Background: Fistula in ano, although benign, poses a significant challenge for surgeons in effectively managing the condition. Successful treatment requires a comprehensive understanding of anorectal anatomy and the etiopathogenesis of anorectal abscesses. The vast majority, over 90%, of cases involving perianal abscesses and anal fistulas are attributed to cryptoglandular infections within the intersphincteric plane. Thus, a thorough grasp of these factors is imperative for the accurate diagnosis and appropriate management of fistula in ano. Methods: This study included Patients exhibiting symptoms indicative of either simple low or high anal fistula admitted to the general surgery ward. All patients were briefed on the nature of the disease and potential postsurgery complications (recurrence, anal incontinence, and anal stricture). During the assessment, a comprehensive history was taken, signs and symptoms were noted, and internal and external openings were identified through thorough digital rectal and proctoscopic examinations conducted under sufficient light. They were operated by one of the following methods fistulectomy, fistulotomy, LIFT, and fibrin glue injection. Results: A total of n=60 cases of fistula in ano were included in the study. Fistulectomy and Fistulotomy exhibit higher rates of chronic pain (16.67% each) and long-term anal incontinence (16.67% for Fistulotomy), with similar recurrence and stricture rates (11.11% and 5.56% for Fistulectomy, 16.67% for all three for Fistulotomy) compared to LIFT and Fibrin Glue Injection. LIFT demonstrates lower chronic pain (5.56%) and no long-term anal incontinence, while Fibrin Glue Injection shows the lowest complication rates overall, with no reported chronic pain, incontinence, recurrence, or stricture. Conclusion: Fistulotomy and Fistulectomy entail moderate intraoperative and postoperative complications, with varied risks of anal incontinence, stricture formation, and recurrence. Fibrin Glue Treatment has no complications but a moderate recurrence rate. LIFT presents minimal complications, brief hospitalization, and low recurrence risk, enabling a swift return to normal activities.

DOI: 10.5281/zenodo.10955709

Background: Snake bite is a major public health problem in India with estimated annual snake bite incidence is about 66-163/1 lakhs population, morbidity about 1.4 to 68 / 1 lakhs population, mortality about 1.1 to 2.4 / 1 lakhs population and case fatality rate of 1.7 to 20%1. The Indian study estimates from a national mortality survey in 2001-03 found that 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), and more commonly among males than females and peaking at ages 15–29. Snakebites also occurred more often during the rainy and monsoon season. This proportion represents about 40,900-50,900 annual snakebite deaths nationally or an annual age-standardized rate of 4.1/100,000, with higher rates in rural areas (5.4/100,000), and with the highest rate in the state of Andhra Pradesh (6.2/100,000). Objectives: To determine the sensitivity and specificity of the 2ml 20 min whole blood clotting test in clinical practice under the usual conditions of its use for detection of coagulopathy in vasculotoxic snake/ viper bites. Methodology: In this study adult patients with suspected vasculotoxic snake bites envenoming were recruited. Age, sex, bite information, clinical effects, serial WBCT20, laboratory investigations and antivenom treatment were recorded. The results of 2ml 20min WBCT was compared with the special Blood Coagulation Profile Test to assess the validity of WBCT20 in early detection of coagulopathy for consideration of ASV in vasculotoxic snake envenoming and reaching end-point of ASV treatment in VICC. WBCT20 was done by using 2ml of whole blood in a 10ml borosilicate glass tube with a dimension of 13mm×100mm. The Prothrombin Time (PT) and INR tests are cost effective, reliable and reproducible. Results: The incidence of snake bites was more common in males (82.3%) with a male to female ratio of 4.6:1. The majority of cases belong to 31 to 40 years with mean age of 39±14.81. . The timing of snake bite most commonly observed was between 6 AM to 6 PM (52.94%) which is working hour for the population. Major site of bite was lower limbs in 75.49% and most of the cases belong to rural areas. Majority of cases i.e. 32.35% presented late to the hospital after 12hours of snake bite. The WBCT20 was positive in 45/67 patients with VICC [sensitivity 67.16% (95% confidence interval (CI): 54.60–78.15%) in relation to INR] and was falsely positive in 3/102 cases without coagulopathy. Conclusion: WBCT20 is an insensitive test to detect coagulation disorder as an indicator of systemic envenomation in the victims of vasculotoxic snake bites though it is simple, rapid, cheap and specific. The WBCT20 can guide therapy after potential snake envenomation in resource poor areas where laboratory testing is unavailable. Along with the WBCT20, a standard coagulation test like PT/INR plus clinical findings can be used to guide the therapy.

DOI: 10.5281/zenodo.10955785

Background: The utilization of ketamine before induction agents to expedite the onset time of neuromuscular blockade with rocuronium bromide holds potential value in anesthesia practice. Objective: The objective of this study was to assess the impact of administering Ketamine and normal saline before induction on the onset time and intubating conditions associated with Rocuronium bromide. Methods: Patients undergoing elective surgeries with ASA I/II categories were selected for the study. They were divided equally into two groups of n=25 each. Group I received 5ml normal saline and group II received Ketamine 0.5 mg/kg. Intubation was conducted at 60 seconds, with conditions assessed using criteria outlined by Cooper et al. including jaw relaxation, vocal cord position, and diaphragmatic movements, graded as excellent, good, fair, or poor. Cormack and Lehane grading determined intubating conditions. Hemodynamic changes in systolic, diastolic, and mean arterial blood pressure were recorded at baseline, premedication, test drug administration, induction, intubation, and post-intubation at 1, 3, and 5 minutes, alongside heart rate variations for comparison. Results: Neuromuscular Blockade: Ketamine administration (Group II) was associated with a significantly faster onset time for Rocuronium-induced neuromuscular blockade compared to saline (Group I).  Blood Pressure: Both groups experienced similar trends in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) throughout the procedure: Group I tended to have slightly higher average SBP and MAP compared to Group II, but the differences were minimal. The baseline heart rate was slightly higher in the Ketamine group (Group II). Both groups experienced an increase in heart rate after induction, with a larger increase in the Ketamine group. At 5 minutes after induction, the control group (Group I) had a higher heart rate compared to the Ketamine group. Conclusion: Our study suggests that pre-administration of a low dose of Ketamine before induction significantly accelerates the onset time of Rocuronium bromide while ensuring stable hemodynamics. Although 88% of cases demonstrated satisfactory intubating conditions with Ketamine, our findings did not indicate a statistically significant difference in mean arterial pressure between the Ketamine and saline groups during induction.

DOI: 10.5281/zenodo.10955957

Background: Various drug combinations, including opioids, intravenous agents, and inhalational agents, are being employed to facilitate endotracheal intubation in the absence of muscle relaxants. Propofol alone versus propofol combined with sevoflurane for induction and intubation. Methods: Patients meeting the inclusion criteria were eligible for participation. Before the administration of general anesthesia, patients were randomly assigned to two groups using lots. Group I (n=25) received sevoflurane induction, while Group II (n=25) received propofol induction. A thorough pre-anesthetic evaluation was conducted on the day before surgery. Detailed history and cardiorespiratory examination were carried out in all patients. All relevant investigations were done. Nil per oral status for a minimum of 6 hrs was advised. On the day of surgery, after the arrival of the patient to the operation theatre pulse-oxymeter, ECG, and non-invasive blood pressure monitors were connected. The baseline heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded. Results: Combining Propofol with Sevoflurane (Group I) achieved faster, and more consistent anesthesia induction compared to Propofol alone (Group II). Both groups had similar mild side effects during induction. Blood pressure decreased in both groups post-induction, with slightly lower values in Group I. However, the differences were small and inconclusive. Group I showed a significantly larger MAP decrease only post-induction, while the heart rate decrease was larger in Group I only at 1-minute post-intubation. Conclusion: The combination of inhalational 4% sevoflurane with intravenous propofol 1.5mg/kg is superior to intravenous propofol 3mg/kg in terms of intubation quality and has fewer hemodynamic effects during induction and intubation in adult patients undergoing various elective surgical procedures without muscle relaxants. Additionally, this combination is cost-effective and may be considered for cases of anticipated difficult intubation.

DOI: 10.5281/zenodo.10956848

There has been an inclination towards preventing deaths due to head injury in motorized two-wheeler accidents in recent years. Since the head injury is a major cause of death in such fatal accidents, thoraco-abdominal trauma is also responsible for the fatalities in such accidents. In this study, we analyzed the fatalities due to thoraco-abdominal trauma in motorized two-wheeler accidents and found that 4^th to 6^th ribs are more prone to fracture in such accidents. Among the abdominal organs, liver is the most common organ to be damaged, followed by spleen and kidney.

DOI: 10.5281/zenodo.10956906

Background: Fractures of the calcaneus, or heel bone, constitute the majority of tarsal fractures, representing about 2% of all fractures and 60% of tarsal fractures. They tend to occur more frequently in men than in women, typically peaking in incidence during the fourth and fifth decades of life. The primary cause of these fractures is often a high-energy fall from a height, responsible for approximately 70% to 80% of cases. Other contributing factors include motor vehicle accidents, crush injuries, and sports-related trauma. Methods: Upon hospital admission, the patient underwent airway, breathing, and circulation assessment, followed by a comprehensive neurological examination to exclude other significant injuries. Radiographs of the calcaneus, ankle mortise, spine, and other pertinent areas were obtained. History-taking encompassed age, sex, occupation, injury details, and medical history. Fracture diagnosis was confirmed via radiographs. Results: Surgical Group: 60% of patients achieved an “excellent” outcome. 20% achieved a “good” outcome. 13.33% had a “fair” outcome. 6.67% had a “poor” outcome. Conservative group: No patients achieved an “excellent” outcome. 40% achieved a “good” outcome. 40% achieved a “fair” outcome. 20% had a “poor” outcome. This table shows that surgical intervention may be associated with better outcomes compared to conservative management for intra-articular calcaneal fractures. A higher proportion of surgically treated patients achieved “excellent” and “good” outcomes, while the conservative group had no patients with “excellent” outcomes and a higher percentage with “fair” and “poor” outcomes. Conclusion: In our study, open calcaneal fractures had good outcomes when surgery was performed, and functional results were better when restoration of Bohler’s angle was performed. The restoration of subtalar congruency is necessary for optimal outcomes. tensile L-shaped lateral approach is associated with minimal postoperative wound complications, better visualization of the subtalar joint, and a wide space for lateral plate fixation. Conservative management resulted in no change in the restoration of Bohler’s angle, and few cases had poor outcomes.

DOI: 10.5281/zenodo.10956981

Introduction:  The hypothesis posited that the use of dexmedetomidine and propofol would yield superior i-gel® insertion conditions when compared to the combination of fentanyl and propofol. The objective of the study was to assess and compare i-gel insertion conditions. Methods: It was a hospital based prospective double-blinded randomised control study, conducted in Rangaraya Medical College. Individuals of both gender posted for short surgical procedure under general anaesthesia aged 18 – 60 years, ASA grade I & II and MPG I & II were included. The study was explained, pre anaesthetic evaluation was carried as per the protocol. Randomly, participants were divided two groups; group D members received 1mcg/kg Dexmedetomidine and Fentanyl 1 mcg/kg for group F members. After successful administration of medicament i gel was inserted; the ease of insertion was assed as per the guidelines, removed at the end of surgery. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were monitored, recorded at baseline, after study drug infusion, propofol induction and 1, 3, 5 and 10 minutes after insertion: Student t-test and chi square test was used, P< 0.05 was considered statistically significant. Results:  As per the degree of jaw relaxation (DOJ), the acceptability was 90% and 100%, respectively in the groups, statistically there was no significant difference. In group F, 36 members had grade 1 movement, and it was 38 in group D; statistically there was no significant difference. Statistically there was no significant difference between in coughing, gagging, overall conditions and number of i gel insertion. Statistically there was significant difference in the mean HR, SBP, DBP, MAP. Conclusion: The combination of Dexmedetomidine with propofol offers superior insertion conditions for the i-gel compared to the combination of fentanyl with propofol. This is accompanied by stable hemodynamics and minimal adverse effects.

DOI: 10.5281/zenodo.10957005

Background: The outbreak of COVID-19, caused by the novel coronavirus SARS-CoV-2, has swiftly become a global health crisis. As the number of cases escalates worldwide, medical professionals are gaining a clearer understanding of the disease’s clinical presentation, including its impact on the skin. Various studies have reported diverse skin manifestations in individuals diagnosed with COVID-19. Objectives: This study aims to offer a concise overview of the cutaneous manifestations associated with COVID-19. Methodology: A comprehensive search of literature databases including PubMed, Scopus, and Web of Science was conducted up to April 30, 2022. This narrative review synthesizes the available information regarding the clinical and histological characteristics of skin manifestations linked to COVID-19. Results: The literature review revealed a broad spectrum of cutaneous manifestations associated with COVID-19, exhibiting variability in presentation and timing alongside extracutaneous symptoms. While the exact mechanisms remain unclear, hypotheses point to an overactive immune response, complement activation, and microvascular damage. Histopathological examination of skin lesions in COVID-19 patients reveals various patterns depending on the specific manifestation. For instance, histopathological features of maculopapular eruptions often include superficial perivascular lymphocytic infiltrates with mild spongiosis, while urticarial lesions typically exhibit perivascular edema and a sparse inflammatory infiltrate.

DOI: 10.5281/zenodo.10957847

Background: Pharmacology is one of the important subjects of MBBS and it is necessary to know the student’s perception on current curriculum and their learning experience in current setting. The teaching programme needs to be frequently reviewed in order to make the pharmacology curriculum more interesting and understanding by incorporating necessary adjustments in teaching learning methods. Feedback helps the educators to revise their teaching methods so that students can easily understand the concepts they are taught in the class. So, the present study was conducted to obtain feedback on pharmacology curriculum and teaching learning methods from the second year MBBS students. Methodology: This was a cross sectional questionnaire-based study. A total of 118 students participated in this study. The feedback from the students was obtained by providing them questions related to the curriculum and the teaching learning methods used to implement the present curriculum. Results: Most of the students in this study rated the depth, extent and applicability of present curriculum to real life situations as good to very good. The present teaching learning methods like small group discussions and use of audiovisual aids in teaching were rated as good to very good by most of the participants. Students suggested to add more case-based discussions, MCQs at the end of lecture, audiovisual aids and small group discussions for the better understanding of the subject. Conclusion: In the present study the general perception of students regarding current teaching learning methods in pharmacology was positive. The results from our study can help as feedback for the educators to modify the teaching learning methods to improve the understanding of the subject.

DOI: 10.5281/zenodo.10957866

Background: Malignancies of urinary bladder or urothelial malignancies are quite common. Urothelial carcinoma account for 90% of all primary tumors of the bladder. Transitional cell carcinoma (TCC) is the commonest bladder cancer followed by squamous cell carcinoma (SCC). Methods: This is a retrospective descriptive study for the period of two years from Jan 2021 to Dec 2022. All the urinary bladder specimens received in form of TURBT and cystoscopic biopsies during the study period were included. Autolysed specimen, Inadequate biopsies were excluded. Biopsy specimens were processed as per routine histopathological technique. Gross examination was done and findings recorded. The tissues were sectioned as per protocol and processed by wax block method. Slides were stained with H&E stain and examined under light microscope. Then bladder lesions were studied according to WHO/ISUP (2016) classification. Results: We received a total of 106 TURBT and UB biopsies specimens, out of that a total of 87 (82.08%) urinary bladder specimens were neoplastic. The age of the patients ranged from 16-76 years of age (mean ± std. dev.  46.14 ± 8.78 years). There were 78 (73.78%) males and 28 (26.42%) females with a male to female (M: F) ratio of 2.78:1. There was clustering of cases in the seventh decade of life with 40 (37.73%) cases followed by fifth decade with 26 (26.91%). Out of 19 non-neoplastic lesions, chronic nonspecific cystitis was the most common type of lesion constituting 13 (68.42%) of all cases. Second most common lesion encountered was acute on chronic cystitis with 3 (5.26%) cases. Others were granulomatous cystits (2 (10.53%) cases) and cystitis cystica et glandularis with 1 (5.26%) case. Invasive urothelial carcinoma (IUC) was more common with 36 cases (41.37%) which included 16 cases of superficially invasive bladder cancer (invasion up to lamina propria) and 20 cases of muscle invasive bladder cancer (invasion into muscularis propria). There was various histological differentiations seen among IUC which included squamous, clear cell and sarcomatoid variant constituting 13.8%, 2.3% and 3.4% respectively. Apart from IUC, various non-invasive lesions, revealing 5 (5.75%) cases of Papilloma, 6 cases (6.90%) of papillary urothelial neoplasm of low malignant potential, 35 cases (40.23%) of non-invasive urothelial carcinoma – low grade, 4 cases (4.60%) of non-invasive urothelial carcinoma – high grade and 1 (1.15%) case of leiomyoma of urinary bladder. Conclusion: Urothelial carcinoma is prevalent and represents a substantial proportion of malignancies in developing nations. Among all carcinoma cases, high-grade urothelial carcinoma with lamina propria and muscle invasion was the most frequently observed. Pathological grade and the extent of muscle invasion stand out as crucial prognostic indicators for survival. There is a critical need for public awareness regarding hematuria, as neglecting its symptoms often leads to the presentation of advanced-stage bladder cancer at the time of diagnosis.

DOI: 10.5281/zenodo.10957887

Introduction: Diabetes mellitus is a global health concern, with diabetic foot disease, marked by neuropathic ulcers and gangrene, requiring surgical interventions to address anatomical issues and aid wound healing. This study aims to evaluate the efficacy of surgical management strategies in addressing diabetic foot complications and minimizing associated risks, with a focus on improving patient care and reducing limb loss. Material and Method: This prospective observational study, conducted between March 2022 and February 2023 at a tertiary care center in Gujarat, India, focused on 50 patients diagnosed with diabetes mellitus presenting with diabetic foot complications. Patients with diabetic foot ulcers or gangrene, whether treated at the outpatient department (OPD) or admitted to the surgical ward, were included. Data, encompassing demographic and clinical details, were gathered through structured checklists from hospital records and interviews. Patient characteristics and associations between risk factors and outcomes were analyzed using statistical tests, with significance at p < 0.05. Results: Utilizing the DIAFORA Score, we categorized the risk of lower extremity amputation, revealing that 42% of patients had a low risk, 36% had a medium risk, and 22% had a high risk. Diabetic foot was most common in patients aged 61-70 years (32%) and males (78%), with obesity playing a significant role, as 58% of obese patients were affected, and 77.8% of those with medium risk were obese. High-risk patients mostly had gangrene (72.7%), while moderate-risk patients had cellulitis with ulcers (33.3%), and low-risk patients had ulcers (61.9%). Significant associations were found between clinical factors like granulation, margins, discharge, and bacterial cultures and the risk of lower extremity amputation. Management strategies varied by risk category, with high-risk patients more likely to have below-knee amputation (27.3%), while low-risk patients predominantly underwent debridement (85.7%). Follow-up revealed higher recovery rates among low and medium-risk patients compared to high-risk ones. Conclusion:  Our study highlights the burden of diabetic foot complications, with high rates of amputation and gangrene. Elevated blood sugar levels, family history, obesity, and wound characteristics were significant predictors of amputation risk, emphasizing the need for comprehensive strategies to improve outcomes through early intervention and multidisciplinary management.

DOI: 10.5281/zenodo.10957897

Introduction: Understanding the diverse array of risk factors contributing to mortality in severe pneumonia among children aged one month to five years is essential for devising targeted interventions to reduce mortality rates and improve overall child health outcomes. By dissecting various risk factors, including demographic, socio-economic, and environmental influences, our research aims to pave the way for targeted interventions and improved health outcomes for vulnerable children worldwide. Material and Methods: The study, conducted at a tertiary care center in Gujarat from March 2021 to September 2022, focused on children aged 1 month to 5 years admitted to the Pediatric Intensive Care Unit (PICU) with severe pneumonia. Severe pneumonia cases were clinically diagnosed according to WHO classification criteria. Inclusion criteria encompassed children meeting the specified age range admitted to the PICU with severe pneumonia, while exclusion criteria included known cases of congenital heart disease, asthma, COPD, and tuberculosis. Detailed clinical assessments, socioeconomic profiling, and investigations including chest X-ray and blood culture were conducted. All patients received antibiotics, and statistical analysis was performed to discern significant differences and associations. Results: Our investigation into severe pneumonia among children aged one month to five years, encompassing a total of 240 subjects, reveals several critical insights into the disease’s dynamics. Notably, limited parental education and a history of exclusive breastfeeding (72.9%) emerged as prominent risk factors. Clinical symptoms such as fever (65.4%), cough (12.5%), and feeding refusal (42.9%) showed no significant correlation with mortality. However, malnutrition, particularly Severe Acute Malnutrition (SAM), demonstrated a strong association with mortality, with SAM children experiencing the highest fatality rate (40.4%). Physiological parameters including hypoxia (90.4%), low blood pressure (97.9%), pallor (32.5%), and leukocytosis (32.9%) were significant predictors of mortality. Additionally, chest X-ray findings, oxygen supplementation, and mechanical ventilation needs were indicative of mortality outcomes. Furthermore, sociodemographic and maternal factors exhibited significant associations with mortality, underscoring the need for targeted interventions to mitigate childhood pneumonia mortality. Conclusion: In conclusion, our study identifies critical predictors of mortality in children with severe pneumonia aged 1 to 5 years, emphasizing the importance of prompt recognition and targeted interventions to improve outcomes in this population.

DOI: 10.5281/zenodo.10957906

Study Background / Introduction: Mucor is the most common genus causing human mucormycetes in most cases followed by rhizopus & lichtheimia. It is associated with significant lymphopenia, long-term neutropenia, malnutrition, intravenous drug use and non-judicious use of corticosteroids. Mucormycosis commonly affects the nasal and paranasal sinuses, upper respiratory tract,lungs, angio-invasion and brain. Usually air-borne spores contaminate food and lab specimens producing infections. To confirm the diagnosis tissue sections are stained with Hematoxylin & Eosin (H& E), PAS / GMS stain. Patients present with clinical features of Periorbital edema, blurring of vision, nasal/paranasal congestion, crusting, dyspnea, cough, mild fever. There are reports of cases in literature with mucormycosis in poorly controlled diabetes mellitus while post covid invasive mucormycosis is the subject of interest due to its aggressive invasiveness & rapid mortality. Early clinical and lab diagnosis is the need of the hour with rational use of antifungal and broad spectrum antimicrobial treatment. Mortality accounts to 30-70% due to angioinvasion with complete cut off of blood supply, thrombosis, tissue infarction & extensive necrosis. Imaging findings on MRI with contrast gadolinium scan shows hyperdense foci within left ethmoid and sphenoid sinuses with orbital extension. Microscopic examination shows respiratory epithelial lining with stroma showing fungal elements in the form of broad aseptate hyphae with wide angle branching, fungal granulomas, foreignbody giant cells dense mixed inflammatory infiltrate with predominant eosinophils and neutrophils admixed areas of necrotic tissue. Gomori’s silver methenamine stain highlights black pigmented Broad aseptate hyphae. Additional confirmatory method by Immunofluorescence with Robin blue/Calcofluor white stain for fungal elements also reveals Mucor species. Fungal cultures are diagnostic for fungal elements obtained after 48hrs on Sabouraud’s/Potato dextrose agar. The present study aims to Evaluate histopathological diagnosis and microbiological evidence in clinically diagnosed mucormycosis in post covid patients. Aim of the study: This study is conducted with an aim to Diagnosis of invasive Mucormycosis on Histopathological examination at a tertiary referral hospital. Rhino cerebral Mucormycosis is the current life-threatening infection commonly affecting immunocompromised patients especially post COVID-19 within 6 weeks having poor glycemic control, Intravenous drug users, ICU patients, post chemotherapy, iron overload, persistent neutropenia and follow-up cases of hematological malignancies. Histopathological features of mucormycosis showing severe fungal load, large areas of necrosis, presence of angioinvasion and perineural invasion were associated with poorer prognosis and decreased survival rate. Thus, histopathologists can help in assessing prognosis at the time of tissue diagnosis so that clinicians could optimize treatment accordingly. Primary Objective: In the general population attending the tertiary care centre to determine the following characteristics of Mucormycosis a) The age wise distribution b) Histomorphological patterns associated aggressiveness. Seconday Objective: a) Frequency of occurrence of infections b) Can analyse associated high risk factors c) To determine the significance of histopathological examination. Justification of study: The frequency of mucormycosis will be analysed and assessed histomorphological features with special attention to angio invasion especially in high risk patients like post covid patients, immunosuppressive patients and Diabetic patients. To determine accurate histopathological diagnosis is essential for treatment and determining the prognosis. ICMR recommended multidisciplinary team approach for early diagnosis and management is highlighted. This present study emphsis Histopathological examination also one of the the gold standard tests like microbiological fungal culture for early diagnosis of mucormycosis. Study area: The present study is a observational retrospective study to be conducted at Government Pudukottai Medical College and Hospital, Tamil Nadu over a period of 2 years from January 2021 to December 2022 in the Department of Pathology. Study population: The data pertaining to samples of tissues infected with mucormycosis received for histopathological evaluation to the Pathology laboratory of our tertiary care hospital. Study design: This study is hospital based Retrospective study. Time duration: 2 years. Sample size: All the resected specimens and biopsies pertaining to our study received and reported in our Pathology Department Inclusion criteria: All the cases of mucormycosis reported in the Department of Pathology in a tertiary care centre in south India from January 2021 to December 2022 were included in the study. Exclusion criteria: Patients diagnosed with small biopsies and same was diagnosed in resected specimens means, the small biopsy datas may be excluded. Data collection Methods: Approval from institutional ethical committee was taken before undertaking the study. All the required Datas/Materials for this study will retreive from the Pathology departmental registers which will be analysed later. Informed consent: NA. Adverse events monitoring: Not applicable. Follow up: Not applicable. Statistical analysis: Data will be summarized using percentages, mean, and standard deviation. Categorical variables will be analysed using Chi-square test and fisher’s exact test. Significance will be assessed at P value <0.05. All data will be entered in excel format and statistical analysis will be done through SPSS software version 26.0 charts and Graphs will be expressed using OriginmPro v9.1.

DOI: 10.5281/zenodo.10957922

Objective: the aim of the study is to analyse the histomorphological spectrum of CNS tumors in a tertiary care centre in central tamilnadu using basic H&E staining and limited IHC resource available in our centre. Materials and Methods: This retrospective histopathological analysis of brain tumors was carried out in the Department of Pathology, Government K.A.P.V Medical College, Thiruchirapalli, Tamilnadu, India, from January 2022 to October 2023. In this study a total of 44 neurosurgical biopsies were retrieved from the archives of the department. The diagnoses in all the cases were made on conventional histopathological examination of the hematoxylin and eosin stained slides and for some of the cases additional IHC markers were used to confirm the diagnosis. Then the tumors were classified according to WHO classification of CNS tumors 2017. The relative frequency of tumors and the distribution as per age, sex, and location of the lesion were analyzed. Results: A wide range of histopathological spectrum of CNS tumors was observed and was classified according to the recent 2021 WHO classification, 5th edition (WHO CNS5). The primary CNS tumors were graded from Grade I to Grade 1V. Overall Tumors of neuroepithelial cells (40.9%) were the commonest followed by tumors of meninges (34.1%). Conclusion: The present study helps to provide information regarding the burden of disease in our area. Despite the use of modern imaging technique that helps in provisional diagnosis of disease, histological examination is gold standard in the diagnosis of varied types of brain tumors. Further utility of immunohistochemistry aids in confirmation of sub type.

DOI: 10.5281/zenodo.10957928

Background: In this study we wanted to compare rocuronium and vecuronium with regard to change is hemodynamic parameters, the start time, tracheal intubation conditions, duration of action, and maintenance of anaesthesia with vecuronium and rocuronium using the TOF (Train of Four) guard monitor. Methods: Over the course of 18 months, from November 2012 to April 2014, 60 patients who were admitted for elective surgeries to the Department of Anaesthesiology at Sree Gokulam Medical College and Research Foundation, Trivandrum, participated in this hospital-based experimental study. The study was approved by the institutional ethics committee, and written informed consent was obtained from the participants. Results: In the rocuronium group, the mean time to the beginning of action was 122 seconds, while in the vecuronium group, it was 238 seconds. It was discovered that rocuronium has a quick start to action. The first dose’s duration of effect was 31.7 minutes for the rocuronium group and 26.0 minutes for the vecuronium group. Rocuronium had an initial dose whose duration of action was noticeably longer. It was observed that, compared to vecuronium (26.2 minutes, 24.6 minutes), rocuronium had a longer mean duration of action (29.8 minutes, 29.6 minutes) during which the top-up dosages were administered. The two medications had steady hemodynamics with no discernible variations. Group A’s heart rate ranged from 81.8 +/- 7.4 to 66 beats per minute, while group B’s heart rate ranged from 80 +/- 6.8 to 67 +/- 6.2 beats per minute. The mean diastolic blood pressure for group A varied from 75.6 +/- 7.6 to 56, and for group B it varied from 76.56 +/- 1.7 to 63 +/- 5.0 (all values in mm of Hg). Group A saw variations in mean systolic blood pressure between 126 and 101, while group B experienced fluctuations between 126.5 +/- 4.2 and 105 +/- 3.2 (all values in mm of Hg). Conclusion: Rocuronium appears to be a safe medication for rapid sequence intubation when there is no expectation of trouble with intubation and also for procedures of longer duration without any negative cardiovascular consequences, despite its high cost and restricted availability.

DOI: 10.5281/zenodo.10960400

Introduction: Abnormal uterine bleeding (AUB) presents diagnostic challenges due to its multifactorial nature. The FIGO PALM-COEIN Classification system offers a comprehensive framework for categorizing AUB, considering both structural (PALM) and non-structural (COEIN) causes. Our study aims to investigate the correlation between clinical presentations and histopathological findings in AUB cases classified according to FIGO’s PALM-COEIN system. Material and Methods: This prospective interventional study, conducted at a prominent tertiary care center in Gujarat from April 2021 to March 2022, focuses on perimenopausal women aged 40 years and older presenting with abnormal uterine bleeding (AUB). Ethical clearance was obtained from the Institutional Ethics Committee, and informed written consent was secured from each participant. Perimenopausal women aged 40 years and above, experiencing symptoms of AUB, were enrolled, while exclusions were made for individuals declining participation or presenting with obstetric causes of bleeding. A total of 150 eligible perimenopausal women were meticulously assessed, with comprehensive demographic data and medical histories collected. Thorough physical exams, gynecological assessments, pelvic ultrasound, and histopathological evaluations were conducted to allocate patients to PALM-COEIN classification. Laboratory tests were correlated with clinical findings, and SPSS analysis ensured rigorous assessment of correlations. Results: Our study investigated the correlation between clinical and histopathological findings in abnormal uterine bleeding (AUB) using FIGO’s PALM-COEIN Classification.  Clinical diagnoses were evenly distributed, with 50% categorized under both PALM and COEIN classifications. Leiomyoma (40.67%) was the most prevalent PALM diagnosis, while ovulatory disorders (29.33%) predominated in COEIN. Histopathological examination revealed diverse endometrial patterns, with secretory phase (41.33%) and proliferative phase (36.67%) being prominent. PALM diagnoses were prevalent in both clinical (50%) and histopathological (64%) assessments, with significant correlations observed for adenomyosis (p < .05), adenomyosis coexisting with leiomyoma (p < .01), and malignancy and hyperplasia (p < .01). In the COEIN category, endometrial abnormalities demonstrated significant correlation (p < .05). Conclusion: In conclusion, our study elucidated the correlation between clinical presentations and histopathological findings in abnormal uterine bleeding (AUB) using FIGO’s PALM-COEIN Classification. Leiomyoma and ovulatory disorders were predominant diagnoses, with diverse endometrial patterns observed histopathologically. Significant correlations were found between clinical and histopathological diagnoses, emphasizing the utility of the PALM-COEIN system in guiding diagnostic and management strategies for AUB.

DOI: 10.5281/zenodo.10960418

Background: Knee osteoarthritis (OA) is a common entity in adults causing disability and decreased work productivity. Management of early OA is not established showing varied results of conservative and medical treatment. Aims and Objectives: We evaluated the functional outcome of intra-articular injection of hyaluronic acid (HA) in OA knee or the management of early stages of OA knee. Material and Methods: 50 patients of OA knee, Kellgren type II or III, more than 45 years of age, were treated with 6 ml of intra-articular HA injection and were assessed by improvement in functional outcome as seen by WOMAC and VAS score. Results: The mean age was 52.65 ± 6.4 years (range 45 to 70 years). 19 (38%) were males and 31 (62%) were females. 17 (34%) patients had KL grade 2 and 33 (66 %) patients had KL grade 3 osteoarthritis. The mean pre-procedural WOMAC score of 46.7 ± 6.4 improved to 22.73 ± 5.78, 22.6 ± 5.02 and 24.83 ± 5.59 at 4 weeks, 12 weeks, and 24 weeks after the HA injection, respectively. The mean pre-procedural VAS score of 5.16 ± 0.82, improved to 1.22 ± 1.01, 1.19 ± 0.60, and 1.52 ± 0.55 at 4 weeks,12 weeks, and 24 weeks after the HA injection, respectively. Pain at the injection site was seen in 2 (4%) patients and 1 (2%) patient developed superficial infection. Conclusion: HA injection provides pain relief and improves the functional outcome in the early stages of Osteoarthritis of Knee.

DOI: 10.5281/zenodo.10960504

Background: Patellar fractures are prevalent, comprising approximately 1% of all skeletal injuries, often caused by either direct or indirect trauma. The patella plays a vital role in knee joint extension, enhancing the force of the quadriceps apparatus through improved leverage. This study focuses on assessing the functional outcomes and complications associated with modified tension band wiring for patellar fractures. Methods: The study included all cases of closed and type 1 open displaced transverse patellar fractures. Upon admission, patients underwent routine clinical examination and a series of investigations including chest X-ray (posteroanterior view), electrocardiogram, and 2D echocardiogram. Detailed patient information, clinical history, and examination findings were recorded. Limb immobilization was achieved with an above-knee plaster of Paris posterior slab. Patients were thoroughly briefed about the surgical procedure, potential complications, and postoperative care instructions. Results: A series of 20 cases of transverse patellar fractures were included in the study and treated surgically by modified tension band wiring. Mode of injury: Road traffic accidents (RTA) were the most frequent cause of injury (75%). Most fractures (75%) received treatment lasting between 2 and 10 days. Pain generally decreased over time, with a significant reduction in persistent pain by 12 weeks. However, the severity and nature of pain are not captured in the tables. Knee flexion ROM progressively improved after surgery. By 12 weeks, 80% of patients achieved full, unrestricted ROM. The overall complication rate was low (15%), with joint stiffness and superficial infection being the most frequent complications. However, details about severity, management, and long-term impact are missing. Conclusion: In fractures involving the patella, the most notable consequence is disruption of the extensor mechanism of the knee. This study demonstrates that treating patellar fractures with modified tension-band wiring provides a definitive solution with minimal complications and favorable functional outcomes. Surgical intervention facilitates early postoperative mobilization. The utilization of the modified tension-band wiring technique ultimately leads to a positive outcome, ensuring satisfactory restoration of knee function.

DOI: 10.5281/zenodo.10960638

Introduction: Laparoscopic cholecystectomy is one of the most common operations done in India especially northern part of our country. But we encountered various cases which were converted to open cholecystectomy. This study was conducted to determine the factors responsible for conversion of lap choles to open one. Methods: This retrospective study was done at NMCH, Patna including 500 cholecystectomies performed over a period of 3 years from Sept, 2020 to July, 2023. Result: In our study overall conversion rate was 10%. Factors of conversion to open cholecystectomy included male gender, age over 50 years, obesity, diabetes, mellitus and previous abdominal surgery and multiple episodes of cholecystectomies resulting in dense adhesion. Conclusion: The conversion of a lap chole to an open procedure is multifactorial. Among them, male gender being the most important .previous upper abdomen surgery , CBD injury and severe inflammation and tissue adhesion are equally responsible for conversion. Advance age being the second most important factor for conversion in our study.

DOI: 10.5281/zenodo.10960713

Suicide is termed as deliberate taking of one’s own life. Suicides are typically conducted in a short and relatively painless kind of way. At times, person chooses means that are rather uncommon and unheard of, to end his life. This case series aims to explore a concerning trend in suicide methodology, specifically focusing on individuals with a background in electrical circuits who choose electrocution as the means to end their lives. The objective is to understand the demographic characteristics, psychological profiles, and potential contributing factors associated with this unique method of suicide. A retrospective analysis was conducted on a series of four suicide cases involving electrocution, utilizing data from forensic reports. And personal history. The study population was limited to individuals with a documented expertise in electrical circuits, ranging from professionals in the field to hobbyists and enthusiasts. Autopsy showed peculiar body gesture and typical electrocution burn marks. Histopathology of cutaneous electrocution burnt lesions showed separation of epidermis, coagulation necrosis and oedema of dermis, congested and thrombosed blood vessels suggestive of antemortem sign. This case series sheds light on a concerning phenomenon within the realm of suicide, emphasizing the need for targeted prevention strategies and mental health interventions for individuals with specialized knowledge in electrical circuits. The methods adopted and the atypical findings make this case series a rare scientific report.

DOI: 10.5281/zenodo.10960801

Background: The kidneys are vital for excretion and hormone production, impacting blood pressure regulation and red blood cell production. Pathological processes, including end-stage renal disease (ESRD) and cancer, may require nephrectomy. Non-neoplastic indications for nephrectomy include ESRD complications, hypertension, and infections. Renal cell carcinoma (RCC) is prevalent, especially in the Asian region, albeit underreported. Histopathological evaluation post-nephrectomy aids in diagnosing renal tumors, crucial for treatment planning. Methods: This is a retrospective study for the period of two years from Jan 2021 to Dec 2022. We included all the nephrectomy specimens from patients aged above 18 years, received during the study period. Clinical data was collected from patient’s records. Autolysed specimen, Inadequate and improperly fixed specimens and specimens of pediatric patients were excluded from this study. Biopsy specimens were processed as per routine histopathological technique. The specimens received were fixed in 10% buffered formalin. Gross examination was done, and findings recorded. The tissues were sectioned as per protocol and processed by wax block method. Slides were stained with hematoxylin and eosin (H&E) stain and examined under a light microscope. Results: In the present study, we received a total of 86 nephrectomy specimens. Out of 86, 23 (26.74%) were simple nephrectomies and 63 (73.26%) were radical nephrectomies. We observed 61 (70.93%) neoplastic lesions and the remaining 25 (29.07%) were non neoplastic. The most common clinical presentation was pain in the flank region in 59 (68.67%) cases, while hematuria was present in 24 (27.91%) of cases. The age of the patients ranged from 22-76 years of age (mean ± std. dev.  58.14 ± 8.78 years). We observed slight female predominance with 45 (52.33%) patients were females and 41 (47.67%) were males with a male to female (M:F) ratio of 0.91:1. There was clustering of cases in the sixth and seventh decade of life with 27 (31.40%) and 24 (27.91%) cases respectively. Out of 25 (29.07%) non neoplastic lesions, on histopathological examination, chronic pyelonephritis was the most common type of lesion constituting 13 (15.12%) of all cases. Second most common lesions encountered were Xanthogranulomatous pyelonephritis and hydronephrosis due to renal stones with 3 (3.49%) and 4 (4.65%) cases. Others were cystic kidney disease with 3 (3.49%) cases and pyonephrosis with 2 (2.33%) case. Out of the 61 neoplastic lesions of various histomorphological categories, there were 7 cases of benign lesions and 54 malignant lesions. The most common lesion encountered was renal cell carcinoma with 46 cases (53.49%), in which different histological differentiations found were, clear cell type with 33 (38.37%) cases, 8 (9.3%) papillary type, 4 (4.65%) chromophobe type and 2 (2.33%) sarcomaoid type.  Other than renal cell carcinoma, there were 5 (5.81%) cases of adenosquamous carcinoma, 2 (2.33%) cases of primitive neuroendocrine tumor, and 3 (3.49%) cases of transitional cell carcinoma. In benign lesions there were 4 (4.65%) cases of oncocytoma and 3 (3.49%) cases of angiomyolipoma. Conclusion: Nephrectomy specimens reveal a diverse array of lesions, some of which may be challenging to diagnose accurately through clinical and radiological means. Therefore, it is imperative that each nephrectomy specimen undergoes thorough histopathological examination to establish a correlation between clinical presentation and morphological features, ensuring appropriate management.

DOI: 10.5281/zenodo.10961002

Introduction: Fistula-in-ano, also referred to as the anal fistula, is an abnormal tract or cavity between the anal canal and perianal skin. The treatment of fistulas requires surgery. Proper manipulations, such as curettage and drainage of blind sinuses, abscess cavities, and accessory tracts, are the key for successful treatment. Owing to high soft tissue resolution of MRI, radiologists can provide detailed anatomic descriptions of the relationship between the fistula and the anal sphincter complex, localization of the site of internal opening of anal fistula, definition of the primary and secondary tracts and their relationships with the sphincter muscles, and presence of horseshoe fistulas and abscesses, thereby allowing surgeons to choose the best surgical treatment, significantly reducing recurrence of the disease or possible secondary effects of surgery, such as fecal incontinence. Methodology: Diagnostic test evaluation to compare the predictive accuracy of MRI findings in identifying anorectal fistula over intraoperative findings in 30 patients referred with clinical diagnosis of perianal fistula from Department of Surgery, Govt TD Medical College, Alappuzha. Result: The study sample included 22 males and 8 females. MRI had 100% sensitivity and specificity in identifying external opening, type of ano rectal fistula and in detecting abscesses. MRI and surgery correlation was excellent for St James hospital university classification Grades 3, 4 and 5 perianal fistula with sensitivity and specificity of 100%. For grade 1 and 2 perianal fistula, MRI and surgery finding had significant correlation; with sensitivity of 87.5% and specificity of 100% for grade 1 and for grade 2 fistulas the sensitivity was 100% and specificity 95.7%. For identifying secondary tract MRI had sensitivity of 84.6% and 88.2%. For all statistical interpretations, p<0.05 was considered the threshold for statistical significance. Conclusion: Correct identification of perianal fistulae and proper grading of fistulae are possible by MRI with very good predictive accuracy and thereby ensuring best surgical outcome to patient.

DOI: 10.5281/zenodo.10961054

Background and Aim: While the safety of using epidural analgesia during labour is well-established, there is a lack of comprehensive data regarding its impact on neonatal and child outcomes. The study aimed to investigate the impact of epidural analgesia during labour and assess its effects on both the mother and the newborn. The specific objectives were to measure the level of pain relief experienced by mothers using the Visual Analogue Scale (VAS) and to evaluate the frequency of operative or instrumental deliveries associated with epidural analgesia. Investigating the duration of labour with epidural analgesia and investigating neonatal outcomes through the use of APGAR scores. Material and Methods: During the study period, 100 parturient women who visited the hospital while in labour and chose to have epidural analgesia were included as cases. These women met the eligibility criteria and provided written informed consent to participate in the study. During the study period, a total of 100 women who visited the hospital and met the eligibility criteria were included as controls after providing written informed consent for the study. Following a test dose of 3 ml of 2% lignocaine with 1:2,00,000 adrenaline, an initial bolus of 10 ml of 0.1% Ropivacaine+1microgram/cc Fentanyl is administered. Results: The study found that most of the participants fell into the 26-30 age range. In the Control group, the average duration of the active stage was 310.01 minutes, while in the Cases group, it was 270.54 minutes. However, the overall difference did not show any significant statistical findings. In the study, it was observed that the mean VAS scores in Group II (Control) were higher, with a value of 8.42, compared to Group I (Cases), which had a mean score of 5.23. Conclusion: In patients who received epidural analgesia, there was no evidence of an increase in the incidence of instrumental deliveries or caesarean sections. The study observed a significant decrease in pain relief when epidural analgesia was administered, as measured by the verbal analogue scale.

DOI: 10.5281/zenodo.10961142

Aim: The aim of the present study was to evaluate the association between Mg intake and the risk of reflux disease and that the addition of magnesium supplements should be considered and added to the LPRD treatment protocol for adults in accordance with the dietary reference intake (DRI). Methods: This was a hospital based prospective study done over a period of 2 years in the Department of ENT  in patients presenting with symptoms suggestive of LPR of the age group 18-65 years. A total of 200 patients were included in the study. Results: Out of total 200 cases, 120 (60%) were females and 80 (40%) were males. Out of 120 female patients, 32 were below 30 years, 74 were within 30 to 50 years and 14 were above 50 years. Out of 80 male patients, 20 were below 30 years, 44 were within 30 to 50 years and 16 were above 50 years. The mean RSI score in each of these age groups for females were 17.5, 18.8 and 16.6 respectively and for males were 12.9, 14.7 and 14.4. Similarly the mean RFS for females were 12.6, 15.5 and 13.7 and for males were 10.5, 13.5 and 12.4 respectively. Foreign body/sticky sensation in throat was the foremost presenting complaint found in 70% of the study population, followed by excessive throat mucus (65%) and constant throat clearing (48%). Hoarseness of voice was seen in 7% of the patients. Dysphagia and dyspnea were the least common symptoms noticed 6% and 4% respectively. A significant number of patients had overlap of two or more symptoms. Among the laryngeal signs of LPRD, granular pharynx, laryngeal erythema and posterior commissure hypertrophy were present in all the cases. 70% of the cases had diffuse laryngeal oedema and thick endolaryngeal mucus (‘positive string sign’) was noted in 40% cases. Subglottic edema and ventricular obliteration were rare findings, found only in 10% and 8% cases respectively. Conclusion: Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.

DOI: 10.5281/zenodo.10961191

The surveillance of SSI brings about the awareness to the present day modern ortho surgery the need of having knowledge of appropriate use of aseptic and antiseptic technique. Proper use of prophylactic antibiotic and therapeutic antibiotic and adequate monitoring and support with novel surgical and pharmacological as well as non- pharmacological aids. The present study compares the single antibiotic with empirical antibiotic in clean elective orthopedic procedures. Objective: To compare the efficiency of single prophylactic antibiotic therapy with empirical antibiotic in clean surgical procedure. Methodology: A sample of 100 patients were selected from amongst the IPD of VIMS Gajraula and were divided in 2 categories of I- Single prophylactic antibiotic usage in clean and other who received empiric therapy after surgical procedure. Observations: 4/50 cases of Class I developed SSI whereas 3/50 cases of Class II developed SSI after empirical therapy. The overall p value when no antibiotic group was compared to empiric group was found 0.201/0.271. Conclusion: The use of no antibiotic therapy in surgical procedure is near to as effective as that of empiric antibiotics in clean case I and II. This prevents the misuse of antibiotic, multi drug resistance and drug toxicity and cost efficient. The data was analyzed by z test, p value of < 0.05 was considered statistically significant.

DOI: 10.5281/zenodo.10961242

Background: Heart rate variability, baroreceptor sensitivity, muscle sympathetic nerve activity, and sympathetic skin response are some of the parameters that can be measured in the temporal and frequency domains, respectively. Cardiovascular rate variability (HRV), which is defined as the variability in time and/or frequency between successive R waves of the heartbeats, is a measure of how well the cardiovascular system and the mechanisms it governs are integrated. Furthermore, heart rate variability (HRV) has been widely acknowledged as a metric for measuring autonomic function and quantifying sympathovagal balance for several decades. By leveraging a multidimensional approach encompassing clinical, biochemical, and audiometric assessments, we seek to elucidate the specific pathways through which emitting fumes may compromise auditory function and HRV. The findings of this research endeavour are anticipated to advance our understanding of the nuanced relationship between smoking and hearing health, potentially paving the way for targeted interventions, public health initiatives, and the development of early detection strategies for this consequential health concern. Materials and Methods: The heart rate variability analysis study was done using VarioWin_HR, apc-based HRV analysis systems. This HRV analysis equipment was validated using the GOLD standards published by the American Heart Association and the European Society of Cardiology. The North American Society of Pacing and Electrophysiology and the Board of the European Society of Cardiology adopted the Task Force 1996 recommendations for HRV recording. The hearing tests were conducted on the outpatient department of the ENT department at SGRRIM & HS Patel Nagar Dehradun. General examination, ear examination, screening tuning fork test, and pure tone air-conduction and bone conduction tests using AD 226 Intra-acoustic audiometry. The study included 220 subjects, including 110 smokers and 110 age-matched non-smokers. Results: Smokers had significantly elevated resting HR values than non-smokers. Heart rate increased acutely during smoking. Mean heart rate increased and returned almost to baseline after 30 min. HRV index significantly decreased in smokers as compared to non-smoking controls participants but the other spectral HRV parameters were comparable. Impaired hearing was found significant associated with smoking. Furthermore, the hearing loss was primarily sensor neural, with the mild type (26–40 dB) being the most usual in smokers. Conclusions: Smoking was found to affect young smokers Heart Rate, increasing HR at rest. Spectral parameters of HRV analysis of smokers remained in normal limits, but more importantly geometrical parameter HRV index, showed significant abnormality.

DOI: 10.5281/zenodo.10961488

Alcoholism is a broad form for problems with alcohol and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the determinant of drinker’s health, personal relationships and social standing. It is medically considered a disease, specifically an addictive illness. Alcohol has numerous adverse effects on the various types of blood cells and their functions. The present study is designed to determine whether or not alcohol, in amounts commonly consumed by drinkers, could alter the complete blood count value like Hb, MCV, MCH, MCH. Total 30 male, moderate to severe alcoholics and 30 non-alcoholic normal subjects were included in study. RBC count, Hb, MCV, MCH, MCH was estimated. Study shows that hemoglobin and RBC counts, MCH, MCHC  was less in alcholics which indicates anemia is common in alcoholics. MCV was high in alcoholics which indicates macrocytic anemia. Detection of hematological changes in alcoholics and giving psychiatric counseling and treatment for alcohol dependence will decrease the future complications.

DOI: 10.5281/zenodo.10961622

Tracheostomy is one of the oldest operations that performed as a lifesaving procedure and it is commonly performed for various indications and different age group. This study designed to review the indications of tracheostomy. This study comprises of 90 patients who underwent tracheostomy. In 33.33% patients indication was for Ventilatory support. 23.33% patients indication was in trauma cases. 16.66% cases indication was tumors  i.e. malignancy cases. 7.7% patients indication was throat injury and same for deep neck injury. 6.66% cases indication was Infection. 1.10% each cases were of tetanus and parapharyngeal abscess. In 2.22% cases indication was foreign body in respiratory tract.

DOI: 10.5281/zenodo.10961714

Objectives: The primary intention of this study incorporated an analysis of the utilization pattern of antimicrobial drugs within the inpatients diagnosed with bacterial pneumonia (BP). Material and Methods: A prospective observational study was undertaken within the Department of General Medicine to examine patients diagnosed with bacterial pneumonia (BP). Detailed records of antimicrobial prescriptions were precisely noted, with subsequent computation of both the Daily Defined Dose (DDD) and Antibiotics Consumption Index (ACI) in accordance with the World Health Organization Anatomical Therapeutic Chemical (WHO ATC) classification system. Additionally, adherence to WHO-prescribed indicators for antibacterial agent utilization was assessed. Dataset containing information of 130 patients was meticulously examined, and subsequent descriptive statistical analyses were applied employing Microsoft Excel and appropriate software packages. Result: The predominant empirical therapy for antibacterial agents was found to be amoxicillin-clavulanic acid, utilized by 73 patients (56%), succeeded by levofloxacin, administered to 33 patients (25%). Following culture and sensitivity testing, the most frequently employed antibacterial agents for definitive therapy included levofloxacin for 31 patients (24.0%), ceftriaxone for 23 patients (17.7%), meropenem for 18 patients (13.8%), and azithromycin for 10 patients (7.7%) and Doxycycline for 6 patients (4.6%). Notably, the highest Antibiotics Consumption Index (ACI) value recorded was 14.2 for amoxicillin-clavulanic acid in empirical therapy, while for definitive therapy; levofloxacin exhibited an ACI of 14.6. A noticeable disparity in ACI values between empirical and definitive therapy was observed (p<0.05), suggesting statistically meaningful differences. Furthermore, a substantial proportion of patients, 115 individuals (88%), received multiple antibacterial prescriptions. The average number of drugs prescribed per patient was 7.69±2.2, with an average of 2.68±1.85 antibiotics per prescription. Approximately 34% of prescribed drugs were denoted by their generic names, indicating a notable size of generic drug usage within the study group. Conclusion: The findings of the present study highlighted a significant pattern in the utilization of antibiotics for the treatment of bacterial pneumonia (BP) within the Medicine Department. This analysis focuses on the need for the implementation of antimicrobial treatment guidelines (Antibiotic policy) within the hospital setting, aiming to enhance the efficacy and rationality of antibiotic usage while concurrently optimizing the allocation of scanty healthcare resources. Such guidelines can work as a crucial framework for clinicians, promoting standardized practices and upholding judicious antibiotic prescribing practices, ultimately contributing to improved patient outcomes and minimisation of antimicrobial resistance. It can also be concluded that tertiary care hospital requires a coordinated mediation to improve rational use of antimicrobials and therefore the clinical outcomes also by improving efficacy and reducing the cost and the chances of adverse effects through establishing an antimicrobial stewardship program and strict implementation of Hospital Antibiotic policy.

DOI: 10.5281/zenodo.10961883

Background: Changes in a woman’s pelvic floor function often accompany menopause. Weakening of the pelvic support structures can lead to pelvic organ prolapse, in which one or more organs (bladder, uterus, urethra, vagina, small bowel or rectum) of the pelvic area drops out of place. This problem affects 50% of parous women, and at least 50% of all women develop a mild form of genital prolapse after pregnancy. Methods: An extensive literature review from 2019 to 2022 was performed on prolapse etiology and its risk factors; analyzing the data, we reviewed the genetic and biological aspects, age-related prolapse, biological tissue modifications, surgical problems, pelvic musculature modifications, and neuropathy. Results: Data suggested that aging, pelvic trauma, and surgery evoke tissue denervation and devascularization, anatomic alterations, and increased degradation of collagen; all of these may lead to a decrease in mechanical strength and predispose an individual to prolapse. It has been demonstrated that there is a reduction in protein content and estrogens in uterosacral ligaments, in the vagina, and in the parametrium of women with prolapse. Increase in age, parity, spacing less than 3 years, increase BMI, delivery by unskilled dais were main contributing factors. Surgical procedures were more satisfying than conservative management with p value 0.04 and PGI I of 2  was highest recorded after surgical intervention. Conclusion: Even if the etiology of pelvic prolapse is poorly defined and multifactorial, aging risk factors, such as biomechanical abnormalities in connective tissue composition, hormonal deficiency, and irregular tissue metabolism, are non-modifiable and therefore largely stated in clinical practice. Regardless of future developments, based on the reported findings, prolapse therapy will be more influenced by genetics, biological pelvic changes, changes in tissue homeostasis, and topical hormones, rather than general pelvic corrective surgical anatomy. Instillation of knowledge of kiegel’s exercise proves to be an important factor for prevention of pelvic organ prolapse. Surgical management proved to be  effective and more satisfying than conservative management.

DOI: 10.5281/zenodo.10962014

Background: In Rheumatoid Arthritis (RA) patients’ involvement of sympathetic and parasympathetic nervous system has rarely been studied. Objective: Evaluation of cardiovascular autonomic neuropathy in RA patients. Material and Methods: 45  RA female patients (age group 35-45 years) along with 45 age and BMI matched female controls  were evaluated by : 30:15 ratio; E: I ratio; BP response to standing; BP Response to sustained handgrip (SHG) by CAN Win analysis system (window based).  Statistical analysis was performed using SPSS software version 20 and Z-test was used to derive the level of significance. Results: The mean 30:15 ratio, E/I ratio, Rise in diastolic blood pressure on SHG were found lower (p value <0.001) whereas mean orthostatic fall in systolic blood pressure was found higher (p value<0.001) in RA patients as compared to control group. Conclusion:  Deranged cardiovascular sympathetic and parasympathetic functions are found in RA patients.

DOI: 10.5281/zenodo.10963343

Background: Plantar fasciitis is defined as localized inflammation and degeneration of the plantar aponeurosis. Heel pain is the most common reason for presentation.” Approximately 10% of the population will experience heel pain in their life. Many methods have already been tried for treating plantar fasciitis, including rest, night splints, Nonsteroidal anti-inflammatory drugs (NSAIDs), foot orthosis, stretching exercises, extracorporeal shock wave therapy, local injection of corticosteroids, and platelet-rich plasma (PRP) therapy has also been used with variable success. Material and Methods: We conducted the study in the Department of Orthopedics and Traumatology at Nalanda Medical College and Hospital, Agam Kuaan, Patna, The study is based purely on clinical observations so no specific investigations were done for outcome analysis. The study was conducted for a total duration of 24 months with a minimum follow-up of 6 months. A total of 60 patients were included in the study. Patients were separated into PRP and steroid groups of 30 subjects each. Results: In our study 60 patients with an average age of 43.6 years. Female to Male ratio is 2.3:1 approx. There was a female preponderance in our study. The majority of the patients were housewives (heavy physical workload). The PRP group had significantly higher mean AFAS and VAS scores at follow-up than the steroid group (p<0.001) There were no complications in 56 patients, 4 patients had a fever, and the patient was given antipyretics and antibiotics for the same and was settled. Conclusion: PRP injection is an effective and well-tolerated alternative to corticosteroid injection in the management of chronic plantar fasciitis with the added advantage of almost no side effects due to its biological nature and better patient compliance. Furthermore, PRP has added analgesic and antimicrobial properties.

DOI: 10.5281/zenodo.10963358

Background: Oral health is an essential component of general health and it plays an important role in improving quality of life. Poor oral health may lead to social and economic consequences in the population, personal and also at health systems levels. These factors can bring serious economic implications in the country. [2] It is thus essential to study oral health problems among people in rural areas to provide appropriate health services.  Objective: (1). To assess the oral health problems among patients attending the Health Training Centres of a Tertiary Care Hospital. (2). To determine the underlying systemic co-morbid conditions among the patients. Methodology: A Retrospective Cross sectional study was conducted for a period 3 months at the Heath Training Centres of a Medical College among patients who attended Dental OPDs. The prevalence of periodontal disease was 39.3% in a study by Vishnuprasad S et al with which sample size was calculated as 300. After obtaining dental OPD registers from the centres, sampling frame for year 2022 was generated and by using simple random sampling, 150 study participants were included in the study from each centre. The collected data from registers were computerised for analysis using SPSS version 21. Descriptive and preliminary inferential data analysis was performed based on the information obtained.  Results: Among the total 300 study participants, 141(47%) were males and 159(53%) were females. It was observed that 31.60% had dental caries followed by periodontal disease (29.3%), other diseases like tooth fracture, leucoplakia, malignancy etc. Diabetes mellitus was the most common co-morbid condition found among the study participants. Conclusion: The prevalence of oral health problems is considerably high among the study population which may lead to poor health status of the population and may even contribute to development of systemic co-morbid conditions.

DOI: 10.5281/zenodo.10963373

Aim of the Study: To study the validity of rapid intra operative diagnosis of glial tumors by examining the squash cytologic smears. Material & Methods: The study was performed over a period of 2 years from November 2019 to October 2021 at Tertiary Care Hospital, Telangana State. We screened 256 inpatients with central nervous system lesions. Results: The present study total of 60 Glial lesion biopsies reported. Out of 60 cases, 39 were consisting of low grade gliomas and 16 were consisting of high grade gliomas. In our study low grade gliomas comprising of 65% and high grade  gliomas were 16 cases (26.6%), non-neoplastic lesions were 3 cases(reactive gliosis) (5%), secondary tumors (metastatic deposits) were 2 cases (3.3%). Conclusion:  Intraoperative squash smear is simple, rapid, reliable and cost effective in the diagnosis of central nervous system tumors. The difficulty on squash smear can be overcome by histopathology and Immuno histochemistry. At present understanding of molecular genetic basis of diseases and application of molecular biology techniques to cell smears offering new approaches for diagnosis, prevention and treatment of central nervous system lesions.

DOI: 10.5281/zenodo.10963380

Introduction:  In the realm of gastrointestinal surgeries, the choice between hand-sewn and stapler anastomosis techniques remains a critical decision for surgeons. Intestinal anastomosis, which establishes communication between segments of the intestine, plays a pivotal role in restoring continuity post-surgery. While hand-sewn anastomosis has long been the conventional approach, stapler devices have emerged as an alternative method offering enhanced precision, reduced operative time, and potentially improved postoperative outcomes. This study aims to provide a comparative analysis of hand-sewn versus stapler anastomosis in elective gastrointestinal surgeries, shedding light on their respective advantages and limitations. Material and Methods: The study, conducted at the Department of General Surgery, Shree M.P. Shah Govt. Medical College, Jamnagar, spanned 12 months and focused on patients undergoing gastrointestinal surgeries necessitating bowel anastomosis. Patients were categorized into two groups: Group A underwent hand-sewn anastomosis using various sutures, while Group B received stapler anastomosis using different stapling devices. Inclusion criteria comprised patients aged 18 to 80 years undergoing elective gastrointestinal surgeries with written consent. Patients were assessed for various parameters such as procedure time, return of bowel sounds, oral feeding resumption, postoperative stay, and complications. Statistical analysis employed independent samples T-Test and Chi-Square tests for comparison, ensuring robust evaluation of outcomes and techniques. Results: The study encompassed 40 cases of resection and anastomosis, with 20 patients undergoing hand-sewn anastomosis and the remaining 20 undergoing stapler anastomosis. The observational comparative design allowed for a detailed examination of the outcomes. Among these cases, 10 involved gastrojejunostomy, 14 involved jejuno-jejunostomy, and 16 involved ileo-colic (right hemicolectomy) procedures. Analysis revealed a trend favoring stapler anastomosis, showcasing shorter operation times, reduced hospital stays, and earlier return to work compared to hand-sewn anastomosis across all three surgery groups. Stapler anastomosis demonstrated advantages such as reduced operation times (ranging from 1.5 to 2.00 hours), shorter hospital stays (ranging from 8.00 to 8.00 days), and earlier return to work (ranging from 2.9 to 4.25 months) in comparison to hand-sewn techniques. Additionally, stapler anastomosis exhibited fewer complications, including lower rates of anastomotic leaks and mortality, highlighting its potential superiority in gastrointestinal surgery. Conclusion: Our study reveals stapler anastomosis as superior to hand-sewn techniques in gastrointestinal surgeries, offering benefits such as reduced tissue injury, shorter operating times, and quicker recovery.

DOI: 10.5281/zenodo.10963392

When a person loses consciousness while standing or walking, they may fall. The direction of the fall (forward, backward, or sideways) depends on various factors. When someone jumps or accidentally falls from a height, different factors influence the types and patterns of injuries they sustain. In this study, we examined autopsies conducted at the VSGH mortuary over a three-year period from 2011 to 2013. We performed 1111 autopsies in 2011, 1181 in 2012, and 1240 in 2013, and among these cases, 5.52% were due to falls from a height. We discovered that over 87% of these deaths were the result of accidental falls, either at the workplace or elsewhere from a height. Males (77.44%) outnumbered females (22.56%) in terms of deaths from falls. The age group of 21-40 years (42.56%) was the most affected, as this is a productive and young age range. Multiple factors influenced the severity of injuries, ranging from no visible external injuries to various external injuries such as contused lacerated wounds (34.35%) and internal injuries such as skull fractures (61.53%).

DOI: 10.5281/zenodo.

Introduction: Magnetic resonance imaging (MRI) is the gold standard for evaluating anterior knee pain (AKP), but it can be expensive and not readily accessible. Ultrasonography is an affordable and easily accessible alternative that provides dynamic evaluation without major contraindications. It has been shown to effectively diagnose knee joint pathologies like joint effusion, bursal fluid accumulation, and meniscal tears. Materials and Methods: This cross sectional study included 80 patients with anterior knee pain who had both an ultrasonography and a recent MRI. One radiologist performed all the USG and the other interpreted all the MRIs. Both radiologists had at least 8 years of experience in performing USG and MRI. Diagnostic accuracy of ultrasonography as compared to MRI was analyzed using receiver operating characteristic curve (ROC). Results: Ultrasonography had an overall diagnostic accuracy of 77.1%, sensitivity of 78.5% and specificity of 70.0% for AKP. It showed high sensitivity in detecting a bipartite patella (100%), infrapatellar bursitis (100%), joint effusion (93.9%), suprapatellar fat impingement (92.3%), and quadriceps tendinopathy (90.0%). However, it had low sensitivity in detecting patellar cartilage defects (0.0%), trochlear cartilage defects (78.9%) and Hoffa’s fat pad impingement (70.0%). Conclusion: Ultrasonography is a valuable diagnostic tool for anterior knee pain (AKP). However, it does have limitations in detecting cartilage defects and Hoffa’s fat pad impingement, which can be better visualized using MRI.

DOI: 10.5281/zenodo.