Introduction: Chronic renal failure is associated with increased inflammation and oxidative stress which is responsible for the development of cardiovascular disorder and it represent leading cause of death in chronic renal failure patient. The present study was undertaken to know whether there is hemodialysis induced generation of reactive oxygen species with further decrease in total antioxidant status and to compare the biochemical parameters in pre and post hemodialysis with that of healthy controls. Aims and Objectives: (1). To study hsCRP, Malondialdehyde (MDA), lipid profile, urea, creatinine, uric acid levels in pre and post hemodialysis session of chronic kidney disease patients. (2). To find the association of oxidative stress with total antioxidant status in pre and post dialysis among chronic kidney disease patients. Materials and Methods:  In our study blood samples were collected from 30 chronic kidney disease patients in one dialysis session both before and after hemodialysis. This study was conducted at ACSR Government Medical college. Results and Discussion: We could establish highly significant (P value ≤ 0.001) increase in hsCRP, MDA values corrected to serum creatinine in post-dialysis in comparison to pre dialysis in our study. The decrease in mean values of urea, uric acid and creatinine after dialysis was highly significant in comparison to predialysis samples. There was decrease in FRAP in postdialysis when compared with predialysis and this was statistically highly significant. We could not establish any association of oxidative stress with total antioxidant status in our study.

DOI: 10.5281/zenodo.10963469

Introduction: Hookworm, Ancylostoma duodenale infection and iron deficiency anemia (IDA) are prevalent in many developing regions. With this a study was undertaken to find the prevalence of IDA among the hook worm infection (HI) individuals. Methods: It was a prospective research conducted in GSL Medical College, Rajahmundry. Study was conducted for a period of 6 months, protocol was approved by Institutional ethical committee. School going children of both gender those attended on outpatient basis to this institution were included in the research. After recruiting the participant, detailed clinical history was collected. Blood sample was collected by venue puncture by following the universal safety precautions in heparin anticoagulant tube. Simultaneously stool specimen was collected. Blood iron was estimated by automated analyser as per the manufacturer instructions as well as by using standard guidelines. Stool microscopy for the diagnosis of HI was also carried as per the guidelines. Anemia classification adhered to the guidelines. Chisqaure test was used for statistical analysis and P <0.05 were considered to be statistically significant. Results: Total 115 (100%) members were included, in this the prevalence of IDA was 38 (33%) and HI was 28 (24.4%). In HI cases, the prevalence of IDA was 21.8%. Statistically there was significant difference. Gender wise, statistically there was no significant difference respectively between HI and IDA. Conclusion: In this study there is high incidence of IDA among the HI children. Consideration should be given to implementing school health program for HI prevention, incorporating behaviour change communication to promote dietary modification, along with universal iron supplementation. However small sample size, short duration of the research are the limitations.

DOI: 10.5281/zenodo.10955785

Aim & Objective: To study pattern of dermatological ADRs due to anti-retroviral therapy in HIV infected patients in tertiary care teaching hospitals in North India. Material & Methods: A prospective observational study was conducted over a period of 15 months at Anti-retroviral therapy centre under department of internal medicine, G.S.V.M Medical College, Kanpur in association with department of pharmacology of tertiary care teaching hospitals in Uttar Pradesh, India. All HIV positive patients, previously registered and new; attending O.P.D. who encountered ADRs were enrolled in our study irrespective to their age and sex. Data was collected using ADR reporting form issued by Indian Pharmacopoeia Commission. Causality assessment was done by using Naranjo’s Probability Scale. Modified Hartwig severity scale was used to evaluate severity, WHO criteria for seriousness and guidelines of council for international organizations of medical sciences to decide the predictability of ADRs. Results: A total no of 250 patients encountered various types of ADRs during the study period. Total number of ADRs recorded was 452. Out of total ADRs (n=452) recorded, 10.8% (n=49) were dermatological ADRs. Most common dermatological ADR was skin rash. Most of dermatological ADRs were of mild type and probable in nature on causality assessment. Conclusion: Female gender, baseline CD4 absolute count above 250 cells/mm3, were predictors for nevirapine-associated rash in HIV patients. We suggest that more stringent evaluation and monitoring should be carefully done in all HIV/AIDS patients who will receive and on NVP therapy, especially if they have the above predictors.

DOI: 10.5281/zenodo.10965968

Background: Hemi arthroplasty is a useful procedure to recommend for intra capsular femur neck fractures. There is controversy regarding the role of bone cement for fixation of the femoral prosthetic stem. Advantages of cementing are stable, secured fixation that allows early mobilization with fewer incidences of implant loosening and post-operative thigh pain. It comes with the burden of longer duration of surgery and relatively increased blood loss. Uncemented prosthesis is associated with less operative time and blood loss. It is associated with implant loosening and peri prosthetic fracture. This study aims to identify the better option between cemented and uncemented prosthesis in management of intra capsular femur neck fractures. Patients and Method: A prospective comparative study on thirty patients with intra capsular femur neck fracture, randomized into two equal groups and treated with either cemented or uncemented bipolar prosthesis. Patients were followed up for at least one year and the functional outcome was analysed using modified Harris hip score. Results: Mean modified Harris hip score in the cemented and uncemented groups observed at the end of one year follow up was 56.06 and 61.86 respectively. Conclusion: The functional outcome, complication and mortality rates observed between the groups were not statistically significant to recommend one procedure over the other.

DOI: 10.5281/zenodo.10966217

Objective: To study Correlation of Blomia Tropicalis sensitization with Asthma severity in children. Methods: In this observational study, Children with Pediatric Asthma were enrolled to undergo skin-prick testing. Sensitivity was checked for Blomia Tropicalis. Then, Correlation of Blomia Tropicalis sensitization with Asthma severity in children was analyzed. Results: Total 100 Asthmatic Children between the age of 5-15 years underwent skin-prick test; 20 (20%) showed significant positivity to Blomia Tropicalis. Out of 20 children sensitized to B. Tropicalis 50% (10) were having uncontrolled asthma symptoms. All the patients (2 children) who were having SPT reaction size of > 8mm were having uncontrolled asthma symptoms. Conclusion:  Sensitization of B. Tropicalis in asthmatic children between 5-15 years of age was a significant number. Those who were sensitized to B. Tropicalis were having more chances of uncontrolled asthma in comparison to non-sensitized children.

DOI: 10.5281/zenodo.10966256

Background: Labor induction involves initiating uterine contractions before the onset of spontaneous labor. It is recommended in situations where the advantages to both the mother and fetus outweigh those of continuing the pregnancy. The present study aimed to compare the efficacy and safety of 50 µg of misoprostol vaginal with oral for labor induction. Methods: Term pregnant women admitted to the labor room and antenatal wards of the Obstetrics and Gynecology department were included in the study. The oral drug consisted of 50 µg of misoprostol in the first dose and 100 µg in subsequent doses, while the vaginal drug contained 25 µg in all doses. Eligible participants were pregnant women between 37 and 42 weeks of gestation, carrying a single, live fetus in cephalic presentation, with reassuring fetal heart rates and intact membranes. Results: The Bishop Score at the time of induction in both arms ranged between 0 and 6 with a mean of 3.30 in the vaginal group and 3.25 in the oral group. All patients were induced with misoprostol either the vaginal route or the oral route along with placebo. The median number of doses of misoprostol used in the vaginal and oral groups was 2 in each group. In the vaginal misoprostol group, 30 cases (60%) resulted in vaginal delivery, while in the oral misoprostol group, 28 cases (56%) ended in vaginal delivery, totaling 58 cases. Instrumental: In the vaginal misoprostol group, 10 cases (20%) required instrumental delivery, and in the oral misoprostol group, 9 cases (18%) underwent instrumental delivery, totaling 19 cases. Both the vaginal and oral misoprostol groups had 10 cases (20%) and 13 cases (26%), respectively, that ended in cesarean section, totaling 23 cases. Conclusion: Our study within its limitations determined that oral misoprostol exhibits comparable effectiveness to vaginal misoprostol in cervical ripening and achieving vaginal delivery within 24 hours. Rates of hyperstimulation and cesarean section were similar between both groups. Additionally, the oral misoprostol group demonstrated a reduced need for oxytocin augmentation.

DOI: 10.5281/zenodo.10966301

Background: Ovarian cancer is a leading cause of cancer-related mortality among women, with outcomes significantly impacted by genetic variability. This study aimed to investigate the correlation between molecular profiling of ovarian cancer and clinical outcomes to guide personalized treatment strategies. Methods: In this prospective observational study, we enrolled 128 ovarian cancer patients over a two-year period, performing comprehensive molecular profiling, including the analysis of BRCA1, BRCA2, and TP53 mutations. Clinical outcomes assessed included overall survival (OS), progression-free survival (PFS), and treatment response. Statistical analysis involved multivariable Cox proportional hazards models and Kaplan-Meier survival curves. Results: Molecular profiling identified significant correlations between genetic alterations and clinical outcomes. BRCA mutations were associated with improved OS (HR: 0.45, p=0.008) and PFS, and a higher response rate to PARP inhibitors (75% vs. 45%, p=0.01). Conversely, TP53 mutations were linked to reduced OS (HR: 1.67, p=0.018). No significant association was found between TP53 mutation status and response to platinum-based chemotherapy. Conclusion: Our findings underscore the importance of molecular profiling in the management of ovarian cancer, highlighting the potential for personalized treatment approaches. BRCA mutations emerged as a positive prognostic factor for survival and treatment response, while TP53 mutations indicated a poorer prognosis. These results advocate for the integration of genetic testing into standard clinical practice, paving the way for tailored therapies that can improve patient outcomes.

DOI: 10.5281/zenodo.10966354

Introduction: The choice of teaching technique is one of the most important factors in the successful implementation of medical education. There is a need to try out novel teaching techniques that can involve the active participation of students to overcome the challenges of passive techniques like didactic lectures. Methods: The study involved a total of 180 second MBBS students who were divided into two groups of 90 students each to carry out one of the two activities, i.e. Students’ Corner or Symposium. The first group of students was told to submit one article each on the pharmacology topics in the form of short essays, crosswords, mnemonics, case studies, diagrams, flow charts, MCQs, etc. The second group was told to prepare and present a symposium in front of their peers. The pharmacology topics were allotted by the faculty. At the end of the academic year, feedback from all the participants was taken using a pre-validated questionnaire. Results: The perception of students was extremely positive for these new teaching techniques. Majority of them agreed that both activities helped them in a better understanding of the topic. Students’ Corner encouraged interest & creativity and helped in revising topics while the symposium helped in learning teamwork and public speaking. However, more than half of the students who contributed to the students’ corner thought that the activity was monotonous and about 2/5th of students thought that these activities were unnecessary. Conclusion: Novel teaching activities involving the active participation of students are effective and helpful in learning, they can be used as a supplement to the traditional methods.

DOI: 10.5281/zenodo.10966560

Introduction: Polycystic Ovarian Syndrome (PCOS) is a heterogeneous, multifactorial and polygenic condition affecting adult females characterised by increased androgen production in the ovaries. The criteria require presence of any two conditions out of the given following three: (a) Oligomenorrhea/ anovulation, (b) Clinical/ biochemical hyperandrogenism and (c) Polycystic ovaries (≥12 follicles in each ovary measuring 2–9 mm). Symptoms like hirsutism and irregular menstrual bleeding, anovulation frequently occurs during puberty time. D-dimer reflects human fibrinolytic activity and is considered to be an important biomarker of hyper-coagulability. C-Reactive Protein (CRP) is a type of protein produced by the liver that serves as an early marker of infection or inflammation. Aim: To study D Dimer, Lipid profile, High Sensitivity C-Reactive Protein (hs-CRP) in relation to anthropometric measurements in PCOS patients of Government General Hospital, Ananthapuramu, and to compare with controls. To determine the correlation between Triglycerides, hs-CRP and D-dimer with respect to BMI. Materials & Methods: 105 female patients attending the outpatient department of Obstetrics and Gynaecology at Government General Hospital, Ananthapuramu, Andhra Pradesh, during the study period from March 2023 to September 2023 diagnosed with PCOS were studied. Results: Cases having BMI ≥ 25, have increased levels of hsCRP, D dimer, triglycerides when compared with cases having BMI < 25 and healthy controls. Triglycerides, hs-CRP and D-dimer levels were also positively correlated to each other. Conclusion: Triglycerides, hs-CRP and D-dimer levels were positively correlated to each other, indicating that there is an interrelationship between hypertriglyceridemia, chronic subclinical inflammation and hypercoagulability in PCOS, which may contribute to intensify the atherogenic and thrombogenic profile. If not addressed or targeted for treatment in early stages it might lead to complications related to pregnancy and its outcome, as well as cardiovascular diseases and type 2 Diabetes mellitus.

DOI: 10.5281/zenodo.10966594

Background and Aim: Tranexamic acid is a fibrinolysis suppressor that is used for a variety of bleeding control procedures such as hematuria, surgery bleeding, and trauma caused bleeding. The advantages of using tranexamic acid are bleeding control and less need for blood transfusion. Current study’s objective was to assess how well tranexamic acid functions in minimising overall blood loss after percutaneous nephrolithotomy. Material and Methods: The present analysis is the double blind clinical study done for the period of one year. The inclusion and exclusion criteria followed in the study were as follows: A total of 150 patients having kidney or upper ureteral stones and the candidate of PCNL were included in the study. According to Goodman & Gilman’s The Pharmacological Basis of Therapeutics Dosing Protocol, 2.5 mg/kg – 100 mg/kg, patients in group (A) got 1 gm (10 cc) of tranexamic acid on call to surgery 20 minutes before to the operation, whereas patients in group (B) received 10 cc of normal saline injection. Results: Nine patients in group B had prior ipsilateral open renal surgery, while 15 patients in group A had a history of ipsilateral open renal surgery, 6 patients had a history of PCNL, and 6 patients had a history of ESWL. Three patients had a history of ESWL, and six patients had a history of PCNL. The total blood loss in millilitres for group A was 73.80 ± 60.1, while for group B it was 117.24 ± 87.9. Both groups had statistically and clinically significant blood loss.  Additionally, the haemoglobin decrease mean with standard deviation for group A was 0.45 ± 0.35 g/dl and group B was 1.00 ± 0.46 g/dl, both of which had a statistically and clinically significant. Conclusion: In percutaneous nephrolithotomy, tranexamic acid is a safe and efficient medication for lowering total blood loss and blood transfusion rates. It is linked to a quicker surgical time and fewer intraoperative and postoperative problems.

DOI: 10.5281/zenodo.10966633

Introduction: India has one of the highest road accident rates in the world. There has been a steady rise in the casualties in road accidents in the country and their proportions in total deaths. Many works of literature were available about the pattern of injury in road traffic accidents. Some reported that the motorized two-wheeler victims are the commonest in RTA. Therefore, this study aimed to assess the factors and patterns of injuries related to RTAs due to two wheelers. Materials and Methods: It is a retrospective study involving 200 two wheeler road traffic accidents victims brought to the mortuary for post-mortem examination. Preliminary data’s collected from the investigating Officer and the injuries measured during autopsy and analysed. Statistical Analysis did using IBM SSPS Version 24. Results: Majority of the Victims were males belonging to the age group of 20- 40 years. Riders were most commonly involved than Pillion riders. Significant proportion of the riders was males. Abrasions were higher in frequency among the external injuries, seen more in the extremities. Among the head injuries contusions are commonly seen followed by fractures. Most commonly involved skull bone is temporal bone, linear fissure fracture type more in frequency than communized fracture. Subdural haemorrhage seen in higher frequency. In riders, Fracture of Forearm bones, Femur commonly involved. Head injury is commonest cause of death. Conclusion: The Present study shows that the mostly commonly involved victims are males, in young age less than 40 years. Cranio Cerebral injuries are the commonest cause of death. Death was more among riders not using helmet. Helmet wearing plays one of the most important factors preventing the fatality.

DOI: 10.5281/zenodo.10966649

Background: Traditional surgical treatment of superficial venous reflux involves high ligation at saphenofemoral junction as well as stripping of GSV from below knee to groin which is a commonly done procedure in general surgical department as it was considered the gold standard of therapy for several decades. The complications in the post-operative period like bruising, hematoma formation is mainly due to stripping and numbness is due to damage to the Saphenous nerve during stripping. In the present study we are comparing the surgical cases with stripping and without stripping of veins in terms of hospital stay and complications. Aim of The Study: is to compare and analyze the outcome of both the modalities of treatment for varicose veins i.e., Trenderlenberg procedure with stripping and without stripping in terms of the objectives mentioned below. Patients And Methods: A Prospective Case Control study done in 50 cases undergoing Trenderlenberg procedure admitted in the general hospital over a period of 2 years. Results: Males contribute the maximum of about 74%. As far as the age is considered, patients aged between 31–60 years were more, which was about 84%. Left lower limb is involved in 72% and right lower limb in 28%. The hematoma formation after venous stripping was 24% whereas it was only 4% in the other group. Comfortable ambulation on first postoperative day is 96% in without stripping group compared to 84% in with stripping group. There is no significant difference in the duration of postoperative hospital stay. Patients were followed up for a period of 2 months and Pain relief was 100% in those who underwent ligation with stripping and 88% in those who underwent ligation alone. Conclusion: Trenderlenberg procedure with ligation of incompetent perforators without venous stripping appears to be better than Trenderlenberg procedure with ligation of incompetent perforators with venous stripping.

DOI: 10.5281/zenodo.10967411

Introduction: Disorders of thyroid hormones are one of the most common endocrine diseases in India, diagnostic and management strategies rely on laboratory tests. With this a study was conducted to evaluate thyroid gland function in adults using biochemical parameters. Methods: It was a prospective research conducted in department Biochemistry, government Medical College, Rajamahendravaram. Study was conducted for a period of 6 months, from May to December 2023. Study protocol was approved by Institutional ethical committee. An informed written consent was taken from the parents of the study participant’s. Individuals of > 18 years, both gender those attended on outpatient basis to this institution were included in the research. Individuals with known thyroid defect (TD) were not considered. After recruiting the participant, detailed clinical history was collected, findings were recorded. Blood sample was collected by venue puncture, parameters were estimated by automated analyser as per the manufacturer instructions as per guidelines. thyroid stimulation hormone (TSH) > 5.4µIU/ml was considered as hypothyroid and <0.5µIU/ml as hyperthyroidism. Those with normal TSH were euthyroid and deviation of this were TD. Chisqaure test was used for statistical analysis and P <0.05 were considered to be statistically significant. Results: Total 106 members were included, gender wise, male female ratio was 0.63. The prevalence of TD was 7.6% (8) and 23.6% (25), respectively among the gender; statistically there was significant difference. Statistically there was no significant difference between the age and TD. Conclusion: There is high incidence of TD among the women and middle age is commonly effected. However small sample size, short duration of research and not considering iodine estimation are the limitations.

DOI: 10.5281/zenodo.10967424

Introduction: The interscalene brachial plexus block (ISB) stands out as a reliable and widely practiced method for providing regional anesthesia during upper limb surgeries. Previous studies have independently compared ultrasound-guided interscalene brachial plexus block (US-ISB) and nerve stimulator-guided interscalene brachial plexus block (NS-ISB). In light of this, we aim to assess the effectiveness and safety of US-ISB alone versus a combination of PNS and US-ISB for achieving ISB block in the shoulder and upper arm surgeries. Methods: It was a prospective research conducted in Rangaraya Medical College, Kakinada. The study was conducted over a period of 6 months from 1^st February 2023 to 1^st August 2023. Individuals of both gender, aged 18 – 60 years with ASA grades I and II scheduled for proximal humerus, shoulder or clavicle surgery under ISB were included. The participants were randomly divided into US-ISB and NS-ISB groups. Study procedures were carried as per the standard guidelines. The ISB procedure was carried by an experienced anesthetist in both research groups. Total duration of anaesthesia was recorded from the onset of blockade to the administration of rescue analgesic. Care was taken to note block complications. Levene’s test, Welch’s unpaired T-test were used; P<0.05 was considered to be statistically significant. Results:  Total 70 members were included, 35 in each group. Male female ratio was 3.37 and 1.92, respectively. Statistically there was no significant difference in block procedure time whereas there was significant difference in total anaesthetic time, respectively in the groups. Block failure was detected in USG but statistically there was no significant difference respectively in the groups. Conclusion: The combined technique ensures an extended duration of ISB, demonstrating enhanced efficacy and heightened safety in nerve block administration. This has resulted in a notable decrease in complications and nerve block failures, consequently reducing the necessity for general anesthesia.

DOI: 10.5281/zenodo.10967496

Introduction: Globally, anemia stands as a significant public health challenge, with substantial implications for health, economics, and society at large. With this back ground, a study was taken to find the prevalence of iron deficiency anemia (IDA) in adults with stomach pain, intestinal obstruction (IO). Methods: It was a prospective research conducted in government Medical College, Srikakulam.  from January to June 2021. Adults both gender those attended with stomach pain and IO on outpatient basis to general medicine and general surgery departments were included in the research. After recruiting the participant in the study, detailed clinical history was collected. All the findings were recorded in the study proforma. Blood sample was collected by venue puncture, serum was used for iron estimation as per the standard guidelines. Age wise, 18 – 30 were considered as group 1 and 31 – 60, group 2. Chi-square test was used for statistical analysis and P <0.05 were considered to be statistically significant. Results: Total 103 members were included, age wise, the incidence of IDA was 12.6% (13) and 26.2% (27) respectively in group 1 and group 2, statistically there was no significant difference. In gender category, there were 9 (8.8%) and 31(31%) IDA respectively in male and female; statistically there was significant difference. Conclusion: In this study there is high incidence of IDA among the women. Not screening parasitic infections and cause for the symptoms are the limitations.

DOI: 10.5281/zenodo.10967500

Background and Objectives: Retinal venous occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and is a major cause of visual loss worldwide. Age is the most important risk factor. Major local risk factor is glaucoma. Though glaucoma has been described as a risk factor for RVO, not many studies describe the occurrence of drop in intraocular pressure (IOP) following venous occlusive event and its mechanism. This study was an attempt to assess the risk factors associated with RVO and the diurnal pattern of IOP in the affected eye and compare it with the normal eye. Material and Methods: The study had a comparative design and was done inside the setting of a hospital. Patients with unilateral retinal vein occlusion (RVO) were chosen from the Ophthalmology Outpatient Department (OPD) at the Ophthalmology department of the Government Medical College and Hospital in Kozhikode, Kerala, India using a convenient sampling method. This was accomplished subsequent to receiving authorization from the Scientific Review Committee and Institutional Ethics Committee, as well as obtaining written agreement from the patients. The ocular examination encompassed a thorough assessment of the anterior segment using a slit lamp, evaluation of visual function, measurement of intraocular pressure (IOP), and inspection of the fundus. SPSS was utilized for statistical analysis. Results: Mean age of retinal vein occlusion is 57.3 years. RVO is seen more commonly in males (60%).Slight preponderance of left eye affection (56.67%) is seen. Hypertension is the most common risk factor (50%). Diurnal variation of intraocular pressure showed no significant difference between affected and unaffected eyes in each visit. Conclusion: RVO is a common vascular disease of retina, of which, Superotemporal branch retinal vein occlusion is the most common type. The most common risk factor was found to be hypertension. Present study did not find any statistical significant difference in diurnal variation of intraocular pressures between affected and unaffected eyes.

DOI: 10.5281/zenodo.10967510

Background and Objectives: Surgical site infections (SSI) still remains a significant problem following an operation and the third most frequently reported nosocomial infections accounting for 14 to 16% of all nosocomial infections. This study aims at determining the risk factors and incidence of surgical site infections. Methods: The material for the present study was obtained from patient’s undergone surgery in Department of General Surgery, JNKTMCH Madhepura, Study duration of two Years. Surgical site were considered to be infected according to the definition by NNIS. The wounds were classified according to the wound contamination class system proposed. Results: A study of 400 operated cases was carried out of which 39 were diagnosed to be having surgical site infection as per the CDC criteria. Thus the incidence of SSI in this study is 9.75%. Conclusion: Incidence of surgical site infection was more in emergency surgery case as compare to elective.

DOI: 10.5281/zenodo.10967515

Background and Objectives:  Empyema thoracis is a condition in which pus and fluid from infected tissue collects in the pleural cavity. Childhood empyema is an important complication of bacterial pneumonia. The incidence of empyema is increasing worldwide. Despite being recognized since the ancient times, the appropriate management of paediatric empyema thoracis remains controversial. To study the clinical and bacteriological profile, various therapeutic options in childhood empyema thoracis in a tertiary care hospital. Methods: The present descriptive study was done at Darbhanga medical college and Hospital darbhanga. 50 patients were included in the age group of less than 12 years with the diagnosis of empyema. All the patients were analyzed for the clinical course of the disease, radiological investigations, pleural fluid biochemical and microbiological parameters, and various treatment options. Short term follow up was done for complications and sequelae. Conclusion: Management of primary empyema continues to be controversial in terms of duration of antibiotic therapy and the indications for and timing of surgery. There should be a changing trend towards Intrapleural instillation of streptokinase with the emphasis laid on minimizing the duration of hospital stay & duration of ICD tube insitu to bring down expenditure, psychological stress and more importantly nosocomial infections due to multidrug resistant organism in fibrinopurulent stage of empyema thoracis.

DOI: 10.5281/zenodo.10967521

Introduction: Despite being a prevalent surgical emergency, the management of acute intestinal obstruction (AIO) remains challenging. This study aimed to investigate outcome in the management of AIO. Methods: It was a prospective study conducted in the government Medical College, Rajamahendrawaram. Study was conducted between January to April 2023. Study protocol was approved by the institutional ethics committee. Informed written consent was taken from all the participants. Individuals > 18 years, both gender with signs and symptoms of AIO those were admitted in the general surgery department were included in the study. Paediatric age group, non-cooperative individuals were not considered in this research; those with acute abdomen having perforation peritonitis, pancreatitis, adynamic ileus, enterocolitis and ascites were also not considered. After admission, all the study members with provisional diagnosis of AIO were evaluated clinically and findings were recorded. The treatment strategy followed as per the guidelines. Patients presenting with clear signs of acute intestinal obstruction underwent optimization and immediate Emergency Exploratory Laparotomy. The choice of the operative procedure was determined by adhering to surgical principles that aligned with the specific findings observed during the surgery.  Simple descriptive statistics like mean and percentage were used for analysis. Results: Total 50 members were included, abdominal pain was complained by all. Age wise majority (34%; 17) were in 38 – 47 years, mean age was 42.21+9.01. Male female ratio was 4.  Small bowel obstruction was the leading (62%) followed by large bowel obstruction (24%) and both (14%). Majority (68%; 34) were treated surgically and the rest by conservatively. Conclusion: For individuals with AIO, timely diagnosis, effective preoperative hydration, swift diagnostic tests, and early surgical intervention have been demonstrated to enhance survival rates.

DOI: 10.5281/zenodo.10967537

Background: Postoperative complications are a significant concern in surgical practice, impacting patient outcomes and healthcare resource utilization. Comprehensive evaluations of complication rates and associated factors are essential for improving surgical care. Methods: This cross-sectional study conducted at a tertiary care center aimed to assess postoperative complication rates and associated factors among surgical patients. Data were extracted from electronic medical records, including demographics, preoperative comorbidities, surgical characteristics, and postoperative outcomes. Descriptive statistics and multivariable regression analysis were used to analyze the data. Results: A total of 1,200 surgical patients were included in the analysis. The mean age was 56 years, with 55% being male. Surgical site infections (10%) were the most common complication, followed by pulmonary complications (6.7%) and wound dehiscence (5%). Multivariable regression analysis identified age, presence of comorbidities, and intraoperative complications as independent predictors of postoperative complications. Conclusion: This study highlights the significant burden of postoperative complications among surgical patients at a tertiary care center. Identification of specific risk factors provides insights for targeted interventions to improve patient outcomes.

DOI: 10.5281/zenodo.10967549

Background: Surgical site infections (SSIs) pose a significant challenge in orthopedic trauma surgery, particularly in patients undergoing internal fixation procedures. Despite advancements in surgical techniques and perioperative management, SSIs remain a common complication, impacting patient outcomes and healthcare resources. Objective: This study aimed to comprehensively assess SSIs in orthopedic trauma patients treated with internal fixation, focusing on prevalence, associated risk factors, microbial pathogens, and outcomes. Methods: A retrospective analysis of medical records was conducted for orthopedic trauma patients who underwent internal fixation between January 2018 and December 2020. Data collected included patient demographics, comorbidities, type of trauma, surgical details, use of prophylactic antibiotics, duration of surgery, length of hospital stay, and occurrence of SSIs. Statistical analysis was performed to assess associations between variables and outcomes. Results: Among 250 included patients, 35 (14%) developed SSIs following internal fixation procedures. Staphylococcus aureus was the most common pathogen isolated from wound cultures. Significant risk factors for SSIs included obesity, diabetes mellitus, and prolonged duration of surgery. Patients who received prophylactic antibiotics had a lower incidence of SSIs. The mean duration of surgery was 2.5 hours, and the mean length of hospital stay was 7 days. Conclusion: SSIs remain a significant concern in orthopedic trauma patients treated with internal fixation. Understanding the epidemiology and risk factors of SSIs is crucial for implementing effective preventive strategies and optimizing treatment outcomes in this population.

DOI: 10.5281/zenodo.10967626

Background: The utilization of subarachnoid blockade applies to all surgical procedures conducted in the infraumbilical region. This research aimed to assess the clinical effectiveness and safety of adding intrathecal fentanyl to 0.75% isobaric ropivacaine concerning the onset, duration, intensity, and recovery time of sensory and motor blockade in the subarachnoid block for infraumbilical surgery. Methods: N=80 consenting adult patients of both genders, categorized as American Society of Anesthesiologists (ASA) I and II and scheduled for infraumbilical surgery, were randomly assigned into two groups of 40 patients each. They received either intrathecal administration of 4 mL of 0.75% ropivacaine with 0.4 mL of 0.9% sodium chloride (Group I: Ropivacaine Control Group – RC) or 20 μg of fentanyl (Group II: Ropivacaine with Fentanyl – RF). The study endpoints included variations in hemodynamics, onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, duration of sensory and motor blockade, and adequacy of surgical anesthesia. Results: Intrathecal fentanyl expedited the onset of sensory blockade to the T10 dermatome and motor blockade. The addition of a small dose of intrathecal fentanyl to ropivacaine prolonged the duration of analgesia during the early postoperative period compared to intrathecal ropivacaine alone. Intraoperative hemodynamic variability did not show statistically significant differences between the groups. Conclusion: Adding intrathecal fentanyl to 0.75% isobaric ropivacaine demonstrated a superior clinical profile compared to ropivacaine alone.

DOI: 10.5281/zenodo.10967701

Introduction: Fiberoptic bronchoscopy (FOB) stands as the primary approach for diagnosing and staging central lung cancer (LC), one of the leading causes of cancer deaths. A study was taken to find out the diagnostic accuracy of bronchial wash (BW), bronchial brush (BB) and endobronchial biopsy (EBB) in the suspected LC individuals. Methods: It was a cross-sectional study conducted in the department of Respiratory Medicine, ASRAM Medical College, Eluru. Study was conducted from January 2017 to August 2018, approved by Institutional ethical committee. An informed written consent was taken from the participants. Individuals of both gender aged > 18 years with abnormal bronchoscopic and radiological evidence of lung were included. The blood parameters were analysed and processed for FOB if they are acceptable limits. BW, EBB and BB were collected and processed for the diagnosis of LC. Date was presented in mean and percentage. Results: Total 44 (100%) members were included, male female ratio was 2.14. Cough (79%) was the leading symptom. FOB findings showed that majority (17; 38.66%) had endobronchial mass. The incidence of LC was 72.8% (32); in this adenocarcinoma was the leading (45.5%) followed by SCC, SCLC, 11.36% each, respectively. LC positivity was 100% with EBB, it was 21 (62.7%) with BB and 14 (44%) with BW. Conclusion: FOB is an important modality to diagnose the etiological cause in patients with clinical suspicion of LC. This study confirms that the EBB gives better yield than BB and BW in visible endobronchial lesions in suspected cases of lung malignancy.

DOI: 10.5281/zenodo.10967717

Background: Calcaneal fractures, comprising 1-2% of all fractures, pose a challenge in management, especially when involving the intra-articular extension of the posterior facet. The lack of consensus on the optimal approach complicates decision-making. Surgical intervention is often necessary for displaced fractures, but the choice between open reduction and internal fixation (ORIF) with a plate and conservative management remains contentious. This study aims to scrutinize the functional outcomes and complication rates associated with the surgical management of displaced intra-articular calcaneal fractures. A case series of 25 patients undergoing various surgical interventions was analysed to provide insights into the efficacy of different surgical approaches. Patients and Method: A prospective study (April 2019 to December 2022) included 25 patients aged 18-60 years with closed or open displaced intra-articular calcaneal fractures. Various surgical interventions were performed, and outcomes were assessed at a one-year follow-up. Statistical analysis utilized SPSS software for descriptive and inferential statistics. Results: Closed reduction succeeded in 64%, while 36% required open reduction. The mean AOFAS score was 74.72 ± 13.84, with good, fair, and poor functional outcomes observed in 64%, 32%, and 4%, respectively. Complications included deep wound infection (12%) and implant-related issues. Conclusion: Managing displaced intra-articular calcaneal fractures require a tailored approach. While surgical interventions may yield better functional outcomes, they come with higher complication rates.

DOI: 10.5281/zenodo.10967830

Background: Glaucoma, one of the leading causes of blindness worldwide, is a progressive optic neuropathy with characteristic optic disc damage and visual field defects for which Intraocular pressure  is considered to be the only modifiable risk factor. Metabolic syndrome  consisting of abdominal obesity, glucose intolerance, dyslipidemia and high blood pressure, has been proved to be associated with cardiovascular morbidity and mortality. Though several studies have revealed possible association of hypertension with primary open angle glaucoma, there is a gap in knowledge regarding association of IOP and metabolic syndrome  in this part of India. Methods: This cross-sectional study was conducted on 50 subjects with metabolic syndrome and 50 subjects without  between 18 – 44 yrs. of age in a tertiary care institute. Detailed ocular examination, systemic examination & relevant laboratory investigations were done in the institution. Statistical analysis was done by SPSS (version 27.0; SPSS Inc). Results: Mean intraocular pressure in cases was 17.7400± 1.2586 mmHg and in control13.8400± 1.3303 mmHg. This difference was statistically significant (p<0.0001). Several metabolic syndrome components (Waist circumference, systolic BP, Serum TG) were related to higher IOP compared to age matched control. Negative correlation was found between IOP and serum HDL. Conclusion: Several components of metabolic syndrome were associated with higher IOP compared to the controls.

DOI: 10.5281/zenodo.10968000

Background: Mass drug administration (MDA) means once-in-a-year administration of diethyl carbamazine (DEC) tablet along with single tablet of albendazole to all people (excluding children under 2 years, pregnant women and severely ill persons) in identified endemic areas. It aims at cessation of transmission of lymphatic filariasis. Objective: What has been the coverage and compliance of MDA in Datia districts of Gwalior division during the campaign in Feb-March 2023. Study Design: Cross-sectional population/Community based house-to-house survey visit. Setting: 04 implementation Unit (IU) were considered from Datia District & 01 ward was selected from each Urban area and 03 villages were selected from each sub centre of rural area from each IU as per guideline. Study Outcome: Coverage, compliance, effective coverage, coverage- compliance gap. Analysis: Percentage and proportions. Results:  In MDA CES Datia- Out of 2509 eligible only 1553 ingested DEC plus albendazol, sufficiently. Hence effective coverage found only 61.9 % which is below than national target. Overall Compliance rate (ingestion of drug by those who received it) was 85% with lowest in Ward no.08 Mahaveer colony, Indergarh (48.2 %) and highest in IUs Datia city (100 %). A total of 260 persons accounted for this gap. The main reason for this was not given importance to medicine i.e. ignorant (n=80), fear of side effects (n= 67), forgot to take or misplaced the drug (n=60), and remaining (n=53) unaware of elephantiasis, so all these people did not taken medicine. Overall coverage was    marginally better in rural areas than in urban areas. The compliance was found marginally larger in urban areas. The causes of poor coverage and compliance have been discussed and relevant suggestions have been made.

DOI: 10.5281/zenodo.10968015

Background: The Scientific study of naturally occurring epidermal ridges and their arrangement on the fingers, palms, and soles—aside from the flexion crease and secondary folds—is known as dermatoglyphics. A fingerprint can be used to identify a person since it has a distinctive pattern. A fingerprint is a slimy, oily imprint of the finger’s friction ridges. Objective: To determine the correlation if any exists between the fingerprint pattern and blood group and gender. Methods: It was a cross-sectional study conducted on volunteered subjects who consented to participate in the study. A total of 250 individuals were enrolled in the study. The pupils were instructed to press each finger on the stamp pad, and their ten fingers’ fingerprints were captured on white paper, which was handed over to the participants immediately after the on-the-spot analysis of the fingerprint pattern using a hand-held magnifying lens, there were four categories for the patterns notably loops, whorls, arches, and composite. Blood type and Rh status were also recorded, and the outcome was compiled and analyzed. Results: The present study indicates that the incidence of blood group B was highest (44.8%) followed by A (27.2%), O (18.4%), and AB (9.6%) blood groups respectively. The incidence of loops was highest in males as compared to females. Similarly, the whorls pattern was found to be higher in males. Arches were higher in females. Whorls are also more common in the B blood group and this was found to be statistically significant (p<0.05). Conclusion: Fingerprint patterns serve as distinctive features for individual identification. Their association with gender and blood group, as well as the awareness of the prevalence of different fingerprint patterns, can aid in identity prediction and authentication.

DOI: 10.5281/zenodo.10968273

Background: Pre-emptive analgesia entails administering an analgesic regimen before the onset of noxious stimuli, aiming to prevent sensitization of the nervous system to subsequent stimuli that may exacerbate pain. This study aimed to compare the efficacy of pregabalin and gabapentin as pre-emptive analgesics in surgeries below the umbilicus under spinal anesthesia. Methods: Fifty patients undergoing elective infraumbilical surgeries were randomly assigned to two groups using an online randomizer. Group I (n =25) received a single dose of gabapentin 1,200 mg, while Group II (n = 25) received a single dose of pregabalin 300 mg. Various parameters were assessed to compare the quality of intraoperative and postoperative analgesia, sedation, and complications. Results: Throughout the 24-hour postoperative period, the mean visual analog scale (VAS) scores at rest were consistently lower in Group I compared to Group II. Rescue analgesia was required after a significantly longer duration in Group P (14.37 ± 1.92 h) compared to Group G (8.54 ± 3.25 h). The incidence of subsequent rescue analgesic requirement was lower in both groups, with fewer cases in the pregabalin group. Additionally, the pregabalin group exhibited a significantly lower incidence of somnolence and dizziness compared to the gabapentin group. Conclusion: Administration of a single preoperative oral dose of pregabalin (300 mg) offers superior postoperative pain management and reduces postoperative rescue analgesic consumption compared to a single dose of gabapentin (1,200 mg) in infraumbilical surgeries under spinal anesthesia.

DOI: 10.5281/zenodo.10968285

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition among those suffering from type 2 diabetes.  It has been shown that up to 75% of these patients exhibit signs of liver fat when assessed through ultrasound imaging. This correlation underscores the intricate relationship between type 2 diabetes and liver health. The present study was conducted to determine the prevalence of NAFLD in cases of chronic diabetes mellitus. Methods: We analyzed 80 patients with type 2 diabetes at Govt Medical College and Hospital, Jagtial, Telangana excluding those with pre-existing liver disease or alcohol intake. Using ultrasound, we identified those with NAFLD and categorized them into “fatty liver” and “non-fatty liver” groups. Further evaluation included body mass index, central obesity, HbA1c, and lipid profile and the correlation between NAFLD existence and duration of diabetes mellitus was analyzed.  Data analysis was performed using SPSS version 20.0. Results: The present study shows 63.75% of T2DM patients in the study had NAFLD, highlighting its significant presence in this population. While younger age groups (30-39 and ≥70) showed lower prevalence, the highest was observed in the 50-59 age group. BMI and waist circumference: Both were significantly higher in patients with NAFLD, suggesting a strong association with obesity and central adiposity. Glycemic control: Patients with NAFLD had significantly higher fasting and post-prandial blood sugar levels, as well as HbA1c, indicating poorer glycemic control. Liver enzymes: Elevated AST, ALT, and GGT levels in NAFLD patients suggested liver injury, while the AST/ALT ratio pointed towards predominant fatty liver disease. Conclusions: This study found Poorer glycemic control, as indicated by higher blood sugar and HbA1c, was associated with NAFLD presence. Elevated liver enzymes (AST, ALT, GGT) suggested liver injury in NAFLD patients, with the pattern pointing towards predominant fatty liver disease. NAFLD patients exhibited an unfavorable lipid profile characterized by high triglycerides, low HDL-C, and slightly elevated total and LDL cholesterol, increasing their cardiovascular risk.  A positive correlation was observed between the duration of T2DM and NAFLD prevalence, suggesting longer diabetes duration increases NAFLD risk.

DOI: 10.5281/zenodo.10968295

Aim of the Study: To find out the occurrence of sick euthyroid syndrome in acute myocardial infarction and prognostic significance of its positive results in myocardial infarction. Material & Methods: A total of 65 patients were enrolled for the study from the patients admitted to coronary care unit Tertiary Care Hospital, Telangana State from the period January 2019 to December 2020. 15 patients were excluded as per exclusion criteria. The remaining 50 patients, who satisfied all the inclusion criteria were selected for the study and followed for one week. Results: In our study 42% of ST elevation MI patients had sick euthyroid syndrome. So occurrence of sick euthyroid syndrome in our patients 42%.pvalue was 0.258. Sick euthyroid syndrome was 60% among females and 37.5% among males. This observation was statistically insignificant with the p value of 0.50 Conclusion:  The sick euthyroid syndrome positivity rate is proportional to the severity of cardiac damage (as evidenced by KILLIP class and Ejection fraction) and may have a possible prognostic value. Thus sick euthyroid syndrome positivity may contribute to the elaboration of an AMI severity index.

DOI: 10.5281/zenodo.10968321

Background: Surgical site infections (SSIs) pose a significant threat, accounting for 15% of hospital-acquired infections. Worryingly, gram-negative bacteria, often resistant to antibiotics, are increasingly causing these infections. This study aimed to understand the types of bacteria causing SSIs and their antibiotic susceptibility patterns to inform better treatment strategies. Methods: Pus samples were collected either using sterile cotton swabs or through aspiration and promptly transported to the laboratory. Standard procedures, including Gram staining and culture on blood agar and MacConkey agar plates, were followed, with the plates then being incubated at 37°C for 48 hours. Organisms that grew were identified using established techniques, and any ambiguous results were confirmed using the automated VITEK 2-compact system (BioMerieux, France) following the manufacturer’s instructions. Results: S. aureus and Enterococcus showed high resistance to common antibiotics like penicillin, ampicillin, and ciprofloxacin. Levofloxacin, gentamicin, and linezolid emerged as effective options. Similarly, Gram-negative bacteria displayed significant resistance, particularly to amoxicillin/clavulanic acid and cephalosporins like cefotaxime. Notably, imipenem remained effective against most tested bacteria, highlighting its potential as a broad-spectrum choice. Conclusion: In conclusion, despite modern surgical and sterilization techniques and prophylactic antimicrobial use, SSIs remain clinically challenging, with MRSA posing a significant threat in healthcare settings. Understanding the microbial epidemiology of SSIs within each institution is crucial for establishing appropriate empirical treatment and antimicrobial policies.

DOI: 10.5281/zenodo.10968331

Background and Objectives: Central serous retinopathy (CSR) is an idiopathic condition characterized by accumulation of transparent fluid with acute serous detachment of neural retina at the macula. CSR mainly affects adults in the age group of 20 to 50 years with a male predominance. It usually present as acute onset of unilateral defective vision or metamorphopsia producing significant visual morbidity in young productive adults. As the CSR is still considered idiopathic and have no genetic relations, but it is a well-known fact that duodenal ulcer has a predilection to ‘O’ group persons and carcinoma stomach to ‘A’ group. Since the duodenal ulcer is one of the consequences of stress, which is also a predisposing factor for CSR, it is logical to search for any blood group predilection to CSR. This study was an attempt to study any individual predilection for CSR in terms of blood groups. Material and Methods: The study was done inside the setting of a hospital. Patients with clinical features of CSR were chosen from the Outpatient Department (OPD) at the Ophthalmology department of the Government Medical College and Hospital, Calicut, Kerala, India using a convenient sampling method. This was accomplished subsequent to receiving authorization from the Scientific Review Committee and Institutional Ethics Committee, as well as obtaining written consent from the patients. A detailed history was taken in each case to find the association of different risk factors. Routine investigations have been done in all patients. After narrating the facts of the study, to each patient, blood group examination was also done in all patients. Results: The main victims of the disease were young people between 25 to 45 years. Among them also, the peak incidence was between 36 to 40 years of age. The male to female ratio was 2.9:1. In the context of ABO system in Indian population, this study shows a most common incidence of B positive blood group in CSR patients. Conclusion: Present study reflects a tendency of earlier occurrence of CSR in Indian people than Western people and does not affect the adolescents in the age group between 15-20 years. In present research, CSR is found to have a higher incidence among individuals with Blood group ‘B’.

DOI: 10.5281/zenodo.10968345

Background: Health-care providers bear a great deal of responsibility for reporting adverse drug reactions (ADRs). Nurses are the backbone of the health-care system; hence they play a significant role in detecting and reporting ADR, particularly for hospitalized patients, as they are in contact with a patient and available round the clock. Aim: To assess the knowledge of Pharmacovigilance and ADR reporting before and after education and assessing attitude towards pharmacovigilance and ADR reporting among healthcare workers. Purpose of this study was to spread awareness and improve reporting of ADR by training Healthcare workers for filling the ADR reporting form. Method: This was a prospective, cross-sectional, questionnaire-based comparative study. A structured questionnaire was given before and after the educational intervention at a tertiary care teaching hospital. Score of questionnaires were then compared and statistical analysis was applied using paired t-test. Result: A total of 230 Healthcare workers Included in study and result depicted that there is improvement in knowledge score post educational training. Responses received demonstrated a positive attitude toward reporting ADRs. Conclusion: The frequent training of Pharmacovigilance is required to enhance the knowledge among healthcare workers and may motivate practice of ADR reporting.

DOI: 10.5281/zenodo.10968392

To compare the transanal suture rectopexy (TR) with conventional Milligan-Morgan hemorrhoidectomy (MH) in patients of grade II, III and IV hemorrhoids.
Methods: From March 2018 to October 2019, 60 patients of hemorrhoids from grade II to IV were randomly selected to undergo either the transanal suture rectopexy (n= 30) or the Milligan-Morgan hemorrhoidectomy (n=30). Results were analyzed during postoperative period and at 1 month. Operative time, post-operative complications, resolution of symptoms and recurrence were taken as variables. Data was analyzed by Open EPI version 2.3. Results: Both the groups were comparable in terms of demographic data. Bleeding per rectum was the major symptom. TR group had more operative time and less intra-op blood loss, post-operative bleeding, pain, anal incontinence, hospital stay and recurrence than MH group. Data was statistically significant (p-value<0.05). In MH group, 16 patients developed postoperative bleeding while this was only 2 in TR group. In MH group 2 patients developed anal incontinence while there were none in TR group. In MH group 6 patients came with prolapse and 7 patients came with bleeding per rectum at 1 month follow up, while count was only 1 in TR group. Conclusion: Transanal suture rectopexy is unique and simple stitching technique appropriate for treating all the grades of hemorrhoids. It offers cheaper, ambulatory and effective alternative to costly newer modalities for the treatment of hemorrhoids. It is better accepted by the patients. More studies are needed to declare it as a standard procedure for the cure of haemorrhoids.

DOI: 10.5281/zenodo.10968408

Background: Polycystic ovarian syndrome (PCOS), alternatively termed Stein-Leventhal syndrome, stands as one of the most widespread endocrine disorders. This syndrome presents as a multifaceted and intricate disorder marked by the presence of polycystic ovaries alongside a spectrum of symptoms. These symptoms include amenorrhea, oligomenorrhea, hirsutism, anovulation, and indications of androgen excess, such as acne and male-pattern baldness. Methods: This study included women aged 18-40 years diagnosed with PCOS according to Rotterdam’s criteria. Of 75 screened patients meeting Rotterdam’s criteria, n=60 were recruited after obtaining informed consent. Participants were randomly assigned to three groups: control (n=20), Metformin (n=20), and Myoinositol (n=20). Clinical assessments, including medical history, anthropometric measurements, blood pressure, and ultrasonography, were conducted at baseline and periodically during the study. Results:  Group 1 (Control): Received no medication or specific intervention. Group 2 (Metformin): Received 500mg Metformin tablets twice a day. Group 3 (Myoinositol): Received 2gm Myoinositol tablets twice a day. Metformin treatment showed a consistent decrease in blood glucose levels compared to the control and Myoinositol groups. Both Metformin and Myoinositol showed reductions in LH levels compared to the control group, with Myoinositol having a more pronounced effect. Only Myoinositol showed a statistically significant decrease in FSH levels compared to the control and Metformin groups. Both Metformin and Myoinositol showed reductions in TSH levels compared to the control group, with Myoinositol having a larger decrease. Myoinositol showed a statistically significant decrease in prolactin levels compared to the control and Metformin groups, who had minimal changes. Conclusion: Our findings suggest that myoinositol (MI), a non-hormonal drug, is effective in PCOS treatment by regulating menstrual cycles, inducing ovulation, and enhancing pregnancy success rates in cases of infertility. Notably, MI demonstrates a high degree of safety and effectiveness, with minimal to no observed side effects compared with both placebo and metformin.

DOI: 10.5281/zenodo.10968417

Background: This study was conducted to ascertain the relative significance of MRI and arthroscopic results when evaluating an anterior cruciate ligament injury in the knee joint. Methods: This was a prospective and retrospective study carried out in a hospital setting with 80 patients who underwent knee arthroscopy and MRI imaging at a tertiary care teaching hospital. Results: We evaluated 77 men (96.25%) and 3 women (3.75%) with ages ranging from 15 to 56 years (mean 27.9) for acute and chronic knee injuries. Thirty instances (37.5%) included the right knee, and fifty cases (62.5%) involved the left knee. 55 patients had sports injuries, 10 had auto accidents, and 15 had falls as the cause of their injuries. The patients’ MRIs were examined, and the results were noted. Six patients with ACL tears were missed by MRI, while 70 patients with ACL tears were found. Degree of concordance between the arthroscopic and MRI findings regarding the accurate identification of ACL damage. MRI and clinical findings that are true positive, true negative, false positive, and false negative when compared to arthroscopic findings. Conclusion: Clinical assessment and MRI are nearly equally useful in identifying isolated ACL damage. The best way to diagnose anterior cruciate ligament problems is with an arthroscopy. The utility of MRI in assessing cruciate ligament injuries is confirmed by the strong connection seen between MRI and arthroscopic results. MRI and skilled clinical assessment rates are comparable. Anterior cruciate ligament injuries can be effectively diagnosed using MRIs, but sometimes a skilled and ideally repeated clinical examination can serve the same purpose. The cost of MRIs for patients, particularly in developing nations like India, may make it prudent to move on with a therapeutic arthroscopy if the clinical diagnosis is suggestive of cruciate ligament injury, but it is equally prudent to question the clinical correctness of the finding.

DOI: 10.5281/zenodo.10968544

Background and Objectives: A painful ailment with a  insidious onset, plantar fasciitis affects the area where the plantar fascia inserts in the calcaneus. One of the most common causes of heel discomfort in the inferior portion is plantar fasciitis. Effective techniques for treating symptoms include appropriate physical programmes, stretching of the plantar fascia and Achilles tendon, removing their stiffness, and strengthening of the interosseous plantar muscles. However, using corticosteroid injections or NSAIDs (steroidal and non-steroidal anti-inflammatory medicines) at the location of pain has been shown to reduce discomfort. For patients who have not improved after 6–12 months of conservative treatment, surgery should be the final option. While several techniques have been attempted in conjunction for therapy, none of them has proven to be particularly effective. This study compared two popular treatment modalities: plantar fascia stretching exercises and topical corticosteroid injections. Material and Methods: 120 patients participated in this clinical research, which was carried out at Government Bundelkhand Medical College in Sagar, MP, between 2019 and 2023. The Foot and Ankle Ability Measure (FAAM) Scale was used to measure functional result, and the Visual Analogue Scale (VAS) was used to measure pain level before and after the intervention, between weeks two and ten. The chi-squared and t tests were used to compare the outcomes of the two groups. P value ≤0.05 was used as the significance level. For all statistical studies, SPSS software for Windows (Version 11.5) was used. Results: Regarding the two groups’ demographic profiles, they were likewise similar. When compared to the group that underwent stretching activities, the pain and functioning (FAAM score) in the corticosteroid group significantly improved on the second evaluation during the second week of the trial. After ten weeks, both groups experienced less severe pain, although it was still equivalent. Conclusion: Our research found that stretching groups are not as effective as local corticosteroid injections for providing temporary comfort. However, local steroid injection proved less safe and less effective than plantar fascia stretching exercise for long-term alleviation. As a result, our research suggested plantar fascia stretching exercise as the recommended course of therapy due to its noninvasive nature, ability to prevent steroid injection-related problems, affordability, and long-lasting benefits.

DOI: 10.5281/zenodo.10968566

Introduction: Dermatophytosis, the leading cause of superficial fungal infections globally, has witnessed a surge in cases in recent years, particularly in India, where an escalating number of chronic and recurrent dermatophytosis cases have emerged. This study addresses the significant rise in steroid-modified tinea corporis, a consequence of the misuse of fixed drug combinations containing steroids. Such cases, presenting with chronic, resistant, and widespread lesions, pose challenges for standard treatment protocols, leading to increased morbidity and economic loss. The primary aim of this study is to investigate the various unusual and atypical patterns associated with steroid-modified tinea corporis. Material and Methods: A Prospective Observational Cross-Sectional Study with a sample size of 500 and duration of 18 months was conducted at the department of Dermatology, Venereology, and Leprology of Teerthanker Mahaveer Medical College and Research Centre. Inclusion criteria encompassed patients willing to participate, aged 1-70 years, with a history of topical and/or systemic corticosteroid use and positive KOH results. Pregnant women were excluded. Results: The study, encompassing 500 patients, revealed that the age group of 21-30 years constituted the majority (37.6%), and males accounted for 67% of cases. Topical steroid formulations were extensively used, with a mean of 17 formulations per patient. Notably, no nodules were observed in lesions on the chest and abdomen. In upper limb lesions, annular shapes predominated at 88.8%, while scaling was absent in 66.9% of cases. The body surface area involved ranged from 1.00% to 60.00%, with a mean of 7.2760% and a standard deviation of 12.46831%. Conclusion: Steroid-modified tinea corporis poses a growing public health concern in India, leading to atypical and chronic presentations that challenge conventional treatment strategies. Understanding the diverse clinical patterns and risk factors is crucial for effective management and prevention. The study emphasizes the need for targeted interventions to curb the misuse of steroid-containing formulations and mitigate the rising burden of dermatophytosis in the country.

DOI: 10.5281/zenodo.10968600

Introduction: Epidural analgesia (EA) is the gold standard technique; inadequate sacral spread and prolonged labor are the limitations. With this background, a study was conducted to compare the EA with dural puncture EA (DPEA) and 0.125% bupivacaine and fentanyl 1mcg/ml were used. Methods: It was a prospective randomized control study conducted in Andhra Medical College, Visakhapatnam. Pregnant women aged >18 years, ASA grade I and II, singleton studycy with vertex presentation with cervical dilatation of 3 – 5 cm and without any labor analgesia contraindication were included in this research. Non cooperative women, ASA grade III & IV were not considered. The study members were divided in to EA and DPEA groups randomly.  VAS score was used for pain analysis. Time of onset of adequate was taken as the time between initial injections until the VAS score became 3. Fetomaternal hemodynamics were monitored regularly. The labor progress was recorded by serial per vaginal examinations and mode of delivery and complications such as hypotension, pruritis, motor blockade, nausea, and vomiting were recorded. Modified Bromage scale was used for motor blockade analysis considered. APGAR score at 1 min and 5 min was used for neonatal outcome. Unpaired T test, chi square test were used, P value < 0.05 was considered significant. Results: Total 80 members were included, 40 in each group. Statistically there was no significant difference in the mean duration of labor, respectively. Statistically there was significant difference in mean time for onset of adequate anaesthesia and mean duration, respectively. In both the group majority underwent vaginal delivery, no statistical significance. All the neonates in both groups had > 7 APGAR score, statistically not significant. Conclusion: The DPEA technique stands as a secure alternative to EA. The study could be enhanced through the incorporation of noninvasive imaging techniques to visualize the drug spread.

DOI: 10.5281/zenodo.10968617

Aim: The aim of the present study was to assess the relationship between iron deficiency anaemia and febrile convulsion in children hospitalized at the tertiary care centre. Methods: This prospective, case–control study was conducted in department of Paediatrics, Study duration was of 8 months.  After applying inclusion and exclusion criteria, total of 100 children were included in present study with 50 cases in each group. Results: Maximum children belonged to the age group of 6 months to 1 year in both the groups, followed by age group of 1-2 year in both the groups. Children above 3 years in both groups were 8% in cases. Iron deficiency anaemia was more prevalent in cases (56%) as compared to controls (28%). Iron deficiency was diagnosed by hematological investigations of Hb less than 11 g/dl, HCT less than 33%, MCV less than 74 fl, MCH less than 24 pg, MCHC less than 32%, SI less than 50 μg/dl, SF less than 12 μg/dl, TIBC more than 400 μg/dl, and transferring saturation less than 15%10. We compared various hematological indices among cases and controls. We also find significant p value for MCV and MCHC among cases and controls. Conclusion: The present study concluded that that iron deficiency anemia is strongly correlated with febrile convulsion probably through increasing the threshold of convulsion in patients with iron deficiency. Iron deficiency anaemia is easily correctable and preventable, most common micronutrient deficiency. Early detection and prompt correction may help in reducing febrile seizures incidence in children below 5 years of age.

DOI: 10.5281/zenodo.10968954

Aim:  The aim of the present study was to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding. Material & Methods: A prospective study including 200 patients were selected randomly from among the patients who presented with a history of epistaxis, to the OPD of Department of ENT for one year. An informed consent was obtained from each patient. Results: Majority of the patients were more than 51 years of age group. Gender distribution of patients as per the result revealed that 80% patients are males and 20% are females, the gender distribution was statistically significant in males (p<0.05). In our study we have 70 patients with anterior epistaxis, which accounts for 35%, 30 patients with posterior epistaxis, which accounts for 15%, and 100 patients with anterior and posterior epistaxis which accounts for 50%. After careful examination of patients the different endoscopic diagnosis was detected in the study showed the bleeding point in the crevices of the lateral nasal wall (BPCLW), posterior deviation of septum with spur (PDWS), enlarged congested significant adenoid (ECSA) and septal spur with ulcer (SSWU) were statistically significant (p<0.05) and strongly associated with age and sex distribution of patients. Endoscopic management of aspects of epistaxis, as per the descriptive statistical analysis endoscopic selective nasal packing (ESNP),endoscopic nasal cautery or bipolar diathermy (ENCD), endoscopic polypectomy (EP),endoscopic mass excision (EME) were highly associated with age and sex matched frequency of the patient and showed statistically significant with different management aspects (p<0.05). Conclusion: Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.

DOI: 10.5281/zenodo.10968964

Aim: The aim of the study was to study the association between Serum Vitamin D and Serum Ferritin levels in children with ADHD. Methods: The study was conducted in the Department of Pediatrics, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for the period of 2 years. A total of 100 children meeting the inclusion criteria were enrolled in the study. Subjects included all new or follow-up patients with diagnosed or suspected ADHD and healthy children of the comparable sex and age group attending the pediatric outpatient department (OPD) were taken as controls. Informed and written consent was taken from parents and assent from children above 12 years of age to participate in the study. Results: 50 cases were diagnosed with ADHD and their results were compared to age and sex matched controls. Serum Ferritin and Vitamin D levels were measured in both cases and controls. Since we matched age, similar age distribution was present in controls. The study found a significant difference in the mean value of serum ferritin levels in cases and controls (p=0.032). No significant difference in the mean value of serum Vitamin D in cases and controls (p=0.555) was noted. Conclusion: ADHD is a common neurobehavioral disorder presenting in pediatric OPD with higher prevalence in males than females. Combined type was found to be the most dominant type of ADHD in the study population. We observed a significant difference in the levels of Serum Ferritin in children with ADHD and controls.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the feto-maternal outcome in oligohydramnios. Methods: A prospective study was conducted of all ANC’S admitted in labor room in Obstetrics and Gynaecology. All the admitted term patients underwent ultrasound examination to assess the liquor. Amount of liquor was calculated using four quadrant method where deepest pockets in each quadrant was measured and their sum gives the AFI. Out of 3680 patients 100 antenatal women at term had AFI of less than 8 cms and were included in the study. Results: In our study, 58% of women were 20-29 years old, 30% were >30, and 12% were under 20. Primigravidas were 54% and multigravidas 46%. Most cases (82%), were between 37 and 40 weeks, while 18% were between 40 and 42 weeks. In 100 pregnant women, 36% experienced non-reassuring NST, 45% had protracted labour, 10% had intrauterine growth restriction, 4% had malpresentations, 2% had foetal malformations, and 3% had postpartum haemorrhage. 64% had borderline AFI and 36% severe oligohydramnios. Clear liquor was seen in 72%, thin liquor in 16%, and thick liquor in 6%. We found 15% foetal discomfort, 5% CPD, 4% malpresentations, 3% failed induction, and 1% deep transverse arrest. Conclusion: Oligohydramnios increases pregnancy difficulties and perinatal death. An intrapartum AFI assessment would identify women who need more antepartum surveillance for pregnancy problems. The babies of women with oligohydramnios are usually smaller, but with foetal surveillance and appropriate intervention, they can survive.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the epidemiology, clinical features and early outcome in traumatic spine injuries at a tertiary hospital. Material & Methods: The present study was single-center, prospective, observational study, conducted in Department of Orthopedics, Sree Narayan Medical Institute and Hospital, Saharsa, Bihar, India for the period of 1 year.  200 patients were included in the study. Results: Out of 200 patients, most of the patients were in the age group 51-60 (32%) and 41-50 (30%). Mean age was 51.59 years. Majority of the patients were male 70% while 30% patients were female. In present study, majority of traumatic spine injuries were due to road traffic accidents (52%), followed by fall from height (45%) and assault (3%). Majority of spine fractures occurred at cervical (40%) followed by Lumbar (30%) followed by thoracic (20%) vertebral level. Out of 100 patients, 55 patients (55%) had no associated injuries. Common associated injuries were hemoperitoneum (12%), head injury (11%), fracture humerus (9%) and fracture clavicle (6%). Out of 100 patients, 54% patients had no Neurodeficit and 46% patients had Neurodeficit. On pre -operative assessment 50% patients had ASIA score of E, 11% had ASIA score of D, 17% had ASIA score of C, 7% had ASIA score of B and 15% had ASIA score of A. Follow up ASIA score after 2 weeks in patients was A in 14% patients, B in 8%, C in 16%, D in 12, E in 50%. Follow up ASIA score after 3 months in patients was A in 8% patients, B in 5%, C in 6%, D in 15%, E in 68%. Follow up ASIA score after 6 months in patients was A in 9% patients, B in 5%, C in 4%, D in 16%, E in 66%. Follow up ASIA score after 9 months in patients was A in 8% patients, B in 6%, C in 4%, D in 20, E in 60%. Follow up ASIA score after 12 months in patients was A in 12%, D in 28, E in 60%. Conclusion: Complication rates were higher in patients treated non-operatively. Leading causes in deaths at cervical level were due to respiratory failure and leading causes of deaths in thoracic and lumbar vertebral level were due to secondary complications of long-standing bed sores.

DOI: 10.5281/zenodo.

Aim: To identifying the risk variables that contribute to the incapacity of older individuals to restore their pre-fracture mobility after undergoing hip fracture surgery. Materials and Methods: In this retrospective was conducted in the department of Orthopaedics, Jannayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India, 473 consecutive patients over the age of 65 who were admitted to the hospital with hip fractures during the study periods were examined. Patients who had a contralateral hip fracture (n:6), had a pathological fracture (n:9), were bedridden before the hip fracture occurred (n:7), died within six months after the operation (n:127), and were alive but were missing postoperative sixth-month follow-ups (n:23), were excluded from the study. The remaining 281 patients were included in the study. Results: In patients whose mFIM scores were calculated, the number of patients whose mFIM score was the same as before the fracture occurred at the postoperative sixth month was 185 (65.8%) patients. The number of patients whose mFIM score worsened in the sixth month postoperatively compared to the score before the hip fracture occurred was 96 (34.2%). In the analysis in which the relationship between the fracture type and pre-fracture mobility was evaluated, it was determined that intertrochanteric fractures were more common in people who did not have normal mobility and who moved with the use of an aid, (p=0.003). In the analysis of the relationship between the fracture type and the postoperative sixth month mobility, it was found that the rate of moving with the use of an aid and immobile was higher in patients with intertrochanteric fractures than in patients with collum femoris fracture (p=0.001). Conclusion: According to the results obtained in this study, the effects of keeping the patients under close follow-up in the postoperative period, ensuring the participation of the patients in the rehabilitation programs to be applied and providing the necessary training to the relatives of the patients about the postoperative rehabilitation of the existing disease will have a positive effect on the results.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the circulatory levels of Hs-CRP in patients of non-alcoholic fatty liver disease and compare them with clinically healthy controls. Material & Methods: The study included 100 NAFLD patients and 100 clinically healthy controls. This study was carried out at Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for one year. The study information was given to all the study participants and their written consent was collected. Results: The lipid profile variables like TG and LDL were high patients than controls. The present study observed a significant increase anthropometric parameters and lipid parameters in patients than controls. The inflammatory marker C-reactive protein levels increased in NASH group than NAFLD. Conclusion: The present study concluded that Hs-CRP can be considered as an important marker of inflammatory status in NAFLD and NASH.

DOI: 10.5281/zenodo.

Aim: The aim of the study was to evaluate the efficacy of platelet count (Platelets) and its indices in the early diagnosis of sepsis. Methods: This was a prospective study conducted in the Department of Pediatrics, IGIMS, Patna, Bihar, India for the period of two years. Sample size of 100 patients was recruited as per hospital neonatal intensive care unit work load during the period of study. Results: The general characteristics of a study group showing 100 patients including 60 males and 40 females. On the basis of NNF guidelines, the patients were divided in three groups – 50% were clinically suspected sepsis (probable sepsis), 35% were with blood culture positive (culture positive sepsis), and remaining 15% in blood culture negative but CRP positive group (culture negative sepsis). The patients were divided into early and late onset. EOS was seen more in males (65%) as compared to females (35%). However, in LOS both male and females were equally affected. Conclusion: Platelets can be considered as an early diagnostic tool for neonatal sepsis as it is cheap, rapid, and easily available and does not require additional equipment.

DOI: 10.5281/zenodo.

Aim: Assessing the vitamin D levels in mothers and their newborns in a tertiary care center. Materials and Methods: This retrospective study was done at the Department of Pediatrics, NMCH, jamuhar, Sasaram, Bihar, India for one year. 100 women and their newborns who were delivered at the hospital were included in this retrospective study. All the subjects gave informed consent for the enrolment. Mothers of Indian origin, between 20-45 years of age with no history of any chronic disease or long-term treatment with drugs in the previous three months were included. Pregnant women with associated medical conditions such as Pregnancy- Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), hypothyroidism was excluded from the study. The study included newborns of these mothers with completed 35 weeks of gestation who were healthy and did not require intensive care. Results: The Mean serum 25 (OH) Vitamin D in mothers was 15.09 ng/mL and Mean serum 25 (OH) Vitamin D in neonates was 13.82 ng/mL. Serum calcium was within normal range in 92% women. Hypercalcaemia was noticed in 3% women and hypocalcaemia in 5% women. In neonates, serum calcium was within normal range in 95% and lower in 5% cases. Serum albumin was normal in 59% of mothers and lower than normal range in 41% of mothers. Almost all i.e., 99% of newborns had low serum albumin levels and 1% had normal serum albumin. About 87% of mothers had a natural conception, whereas 13% had IVF conception. The association between maternal serum 25 (OH) Vitamin D levels and daily hours of sun exposure (up to 2 hours vs >2 hours) was statistically significant. The five mothers who received 3,00,000 IU Vitamin D supplements were all found to be Vitamin D sufficient. The comparison between serum 25 (OH) Vitamin D levels in mothers and gestational age found no statistically significant association. Conclusion: To conclude, the study results add to the accumulating evidence of a high prevalence of vitamin D deficiency in pregnant mothers and newborns, which needs further evaluation and response.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to explore the link between Vitamin D and cellular senescence measured with the enzyme telomerase in pre-HTN. Methods: The present study was conducted from in the Department of Physiology, Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India for two years . Inclusion criteria for the pre- hypertensive group (pre-HTN) (n =50) were both genders between 18 and 25 years of age with SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg in apparently healthy individuals. The controls (n = 50) population were healthy individuals with 18– 25 years of age with SBP between 100 and 119 mmHg and DBP between 60 and 79 mmHg. Results: The study population included 100 apparently healthy individuals. 50 were pre- hypertensive with the age of 22.58±1.56 and the age of controls was 18.82±1.22. Out of 100, 27 males, 23 females in pre- HTN group and 26 males, 24 females were in the control group. A significant difference was not found between-group differences in height and waist-hip ratio. However, pre- HTN group subject’s BMI (P < 0.001) and weight (P < 0.001) was more compared to controls. In pre-HTN group, significantly higher HR (P < 0.001), SBP (P < 0.001), DBP (P < 0.001), MAP (P < 0.001), and RPP (P < 0.001) were seen when compared to controls. No significant difference was seen in PP but it was slightly high in pre-HTN group and negatively associated with Vitamin D. High telomerase levels have correlation with waist-hip ratio, SBP, DBP, MAP, and RPP but no significant correlation was seen with BMI, HR, and PP. Conclusion: It can be concluded that reduced Vitamin D levels in pre-HTN may cause derangements of cardiovascular homeostatic mechanism, enhance the speed of cellular senescence measured by telomerase.

DOI: 10.5281/zenodo.