1 software was used to run the necessary statistical tests for the investigation. Results: ITM patients had considerably greater hemodynamic stability during pneumoperitoneum and in the PACU than those who did not get the treatment. The morphine group required considerably less rescue fentanyl both intraoperatively (P = 0.01) and postoperatively (P = 0.000) up to 24 hours. In both the resting and active VAS measures taken after surgery, the morphine group fared better than the control group. Conclusion: “ITM 5 µg/kg provides better intraoperative and postoperative analgesia and reduces postoperative PCA fentanyl requirement in laparoscopic donor nephrectomy compared to TAP block or intravenous fentanyl.