Background: Thyroid disorders are common during pregnancy. The availability of thyroid hormones is essential for a healthy pregnancy and optimal fetal growth and development. Overt hypothyroidism is associated with various obstetric and child development complications. Emerging research suggests that even mild thyroid dysfunction can negatively affect pregnancy outcomes. Early diagnosis, appropriate treatment, and maintenance of normal thyroid hormone levels can significantly reduce risks for both mother and fetus, ensuring a safer pregnancy and reducing complications. Methods: This case-control study was conducted on 50 pregnant patients from the obstetric outpatient department of the Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Thyroid-stimulating hormone (TSH) tests were performed during the first antenatal visit along with routine obstetrical examinations. Patients were monitored until delivery, with those diagnosed with hypothyroidism receiving levothyroxine treatment. Results: Hypothyroidism is prevalent in pregnant women, with a significant proportion of cases (50%) detected during pregnancy. The highest prevalence was observed in women aged 26-30, followed by 31-35. Early screening and diagnosis of hypothyroidism in pregnancy are crucial, with a majority of cases (48%) detected in the first trimester. Maternal hypothyroidism can increase the risk of adverse fetal outcomes, including recurrent miscarriage, preeclampsia, preterm birth, postpartum hemorrhage, and neonatal intensive care unit (NICU) stay. Conclusions: Pregnant women should undergo thyroid function screening at their first outpatient visit to detect hypothyroidism and receive appropriate treatment to prevent maternal and fetal complications.

DOI: 10.5281/zenodo.

Background: Uveitis is a complex intraocular inflammatory condition with various etiological factors Anterior uveitis is the most common form of uveitis. The inflammation may be triggered by an infectious agent or trauma, but in some instances, it is suspected to have an autoimmune origin. This study aimed to assess the etiological patterns, treatment outcomes, and complications of anterior uveitis. Methods: This prospective clinical study was conducted in the Department of Ophthalmology. Patients aged 20-60 years presenting with anterior uveitis were included. Comprehensive clinical evaluations and investigations were carried out to determine the underlying causes. Patients received specific and non-specific treatments and were followed for 6 months. Complications were recorded. Results:  A total of 40 cases were included in the study. Most anterior uveitis cases occur in middle-aged adults (31-50 years), with fewer cases in younger and older age groups. There is no strong preference for the involvement of either the right or left eye, suggesting that anterior uveitis can affect both eyes with similar frequency. The most common cause of anterior uveitis is idiopathic, meaning the underlying cause remains unknown. However, other factors, including inflammatory conditions, infectious agents, and lens-related issues, can also contribute to the development of the disease. The specific management approach for anterior uveitis will depend on the underlying cause. Treatment may involve medications, corticosteroids, or in some cases, surgical intervention. Conclusion: The primary cause of anterior uveitis remained unidentified in many cases. Comprehensive examination and investigations are essential for accurate diagnosis. Timely treatment leads to favorable visual outcomes, though chronic and recurrent cases often result in ocular morbidity.

DOI: 10.5281/zenodo.

Introduction: The prostate is vital for male fertility, and Transurethral Resection of the Prostate (TURP) is a gold-standard procedure for treating moderate to severe LUTS and complications from BPH. Spinal anesthesia (SA) is preferred for TURP, with adjuvants like Buprenorphine or Dexmedetomidine enhancing analgesic duration and minimizing local anesthetic dosage. Methods: This prospective study, conducted at NRI Institute of Medical Sciences, involved 18 to 60 year old patients undergoing TURP under GA. Participants were randomized into two groups: Group A received 0.5% hyperbaric Buprenorphine and Dexmedetomidine, while Group B received 0.5% hyperbaric Bupivacaine and Buprenorphine intrathecally. Sensory and motor block durations were assessed. Results: The mean age was 54.8 ± 8.7 years in Group A and 56.2 ± 9.6 years in Group B, with no significant differences in age or surgery duration. Time to S1 regression was similar between groups. However, there was a statistically significant difference in mean motor recovery time and first postoperative analgesic requirement. Conclusion: The study shows that dexmedetomidine, as an adjuvant to bupivacaine in spinal anesthesia, significantly prolongs motor recovery time compared to buprenorphine. This highlights the impact of adjuvant choice on motor block duration, reinforcing dexmedetomidine’s potential in prolonging spinal anesthesia, especially important for optimizing care in elderly patients.

DOI: 10.5281/zenodo.

Introduction: Oxytocin, used during Caesarean sections (CSs) under spinal anesthesia (SA) to reduce postpartum hemorrhage, can cause hypotension. To counteract this, phenylephrine, an α1-adrenergic agonist, is often coadministered. This study examines the efficacy and safety of combining phenylephrine with oxytocin to improve maternal hemodynamic stability during Caesarean sections. Methods: This prospective randomized study, approved by the ethics committee, was conducted at KIMS. Parturients with uncomplicated singleton pregnancies undergoing elective or emergency CSs were included. They were randomized into two groups receiving different phenylephrine doses with oxytocin. Parameters were monitored, and adverse effects were managed accordingly. Results: Statistically there was no significant difference in the mean duration of the surgery, extraction time of baby.  In group A, 30 (37.5%) were identified with hypotension and it was 6.25% (5) in groups; statistically there was significant association. There were more episodes of hypertension in group A and statistically there was significant difference between groups. Conclusion: This study confirms that phenylephrine is significantly more effective than ephedrine in preventing hypotension during cesarean sections under spinal anesthesia. The findings align with existing literature, demonstrating phenylephrine’s superior ability to maintain maternal hemodynamic stability, thereby supporting its use in clinical practice for optimal outcomes.

DOI: 10.5281/zenodo.

Introduction: Surgical site infections (SSIs) are a major healthcare challenge, driven by diverse bacterial pathogens with complex resistance patterns. The rise of multidrug-resistant organisms, such as MRSA and resistant Gram-negative bacteria, necessitates ongoing surveillance and tailored antibiotic therapy. This study evaluates the bacteriology and antimicrobial resistance in SSIs to guide effective treatment and prevention strategies. Methods: This cross-sectional study, conducted at Government Medical College, Anantapuram from January to December 2023, assessed SSIs in patients over 15 years old. Wound samples were cultured and tested for antimicrobial susceptibility using standard methods. Statistical analysis was performed using SPSS version 22.0, with significance set at p<0.05. Results: The study included 200 patients, with 54% female. Culture positivity rates were 29% in males and 37% in females, with no significant difference. Diabetes mellitus (16%) and anemia (13.5%) were common risk factors. Among isolates, 43.18% were Gram-positive cocci (GPC) and 56.81% Gram-negative bacilli (GNB). GPC showed highest susceptibility to Vancomycin and GNB to Meropenem. A total of 132 multidrug-resistant strains were identified, with 43% being GNB and 31.8% GPC. Conclusion: This study reveals a high prevalence of multidrug-resistant organisms in postoperative wound infections, notably MRSA and Gram-negative bacteria like Klebsiella pneumoniae. Vancomycin effectively treated all S. aureus isolates, while GNB showed high susceptibility to imipenem, amikacin, and piperacillin-tazobactam, despite some imipenem resistance. Continuous surveillance and tailored therapy are crucial.

DOI: 10.5281/zenodo.

Introduction: Oxytocin, used during Caesarean sections (CSs) under spinal anesthesia (SA) to reduce postpartum hemorrhage, can cause hypotension. To counteract this, phenylephrine, an α1-adrenergic agonist, is often coadministered. This study examines the efficacy and safety of combining phenylephrine with oxytocin to improve maternal hemodynamic stability during Caesarean sections. Methods: This prospective randomized study, approved by the ethics committee, was conducted at KIMS. Parturients with uncomplicated singleton pregnancies undergoing elective or emergency CSs were included. They were randomized into two groups receiving different phenylephrine doses with oxytocin. Parameters were monitored, and adverse effects were managed accordingly. Results: Statistically there was no significant difference in the mean duration of the surgery, extraction time of baby.  In group A, 30 (37.5%) were identified with hypotension and it was 6.25% (5) in groups; statistically there was significant association. There were more episodes of hypertension in group A and statistically there was significant difference between groups. Conclusion: This study confirms that phenylephrine is significantly more effective than ephedrine in preventing hypotension during cesarean sections under spinal anesthesia. The findings align with existing literature, demonstrating phenylephrine’s superior ability to maintain maternal hemodynamic stability, thereby supporting its use in clinical practice for optimal outcomes.

DOI: 10.5281/zenodo.

Background: Various changes in body composition and body fat distribution significantly notable during menopause transition. Recently changes in body composition in post-menopausal women has gained importance in the research field. Objectives: The aim was to determine the body composition in post-menopausal women. Materials and Methods: Fifty postmenopausal women of age 45 to 60 years and fifty premenopausal women of age 35 to 45 years were selected for the study. Body composition parameters recorded by using bioelectrical impedance analysis. Results: In postmenopausal women, body mass index was significantly higher than premenopausal women (p=0.013). Body fat percentage was significantly higher in postmenopausal women (p=0.043). In postmenopausal women, lean body mass percentage was significantly lower than premenopausal women (p=0.043). Conclusion: The findings of our study suggest that change in body composition is due to  menopausalstatus, age, health and life style factors.

DOI: 10.5281/zenodo.

Background: Sepsis is one of the top causes of hospital-related mortality worldwide, and tropical countries bear a significant portion of the burden. Arterial Blood Gas Analysis (ABGA) is an essential investigation for sepsis patients in the intensive care unit (ICU) because it reveals the acid-base status and electrolyte levels, and this study aims to assess the ABGA parameters of sepsis patients and their relationship with mortality. Methodology: A prospective observational study was conducted on 100 patients over the age of 18 who had sepsis in a tertiary care center’s ICU. Each patient underwent a microbiological examination to isolate the causal pathogen, and all individuals received an APACHE II score. The relationship between the end outcome and the ABGA parameters, MODS, and APACHE II score was calculated. Results: The majority of patients were older than 60, with a male preponderance. Twenty-six percent of individuals had MODS, and 61.53% died. Gram-negative bacteria were the most common cause, with Klebsiella infecting 22% of sepsis patients. The two most prevalent acid-base diseases were primary respiratory alkalosis with secondary metabolic acidosis and primary metabolic acidosis with secondary respiratory alkalosis. Conclusions: Tropical sepsis is a condition unique to nations such as India, and it demands special attention since it differs from non-tropical sepsis in terms of pCO2, bicarbonate level, and anion gap. The onset of MODS and a rising APACHE II score were independent predictors of mortality in these patients.

DOI: 10.5281/zenodo.

Background: Hepatitis C virus (HCV) infection is currently the most significant public health problem globally and also in India. HCV is one of the leading causes of chronic hepatitis worldwide and an important risk factor for progression to advanced entities such as liver cirrhosis, hepatic decompensation, and Hepatocellular Carcinoma (HCC). Aims and Objectives: The present study deals with prevalence of HCV infection in adult patients and determines the effectiveness of treatment with Directly Acting Anti-viral Drugs (DAA) by undetectable HCV RNA in blood at the end of treatment. Material and Methods: A total of 10,000 patients whose serum samples underwent the anti HCV ELISA testing were enrolled in the study. Anti HCV antibody production was tested by using 3^rd generation ELISA and HCV RNA detection was performed by RT PCR.HCV RNA positive patients were given anti-viral treatment for 3 months. After 12 weeks of completion of treatment for HCV infection, patient’s samples were tested again for HCV RNA in plasma by RT-PCR for monitoring effectiveness of treatment. Results: The seroprevelence of HCV infection was 0.8%.The positive rate of anti –HCV antibodies were higher among males of 18-30 years of age. The most probable risk factor for HCV transmission was blood transfusion due to thalassemia which was seen in 31.25%.Among the anti-HCV positive patients, the HCV RNA positive rate was 66.25%. After the treatment with DAA in HCV RNA positive patients Sustained Virological Response (SVR) was achieved in 91% of patients. Conclusion: The seroprevelence of HCV infection was 0.8%.Approximately 66.25% of the anti-HCV positive patients also tested positive for HCV PCR. This positive correlation between serum anti-HCV and HCV PCR improve screening and facilitates timely intervention to prevent the spread of infection. And HCV PCR is highly sensitive and specific for detecting active infection and monitoring viral response after treatment with DAA.

DOI: 10.5281/zenodo.

Background: The use of neuraxial anesthesia, such as spinal anesthesia, has become increasingly popular for elective cesarean sections. Local anesthetics are crucial in providing effective pain relief during these procedures. Ropivacaine and bupivacaine are two commonly used local anesthetics with different properties. This study aimed to compare the efficacy of 0.75% isobaric ropivacaine and 0.5% hyperbaric bupivacaine in providing spinal anesthesia for elective cesarean sections. The current study aimed to compare the clinical effects of 2ml of 0.75% intrathecal isobaric Ropivacaine with 2ml of 0.5% hyperbaric Bupivacaine for elective cesarean section. Methods: N=100 parturients belonging to ASA physical status I & II scheduled for elective cesarean section were randomly selected for the study and were divided into two groups of 30 each Group B patient received 2ml of 0.5% hyperbaric Bupivacaine intrathecally. Group R patients received 2ml of 0.75% isobaric Ropivacaine intrathecally  Onset and duration of sensory block, onset and duration of motor block, maximum height of sensory block, quality of anesthesia, and time of request for analgesia, hemodynamic parameters and adverse effects if any were studied. Results: There was no significant difference in the onset of sensory block at T8 between the two groups: 158.40±41.89 sec with Bupivacaine and 174.00±44.12 sec with Ropivacaine (P=0.073). Maximum sensory height was higher in group R (T₂-T₆) than in group B (T₄-T₆) (P<0.001). The duration of sensory block was similar between groups, while motor block onset was faster in group B (P<0.001). Motor block duration was longer in group B (P<0.001). Analgesia request time, hemodynamic parameters, and side effects were comparable. Conclusion: Ropivacaine 15 mg (2 ml of 0.75% isobaric Ropivacaine) provides a comparable quality of sensory block but has a slower onset and significantly shorter duration of motor block compared to Bupivacaine.

DOI: 10.5281/zenodo.

In a tribal region in Southern Rajasthan, 105 dermatological patients participated in this descriptive cross-sectional study to examine their illness and quality of life. There were 56 men and 49 women in the sample. With 42 cases of dermatitis and 15 cases of psoriasis, respectively, these two disorders were the most common. Most skin problems (63 individuals) persisted for six months to a year. Only a tiny percentage (18 instances) had genital involvement. According to the Dermatology Life Quality Index (DLQI), intermediate severity was the most prevalent and showed substantial consequences on quality of life. The study emphasises how significantly skin illnesses impair patients’ quality of life.

DOI: 10.5281/zenodo.

Background: Preoperative anxiety is known to negatively impact the outcomes of patients undergoing spinal anesthesia. Audiovisual educational tools have demonstrated greater efficacy in alleviating anxiety compared to conventional verbal explanations. Aims: This study aimed to assess the effectiveness of an audiovisual film in alleviating preoperative anxiety in patients scheduled for spinal anesthesia. Methods: This prospective cohort study included 260 patients undergoing elective surgery with spinal anesthesia. Participants were randomly assigned to one of two groups: one group received verbal information regarding the anesthesia procedure, while the other was provided with information via an audiovisual film. Anxiety levels were assessed at three time points—baseline, one hour prior to surgery, and postoperatively—using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Visual Analog Scale for Anxiety (VAS-A). Data were analyzed using SPSS. Results: Patients who watched the audiovisual film exhibited significantly lower anxiety scores than those who received verbal information, as measured by APAIS and VAS-A (p < 0.001). Moreover, patients in the film group reported higher satisfaction with the information provided. Conclusion: Audiovisual films are a highly effective approach to reduce preoperative anxiety in patients undergoing spinal anesthesia. Integrating these tools into preoperative care protocols may enhance patient satisfaction and improve overall outcomes.

DOI: 10.5281/zenodo.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide, with smoking being the leading risk factor. However, non-smokers, particularly those exposed to biomass fuel, occupational hazards, or second-hand smoke, also contribute significantly to the disease burden. This study aims to compare the clinico-demographic and lung spirometry profiles between non-smoker and smoker COPD patients, highlighting the differences in risk factors, symptom presentation, and disease severity. Materials and Methods: This cross-sectional study was conducted at a tertiary care center, including 200 COPD patients diagnosed through clinical features and spirometry. Patients were divided into two groups: smokers and non-smokers. Data on clinical symptoms, demographic factors, and lung function (via spirometry and GOLD classification) were collected. Non-smokers were those exposed to biomass or occupational risks, while smokers had a smoking history of at least 10 pack-years. Statistical analyses were performed to compare the two groups, with a p-value <0.05 considered significant. Results: In our study, 67% of the COPD patients were smokers, and 33% were non-smokers. The majority of smokers (99 out of 134) were classified as GOLD 3, with 17 in GOLD 4, while non-smokers were primarily in GOLD 3 (39 out of 66), with only 2 in GOLD 4 (p < 0.001). Non-smokers had significant risk factors like biofuel exposure (71.2%), second-hand smoke (15.2%), and underlying causes (13.6%). Smokers experienced more severe symptoms, including cough (102 out of 134), sputum (73), and chest tightness (42), compared to non-smokers (p-values ranging from 0.011 to 0.034). Additionally, 116 smokers had 3-5 acute exacerbations compared to 44 non-smokers (p = 0.001). Smokers also had a higher mean CAT score (31.43 ± 4.204) than non-smokers (29.17 ± 4.508, p = 0.001). Lastly, socioeconomic status showed a significant difference, with most smokers from lower classes (p < 0.001). Conclusion: Our study demonstrates significant differences between smoker and non-smoker COPD patients, with smokers exhibiting more severe lung function impairment, higher symptom burden, and frequent exacerbations. Non-smokers were primarily affected by biofuel exposure and environmental factors, indicating the need for targeted interventions in both groups to manage and prevent COPD.

DOI: 10.5281/zenodo.

Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most common cause of chronic liver disease worldwide, affecting approximately 25% of the adult population. NAFLD encompasses a spectrum of conditions ranging from simple hepatic steatosis to the more severe Non-Alcoholic Steatohepatitis (NASH), which can lead to fibrosis, cirrhosis, and hepatocellular carcinoma. The etiology of NAFLD is multifactorial and involves complex interactions between genetic, metabolic, and environmental factors. Central to the pathogenesis of NAFLD is insulin resistance, which promotes fat accumulation in the liver through increased de novo lipogenesis and impaired lipid oxidation. Other contributing factors include dyslipidemia, oxidative stress, chronic inflammation, and dysregulation of the gut-liver axis. This systematic review aims to provide a comprehensive synthesis of the current understanding of the etiology of NAFLD, including key mechanisms and risk factors that drive disease development and progression. The review also highlights emerging research on the role of genetic predisposition and the gut microbiome in NAFLD.

DOI: 10.5281/zenodo.

Background: The femur’s Neck shaft angle (NSA) plays a crucial role in determining biomechanical properties and susceptibility to fractures. Knowledge of NSA is essential in understanding and treating pathological conditions of the hip joint. Despite its clinical importance, there remains a dearth of comprehensive data regarding the range and distribution of NSA values in cadaveric specimens. Aims: This study aims to measure the NSA of femur bones in dry cadavers, compare them with the previous studies, and discuss their clinical importance. Materials and Methods: Sixty (60) dry femur bones from cadavers were meticulously examined between 31 August 2020 and 30 August 2023. Approval from the concerned ethical committee was taken before starting the study. The NSA (defined as the angle made by the long axis of the shaft and the long axis of the neck of the femur) was measured by drawing the long axes of the femoral shaft and neck of the femur on the white sheet using a pencil, scale, and sketch pen and the NSA was measured using a goniometer (Figure-3). The Statistical analysis was done to determine the mean, standard deviation, and range of NSA values within the sample population. The results of the present study were compared with the previous studies on this topic. Results: The mean neck shaft angle (NSA) observed in 60 dry femur bones of cadavers was 130.5 degrees, with a standard deviation of 6.2 degrees. The range of NSA values varied from 120.3 degrees to 140.8 degrees within the study population. Conclusion: This study provides valuable insights into the neck shaft angle (NSA) of femur bones in dry cadavers, shedding light on anatomical variations. The observed range of NSA values underscores the importance of individualized surgical approaches in orthopedic procedures involving the femur.

DOI: 10.5281/zenodo.

Background: Pathologies in the extreme periphery of the fundus often go undiagnosed with conventional imaging methods, potentially leading to mismanagement. Ultrasound Biomicroscopy (UBM) offers a high-resolution imaging modality to visualize subtle changes and structural abnormalities in these regions. Objective: This study aims to evaluate the role of UBM in diagnosing pathological changes in the extreme periphery of the fundus. Material and Methods: A total of 120 patients were included in the study, conducted in the Department of Ophthalmology at a tertiary care hospital. Each participant underwent detailed ophthalmic examination and UBM assessment for peripheral fundus evaluation. Results: UBM identified peripheral retinal degenerations, vitreous detachments, and ciliary body abnormalities in 65%, 15%, and 10% of patients, respectively. The findings of UBM were significantly correlated with clinical examination and patient symptoms. Conclusion: UBM proves to be a valuable tool in identifying subtle pathologies in the extreme periphery of the fundus, which may not be detected by traditional diagnostic modalities. Early detection allows for timely management, potentially preventing further complications.

DOI: 10.5281/zenodo.

Background: Progressive myopia is a growing concern in pediatric ophthalmology, necessitating effective management strategies. Orthokeratology (OK) lenses have emerged as a potential solution, aiming to halt myopic progression through corneal reshaping. Objective: To evaluate the efficacy of orthokeratology lenses in controlling progressive myopia in children and assess the associated clinical and laboratory parameters. Materials and Methods: A prospective study was conducted on 80 children diagnosed with progressive myopia in the Department of Ophthalmology at a tertiary care hospital. Patients underwent comprehensive ophthalmic evaluations, including visual acuity assessments, refractive error measurements, and corneal topography before and after wearing OK lenses for a duration of six months. Results: The study demonstrated significant reductions in both spherical equivalent and axial length measurements among participants. Visual acuity improved markedly, and corneal reshaping was evident in topographical analyses. Conclusion: Orthokeratology lenses are effective in managing progressive myopia in children, offering a non-invasive alternative to traditional corrective methods.

DOI: 10.5281/zenodo.

Background: The ingestion of Aluminium phosphide leads to considerable oxidative stress. In this study, we assessed the management of Aluminium phosphide poisoning in patients utilizing Glutathione, NAC, and MgSO₄. Methods: This is prospective study included criteria comprised all subjects presenting with Aluminium phosphide poisoning. The treatment protocol involved administering antioxidant NAC, Glutathione, and MgSO₄ to all patients. The incidence of secondary complications, such as multiorgan dysfunction syndrome as well as hepatic failure was evaluated. Results: A total of 30 patients were recruited. An increase was seen from day 1 to day 3 in Total Bilirubin (mean diff: -3.44); albumin (mean diff: -0.086); Globulin (mean diff:-0.103); aspartate aminotransferase (mean diff: -71.86); alanine aminotransferase (mean diff: -59.46) and gamma-glutamyl transferase (mean diff: -20.40) whereas, total leucocyte count, pH and partial pressure of carbon dioxide showed decrease in the mean values from day 1 to day 3. There was an increase in direct Bilirubin, Indirect Bilirubin, ALP, PO_2, and Lactate from day 1 to day 3, but HCO₃ showed a decrease in the values from day 1 to day 3. There was a statistically significant difference from day 3 to discharge with respect to TLC (p=0.001); Total Bilirubin (p=0.001); Albumin(p=0.006); AST (p=0.001); ALT (p=0.001); GGT (p=0.001); pH(p=0.001) and PCO₂(p=0.001). Conclusion: The administration of N-acetylcysteine, glutathione, and magnesium sulphate as potential antioxidant therapy in Aluminium phosphide poisoning has demonstrated a reduction in the fatal outcome.

DOI: 10.5281/zenodo.

Background: Sudden sensory-neural hearing loss (SSNHL) is defined as loss of hearing within 3 days, more than 30 dB in consecutive 3 frequencies. It is an otological emergency for which a definitive aetiology is unknown in most of the cases and treatment remains controversial. Prompt diagnosis and management have shown to improve hearing outcomes. Methods: In our study we assigned patients to 2 groups randomly selected from patients fulfilling the criteria of SSNHL. All the patients with SSHNL between the study periods were taken in the study. After applying the inclusion and exclusion criteria 60 patients were included in the study. Patients were divided into two groups randomly (30 in each group). Group 1 patients were given intra tympanic steroids and group 2 patients were given oral steroids. Result: Our study showed that majority of the subjects reported hearing improved with intra tympanic steroids (90%), whereas, only 10% of the subjects reported hearing improved with oral steroids. These differences in proportions were statistically significant (p value<0.001). This study also showed that the duration of SSNHL and hearing at 4 weeks of the study was significantly correlated with more than duration of SSNHL. More the duration of SNHL less improved was the hearing at 4 weeks (p value <0.001). Conclusions: Our study showed better hearing outcome with intra tympanic steroids than with oral steroid with lesser side effects in cases of SSNHL. The specific action of steroids in the cochlea is uncertain but their use has been based on their ability to decrease inflammation and edema and in most of the cases there are improvements of hearing. Intra tympanic steroids can be given safely where oral or systemic steroids are contraindicated. This is safe and office based procedure.

DOI: 10.5281/zenodo.

Hanging is a form of mechanical asphyxia which is caused by suspension of the body by a ligature which encircles the neck, the constricting force being the weight of the body. Most hangings produce gradual, subtle and painless death. If done correctly, it is highly lethal. Since time immemorial, hanging has been practiced as a method of suicide. It is a significant public health concern. Understanding various socio-demographic factors that are related with hanging is essential for curbing this issue. A one year retrospective (record based) cross sectional study was conducted in the Department of Forensic Medicine, Diphu Medical College & Hospital, Diphu for a period of one calendar year from 1^st January 2022 to 31^st  December 2022 on all the cases of death due to suicidal hanging brought for medico legal autopsy. During this period, 65 cases out of 355 medico-legal autopsies conducted were death due to hanging.

DOI: 10.5281/zenodo.

Introduction: Hanging is a common method of suicide, though it can also be accidental or homicidal, especially in dowry cases. Ligature marks play a crucial role in determining the cause of death, with variations in their characteristics based on the ligature used, bodily weight, and suspension time. This study aims to examine ligature patterns, improving postmortem accuracy in identifying ligature-related deaths. Methods: The study, conducted From July 2021 to June 2023 at Hind Institute of Medical Sciences, Sitapur, Luknow. Examined 30 hanging-related deaths after receiving ethical approval. 30 patients data were gathered from family, police, and scene visits. Patients were categorized by suspension type (complete or partial) and ligature marks (typical or atypical). Both internal and external autopsies were performed, with ligature materials classified as soft or hard. Histological examination determined whether ligature marks were antemortem or post-mortem. Results: The highest number of cases occurred in the 20-29 age group (33.33%), followed by 10-20 years (26.67%). Males accounted for 58% of cases. Complete suspension was more common (73.33%) than partial. Atypical ligature marks (80%) were predominant, and soft materials were used in 53.34% of cases. Knots were mostly positioned in the left occipital region. Slipping knots were observed in 54% of cases. Thyroid cartilage fractures were less common (10%) compared to absent fractures (56.67%). Conclusion: Suicidal cases are more common in younger age groups, particularly 20-29, with a slight male predominance, while older age groups (above 50) show a higher proportion of homicidal cases. Atypical hangings are more prevalent overall, with complete suspension linked to homicides and partial suspension to suicides.

DOI: 10.5281/zenodo.

Introduction: Even in India, because of a combination dry heat and burns from flames, over 1 million burn victims are recorded each year causing massive trauma. Women were more likely to be burnt during cooking, whereas men faced the main risks from electricity or construction work. 0800 843 A person may also experience pain from a fourth-degree burn in which the skin is visibly charred and likely to need surgery or prolonged treatment. Preventing burns and their complications is by prevention, early intervention as well as raising community Awareness. Aims and Objective: To analyze the demographic and clinical features of the cases of burn injury among adult patients in this hospital. Method: This is a prospective observational study where burn injury patterns in adults (n = 45) were analyzed at the department of Forensic Medicine, from July 2021 to April 2023 [Hind Institute of Medical Sciences, Sitapur (Lucknow)]. Data were collected with ethical approval and patient consent from hospitals, family members or witnesses (in the event of a deceased arrest) and post-mortem examinations. This only included adults with burn injuries. Wallace rule of nine was utilized to estimate the total body surface area (TBSA) involved. The data was analyzed and observed in MS Excel. Result: The study found that the majority of burn injuries occurred among individuals aged 11-20 (26.66%) and 21-30 (22.22%), with 55.55% of victims being unmarried. Fire-related accidents (37.78%, P<0.05) and scalds (26.67%, P<0.05) were the leading causes of burns. Burns primarily occurred in the afternoon (31.11%) and in domestic settings, particularly kitchens (42.22%). Extensive burns covering 51-60% BSA were most frequent, affecting 10 patients. Conclusion: The study has concluded that burn injuries are most common among younger individuals, housewives, and government employees, predominantly occurring in domestic settings, especially the kitchen.

DOI: 10.5281/zenodo.

Introduction: The present study explores the relationship between the duration of diabetes and the severity of diabetic foot ulcers using the Diabetic Ulcer Severity Score (DUSS) in a tertiary care setting. By examining ulcer characteristics and healing outcomes, the study aims to identify key factors impacting ulcer severity and treatment outcomes among middle-aged and elderly diabetic patients. Material and Methods: This prospective observational study was conducted over one year in the Department of General Surgery at a tertiary care hospital, focusing on 50 diabetic foot ulcer patients. Data, including demographic and clinical parameters, were collected and analyzed with SPSS to examine the association between ulcer severity scores (DUSS) and healing outcomes. Patients received comprehensive treatment and follow-up care, with ulcers assessed for depth, infection, and other severity indicators, allowing for targeted interventions based on severity and diabetes duration. Results: In this study of 50 diabetic foot ulcer patients, males represented 76.71% of the cohort, with most patients being middle-aged (41-60 years, 48.0%) or seniors (61-70 years, 28.0%). Diabetes duration influenced ulcer severity, with 53.42% of patients having diabetes for under 6 years, while none had it beyond 15 years. Healing outcomes varied: 47.95% achieved healing by primary intention, 17.81% required skin grafting, and 34.25% underwent amputation. DUSS scores showed that moderate ulcers (Score 2) were most common (34.0%), with both genders similarly affected. Healing outcomes also varied by gender, with primary intention healing highest in males (47.37%) and females (50.0%), while amputation rates were consistent across gender and age groups, underscoring the complexity of advanced ulcer cases. Conclusion: Diabetic foot ulcer outcomes are significantly impacted by diabetes duration, ulcer severity, and patient demographics, with early intervention being crucial to minimize complications and amputation rates. Tailored management strategies are essential to improve healing and patient quality of life.

DOI: 10.5281/zenodo.

Background: Pre-eclampsia and eclampsia are significant hypertensive disorders in pregnancy that can affect maternal thyroid function, potentially leading to adverse outcomes. This study aims to assess the impact of pre-eclampsia and eclampsia on thyroid function compared to normal pregnancies. Material and Methods: A total of 200 pregnant women were included, with 100 in the pre-eclampsia/eclampsia group and 100 in the normotensive group. Clinical data, including blood pressure and thyroid profiles (TSH, T3, and T4), were collected during the third trimester. Thyroid function was analyzed using chemiluminescent immunoassays, and statistical comparisons were made between the groups. Results: In our study, case group showed significantly higher blood pressure (SBP: 150.00 vs. 120.04 mmHg; DBP: 101.00 vs. 79.36 mmHg, P < 0.001) and elevated urine albumin levels (P < 0.001). Thyroid function analysis revealed higher serum TSH (4.32 vs. 1.98 mIU/L) and T T3 levels (2.25 vs. 1.45 ng/mL) in the case group, with P values <0.001 and 0.010, respectively, while T T4 levels were comparable (P = 0.639). Hypothyroidism was more prevalent in the case group (30%) compared to the control group (10%, P = 0.001). Conclusion: Pre-eclampsia and eclampsia significantly impact thyroid function, with higher TSH and T3 levels and increased prevalence of hypothyroidism compared to normotensive pregnancies. Early screening and management of thyroid dysfunction in hypertensive pregnancies are essential for improving maternal and neonatal outcomes.

DOI: 10.5281/zenodo.

Introduction: The prostate is vital for male fertility, and Transurethral Resection of the Prostate (TURP) is a gold-standard procedure for treating moderate to severe LUTS and complications from BPH. Spinal anesthesia (SA) is preferred for TURP, with adjuvants like Buprenorphine or Dexmedetomidine enhancing analgesic duration and minimizing local anesthetic dosage. Methods: This prospective study, conducted at NRI Institute of Medical Sciences, involved 18 to 60 year old patients undergoing TURP under GA. Participants were randomized into two groups: Group A received 0.5% hyperbaric Buprenorphine and Dexmedetomidine, while Group B received 0.5% hyperbaric Bupivacaine and Buprenorphine intrathecally. Sensory and motor block durations were assessed. Results: The mean age was 54.8 ± 8.7 years in Group A and 56.2 ± 9.6 years in Group B, with no significant differences in age or surgery duration. Time to S1 regression was similar between groups. However, there was a statistically significant difference in mean motor recovery time and first postoperative analgesic requirement. Conclusion: The study shows that dexmedetomidine, as an adjuvant to bupivacaine in spinal anesthesia, significantly prolongs motor recovery time compared to buprenorphine. This highlights the impact of adjuvant choice on motor block duration, reinforcing dexmedetomidine’s potential in prolonging spinal anesthesia, especially important for optimizing care in elderly patients.

DOI: 10.5281/zenodo.

Introduction: Heel pain brought on by recurrent tension on the plantar fascia is a common symptom of plantar fasciitis. The purpose of this study is to investigate the relationship between the severity of plantar fasciitis symptoms and morphological changes in the plantar fascia, such as thickness and the existence of calcaneal spurs. Methodology: 180 people (60 controls and 120 patients with plantar fasciitis) participated in a cross-sectional study. Ultrasound imaging detected calcaneal spurs and evaluated the thickness of the plantar fascia. The Visual Analog Scale (VAS) was used to measure the degree of pain in the group with plantar fasciitis. Result: There were more calcaneal spurs (52% vs. 15%, p < 0.001) and noticeably thicker plantar fascia (5.2 mm vs. 3.6 mm in controls, p < 0.001) in the group with plantar fasciitis. Higher VAS pain levels were associated with thicker fascia. Conclusion: The degree of plantar fasciitis is closely correlated with morphological alterations in the plantar fascia, such as thickening, underscoring the diagnostic utility of ultrasound imaging.

DOI: 10.5281/zenodo.

Introduction: Dyspnea poses diagnostic challenges due to overlapping symptoms from various causes. Immediate treatment is critical in emergencies, where Point-of-Care Ultrasound (POCUS) offers a rapid, non-invasive solution for diagnosing conditions like cardiogenic pulmonary edema, pneumonia, pneumothorax, and pleural effusion. This study aims to evaluate the diagnostic accuracy of POCUS in dyspnea within a tertiary care setting. Methods: This cross-sectional study, approved by the Institutional Ethics Committee, was conducted at Pushpagiri Institute of Medical Sciences, Kerala. It included patients with acute dyspnea and excluded those with ischemic ECG changes or trauma. POCUS, trained with 36 hours of prior USG training, assessed lung, heart, and IVC. Diagnostic accuracy was analyzed using SPSS, with significance set at p<0.05. Results: Pre-clinical POCUS identified pleural effusion (2.4%), ACPE (30%), PE (2.4%), COPD (0.8%), pneumonia (8.9%), and pneumothorax (1.6%). Post-clinical impressions showed similar findings with updated rates. Pleural effusion and PE had 100% sensitivity and specificity. ACPE had high sensitivity and specificity, while COPD and pneumonia showed varied accuracy. Conclusion: POCUS demonstrated high diagnostic accuracy for pleural effusion and pulmonary embolism, with 100% sensitivity and specificity. Acute cardiogenic pulmonary edema also showed excellent diagnostic performance. While COPD and pneumonia had varied sensitivity and specificity, POCUS remains a valuable tool for rapid and accurate assessment of dyspnea in emergency settings.

DOI: 10.5281/zenodo.

Introduction: Otitis media (OM), especially Chronic Suppurative Otitis Media (CSOM), is a prevalent childhood infection, notably high in India. Major factors include poor hygiene and improper antibiotic use, leading to social stigma and potential drug resistance. This study identifies aerobic bacterial and fungal profiles in CSOM, guiding targeted therapies and improving management. Methods: This prospective study, conducted at GSL Medical College from January to May 2024, included adults with ear discharge or pain. Aural swabs were processed for aerobic culture, sensitivity testing, and pathogen identification via Gram staining and biochemical assays. Antibiotic sensitivity was assessed using the Kirby-Bauer method, with E. coli ATCC 25922 as control. Results: In this research, 116 members were included. Culture positivity was 82%. The mean age was 46.4 years and male female ratio was 1.12.  GNB (47.4%) were isolated maximum, followed by GPC (42%) and fungi (10.5%). Pseudomonas aeruginosa (25; 56%) was the leading cause of CSOM. No significant drug resistance was identified. Conclusion: The study identifies Pseudomonas aeruginosa as a primary pathogen in CSOM, with minimal antibiotic resistance, supporting current treatment effectiveness. Regular monitoring of resistance and culture testing are advised to sustain efficacy. Targeted antimicrobial therapy, based on pathogen profiles, can improve outcomes.

DOI: 10.5281/zenodo.

Background and Aim: Diabetic foot ulcers remain a critical concern worldwide, even with the progress achieved in diabetes management. Diabetic foot ulcers remain a critical global challenge, even with the progress achieved in diabetes management. Material and Methods: This study, designed as a prospective comparative analysis, focused on patients suffering from diabetic foot ulcers who were admitted to the surgical department over the course of one year. In this study, participants were categorised into two distinct groups: Group A, which was treated with conventional ordinary dressing (n=40), and Group B, which received Platelet-Rich Plasma (PRP) dressing (n=40, %). The average duration of follow-up was 6 weeks. Results: The findings from our study indicated that participants treated with PRP experienced a wound contraction rate of 22.50%, surpassing that of the group receiving conventional treatment alone. The findings were statistically significant, indicating that PRP may improve wound healing in diabetic wounds. The time needed for wound contraction in the case group was significantly shorter than that observed in the control group (p<0.05). Conclusion: The wounds of subjects receiving PRP dressing exhibited greater contraction compared to those in the non-treated group. This finding suggests that PRP dressing serves as an effective method to enhance wound contraction in diabetic patients and can be utilised alongside traditional treatment approaches for the healing of diabetic wounds.

DOI: 10.5281/zenodo.

Background: Sudden lower Gastrointestinal (GI) bleed is an emergent condition and a dangerous one at that and often demands quick identification as well as prompt treatment. The use of mesenteric angiography is often used when other diagnostic approaches could not locate the cause of bleeding. Therefore, the site of the catheter during this angiography is vital in determining the diagnostic value in localizing the cause of bleeding. Objective: This work assesses the effect of catheter position during mesenteric angiography for patients with acute lower GI bleeding to diagnose the bleeding origin. Methods: A scholarly retrospective analyse of 150 consecutive patients who had the procedure of mesenteric angiography for acute lower GI bleeding in the 2018 to 2023 period was conducted. Specifically, catheters were inserted to SMA, IMA and CIA. Diagnostic yield, sensitivity and specificity were calculated with reference to the catheter position. Results: Catheter placement at the SMA provided the highest diagnostic success, mainly a correct bleeding source was identified in 72% of the patients. The IMA and CIA placements pointed to bleeding in 55% and 23% of cases respectively. The SMA was most sensitive with an accuracy of 89% and high specificity of 95%. Conclusion: Therefore, the location of catheter during mesenteric angiography largely defines its ability to provide the diagnosis. SMA endoscopy offer the greatest diagnostic accuracy, therefore, should be performed in the initial management of acute low GI bleeding.

DOI: 10.5281/zenodo.