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.

Menopause is a phase from where bone mineralisation becomes critics because of various physiological and hormonal changes. Oestrogen deficiency and age related processes alter the rate of calcium turnover in bone that aging woman faces. Osteoporosis especially in postmenopausal women is a well-documented problem. In India lack of nutritional and health awareness makes its prevalence like tip of iceberg phenomenon. Changes in sex hormones during the menopause transition period have an impact on calcium homeostasis. This cross-sectional study was conducted in women of age 27–70 years. Serum calcium levels were estimated in Pre and Post Menopausal women. In postmenopausal women significant decrease in serum calcium level indicate remarkable risk towards negative calcium balance. They should be monitored for serum calcium levels, for reducing the risk of bone resorption.

DOI: 10.5281/zenodo.

Blood transfusion is a critical component of modern healthcare, especially in emergency medicine, oncology, surgery, and for patients with chronic anemia or severe trauma. Blood is a unique tissue comprising cellular and non-cellular elements, essential for various physiological functions. The components, are white blood cells (WBCs), packed red blood cells (RBCs), and platelets (PLT), which play crucial roles in immune response, oxygen transport, and clot formation. Packed Red blood cells (PRBCs) can be preserved and stored under optimum conditions at temperatures of 2-6⁰ C up to a period of 42 days in dedicated blood storage refrigerators specifically made for blood storage with temperature monitoring systems, alarms, power backup and preferably data logger systems are needed for various life-saving blood transfusions, but during the above-mentioned shelf life even under optimal conditions they undergo continuous degradation. The extent of degradation of PRBCs depends on a number of variable factors like collection, transport, separation, handling quality of preservatives and bag. Shelf life of whole blood is 35 days while that of Packed red blood cells collected in triple bag is 42 days.

DOI: 10.5281/zenodo.

Background: Obesity is a major risk factor for developing insulin resistance, leading to metabolic complications like type 2 diabetes and cardiovascular diseases. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is a validated index used to assess insulin sensitivity. Dyslipidemia, particularly high triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C), is commonly associated with insulin resistance in obese individuals. This study aims to evaluate the HOMA-IR index and its correlation with serum TG and HDL-C levels in obese and non-obese individuals. Objective: To assess the relationship between serum insulin levels, triglycerides, HDL, and the HOMA-IR index in obese patients and compare the findings with non-obese control subjects. Material and Methods: This cross-sectional study involved 100 participants, divided into two groups: 50 obese patients (BMI ≥30 kg/m²) and 50 age-matched non-obese controls (BMI 18.5–24.9 kg/m²). The study was conducted in the Department of Biochemistry at a tertiary care hospital. Fasting plasma glucose and insulin levels were measured, and the HOMA-IR index was calculated for all subjects. Lipid profiles, including serum triglycerides and HDL, were also measured. The correlation between HOMA-IR, serum insulin, TG, and HDL was analyzed. Results: Obese individuals showed significantly higher HOMA-IR values (mean ± SD: 4.5 ± 1.3) compared to the control group (mean ± SD: 1.8 ± 0.5). Serum triglycerides were elevated (p<0.01), and HDL levels were lower (p<0.05) in the obese group. A significant positive correlation was observed between HOMA-IR and serum triglycerides (r=0.62, p<0.01) and a negative correlation with HDL (r=-0.48, p<0.05) in obese individuals, while no significant correlations were found in the control group. Conclusion: The study demonstrates a strong association between insulin resistance and dyslipidemia in obese patients. Obese individuals exhibited significantly higher insulin resistance as measured by HOMA-IR, along with elevated triglycerides and reduced HDL levels. These findings underline the importance of addressing lipid abnormalities in obese individuals to prevent long-term metabolic complications.

DOI: 10.5281/zenodo.

Introduction: Gestational Diabetes Mellitus (GDM) is a significant pregnancy complication requiring timely diagnosis to prevent adverse outcomes. While the oral glucose tolerance test (OGTT) is standard, its limitations have prompted interest in alternative markers like HbA1c. This study aims to evaluate HbA1c’s diagnostic utility in GDM, particularly when combined with glucose testing. Methods: This cross-sectional study, conducted over 12 months, involved pregnant women without diabetes. GDM diagnosis was based on a 75-gram OGTT, while HbA1c levels were measured using HPLC. Sensitivity, specificity, and ROC analysis determined HbA1c’s diagnostic accuracy. The study also evaluated HbA1c’s association with pregnancy outcomes like birth weight and complications. Results: In this study of 300 pregnant women, 68 (22.7%) were diagnosed with GDM. The mean HbA1c level in GDM cases was 5.8% versus 5.2% in non-GDM (p<0.05). HbA1c showed 72% sensitivity, 85% specificity (AUC 0.78). Combining HbA1c with fasting glucose improved sensitivity to 82%, enhancing GDM detection. Conclusion: HbA1c demonstrates moderate diagnostic accuracy for GDM, with fair sensitivity and specificity. When combined with fasting glucose, its diagnostic performance significantly improves, enhancing GDM detection. Elevated HbA1c levels are also linked to adverse pregnancy outcomes, highlighting the importance of using HbA1c as an adjunct diagnostic tool for GDM.

DOI: 10.5281/zenodo.

Introduction: Usage of internet has increased drastically over the past few years and excessive use has negative health consequences posing a serious public health concern. Present study was undertaken with an objective to determine the internet addiction among students from a teaching medical college. Material & Methods: It was a cross sectional study done among 550 Undergraduate Medical students, Post graduates, BSC and allied science students. Internet Addiction Test (IAT) tool was used to assess the internet addiction. Students were explained about purpose of study and confidentiality of information was ensured. Results: Mean age of the respondents was 21.42 years with female preponderance (74.4%). In undergraduate and post graduate medical students, majority of them had mild and moderate addiction compared to BSC and allied science students. Among MBBS students, highest mean IAT score was found in 3^rd year (44.47) followed by Internship & 4^th year. No significant difference was observed in mean IAT score among post graduates. Among BSC students, 2^nd and 3^rd year students had higher mean IAT scores which was statistically significant (p=0.04). With regards to symptoms in specific, excessive use, neglect work, lack of control and neglect social life were statistically significant with category of students. Conclusions: High prevalence of Internet addiction was found in the present study across all the four categories of students included. A multidisciplinary approach involving students, parents, college faculty, psychiatrists, psychologist and stakeholder’s opinions and suggestions needs to be considered to tackle this global public health issue and to reduce its impact.

DOI: 10.5281/zenodo.

Introduction: Vitamin D has a huge impact on human health and disease. It plays an important role in glucose homeostasis by promoting insulin secretion and reducing resistance. Vitamin D insufficiency may increase the occurrence and progression of type-2 Diabetes Mellitus (T2DM) and its associated complications. Objectives: The present study aims to compare vitamin D levels in type-2 diabetes mellitus patients with and without microvascular complications and also to investigate the relationship between vitamin D insufficiency and T2DM microvascular consequences. Material & Methods:  A case control study was conducted on 60 type-2 diabetes mellitus patients, aged between 40-70 years, as per inclusion and exclusion criteria and divided into 2 groups. Group-I: T2DM patients with microvascular complications (n=30) served as study group; and Group II: T2DM patients without microvascular complications (n=30) used as control group. Venous blood samples were collected using aseptic techniques. Fasting blood sugar, glycosylated haemoglobin (HbA1c), post prandial blood sugar and vitamin D levels were measured. The collected data were analyzed using student “t” test for evaluating the differences between both groups in reference to above parameters. Pearson correlation analysis was used to find out association of vitamin D levels with glycaemic control (blood sugar and HbA1C levels). The results were expressed as Mean ± Standard Deviation (SD). Results: Vitamin D deficiency and insufficiency was found to be significantly higher in T2DM patients with microvascular complications (14.51 ± 3.79 vs 19.80 ± 5.02) as compared with T2DM patients without microvascular complications (p< 0.01). Vitamin D insufficiency was found to be more common in females than males (10.52 ± 1.59 vs 16.50 ± 2.77; p<0.001). Vitamin D level also shows statistically significant negative correlation with HbA1C (r=-0.887, p <0.001); fasting blood sugar (FBS) r=-0.901, p<0.001; and 2 hour post prandial blood sugar (PPBS) r=-0.583, p<0.001 and prevalence of microvascular complications. Conclusion: Vitamin D insufficiency is significantly associated with glycaemic control and with any of the individual microvascular complications, i.e. neuropathy, retinopathy, and nephropathy. Therefore, early screening for vitamin D levels in T2DM patients may be beneficial due to the diverse implications of vitamin D deficiency and insufficiency. Estimation and correction of vitamin D deficiency may also help in prevention of microvascular complications.

DOI: 10.5281/zenodo.

The middle cerebral artery (MCA) plays a crucial role in the cerebral vascular system, supplying blood to regions associated with motor, sensory, and language functions. Variability in its branching pattern poses important implications for neurovascular interventions and clinical diagnostics. This cross-sectional study investigates MCA branching patterns, focusing on bifurcation, trifurcation, and other rare configurations to understand their prevalence and significance in neurosurgical planning and stroke management. Data were collected from both cadaveric samples and patient imaging, allowing for a thorough analysis of morphological variations. Findings reveal bifurcation as the predominant pattern, followed by trifurcation, with limited demographic influences observed on pattern distribution. These results highlight the necessity for customized clinical approaches in neurovascular procedures, advancing patient care and enhancing neurosurgical outcomes.

DOI: 10.5281/zenodo.

Background: Estimating stature from skeletal remains is an essential tool in forensic anthropology, especially when only fragmentary remains are available. The ulna, being a commonly preserved long bone in forensic cases, offers significant potential for height estimation, particularly from the bony markers at its proximal end. Objective: This study aims to establish a reliable method for estimating human stature based on the bony markers of the proximal ulna, focusing on its anatomical features such as the anteroposterior and transverse diameters, as well as the maximum length. Methods: The study included 100 adult human skeletal specimens (50 males, 50 females) with intact ulnas. Various bony measurements of the proximal ulna were taken using digital callipers, including the maximum length, anteroposterior, and transverse diameters. Statistical analysis, including correlation coefficients and regression models, was applied to establish the relationship between these markers and stature. Results: A strong positive correlation (r = 0.85) was found between the proximal ulna measurements and the stature of individuals. The anteroposterior diameter exhibited the highest predictive accuracy (r² = 0.72) for stature estimation. A regression equation was derived for both sexes to estimate stature based on the proximal ulna’s measurements. Conclusion: The bony markers of the proximal ulna provide a valuable and reliable method for estimating stature, particularly in forensic cases involving partial skeletal remains.

DOI: 10.5281/zenodo.

Introduction: Self-medication is widespread among medical students, impacting health outcomes. Understanding knowledge, attitudes, and practices (KAP) on self-medication among this population is essential to guide interventions for responsible medication use. Methods: A cross-sectional study was conducted among 300 undergraduate medical students at Government Medical College Suryapet to assess their KAP towards self-medication using a structured questionnaire. Descriptive statistics were employed to analyse the data. Results: Demographic: The sample comprised 150 males and 150 females. Age distribution: 35%, 42%, and 23% were aged 18-20, 21-23, and above 23. Year of study distribution: 31%, 36%, and 33% in 2nd, 3rd, and 4th year. Approximately 3% reported that they have chronic medical illnesses. Knowledge: Fifty four percent accurately defined self-medication. 62% acknowledged potential adverse effects in all medications. Furthermore, 57% stressed the importance of basic drug knowledge was essential for self-medication. While 65% correctly identified age-based self-medication limitations.41% suggested discontinuation if adverse effect appears. Attitude: Fifteen percent endorsed that all dosage ranges posed risks, and 20% strongly agreed that self-medication was unsafe across age groups. Further, 53% endorsed close symptom monitoring during self-medication, while 64% believed self-medication drugs could interact with other drugs and food. Additionally, 45% considered certain self-medication drugs unsafe during pregnancy. Practice: Twenty nine percent admitted consuming medication without reading package inserts, 17% shared prescriptions with symptomatic peers. Additionally, 38% self-medicated without medical knowledge, and 21% extended self-medication without medical oversight. Cost-saving motivated 25%, while 18% were uncertain about prescription necessity. Moreover, 12% reported adverse effects from self-medication. Conclusion: This study emphasizes the diverse KAP regarding self-medication among undergraduate medical students, with demographic-specific targeted educational interventions that can cultivate responsible self-medication practices, ensuring safe and effective medication use.

DOI: 10.5281/zenodo.

Introduction:  Rational drug use refers to the precise administration of medications, including appropriate dosage, duration, clinical relevance and affordability. This study aims to assess the Knowledge, Attitude, and Practice (KAP) related to the rational utilization of medications. Methods: The study involved 300 undergraduate medical students from Government Medical College Suryapet. Demographic information and KAP regarding medicine use were gathered through a structured questionnaire. Descriptive statistics, including percentages and frequencies, were used for data analysis. Results: Socio-demographic data featured 18-20 years (60%), 20-23 years (30%), and >23 years (10%) age groups. Gender distribution was 45% male and 55% female. Year of study distribution was 30% 2nd year, 40% 3rd year, and 30% 4th year. Knowledge: Seventy percent of students familiar with over the counter (OTC) medicines, only 40% were aware of OTC medicines can be safely taken with prescriptions, and 55% acknowledged price disparities among different brands of the same medicine. Notably, 65% knew precautions for geriatric medicine use. Approximately 75% were informed about medicine expiry periods. Top of FormAttitude: Sixty percent disagreed that costlier medicines are superior to cheaper ones, and 55% disagreed that medicines from foreign multinational companies are better. 70% disagreed that mass communication is ineffective for educating people about medicines, while 15% believed doctors can solely rely on pharmaceutical industry-provided information. Practice: Eighty percent sought medical consultation before discontinuing medication, while 70% followed doctor’s advice diligently. Merely 10% acquired medicines through direct-to-consumer advertising, and 15% reused prescriptions for comparable ailments in others. Conclusion: The evaluation unveiled varying KAP levels concerning rational medicine use among undergraduate medical students. Thus, results emphasize the need for curriculum improvements and interventions to address gaps in their understanding and behaviours, contributing to better patient care.

DOI: 10.5281/zenodo.

Background and Aim: Pancreatic pseudo cysts may develop as a result of either acute or chronic pancreatitis. The comprehension of pseudo cysts has evolved over time, driven by advancements in radiology and the emergence of new treatment options. This study seeks to evaluate the range of diagnostic and therapeutic options for intervention, as well as to assess the effectiveness of various management strategies for pseudocysts. Material and Methods: A total of 40 cases were examined, each presenting with either palpable or non-palpable abdominal lumps. These cases raised clinical suspicion of pancreatic pseudocysts, which were subsequently confirmed through ultrasound or CT scans of the abdomen, revealing fluid associated with the pancreas. A total of 28 patients received conservative management, while surgical intervention was performed on the remaining 12 patients. Results: The findings indicate that the predominant risk factor for pancreatic pseudocysts was alcohol-induced pancreatitis, observed in 28 patients (70%). This was followed by gallstone-induced pancreatitis, which was present in 7 patients (17.5%). Abdominal pain emerged as the most prevalent symptom, affecting 36 patients, or 90% of the cohort. This was closely followed by anorexia, reported in 30 patients, accounting for 75% of those studied. Among the 40 patients studied, 9 experienced complications related to pancreatic pseudocysts. In three cases, representing 7.5%, there was a presence of infected pseudocyst and pleural effusion. Among the 28 patients who received conservative treatment, 14 individuals (50%) experienced complete resolution of the pseudocyst. In contrast, 7 patients (25%) showed no change in the size of the cyst, while another 7 patients (25%) exhibited an increase in the size of the pancreatic pseudocyst. Conclusion: Pseudocyst of the pancreas is primarily observed in males, with alcohol consumption identified as the most prevalent contributing factor. The most frequent site is near the head of the pancreas, where abdominal pain often serves as the initial symptom, accompanied by an abdominal lump as a notable clinical sign.

DOI: 10.5281/zenodo.

Background: Upper Gastrointestinal (UGI) haemorrhage is one of the common emergencies met in clinical practice. The mode of presentation is diverse and depends on the cause and the amount of blood loss. Early upper gastrointestinal endoscopy, defined as within 24 hours of hospital presentation or admission is the cornerstone of management of UGIB. Early endoscopy helps in diagnosis, treatment and risk stratification. Therapeutic endoscopy is considered a safe and effective form of treatment today. Objective: To study endoscopic findings and determining the outcomes (mortality and rebleeding) in patients presenting with Upper Gastrointestinal Bleed (UGIB) and in patients on blood thinners in our institute. Methods and Material: A total of 56 patients who were referred to emergency department of Shree Krishna Hospital Gokalnagar in the district of Anand of state of Gujarat which is a part of western India were properly managed and were subjected to therapeutic and diagnostic endoscopy were included in this prospective cross -sectional study and were studied for 6 months. Results: In the studied population among 56 patients, the most common cause of UGIB was variceal bleed 45 (80%); than that of non-variceal bleed 11(20%). The mean Rockall score was 4.7 which indicated that most patients belong to moderate risk group. Conclusion: Rockall score helped in identifying that most of the patients belonged to moderate and high risk group. The mortality was significantly high in the high risk group compared to the low and moderate risk group in which there were no mortality.

DOI: 10.5281/zenodo.

Background and Aim: Visual impairment resulting from childhood cataract at an early age can significantly impact education, hinder personality development, and limit career opportunities. This study aims to deliver evidence-based insights into paediatric cataract in Indian population. Material and Methods: The study group for this analysis included individuals aged six months to sixteen years. Snellen’s Chart and Tellers Acuity cards were both used to assess and document the visual acuity of the individual. The posterior segment was assessed using indirect ophthalmoscopy, and a B-scan was conducted to address any media opacity that might hinder visibility. Phacoemulsification, posterior capsulorhexis, anterior vitrectomy, and primary intraocular lens implantation were the standard surgical procedures performed on all patients. A post-operative evaluation was conducted on postoperative day 1, one week, one month, and six months, if feasible. Results: The current study involved 80 paediatric patients, with a total of 120 eyes undergoing surgery in this analysis. The study included a total of 46 males and 34 females. Among the 80 patients assessed, 48 were found to have unilateral cataract, while 32 presented with bilateral cataract. The analysis of frequency and proportions of various types of cataracts was conducted across different age groups at the time of surgery. The highest incidence of congenital and traumatic cataracts was observed in the age group of 6 to 11 years, while developmental, complicated, and other cataracts were predominantly found in the 12 to 16 years age group. Conclusion: It is important to promote long-term follow-ups for parents by offering comprehensive counselling both prior to and following surgery within the community. This will enhance their comprehension of the seriousness of the disease and the potential outcomes following surgery.

DOI: 10.5281/zenodo.

Background and Aim: Alvarado scoring system is one of them and is purely based on history, clinical examination and few laboratory tests and is very easy to apply. Present study was done is to evaluate the role of Alvarado Scoring System (MANTRELS Scoring) in preoperative diagnosis of acute appendicitis. Material and Methods: This study was carried out on 100 patients who are having pain in right Iliac Fossa region and these patients were admitted in Department of General Surgery, in our hospital for further evaluation and management. Evaluation of these patients will be done by Alvarado Score and Ultrasonography. Patients were divided in 3 groups: 1) Cases with score of 1-4 were observed and not operated.  2) Cases with score of 5-6 were observed for next 24 hours for revision of scoring. 3) A Patients with score of 7-10 who are considered candidates for appendectomy were assessed again after ultrasonography. The reliability of Alvarado scoring system is assessed by calculating Negative appendicectomy rate and Positive predictive value. Results: There were 70 males and 30 females included in the study. The age range of included patients was found to be 8 to 55 years. Out of 100 cases, 14 patients had a score of <5. Out of them, 6 patients seemed to have an inflamed Appendix and 4 patients seemed to have a normal Appendix intraoperatively. On histopathological examination, it was proved that out of these 48 cases, 32 actually had acute appendicitis, 12 patients had chronic appendicitis while the remaining 4 had a normal Appendix. Conclusion: Alvarado scoring System is a fast, simple, cost-effective, reliable, non-invasive, repeatable, and safe diagnostic method for acute appendicitis without complications.

DOI: 10.5281/zenodo.

Background: Glucocorticoids- Prednisolone, Hydrocortisone are available in various formulations like oral and parenteral, inhalation and topical. Though they are many medicinal benefits of steroids nowadays, this study aims to compare the natural product  Tectona grandis which possess steroid like activity with the Standard steroids like Hydrocortisone  Aim of our study is to determine the potency of Tectona grandis decoction with Standard steroids (Prednisolone, Hydrocortisone) by analytical method  and to compare steroid in Tectona grandis  extract with    Standard  Steroid  by  FTIR  and HPTLC. Methodology: 20 mg of Tectona grandis‘s bark were dried, weighted and made in to fine powder using blender, thus Tectona grandis powder was prepared. The processed Tectona grandis were fractionated /extracted using chloroform. The extract were subjected to phytochemical analysis focusing on phytosterols by two methods-Salkowski test and Lieberman burchardt test. Estimation of Steroid in Tectona grandise as done by Spectrophotometry and HPTLC. Results: The appearance of reddish brown precipitate by Salkowski test and reddish brown ring formation by Lieberman-burchardt test indicate the presence of phytosterol. TG decoction is equal to 1.25 mg of hydrocortisone and 1.75mg of prednisolone. Tectona grandis extract showed that the spectrum  similar to spectrum of Prednisolone whose characteristic band of the OH group were found at 3200-3500 cm-1 and two carbonyl stretching peak appear as  a very strong band at 1708cm-1 and 1654 cm-1, denotes Prednisolone like structure in FTIR. Conclusion: Tectona grandis‘s stem bark is a commercially available plant product that possess steroidal activity and the structure resembles prednisolone. It can be used to reduce inflammation whenever corticosteroid are indicated as alternative cost effective treatment.

DOI: 10.5281/zenodo.

Background: Poisoning is a global public health problem. The World Health Organization (WHO) estimates that nearly 250,000 deaths occur globally due to poisoning each year, with pesticides alone causing 150,000 deaths. Most poisoning deaths occur in lower- and middle-income countries (LMIC).The number of deaths occurring from particular poisons or poison classes varies from place to place, and over time, as a result of changes in access, effective and timely medical management, preventative measures, and regulatory policies. Paraquat (1,1′-dimethyl-4,4′-bipyridylium dichloride) is one of the most widely used herbicides. Methodology: The study was conducted in the Department of General Medicine in collaboration with Department of Biochemistry, Radiology, ENT, Chest medicine, of Calcutta National Medical College and Hospital, Kolkata along with sonography unit of department of General medicine and Dialysis unit. 50 patients were recruited after taking written consent from the inpatient as well as outpatient department of Dept. of General Medicine of CNMCH. Results: Mean age of female population was 38.14 ± 12.25 year which was slightly higher than mean age of male population (36.78 ± 11.85 year). Majority of male population belonged to the age group of (31 – 45) year. Predominantly people from farming background took PQ as a suicidal poison and majority of them were from a rural area. Study showed that majority of Paraquat poisoning was suicidal. Only 1 subject is exposed to it accidentally. Overall, suicidal poisoning is much more severe than accidental poisoning due to the consumption of higher doses of poison. Most common sign of paraquat poisoning was oral ulceration (94%) followed by tachypnoea (48%), icterus (32%) and Shock (14%). The present study showed that almost all patient had raised creatinine value during hospital stay. The most common cause of death was multi organ damage followed by Respiratory failure, shock, and renal failure (61%, 30%, 6% and 3% respectively). Conclusion: PQ was used for suicide in rural area mainly from families dependent on cultivation. As a corrosive poison almost all patient with significant intake had local ulceration in mouth and pharynx. Its systemic toxicity can affect all major organs though kidney, lung and livers were commonly effected ones. By using consensus based guidelines we found that one third of the patient survived which was better than the data reported in last decade. Amount of ingestion was one of the main predictors of outcome whereas early hospital admission and early hemodialysis significantly increases the chance of survival.

DOI: 10.5281/zenodo.

Background: Hypertension is listed globally as a significant public health problem, hypertension results in cardiovascular burden and death. Carburation and management of blood pressure require the proper administration of such drugs as antihypertensive agents. The purpose of the present research will be to investigate the prescription approach of antihypertensive medication in a tertiary care hospital setup. Objectives: The objectives of the study was, yo assess the type / forms of antihypertensive drugs used in a tertiary health institution. Another objective of the planned study was to determine the relationship between demographic aspects of patients and the choice of oral antihypertensive medications. Methods: The current work is a cross-sectional study done in one of the tertiary care hospitals, to evaluate the prescription pattern of outpatient prescriptions for antihypertensive medication within 12 months. Patient records included socio-demographics, medication information including the name of drugs, dose, and drug classifications were retrieved. Results: The prescriptions of the selected healthcare entities were reviewed making a total of 500 prescriptions.: ACE inhibitors were the most prescribed drugs (35%) compared to CCBs (28%) and beta-blockers (22%). Of the treated patients, 60% were on combination therapy. Specifically, the A, B and C options identified ACE inhibitors as the most commonly prescribed antihypertensive to older patients (age >60) and those with complications such as diabetes. Conclusion: The study also shows that ACE inhibitors and CCBs are among the frequent drugs used to address hypertension. The prescription pattern is consistent with current guidelines, but there is a possibility to enhance individualised therapy.

DOI: 10.5281/zenodo.

Background: Cephalosporins are categories of broad-spectrum antibiotic that has been incorporated in clinical practice in the management of bacterial infections. Therefore, correct usage of cephalosporin antibiotics is effective for obtaining the maximum therapeutic effect and preventing bacteria resistance. This paper assesses the trend of cephalosporin utilization in a third level hospital. Objective: To identify and compare the most frequently used cephalosporin antibiotics in a large volume teaching hospital. In this study, the authors’ intention was to determine the relationship between cephalosporin prescription and the age, gender, and comorbidity of patients. Methods: This was carried out with data obtained from medical records of patients at a tertiary care hospital using data from the hospital’s pharmacy. A retrospective prescription audit of cephalosporin antibiotics was conducted for a 24-month period for drug name, dosing, course days and patient demographics. Results: A total of 400 prescriptions were analysed . Cephalosporin prescribing preferences remained fairly constant Ceftriaxone accounted for 45% of prescribed cephalosporins, cefuroxime 30% and cefepime 15%. Majority of those prescriptions were meant for respiratory and urinary tract infection patients, and for severe infections, ceftriaxone was typically prescribed. Hypoglycemia was seen in 5 % of the cases, more frequently in patients who received higher doses or combination therapy and those with co morbid conditions like diabetes and hypertension. Conclusion: Neither do the results point out the lack of use of any particular type of antibiotic like cephalosporins; in fact the study found that ceftriaxone was frequently prescribed in treating infective diseases in a tertiary care setting, thus implying that the use of any particular type of antibiotics is in compliance with the laid down clinical protocols. But sustained awareness creation on the use of antimicrobial is important on curbing resistance.

DOI: 10.5281/zenodo.

Background and Aim: Diabetes mellitus has emerged as a significant global health crisis. Heightened platelet activity could contribute to the emergence of vascular complications associated with this metabolic disorder. The mean platelet volume (MPV) serves as a crucial marker for assessing the average size and functionality of platelets. Research indicates that larger platelets are typically younger and demonstrate increased activity levels. This study focused on comparing mean platelet volume (MPV) in patients with Type 2 Diabetes against non-diabetic controls. It also examined the relationship between MPV and vascular complications in diabetic individuals, as well as the correlation of MPV with diabetes duration, HbA1C levels, and fasting blood sugar levels. Material and Methods: A comparative cross-sectional study involving 300 participants, consisting of 150 diabetic patients and 150 nondiabetic controls, was conducted at a tertiary care institute in Gujarat. The analysis of MPV was conducted in both groups, examining its potential association with diabetic complications and glycaemic parameters. Results: The findings indicate that mean platelet volume (MPV) levels were notably elevated in individuals with diabetes when compared to the control group. In a similar vein, our findings indicated that individuals with diabetes who experienced vascular complications exhibited notably elevated MPV levels when contrasted with their counterparts who did not have such complications. In individuals with diabetes experiencing microvascular complications, there is a notable correlation between Mean Platelet Volume (MPV) and both Diabetic Nephropathy and Diabetic Retinopathy. In a similar vein, individuals experiencing macrovascular complications exhibited a notable correlation between Mean Platelet Volume and Peripheral Artery Disease. Conclusion: The findings indicate a notable association between fluctuations in mean platelet volume and diabetes, along with its associated complications. The affordability, accessibility, and clarity of this tool position it as a valuable indicator for identifying thromboembolic events and mitigating vascular damage in individuals with type 2 diabetes.

DOI: 10.5281/zenodo.

Background: Corticosteroids are used consistently in healthcare for the management of several immunological and inflammatory diseases. To keep better regulation over the quality of drug utilization or prescribing in terms of appropriate/rational use of corticosteroids in any healthcare setting, it is necessary to estimate and evaluate its pattern of drug utilization by periodically conducting the DUE (drug utilization evaluation) studies. Aim and Objectives: Estimation and evaluation of the pattern of corticosteroid utilization to promote their safer and appropriate use. Materials and Methods: This was a 12 months long, observational, cross-sectional DUE study carried out in a total of 260 participants which included patients (OPD and IPD) of all ages receiving corticosteroid in the department of general medicine and dermatology, SHKM GMC, Nalhar. Outcomes measured were the socio-demographic characteristics, drug use related information of corticosteroids and evaluation of pattern of utilization using WHO Prescribing indicators. The results were expressed as frequencies, percentages, and averages. Results: Out of 260 participants, with 66.9% (174) majority of the participants were males. A total of 333 corticosteroids were utilized with a prevalence of 16.9%. A higher corticosteroid use prevalence of 28.5% and FDCs prescribing of 46.8% was observed in the department of dermatology to that of general medicine department with use prevalence of 11% and FDC prescribing of 16.3%. However, in general medicine department, a higher injectable prescribing of 44.7%, generic prescribing of 89.5% and prescribing from NLEM of 100% was observed when compared to that of dermatology department with an injectable prescribing of 7.8%, generic prescribing of 42.2% and prescribing from NLEM of 29.2% only. WHO Prescribing indicators revealed that a total of 197 corticosteroids were prescribed in 160 outpatients, out of which 49.7% corticosteroids were generic and 41.1% were prescribed from NLEM, average number of drugs prescribed per outpatient was found to be 4.4, prescriptions with antibiotics and injectable were 65% and 4% respectively. Conclusion: Corticosteroid use prevalence was found to be lower than the use prevalence reported by some previous studies conducted in different parts of India as well as internationally. However, to further enhance the appropriateness of corticosteroid utilization, reduction in the average number of drugs and corticosteroids per prescription, more prescribing from the essential medicines list and generic prescribing are needed.

DOI: 10.5281/zenodo.

Occupational stress is documented to have catastrophic effects on cardiovascular health in the workplace. The physiological effect of chronic stress has been shown to alter the HPA axis and the sympathetic nervous system, in proving higher cortisol levels, higher catecholamine levels, and an imbalance of the autonomic nervous system. These physiological changes cause hypertension, endothelial dysfunction, atherosclerosis and reduced HRV which in turn predispose individuals to CVDs. In addition, there are inflammation and oxidative stress that enhance arterial plaque formation as well as thrombogenesis and increase cardiovascular morbidity and mortality. This study examines how occupational stress promotes cardiovascular disease through autonomic and hormonal systems and through biochemical stress responses. Conclusions derived from the study provides substantial support for measures such as stress control and organizational approaches to decrease these risks.

DOI: 10.5281/zenodo.

Background: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and fetus. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm, body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage), no antibiotic prophylaxis, duration of labor >12 h, premature rupture of membranes, gestational diabetes, previous cesarean delivery and emergency delivery. Diagnosis of surgical site infection requires evidence of clinical signs and symptoms of infection which may be further supported by microbiological evidence. Material and Methods: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors at ANMMCH, Gaya. Conclusion: To reduce the SSI rates post LSCS, proper assessment of risk factors and their modification is required. Frequent antibiotic susceptibility testing for resistance is required.

DOI: 10.5281/zenodo.

Background: The onset of infectious complications following abdominal surgery may be insidious, their presence obscure and the diagnosis difficult. Methods: A prospective study of patient in whom emergency laprotomy was performed and post operative abdominal drain fluid analysis was done by ph for rapid detection of infectious complications. At ANMMCH, Gaya. Results: In our study those patients who developed intraabdominal complications (Failure) there 65.3% of samples have pH 7.1. While in patients who considered cured & improved 76.62% samples have pH >7.1 & 23.37% have pH. Conclusion: The pH during the postoperative follow-up period to evaluate the potential for rapid, simple, and early detection of infectious complications following abdominal surgery.

DOI: 10.5281/zenodo.

Introduction: Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder in women of reproductive age, marked by hormonal imbalances, metabolic disruptions, and reproductive abnormalities. Clinical features such as irregular cycles, hirsutism, and obesity, combined with ultrasonographic findings like multiple small follicles and elevated biochemical markers, necessitate a comprehensive diagnostic approach to understand and manage PCOS effectively. Material and Methods: This prospective study was conducted over a year at a tertiary care center in Western Gujarat, including 60 PCOS patients and 20 healthy controls. Participants underwent detailed clinical evaluations, ultrasonographic imaging, and biochemical analysis, adhering to the Rotterdam criteria for PCOS diagnosis. Key parameters like BMI, hormone levels, and ovarian morphology were assessed to investigate the clinical, ultrasonographic, and biochemical correlates of PCOS. Data analysis included descriptive statistics and correlation tests, with a p-value of <0.05 considered statistically significant. Results: Our study demonstrated significant clinical, hormonal, and immunological differences between PCOS patients and healthy controls. The study group showed a high prevalence of hirsutism (70%), oligomenorrhea (66.67%), and polycystic ovaries on ultrasonography (63.33%), all absent in the control group (p < 0.001). BMI (28.95 ± 6.15 kg/m²), LH levels (12.75 ± 4.25 mIU/mL), and the LH-FSH ratio (2.15 ± 0.95) were significantly elevated in the study group (p < 0.001), alongside increased anti-TPO antibody levels in patients with polycystic ovaries (65.50 ± 85.25 IU/mL, p < 0.001). While fasting blood sugar, prolactin, and TSH levels showed no significant differences, strong correlations between BMI, LH, and anti-TPO levels highlight the intricate interplay of metabolic, hormonal, and immunological factors in PCOS. Conclusion: Our study identifies significant correlations between clinical features, ultrasound findings, and biochemical markers in PCOS patients, emphasizing the role of thyroid autoimmunity, BMI, and hormonal imbalances. These results highlight the value of integrated diagnostic approaches for effective management of PCOS.

DOI: 10.5281/zenodo.

Background and Aim: Peripheral administration of opioids has been suggested for prolongation of regional analgesia. Aim of the present study is to evaluate efficacy and safety of Buprenorphine as an adjuvant to Axillary brachial plexus block for post-operative analgesia. Material and Methods: Present randomized prospective double blind controlled trial was performed at P.D.U. Medical College, Rajkot in 50 Adults. Each patient was randomly allocated to one of two groups of 25 patients each. Group C receives 15 ml Lignocaine + Adrenaline 1.5%- and 15-ml Bupivacaine 0.5% diluted upto 1ml of normal saline while Group B receives 15 ml Lignocaine + Adrenaline 1.5%- and 15-ml Bupivacaine 0.5% and Buprenorphine 3 mcg/kg diluted upto 1ml normal saline. Onset, duration of sensory and motor block, hemodynamic parameters, sedation score, and pain scores using visual analog scale, duration of postoperative analgesia, rescue analgesic (RA) requirement, adverse events, and patient satisfaction were noted. Results: Both groups were comparable in demographic parameters. Onset and duration of sensory and motor block was similar in both groups. B group had significantly higher VAS scores compared to C group (P≤0.05). Duration of analgesia was the higher in B (20.39±1.22) Compared to in Group C (10.88±0.74) (P < 0.05). Conclusion: Buprenorphine 3 mcg/kg in axillary plexus block provides significantly prolonged analgesia with less RA requirement and greater patient satisfaction compared to Placebo groups.

DOI: 10.5281/zenodo.

Overview: Hip fractures are among the most frequently seen injuries by orthopaedic surgeons and are particularly prevailing in the geriatric community. This study was performed to evaluate the efficacy of the bipolar hemiarthroplasty among elderly patients with a proximal femoral [neck & I/T] fracture. Materials and Methods: This was a prospective study undertaken at the Department of Orthopaedics at a NIMS, Jaipur from January 2023 to June 2024. The patients were selected based on the convenience sampling (Judgment sampling) method. Bipolar hemiarthroplasty was performed. All had cemented implants. Functional outcome was assessed periodically at 6 weeks, 3 months, 6 months, and 1 year using modified Harris hip scoring system using guide for statistical analysis and p value set at 0.05. Observations: A total of 40 patients >50 years of age with 22 (55%) males and 18 (45%) females, among which 36 (90 %) with fractured neck of femur and 4 (10%) with Inter- trochanteric fracture were studied. Harris hips ROM score 5 was noted in 50% of the participants, scores 4 and      3 in 42.5 and 7.5%, respectively. Excellent functional score was noted in 16 (40%), good in 18 (45%), satisfactory in 3 (7.5%), and 3 (7.5%) had poor score. Only two (5%) participants had radiolucent zone >2 mm and one (2.5%) had subsidence of prosthesis >5 mm. Conclusion: Cemented bipolar hemiarthroplasty is a option of treatment in mobile geriatric patients above 50 years of age with a proximal femoral [Neck/ I/T] fracture. A bipolar hemiarthroplasty is a reliable option in treating fracture neck/ I/T femur in the elderly with several comorbidities. All the participants had a satisfactory functional outcome in form of regular daily activity, less hospital stay, less residual pain, good post-operative functionality and fewer post-operative complications. It can be used in day-to-day clinical practice as a effective treatment modality.

DOI: 10.5281/zenodo.

Introduction: COVID -19 pandemic had a significant impact on both mortality and morbidity of many diseases with no exception on Tuberculosis. This study was done to describe the clinical and laboratory profile of tuberculosis patient and to estimate the prevalence of malnutrition. Materials and Methods: The cross-sectional study was done in the TB hospital attached to the tertiary care hospital, in Madurai among all 226 TB patients admitted during March-May 2024. Data on clinical and laboratory profile was collected using predesigned semi-structured questionnaire. Data analysis done using SPSS and descriptive statistics was used. Results: Among 226 TB patients 78% of them did not have any co-morbidity. Most common comorbidity was Diabetes seen in 15%, 5.8% were reactive for HIV. Smokers and alcoholics were 55.3% and 63.3% respectively. 93.4% were severely malnourished and 94.2% of their BMI fell into underweight category. For 57.5% of the individuals haemoglobin was more than 10g/dl and 97.8% of them had normal temperature. 62.8% and 58% had urea and creatinine within the normal range respectively. Nearly 84% of them had abnormal WBC total count. Majority of them had respiratory rate 18-24 per min (62.8%) and Spo2 >93% (84.1%). Mean TN-KET score was 6.8. Extra pulmonary TB was among 3.9% and 5.3% had drug resistant TB. Conclusion: TB is more prevalent among male population, 40-50 years age group. Infection leads to other secondary problems like anaemia and malnutrition and most common co-morbidity associated is Diabetes.

DOI: 10.5281/zenodo.

Background: Iron deficiency anemia is the most common cause of anemia. Pregnancy is usually associated with anemia, and additionally in late pregnancy, iron deficiency anemia is seen which is caused by increase in iron demands. HbA1c is affected by several factors including pregnancy. Objective: To estimate HbA1C and serum ferritin levels and compare them among Iron deficient anemic pregnant women and normal pregnant women. Methods: Comparative cross- sectional study was performed on 100 patients, among which 50 were Iron deficient Anemic (IDA) pregnant women and 50 were normal pregnant women, attending obstetrics OP, GGH, Ananthapuramu. Detailed history of patient, clinical examination was done. Laboratory   parameters estimated were HbA1c, serum ferritin, complete blood count, and fasting blood sugar. Pregnant women aged 18-35 years and those willing to give consent were included in the study. Pregnant women with a known H/o Diabetes, Hemoglobinopathy, Chronic liver and kidney disease were excluded from the study. Institutional ethical committee clearance was obtained. Results: In the current study mean±S.D levels of HbA1c was 4.54 ± 0.66 in control group, while in cases was 6.21 ± 0.36. The difference was statistically significant (p value <0.05). In our study, among cases HbA1c inversely correlated with serum ferritin (r value -0.336 and p value <0.05). Conclusion: The present study concluded that the levels of HbA1c were increased significantly among patients with iron deficiency anaemia. So, Iron deficiency anaemia has to be kept in mind before taking into consideration HbA1c levels to diagnose diabetes mellitus.

DOI: 10.5281/zenodo.

Background: Ropivacaine and Levobupivacaine are amide local anesthetics with better safety profile as compared to Bupivacaine. This study was performed to compare the anesthetic efficacy and safety of two local anesthetic agents, Isobaric 0.5% Ropivacaine and Isobaric 0.5% Levobupivacaine, in patients undergoing elective lower limb surgeries under spinal anesthesia, using 3ml (15mg) of each. Materials and Methods: 60 healthy consenting patients meeting our inclusion criteria were selected for the trial and randomly allotted into one of two groups of 30 each to receive intrathecally isobaric 0.5% Ropivacaine or isobaric 0.5% Levobupivacaine respectively. Characteristics of sensory and motor nerve block, intra-operative haemodynamic changes and adverse effects such as hypotension, bradycardia, vomiting, shivering were evaluated. The demographic quantitative data was analyzed by student’s t’ test and qualitative data was analyzed by Chi-square test using MEDCALC software. Results: Isobaric Levobupivacaine had a significantly similar onset and progression of sensory block and height of sensory blockade after 20min as compared to the isobaric Ropivacaine group. The onset and progression of motor block (modified Bromage scale) were similar in both groups. The duration of sensory and motor block was significantly shorter (P<0.01) in Ropivacaine group (45 ± 5.14 minutes and 139 ± 10.37 minutes) as compared to the Levobupivacaine group (58 ± 9.15 minutes and 172 ± 14.4 minutes). Conclusions: 0.5% isobaric Ropivacaine has shorter duration and similar onset and progression of motor and sensory blockade on comparing with 0.5% isobaric Levobupivacaine intrathecally with comparable haemodynamic changes and complications.

DOI: 10.5281/zenodo.

Background and Aim: Diabetes mellitus has emerged as a significant global health crisis. Heightened platelet activity could contribute to the emergence of vascular complications associated with this metabolic disorder. The mean platelet volume (MPV) serves as a crucial marker for assessing the average size and functionality of platelets. Research indicates that larger platelets are typically younger and demonstrate increased activity levels. This study focused on comparing mean platelet volume (MPV) in patients with Type 2 Diabetes against non-diabetic controls. It also examined the relationship between MPV and vascular complications in diabetic individuals, as well as the correlation of MPV with diabetes duration, HbA1C levels, and fasting blood sugar levels. Material and Methods: A comparative cross-sectional study involving 300 participants, consisting of 150 diabetic patients and 150 nondiabetic controls, was conducted at a tertiary care institute in Gujarat. The analysis of MPV was conducted in both groups, examining its potential association with diabetic complications and glycaemic parameters. Results: The findings indicate that mean platelet volume (MPV) levels were notably elevated in individuals with diabetes when compared to the control group. In a similar vein, our findings indicated that individuals with diabetes who experienced vascular complications exhibited notably elevated MPV levels when contrasted with their counterparts who did not have such complications. In individuals with diabetes experiencing microvascular complications, there is a notable correlation between Mean Platelet Volume (MPV) and both Diabetic Nephropathy and Diabetic Retinopathy. In a similar vein, individuals experiencing macrovascular complications exhibited a notable correlation between Mean Platelet Volume and Peripheral Artery Disease. Conclusion: The findings indicate a notable association between fluctuations in mean platelet volume and diabetes, along with its associated complications. The affordability, accessibility, and clarity of this tool position it as a valuable indicator for identifying thromboembolic events and mitigating vascular damage in individuals with type 2 diabetes.

DOI: 10.5281/zenodo.

Pharmacomicrobiomics is an emerging branch of Pharmacology, which deals with effect of variations in microbiome on drug related pharmacokinetics and pharmacodynamics. Gut microbes are of numerous types and millions in numbers. Studying alteration of these microbes and its effect on modifying drugs response and disease prognosis has opened many gateways of treatment in many difficult to treat chronic diseases. Cancer, diabetes mellitus, hypertension, rheumatoid arthritis are certain examples of such diseases. Recent advancement like organ-on-chips and bacterial culturomics may allow pharmacomicrobiomics to completely revolutionize the concept of personalized medicine. Present article is about current and possible future clinical applications of pharmacomicrobiomics.

DOI: 10.5281/zenodo.

Background and Aim: Thyroid swellings are commonly observed in ENT practice, varying from benign cysts to malignant tumours. A clinical study was conducted to investigate the prevalence of different types of thyroid disorders among patients presenting with thyroid swellings in the region, focussing on their age and sex distribution as well as any notable trends. Material and Methods:  A total of 100 patients with thyroid swellings were examined in this study. The study included patients over the age of 6 who presented with thyroid swellings. Patients underwent a thorough clinical examination that included inspection, palpation, percussion, and auscultation, along with thyroid function tests to assess their health status. All patients underwent ultrasonography (USG) and fine needle aspiration cytology (FNAC). Results: Significant portion of thyroid swellings presented bilaterally, accounting for 52% of cases. The majority of unilateral thyroid swellings observed were predominantly located in the right thyroid lobe, accounting for 24% of cases. Ultrasound and fine needle aspiration cytology revealed that 91% of the cases presented benign lesions, whereas a mere 9% were identified as malignant lesions. The FNAC report indicated that colloid goitre was present in the majority of cases, accounting for 44%. This was followed by colloid nodules in 14% of cases, thyroiditis in 10%, and colloid cysts also in 10% of cases. Conclusion: The ultrasonographic findings yield critical insights into various aspects such as nodularity, vascularity, calcification, and the extent of infiltration into adjacent structures. Ultrasonographic findings alone are insufficient for a definitive diagnosis, making it essential to perform FNAC to confirm histopathological features.

DOI: 10.5281/zenodo.

Introduction: Hepatitis C virus (HCV) infection prevalence is believed to be elevated in Bihar, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Bihar. Material & Method: A prospective, OPD-based serosurvey was conducted from March-2024 to October-2024 at ANMMCH Gaya, Bihar. Children aged >=5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serological specimens were obtained and tested for anti-HCV antibody. Result: 8767 OPD patients participated in the study shows anti-HCV prevalence of 0.27%. Anti-HCV positivity was most prevalent in the 40–49 year-old and 30–39 year-old age groups (33.33% and 25.0% respectively). Sex wise distribution shows that there was slight male preponderance (58%). Out of total number of positive cases (24), 14 (58.33%) were males and 10 (41.66%) were females. Among all positive cases having a history of Diabetes, tuberculosis, Chronic Renal Failure and Cancer were 3.15%, 3.94%, 0.79% and 0.79% respectively. Conclusion: The study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged would be the most effective for identifying infected individuals.

DOI: 10.5281/zenodo.

Background and Aim: Rib fractures are among the most prevalent injuries seen in trauma cases, significantly elevating the risk of both mortality and morbidity. This study aimed to evaluate how effective transdermal NSAID administration is for pain relief in patients with rib fractures, while also comparing its effectiveness to that of intravenous NSAID administration. Material and Methods: This study prospectively compares 80 subjects with rib fractures who sought treatment at the Emergency Medicine Department of a tertiary care institute in Gujarat over the course of one year. The study group received transdermal NSAIDs, while the control group was given intravenous NSAIDs. Results: In this study involving 80 participants, the gender distribution revealed that 13 were female while 67 were male. The mean VAS score recorded on day 1 for Group A was 8.5, while Group B reported a score of 7.4. The variation in mean VAS score on Day 1 between the two groups was found to be statistically significant. The average VAS score recorded on day 3 was 3.5 for both groups involved in the study. The variation in mean VAS score on Day 3 between the two groups did not reach statistical significance. (p>0.05) Conclusion: The use of transdermal NSAIDs has proven to be an effective method for managing pain in patients with rib fractures. The analgesic effect of transdermal NSAID administration shows a delayed onset, as indicated by elevated VAS readings on day 1. However, by day 3, its effectiveness aligns with that of intravenous NSAID administration, as reflected in the VAS readings.

DOI: 10.5281/zenodo.

Background and Objectives: Dengue virus infection is a significant public health concern, particularly in tropical and subtropical regions. Characterized by a wide range of clinical manifestations from mild febrile illness to severe hemorrhagic fever, dengue poses a substantial burden on healthcare systems. Serum ferritin, an acute-phase reactant, has been suggested as a potential biomarker for disease severity in dengue infections. This study aims to examine the clinical-epidemiological features of dengue virus infection and to investigate the correlation between serum ferritin levels and disease severity. Methods: This observational study was conducted in Department of General Medicine, J L N Medical College and Hospital, Bhagalpur, Bihar, India for one year  involving 100 patients diagnosed with dengue virus infection. Patients were categorized based on disease severity: Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS). Serum ferritin levels were measured on the day of admission and correlated with clinical outcomes. Data on demographic characteristics, clinical features, laboratory findings, and outcomes were collected and analyzed. Results: The mean serum ferritin levels were significantly higher in patients with severe dengue (DHF and DSS) compared to those with DF (p < 0.001). A positive correlation was observed between serum ferritin levels and the severity of thrombocytopenia (r = 0.72, p < 0.001). Additionally, elevated ferritin levels were associated with prolonged hospitalization and higher rates of complications such as bleeding and organ impairment. Multivariate logistic regression identified serum ferritin as an independent predictor of severe dengue (adjusted OR: 3.4; 95% CI: 2.1-5.6). Conclusion: Serum ferritin levels are significantly associated with the severity of dengue virus infection, suggesting its potential role as a biomarker for predicting disease progression. Clinicians should consider serum ferritin levels in the early management and risk stratification of dengue patients to improve outcomes.

DOI: 10.5281/zenodo.

Background: Oxyfluorfen is one of the herbicides placed in the third category of toxicity used for the control of broad-leaf and grassy weeds. The investigation aims to evaluate the effect of oxyfluorfen on adult male mice. Objectives: In the present investigation studied one of the Herbicides- Oxyfluorfen impact (an endocrine disruptor) on the hypothalamic –pituitary- gonadal-Adrenal axis, infertility and Ache activities in male adult mice. Methods: The treatment group received 350 mg/kg, 500 mg/kg 750mg/kg body weight for 14 days and autopsied on the 15^th day of the experiment.  The serum was collected and subjected to ELISA using specific antibodies for sex steroids. The testis and adrenal were subjected to histology. The results were reveal that significantly decreased fertility index, serum testosterone level, sperm motility and count with increased morphological abnormalities in sperm and an insignificant increase in estradiol level in males. Histological observations of the testicle revealed degenerative changes of seminiferous tubules, reduced interstitial space and Sertoli cell disruption could signify the impact on fertility. The hypertrophy of adrenal medullary cells and decreased AChE activity indicate neuroendocrine imbalance. Conclusion: The observed results reveal that Oxyfluorfen exhibits estrogenic action, induced changes on the hypothalamic-pituitary-gonadal-adrenal axis and impairment in fertility hence may be considered  an endocrine disruptor.

DOI: 10.5281/zenodo.

Introduction: Esophageal lesions, both malignant and non-malignant, pose significant clinical challenges due to their overlapping symptoms, the potential for malignancy, and the global burden of esophageal cancer, particularly in developing regions. Methods: The study included 103 esophageal biopsy specimens collected at a regional cancer center in Rajasthan. Biopsies were processed via paraffin embedding, microtome sectioning, and staining techniques, including hematoxylin and eosin. Inadequate, improperly fixed, or degenerated specimens were excluded. Data analysis considered patient demographics, lesion classification, and histopathological findings. Chi-square tests were used to assess statistical significance among groups. Results: The mean participant age was 54.41 years, with a near-equal gender distribution (51.5% females, 48.5% males). Malignant lesions dominated the spectrum, accounting for 88.3% of cases, primarily squamous cell carcinoma (97.8% of malignant lesions). Non-neoplastic lesions constituted 8.7%, with conditions like Barrett’s esophagus (22.2%) and reflux esophagitis (44.4%) being the most frequent. Benign lesions were rare, comprising 2.9% of the total cases. Age was significantly associated with lesion type (p = 0.009), with malignant lesions most prevalent in the 41–80 age group. Conclusion: This study highlights the predominance of squamous cell carcinoma among esophageal lesions in Northwest Rajasthan, emphasizing the significance of histopathological analysis in diagnosing and managing esophageal conditions. The findings advocate targeted screening, especially for older adults.

DOI: 10.5281/zenodo.

Introduction: Pharmacovigilance means detecting, assessing, and preventing adverse drug reactions (ADRs). This study examines the knowledge, attitudes, and practices (KAP) of medical undergraduates towards pharmacovigilance and ADR. Methods: A cross-sectional survey evaluated 300 under graduate medical students at Government Medical College, Suryapet, focusing on demographics and KAP. Data interpretation employed descriptive statistics. Demographics: Participants were primarily aged 18-20 (62.3%) and 21-23 (37.7%), with a gender distribution of 48.3% males and 51.7% females. Most were in their 2nd or 3rd year (72.7%). Knowledge: A significant 81.7% correctly identified ADRs. Pharmacovigilance’s role in post marketing surveillance was understood by 76.3%. Awareness of the National Centre for ADR Monitoring in Ghaziabad was at 71.8%. Most (95%) acknowledged the fatality risk in severe ADRs and healthcare professionals’ reporting role (92%). Attitudes: A strong inclination for mandatory ADR reporting (69.7%) and its positive impact on patient safety (86%) was evident. High percentages (95.3% and 91%) viewed ADR reporting as a professional obligation and an area where medical students can contribute. Practices: Difficulties in ADR reporting were encountered by 41.3%, mostly due to the unavailability of forms (35.7%) and time constraints (27%). Awareness of immediate cessation for severe ADRs was high (78.7%), and 66.3% had reported ADRs. Preferred reporting methods were via email or website (44.7%), with 42.3% prioritizing patient management over reporting. Conclusion: The study revealed diverse degrees of knowledge, attitude, and practice in undergraduate medical students concerning pharmacovigilance and ADR reporting. Favourable views towards ADR reporting were noted. Tackling obstacles and improving education are crucial for equipping future healthcare workers to contribute meaningfully to patient safety.

DOI: 10.5281/zenodo.

Background: Laryngoscopy as well as d endotracheal intubation are standard measures during anesthesia but are frequently linked to significant cardiovascular outcomes like as elevated heart rate (HR) and blood pressure (BP). Numerous pharmacological agents have been employed to mitigate these hemodynamic fluctuations. Esmolol, a short-acting β1-selective adrenergic blocker, has shown potential in minimizing the pressor effects associated with these procedures. Objective: The objective of this study was to assess the effectiveness of intravenous esmolol in reducing the pressor response during laryngoscopy and endotracheal intubation in patients scheduled for elective surgeries. Methods: This prospective observational study was conducted at SKMCH, Muzaffarpur, over a one-year period. The study included 100 patients aged 18 to 60 years undergoing elective surgeries. The primary goal was to compare the effectiveness of intravenous esmolol in attenuating the hemodynamic response during laryngoscopy and intubation. Heart rate and blood pressure were continuously monitored before and after intubation. Data analysis was performed using SPSS version 21.0, with statistical significance evaluated through t-tests and chi-square tests. Results: Intravenous esmolol significantly decreased both heart rate and blood pressure in patients during and after laryngoscopy and intubation, as compared to the control group. At 1, 3, and 5 minutes post-intubation, patients in Group A (esmolol) exhibited notably lower heart rates and systolic/diastolic blood pressures (p < 0.05). There were no significant changes in oxygen saturation, and no adverse effects attributed to esmolol were observed. These findings indicate that esmolol effectively blunts the pressor response during intubation. Conclusion: Esmolol administered intravenously is an effective agent for reducing the pressor response during laryngoscopy and endotracheal intubation, enhancing hemodynamic stability in patients under general anesthesia. This may be particularly advantageous for individuals with elevated cardiovascular risk. Recommendations: Routine use of esmolol in elective surgeries involving endotracheal intubation is recommended, especially for patients prone to cardiovascular complications. Further research comparing esmolol with other beta-blockers or exploring its combination with different pharmacological agents is suggested to optimize control of hemodynamic parameters during anesthesia.

DOI: 10.5281/zenodo.

Background: Spinal anaesthesia is commonly used for caesarean deliveries due to its effectiveness and safety profile. However, it frequently causes hypotension, leading to maternal and fetal complications. Various strategies have been proposed to mitigate this, with maternal positioning being a key focus. Delayed supine positioning post-spinal anaesthesia has shown promise in reducing hypotension. This study aims to evaluate the efficacy of delayed supine positioning in preventing post-spinal anaesthesia hypotension in caesarean deliveries. Methods: Sixty pregnant women scheduled for elective caesarean delivery were randomised into two groups: delayed supine positioning (n=30) and immediate supine positioning (n=30). The primary outcome was the incidence of hypotension. Secondary outcomes included vasopressor requirements, incidence of nausea and vomiting, neonatal Apgar scores, and total intravenous fluid administration. Data were analysed using SPSS version 20.0. Results: The incidence of hypotension was significantly lower in the delayed supine group (20%) compared to the immediate supine group (50%, p=0.025). Vasopressor requirements were also reduced in the delayed supine group (p=0.035). The incidence of nausea and vomiting was significantly lower in the delayed supine group (p=0.046). Neonatal outcomes and total intravenous fluid administration were similar between the two groups. Conclusion: Delayed supine positioning significantly reduces the incidence of hypotension and vasopressor requirements in caesarean deliveries under spinal anaesthesia, without compromising neonatal outcomes. This technique enhances maternal safety and comfort during surgery. Recommendations: Based on these findings, delayed supine positioning should be considered as a standard practice to prevent hypotension in caesarean deliveries under spinal anaesthesia. Further studies with larger sample sizes and diverse populations are recommended to validate these results.

DOI: 10.5281/zenodo.

A person’s physiology is mostly influenced by the microbiota present in their gut. Studies revealed myriad patterns of microbiome composition at various stages of life, with major alterations in the dominating phyla and species identified as age progresses. Notably, the quantity of Actinobacteria declines after weaning, whereas Firmicutes and Bacteroidetes increase in prevalence, particularly in older individuals. When the gut microbiota is compromised, the entire body is impacted. Diverse human illnesses are related to the onset and progression of gut microbiota dysbiosis. During the last ten years, research has been aimed at the interactions that occur between the gut microbiota and other body systems, such as the immunological, neurological, and metabolic systems. Neurodegenerative diseases (NDs) are defined as the gradual decline in selectively susceptible neurons. Worldwide, people face significant medical and public health challenges as a result of degenerative illnesses of the neurological system. Among the most common neurological disorders are Parkinson’s disease (PD), Alzheimer’s disease (AD), and amyotrophic lateral sclerosis (ALS). These illnesses have a sharp increase in incidence and frequency as people age. There has been increasing curiosity regarding the connection between brain development and gut bacteria. Germ-free (GF) mice were shown to exhibit higher levels of motor activity and a decrease in anxiety-like responses in comparison to specific-pathogen-free (SPF) mice. The blood–brain barrier (BBB) is crucial in regulating the flow of nutrients, as well as chemicals, between the blood and the brain. The GF mice exhibited higher blood–brain barrier permeability in comparison to SPF mice. The Pavlov pouch, an externalized section of the dog intestine used to research canine digestive processes, was contributed by Ivan Pavlov, who, as well as defining classical conditioning, was also a forerunner in the arena of the gut–brain axis (GBA). He refined the methods by preserving innervation to the intestine section, enabling more precise monitoring of digestive processes in real time over prolonged periods. The GBA, is a two-way interaction that mediates the significant influence of bacteria on physiological processes in the brain. Neurotransmitters and other metabolites are used by the gut–brain axis to engage in bidirectional communication between the brain and the gut. Many clinical and experimental studies have revealed the significance of the microbiota in NDs via different microbial chemicals that travel through the GBA or neurological system from the gut to the brain. The central, autonomous, and enteric neural systems, together with the immunological, endocrine, and metabolic systems, are all involved in the communication process. However, the precise mechanism regulating the signal propagation and stimulating alterations in host diseases is still unknown. Through these pathways, the metabolites of the gut microbiota, which include SCFAs, histamine, gamma-aminobutyric acid (GABA), norepinephrine, serotonin, etc., affect several cerebral physiological functions. An imbalance in the composition of the gut microbiome, causes the brain to receive signals that lead to low-grade inflammation, increased oxidative stress, disturbed energy metabolism, and increased cellular aging. These pathological processes are involved in a variety of neurological diseases.

DOI: 10.5281/zenodo.