Background: Heart rate variability (HRV) is considered an indicator of cardiovascular health. Women generally show a lower risk of coronary heart disease and serious arrhythmias compared to men, with a significant delay in the incidence of sudden death. This disparity suggests potential gender differences in autonomic modulation. We in the current study aimed to evaluate the Heart rate variability in young adult male and female students of our institute. Methods: The study involved 120 participants (60 males and 60 females). We measured anthropometric parameters such as age, height, weight, and BMI. Baseline characteristics, including resting heart rate and systolic and diastolic blood pressure, were recorded during five minutes of supine rest. HRV parameters like total power, low frequency, low frequency normalized units, high frequency, high frequency normalized units, and low frequency/high-frequency ratio were analyzed using ECG recordings. Results: Males have a significantly higher LF power in milliseconds squared (ms²) compared to females (p=0.023). This suggests greater sympathetic activity or response to stress in males. While the average normalized LF power (nu) is also higher in males, the p-value (0.051) is borderline significant. It suggests a possible trend but needs further investigation. Females have a significantly higher HF power in ms² compared to males (p=0.019). Conclusion: Our study shows that there are possible gender differences in heart rate variability (HRV) among young healthy individuals. Males were more likely to have low frequencies which might be being regulated sympathetically. This corresponds to the previous findings that sympathetic dominance might be related to the cardiovascular disease risk.

DOI: 10.5281/zenodo.

Introduction: Lymphadenopathy, often known as the swelling of lymph nodes, is a common illness that is often encountered in clinical settings. FNAC has become an essential diagnostic technique for identifying the root causes of lymphadenopathies. A new category approach for the classification and reporting of lymph node cytopathology was presented at the 20th International Congress of Cytology in Sydney in May 2019, bringing about a significant transformation in the discipline. Materials and Methods: This retrospective study was carried out at a single center over the course of two years, and it involved the review of slides from cytology and histopathology by two pathologists with extensive experience. The objective of the study was to assess the performance of the Sydney system in terms of its diagnostic accuracy and clinical utility for reporting lymph node cytopathology. Results: The findings showed that the majority of cases (41 cases) were discovered in patients between the ages of 11 and 20. There were 127 cases of lymphadenopathy in the cervical region, which was the region with the highest number of cases. The majority of instances, which totaled 143, were deemed to be benign. It is important to note that the Sydney method has a high diagnostic accuracy, as evidenced by the fact that the study discovered a Risk of Malignancy (ROM) of 100% in categories IV and V, 50% in category III, and 3.8% in category II. Conclusion: This study demonstrates that FNAC is a safe, cost-effective procedure for diagnosing lymph node lesions. Furthermore, the Sydney system provides an effective framework for classifying and reporting lymph node cytopathology, aiding in patient management and treatment decisions.

DOI: 10.5281/zenodo.

Background: Coronaviruses are RNA viruses that are phenotypically and genotypically myriad. In this Review, we light on the basic virological concept of SARS-CoV-2, including genomic attributes and receptor use, highlighting its role key variance from previously known coronaviruses. The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which is also called, as the 2019 novel coronavirus (2019-nCoV) was rapidly spreaded from its origin in Wuhan City of Hubei Province of China to all parts and became a cosmopolitan problem for world. Around 704,539,018 cases of coronavirus disease 2019 (COVID-19), 7,008,958 deaths and 675,395,611 have been reported till 31/ 03/2024 in the world. India has reported 45,034,136 cases, and 533,547 deaths till 31/ 03/2024. But the future course of this virus is unknown. Coronaviruses are known to be associated with a variety of diseases in humans and domestic animals. It has been postulated that the proximity of humans to wild animals might have led to animal pathogens jumping across species from animals to humans, and become the causative pathogen in the latter. It is important to determine whether there is an animal reservoir, as breaking transmission of the virus may be more difficult and a recurrence of the disease is more likely. The clinical manifestations of COVID-19 are found myraid, ranging from asymptomatic state to acute respiratory distress syndrome and multi organ dysfunction. Common characteristics wasclude fever,  cough, sore throat, headache, fatigue, headache, myalgia and breathlessness. Conjunctivitis has also been described. Thus, they are indistinguishable from other respiratory infections. In a subset of patients, by the end of the first week the disease can progress to pneumonia, respiratory failure and death. This progression is associated with extreme rise in inflammatory cytokines including IL2, IL7, IL10, GCSF, IP10, MCP1, MIP1A, and TNFα. This finding suggests that receptor usage may not be the only factor that determines the severity of HCoV infection. Dipeptidyl peptidase 4 (DPP4, also known as CD26), the receptor for MERS-CoV, is a multifunctional cellsurface protein widely expressed on epithelial cells in kidney, small intestine, liver and prostate and on activated leukocytes. DPP4 is expressed in the upper respiratory tract epithelium of camels. In the human respiratory tract, DPP4 is mainly expressed in alveoli rather than the nasal cavity or conducting airways. DPP4 is a key factor in the activation of T cells and immune response costimulatory signals in T cells, which could indicate a possible manipulation of the host immune system. Human aminopeptidase N (CD13), a cell-surface metalloprotease on intestinal, lung and kidney epithelial cells, has been identified as the receptor for hCoV229E. The receptor for HCoV-OC43 is 9-O-acetylated sialic acid. Currently, the receptor for HCoV-HKU1 has not been identified. Aim: This article may try to gives a blue eye view about this new virus. Since knowledge about this virus is rapidly updating and evolving, readers are urged to update themselves regularly. Discussion: Current understanding of the pathogenesis of HCoVs infection is still limited. However, several significant differences in the pathogenesis exist among SARS-CoV, MERS-CoV and the other HCoVs. Cell entry and receptors. The critical first step for HCoV infection is entry into the susceptible host cells by combining with a specific receptor. Spike proteins (S proteins) of HCoVs are a surface-located trimeric glycoprotein consisting of two subunits: the N-terminal S1 subunit and the C-terminal S2 subunit. The S1 subunit specializes in recognizing and binding to the host cell receptor while the S2 region is responsible for membrane fusion. To date, a wide range of diverse cellular receptors specifically recognized by the S1 domains have been identified for all HCoVs except HCoV-HKU1. ACE2, the receptor for SARS-CoV and HCoVNL63. is a surface molecule localized on arterial and venous endothelial cells, arterial smooth muscle cells, epithelia of the small intestine and the respiratory tract. In the respiratory tract, ACE2 is expressed on the epithelial cells of alveoli, trachea, and bronchi, bronchial serous glands, and alveolar monocytes and macrophages. Conclusion: The 2019 novel coronavirus (2019-nCoV) outbreak is a major challenge for clinicians, and social, economic & public health prosperity to almost whole world. In India the economic progress and prosperity sturdily challenged and affected. The clinical course of patients remains to be fully characterized, little data are available that describe the disease pathogenesis, and no pharmacological therapies of proven efficacy yet exist.

DOI: 10.5281/zenodo.

Background and Objectives: Antiretrovirals, as most other chronically administered drugs, are reported to have adverse reactions, and particularly higher occurrences are seen at the beginning of ART. The main aim of this study is to gain knowledge on the profile of early onset ADRs associated with antiretroviral drugs, the burden of ADRs of ART in this setup with the ultimate goal of improving the patients’ compliance and effectiveness of treatment. Methods: An observational longitudinal study conducted at ART Centre of Tertiary care hospital of Eastern Gujarat. Data was collected through active pharmacovigilance and ADRs were recorded through ADR reporting forms. ADR causalities were assessed through WHO and Naranjo’s causality scale, Severity was assessed through Modified Hartwig and Siegel Scale and Preventability was assessed through Modified Shumock and Thorton criteria. Results: A total of 431 patients were interrogated in 6 months, of which 93 patients (21.58%) reported a total of 141 ADRs. ADRs were associated more with TDF+3TC+EFV Regimen. Most common system involved was gastrointestinal system (41.13%) followed by nervous system (34.04%) and the most frequently reported ADRs were of Nausea (17.73%) and Dizziness/Vertigo (17.02%). Majority of ADRs observed under Mild (83.69%) category. Causality assessment of suspected drug using WHO and Naranjo’s scale revealed maximum ADRs were Possible (94.33% and 79.43%). Maximum ADRs were not preventable (59.57%). Interpretation & Conclusion: We can improve the quality of care to patients living with HIV by providing an ADR profile, thus enabling a direct approach for the early detection and subsequent treatment of adverse drug reactions. To optimize adherence and hence effectiveness of treatment, clinicians must focus on preventing adverse effects whenever possible and distinguishing between self-limited and easily treatable ones from the potentially serious ones.

DOI: 10.5281/zenodo.

Introduction: The severity of symptoms of Dengue patients depends upon their nutritional status. Therefore, study on relation of vitamin D deficiency with severity of dengue patients needed attention. Vitamin D plays a crucial role in regulating bone metabolism and maintaining calcium and phosphorus levels in the body. It has been found to be associated with autoimmune diseases, metabolic syndromes, cardiovascular disease, cancers, and all-cause mortality. There is an increasing interest in the potential role of vitamin D in Dengue viral infection. Dengue patients had major complain of severe bodyache, fatigue when other symptoms are absent, which is variable in different patients. Aim: To identify a possible association between low levels of systemic 25-(OH) D and the likelihood of developing severe dengue fever. Materials and Methods: This was a single-center, cross-sectional study conducted in the Department of Medicine, Dr. RMLIMS, Lucknow, Total 156 Dengue patients were taken after confirmation from NS1 Ag and IgM positive reports. Serum vitamin D levels were measured at the time of admission in all patients. MS Excel and R-4.3.2 statistical software were used for statistical analysis. A p-value < 0.05 was considered significant. All statistical tests were two-sided. Results: The results reflected mean age of 36 years with SD of 14.428 and low Serum Vitamin D < 20 ng/ml (P-value 0.944). Out of total (n= 156), 47.4% (n=74) were females and 52.6% (n=82) were males. The levels of vitamin D ranges between 5 and 109 ng/ml. Serum vitamin D was found deficient in 66.7% (n=102) of total Dengue patients. The prevalence of Dengue without warning signs, Dengue with warning signs and severe Dengue fever (according to the latest classification of WHO- 2021, for Dengue) was found to be 69.5%, 75% and 89% respectively in low vitamin D patients. Studies were also done for various demographic characteristics and clinical features in dengue patients with vitamin D deficiency. Conclusion: The study concludes that severity of Dengue patients was directly related and more in low vitamin D patients. The present study revealed that serum vitamin D may contribute in the pathogenesis of dengue infection; thus, vitamin D levels might serve as useful prognostic marker for predicting disease progression.

DOI: 10.5281/zenodo.

Background: Ansa cervacalis is a nerve loop which gives branches to innervate the infrahyoid group of   muscles.  Any injury to these muscles would cause disturbance in phonation.  The Ansa cervicalis nerve loop is formed by superior root i.e arise from the cervical spinal nerves (C1-C2) inferior root is descending from C2-C3 .In the present study, We aim to document anatomical variations of Ansa cervicalis and can be important acknowledgment in specific surgeries of the neck region and its clinical implications. Materials & Methods: During routine dissection of adult cadavers of age 30-60 years old at department of anatomy, Rangaraya Medical College, Kakinada. while performing neck dissection, location and level of ansa cervicalis are  observed in 25 cadavers on both sides of neck (50 hemineck dissections). Results: Among 50 hemineck dissections (In 25 cadavers ), 1 hemineck dissection on right side of neck showing abnormal location of ansa cervicalis i.e inside to the carotid sheath and in remaining 49 hemineck dissections ansa cervicalis is located on anterior aspect of carotid sheath intermediate level ansa seen in 40 hemineck dissections, low level ansa seen in 10 hemineck dissections but high level ansa not observed in any hemineck dissection. Conclusion: Knowledge regarding the location & level of ansa cervicalis is very useful to ENT Surgeons ,Head and neck surgeons, Onco surgeons to minimize the complications like paralysis of infrahyoid muscles while performing surgeries over the neck.

DOI: 10.5281/zenodo.

Background: The supraclavicular block provides effective anesthesia for the brachial plexus for surgical procedures at or below the elbow level. Traditionally, the landmark technique has been used, but this blind method often necessitates multiple needle attempts through trial and error, leading to prolonged procedure times, associated pain, discomfort, and potentially severe complications. Peripheral nerve locator, a newer technique, offers advantages such as reduced procedure time, less pain, and discomfort, and fewer complications. This study aimed to compare two techniques in terms of the time required for the procedure, the onset and duration of sensory and motor blockade, and the overall effectiveness of the block. Methods: Surgeries involving upper limbs. Patients belonging to the American Society of Anesthesiologists Grade I & II. Patients of either sex, aged between 15-70 years. In one group (Group C, n=30), the conventional subclavian perivascular technique was employed, while in the other group (Group NS, n=30), the supraclavicular nerve block was administered under peripheral nerve locator guidance. In both groups, the block consisted of 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with 1:200,000 adrenaline. Results: The nerve locator technique was quicker (average time: 5.66 minutes) than the conventional method (8.7 minutes), potentially due to simpler procedures in the latter. The nerve locator approach significantly accelerated the onset of both sensory and motor blocks (p<0.005), likely because of direct nerve stimulation and more precise injections. It also prolonged the duration of these blocks (p<0.005) and achieved a higher success rate, with 97% complete block compared to 73% in the conventional group. Both methods exhibited low complication rates, which might be attributed to the use of short needles and correct techniques. Conclusion: Our study reveals that among the available anesthesia techniques to be utilized for the supraclavicular blocks during upper limb surgeries, locating a nerve with a nerve locator results in an early onset of both sensory and motor blockade and a prolonged blockade duration and a decreased need of analgesics both during and after surgery. Furthermore, this technique is seen to have a relatively higher success rate and fewer complications.

DOI: 10.5281/zenodo.

Background and Aim: Clinical profile of patients having tachypnoea in tertiary care hospitals reflects the burden in the community and identifying the risk factors for mortality and morbidity in the children between 2months to 60 months, will help proper utilization of available resources and ensure adequate management of these children. Aim of this study was to identify the various causes of tachypnoea among 2months to 60 months old and to analyze various factors influencing morbidity and mortality patterns among them. Material and Methods: Present Descriptive observational study was conducted at Paediatric ward in a tertiary care hospital in All Indoor patients between 2 months to 5 years for the duration of 6 months. A structured proforma was prepared, after taking consent from the parents, detailed history with presenting complaints and detailed general and systemic examination was done. Nutritional status assessed using WHO Z score weight for Age. WHO weight for age less than -2 Z score is considered as a risk factor in this study. Details regarding immunization were taken from parents and immunization cards. Results: Out of 846 total admissions, 145 children (2 months – 5years of age) had Tachypnea, overall occurrence of Tachypnea was 17.13%. Occurrence of tachypnea among 2 months – 12 months (Infants) was 24.53% and 13 months to 60 months was 11.13%, more number of infants was suffering from tachypnea owing to the infantile respiratory anatomy they have. More deaths were observed in infantile age group. 54 children admitted with tachypnea had longer hospital stay (>7 days) out of which 28 were suffering from pneumonia, 6 were suffering from underlying CNS disease and 5 had septic shock. Conclusion: Prevention of anemia and malnutrition will significantly improve the less than 5 morbidity and mortality. Strengthening of immunization is still required even in urban areas. Introduction of pneumococcal vaccine and flu vaccine will help to improve less than 5 morbidity and mortality.

DOI: 10.5281/zenodo.

Background: Epidural administration of ropivacaine offers effective analgesia, minimal motor blockade, and cardiac stability. The incorporation of adjuncts such as dexmedetomidine extends the duration of analgesia, prolongs motor blockade, and ensures sufficient sedation. Our research directly compares the effects of ropivacaine alone versus ropivacaine combined with dexmedetomidine on block characteristics, postoperative pain relief, and sedation levels. Methods: A total of 60 cases were identified and included in the study during the duration of the study. They were equally and randomly allotted by a computer-generated random number into one of the two groups.  Group I (n=30) received 15 ml of 0.75% ropivacaine (Ropivacaine 0.75% preservative-free 0.75% 20 ml ampoules.  Group RD (Number of patient-50) 15ml of 0.75% ropivacaine + 0.6µg/kg of dexmedetomidine (inj.1ml = 100µg, 1ml ampoule). Results:  There were no significant differences between the two groups regarding age, sex, height, weight, or body mass index. On average, Group II achieved a slightly higher level of sensory block, but the difference wasn’t statistically significant.  Group I experienced a more complete motor block (no leg movement) compared to Group II. Patients in Group II had deeper sedation levels compared to Group I. The sensory and motor blocks lasted significantly longer in Group II compared to Group I. Group II experienced a significantly faster onset of both sensory and motor blocks compared to Group I. Overall, the findings suggest that adding Dexmedetomidine to Ropivacaine (Group II) might lead to deeper sedation but result in a less complete motor block compared to using Ropivacaine alone (Group I). Conclusion: The Dexmedetomidine group exhibited a rapid onset of action, prolonged duration of sensory and motor block, improved sedation scores, and a more pronounced motor block. No difference was noted in the maximal dermatomal level of analgesia, and any associated side effects such as bradycardia and hypotension did not pose significant challenges to the hemodynamic profile.

DOI: 10.5281/zenodo.

Objective: To determine the prevalence of vitamin D deficiency in Indian children hospitalized with diarrhea and evaluates the association between vitamin D status and severity of diarrhea. Methods: A hospital-based cross-sectional study was conducted from June 2023 to March 2024 in Nalanda Medical College and Hospital in the state of Bihar, India. Infants and young children aged 6–60 months hospitalized with diarrhea were recruited. Serum blood samples were collected on admission and analyzed for total serum 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 concentrations using liquid chromatography-tandem mass spectrometry. Vitamin D deficiency was defined as a level of serum vitamin D <50 nmol/L. The association between vitamin D deficiency and severity of hospitalized diarrhea patients according to WHO criteria, including the presence of danger signs, signs of severe dehydration, shock, duration of hospitalization, and admission to Intensive Care Unit (ICU), was analyzed using logistic regression. Results: 133 children with WHO-defined diarrhea were enrolled in the study and 127 (96%) had their vitamin D status determined. The mean vitamin D concentration was 56 (± 18 SD) nmol/L and 30.7% of participants were vitamin D deficient. Age younger than 12 months was associated with prolonged hospitalization (> 5 days) and low birth weight and poor nutritional status on admission were risk factors for severe dehydration. However, vitamin D status was not associated with the presence of danger signs, duration of hospitalization, or severe dehydration. Conclusions: One in every three children hospitalized with diarrhea was vitamin D deficient. Vitamin D status was not associated with the severity of diarrhea.

DOI: 10.5281/zenodo.

Introduction: Aedes aegypti mosquitoes are common carriers of dengue virus (DENV) and CHIK virus (CHIKV). At times where both viruses coexist, they can spread simultaneously. There are extremely few investigations on the dengue-chikungunya coinfection, which results in the difficulty in treatment aspects. Methodology: In the present study 200 suspected samples were subjected to the presence of antibodies sensitive to DENV for detection of NS1 antigen and Dengue IgM and the Chikungunya IgM was used for diagnosis of chikungunya. Results: A total of 200 samples from suspected patients for dengue infection, 29 (14.5%) samples were positive for DENV NS1. While 21 (10.5%) were tested positive for DENV IgM, 11 (5.5%) samples were positive for CHIK IgM antibodies. A total of 7 (3.5%) patients showed dengue chikungunya coinfection. Conclusion: The rise in the rate of Dengue and Chikungunya illnesses, as well as their cocirculation, is an important health issue that necessitates intensive prevention and control strategies.

DOI: 10.5281/zenodo.

Background: Infectious diseases significantly contribute to morbidity and mortality in our country, with tuberculosis, falciparum malaria, and leptospirosis being common causes of death. This study aims to investigate the causes, clinical features, and associated organ dysfunction in patients with acute febrile illnesses and acute renal failure. Methods: This cross-sectional study was conducted in the Department of General Medicine, Government Medical College, and Hospital, Wanaparthy, Telangana State. Patients over 18 years old with an acute febrile illness and a platelet count below 150,000/mm³, who have acute kidney injury due to Dengue, Malaria, Leptospira infection, Rickettsial fever, Typhoid, or Chikungunya, confirmed by laboratory tests. AKI was diagnosed based on the recent KDIGO AKI Guidelines. Results: A variety of AFI diagnoses were identified, with Dengue being the most frequent, followed by Malaria, Scrub Typhus, Leptospirosis, and unspecified causes. The majority of patients (64.0%) presented with mild thrombocytopenia. A significant proportion also had moderate (18.0%) and severe thrombocytopenia (18.0%). Dengue appeared to be associated with a higher risk of moderate and severe thrombocytopenia compared to other diagnoses. A significant proportion of patients (50.0%) developed AKI during their AFI illness. Dengue and Leptospirosis were associated with a higher prevalence of AKI compared to other diagnoses. The severity of AKI also differed based on the diagnosis. Dengue and Leptospirosis had a wider range of AKI stages, while Scrub Typhus and Malaria had mostly less severe stages. Conclusion: This study highlights the complex clinical picture associated with AFI and thrombocytopenia. While Dengue appears to be the most common diagnosis, other infectious agents can also contribute. The presence of thrombocytopenia is a frequent finding, with Dengue potentially leading to more severe cases. The study also emphasizes the significant risk of AKI in this patient population, particularly with Dengue and Leptospirosis.

DOI: 10.5281/zenodo.

Introduction: Snakebite envenomation represents a persistent health challenge, particularly in regions like India, where it exacts a considerable toll in terms of morbidity and mortality. Despite efforts to address this issue, gaps persist in understanding the treatment patterns and outcomes associated with snakebite incidents. In this study, we aim to investigate the patterns of snakebite envenomation treatment and its outcomes, focusing on factors such as treatment timing, anti-snake venom administration, complications, and mortality rates. Material and Methods: This prospective observational study, conducted over an eight-month period at a tertiary care center in Mumbai, aimed to investigate the time interval between snake bite incidents and the administration of anti-snake venom (ASV) as a prognostic indicator of patient outcomes in snake bite envenomation cases. Patients presenting with confirmed snake bite envenomation were included, and detailed clinical assessments, including history, physical examination, and laboratory investigations, were conducted. ASV administration and clinical outcomes were closely monitored, with data analyzed to assess the association between treatment timing and patient outcomes. The study underscores the importance of timely intervention in snake bite management to improve patient prognosis. Results: In our study involving 80 patients treated for snake bite envenomation, significant findings emerged regarding demographics, treatment timing, complications, and outcomes. A notable gender disparity was observed, with males comprising 58.75% of cases, and individuals aged 19-30 years represented 22.5% of the cohort. Kraits were the most common snake species encountered (41.25%), followed by Vipers (25.0%) and Cobras (18.75%), with 15.0% of cases involving unidentified species. Most patients received anti-snake venom within 6 hours of the bite (47.5%), and the distribution of ASV vials varied significantly, with 37.5% receiving 5 vials and 25.0% receiving 20 vials. Complications, predominantly cellulitis (56.25%) and acute kidney injury (37.5%), were observed, alongside an overall mortality rate of 8.75%. Notably, associations were found between treatment timing, vial administration, and mortality rates, emphasizing the critical importance of timely intervention and appropriate management strategies in snake bite cases (p<0.05). Conclusion: Our study highlights key associations in snakebite management, revealing that prompt anti-snake venom administration within 6 hours correlates with increased vial usage and longer hospital stays. Additionally, higher vial usage is linked to higher mortality rates, emphasizing the critical importance of timely intervention in improving patient outcomes.

DOI: 10.5281/zenodo.

Introduction: Quality control is important in a laboratory to detect errors and to reduce false rejections. Sigma measures how far a given process deviates from perfection. Sigmametrics can be applied wherever an outcome of a process has to be measured. A poor outcome is counted as an error or defect. Sigma metrics shall be calculated from CV, percentage bias and total allowable error for the parameters by the following formula: sigma= (TEa- bias%) / CV%. The quality goal index (QGI) ratio represents the relative extent to which both bias and precision meet their respective quality goals. Aims and Objectives: 1. To understand the value of Six Sigma performance and apply it to quantify our laboratory performance on Sigma metrics. 2. To estimate the quality goal index of the biochemical parameters. Materials and Methods: The study was conducted in the central biochemistry laboratory at ACSR Government medical college Nellore. We run internal quality control level 1 and level 2 daily. We participate CMC VELLORE EQAS program for chemistry II parameters. In this study the control data for a period of six months from January to June 2020 on nine parameters were studied for sigmametrics. Inclusion criteria: Only those parameters enrolled for external quality control (i.e Chemistry II) were included in the study. Institutional ethical committee clearance was obtained. Results & Discussion: In our study sigma values for nine biochemical parameters were calculated from both internal quality and external quality control values as sigma calculation requires C.V, Bias and TEa values.  Quality Goal index calculation in our study revealed that 37 values were due to imprecision, 36 values showed inaccuracy and 11 values were due to both imprecision and inaccuracy and 24 values showed six sigma (N=108). Sigma metric analysis helps to improve the quality of lab performance by giving a scope for thorough root cause analysis. Conclusion: In our laboratory world class performance was obtained for analytes uric acid, bilirubin, albumin and triacylglycerol. Application of sigmametrics helps to reduce number of control measurements and control limits. Calculation of Quality Goal Index helps to identify whether the error was due to imprecision or inaccuracy or both.

DOI: 10.5281/zenodo.

Adenoid basal cell carcinoma [BCC] is a rare histological subtype of basal cell carcinoma, which is the most prevalent form of skin cancer. This variant is distinguished by unique histopathological features that can make it challenging to differentiate it from other similar lesions, such as adenoid cystic carcinoma. Typically presenting in sun-exposed areas of the body, adenoid BCC highlights the significant role of ultraviolet [UV] radiation in its development.

DOI: 10.5281/zenodo.

Background: Cesarean section (CS) is one of the most common obstetric procedures worldwide, and an increased rate of cesarean section has been observed in recent studies. Maternal mortality and morbidities associated with repeat cesarean section is a significant health problem worldwide. It can save the life of the mother and newborn but is also known to have the typical complications of any major surgery: hemorrhage, infection, venous thromboembolism and complications of anesthesia, sometimes leading to maternal death. Aims and Objectives: To study the types and frequencies of intra-operative surgical complications and immediate maternal and perinatal outcomes associated with repeat cesarean sections, which will help identify the magnitude of problems and improve feto-maternal care. Methodology: This is a prospective study conducted in the Department of Obstetrics   and Gynaecology, in SV medical College during the period from October 2022 to June 2023. One hundred women with pregnancies randomly selected those meeting the inclusion. All women in this study who underwent a repeat cesarean section are divided into two groups based on the number of previous sections. Results:  The incidence of placenta previa and placenta accrete was 14.8% and 3.7%, respectively. Adhesions in women with previous one cesarean section (45.2%), dense adhesions in previous two or more cesarean sections (51.8%) than in women, TLUS was in 51.8% women, Scar Dehiscence in 33.3%. Excessive Blood Loss complication was in 33.3%.low birth weight, low Apgar, preterm delivery was more common in previous sections. Conclusion: In conclusion, fetomaternal complications are increased in multiple repeat cesarean sections. Risk reduction may be possible by managing in tertiary centres, following strict indications in first CS, regular antenatal checkups, and prior anticipation and preparedness for complications.

DOI: 10.5281/zenodo.

Background and Aim: Video laryngoscope (VL) is currently introduced Intubating device with high resolution CMOS camera. The primary aim of this study was to compare the efficiency of video laryngoscope with direct laryngoscope regarding their usefulness for tracheal intubation for elective surgical procedure. We compare suitability of video laryngoscope with direct laryngoscope in terms of glottic exposure time, tube insertion time, total duration of intubation, Number of attempts, Cormack and Lehane grading, optimization Maneuvers, Complications and hemodynamic changes. Materials and Methods: After taking written informed consent, patients between age of 18-60 years of both gender and ASA grade I and II scheduled to undergo elective general surgery were included. Patients with oral pathology, needing rapid sequence intubation and not willing were excluded. The patients were randomly assigned into Group V (video laryngoscope) and Group-M (Macintosh laryngoscope) using sealed envelope method. Glottic exposure time, tube insertion time, total duration of intubation, Number of attempts, Cormack and Lehane grading and optimization Maneuvers were recorded at the time of intubation. Haemodynamic and complications were recorded perioperatively. Results: Attempts of intubation, optimization maneuvers and complications were comparable amongst both the groups. Glottic exposure time and total duration of intubation time was more and quality of glottic visualization was better with video laryngoscope than with Macintosh Laryngoscope. Hemodynamic parameters were better in group V than in group M. Conclusion: Video laryngoscope takes short time to achieve successful intubation, offer hemodynamic stability and better quality of glottic view than Macintosh during intubation. Video laryngoscope less frequently need assist maneuvers, so facilitates intubation with less complication. Both devices are useful for routine intubation in adult patients.

DOI: 10.5281/zenodo.

Purpose: To evaluate the presence of COVID-19 viral RNA in conjunctival secretions of moderate to severely ill hospitalized patients with COVID-19 and to find its association with clinical and laboratory characteristics of patients. Methods: Total of 98 subjects from the COVID-19 admission unit with laboratory-confirmed SARS-CoV-2 infection was included. Presence of any ocular manifestations were noted and asked for via a questionnaire and RT-PCR conjunctival swab testing for Corona virus was done by on duty ophthalmologist. Results: 51(52.04%) out of 98 subjects were males. 11 patients (11.2%) had viral RNA detected by RT-PCR, 4(4.08%) patients had inconclusive results and remaining were negative. In the positive group males significantly outnumbered females [p=.008], 5(45.45%) had some co-morbid condition, 2(18.18%) of them had conjunctivitis and the TLC (total leukocyte count) and NLR (neutrophil lymphocyte ratio) were significantly lower in this group [p=.01]. Mortality rate in conjunctival swab positive patients was 54.54% (6 out of 11), while it was 24.13% (21 out of 87) in swab negative patients. Conclusion: Lower TLC and NLR along with appreciably higher mortality rates in the positive group tells us that the severity of the disease cannot only be judged by the laboratory parameters but also by the wide dissemination of the virus in other tissues like conjunctiva and thus conjunctival swab testing can be used as an additive tool and serve as a marker of prognostic value.

DOI: 10.5281/zenodo.

Introduction: Peripheral venous cannulation and propofol infusion can induce preoperative pain, impacting postoperative discomfort. Understanding this link aids in tailored pain management. This study assesses preoperative pain’s predictive value for postoperative pain, aiming to enhance perioperative care guidelines and improve surgical patient outcomes. Methods: Before surgery, patients underwent pre-anesthetic evaluation, including history-taking, vital signs assessment, and basic tests. They were instructed on using a VAS slide ruler to rate pain. Oral medications were administered, and a research investigator cannulated a vein, recording pain levels. Anesthesia comprised propofol, fentanyl, and vecuronium bromide for laparoscopic cholecystectomy. Postoperatively, pain severity was monitored, with fentanyl administered as needed. Results:  The study comprised 130 members, with a mean age of 36.15 ± 11.13 years and 28.5% males. ASA grade distribution was 46.9% grade I and 53.1% grade II. Mean intraoperative fentanyl dose was 114.08 ± 29.64 mg. Preoperative VAS scores varied between venous cannulation and propofol injection. Postoperative fentanyl dosing and timing varied, with significant differences observed in VAS scores. Conclusion: Preoperative assessment of pain during venous cannulation and propofol infusion is vital. Tailored pain management is crucial, aiming to maintain postoperative pain below 4.0 VAS units. Reduced pain threshold during these procedures correlates with lower likelihood of postoperative discomfort. Preoperative pain assessment can be easily conducted at the bedside, potentially improving patient outcomes.

DOI: 10.5281/zenodo.

Introduction: The escalating prevalence of obesity and hypertension in adolescents aged 11 to 15 years is a global health concern. This study aims to assess their prevalence and potential correlations, crucial for informing interventions to mitigate long-term health risks and promote healthier lifestyles in this vulnerable population. Methods: This cross-sectional study took place at the Department of Pediatrics, District Government General Hospital, Vijayanagaram. Ethical approval was obtained, and written consent from parents was secured. A sample size of 2854 children, aged 11-15, from Vijayanagaram town, excluding those with chronic illnesses, underwent data collection and analysis using SPSS version 19, employing chi-square test and logistic regression. Results: Government schools exhibited a higher proportion of male students (18.4%), contrasting with private schools where females predominated (22.6%). Gender distribution disparities were significant. Among 2854 children, 47.5% were above the poverty line, and 55.9% were uneducated. Mean BMI was 17.76 ± 3.013, with 1.9% classified as obese, notably higher in government schools (1.1%). Significant differences were observed between obesity and economic status. Conclusion: The study highlights the concerning prevalence of obesity and hypertension among adolescents, emphasizing the urgent need for intervention strategies. Disparities in gender distribution, school type, and economic status underscore the multifaceted nature of these health issues.

DOI: 10.5281/zenodo.

Introduction: Chronic kidney disease (CKD) complicates lipid metabolism and diabetes mellitus (DM), contributing to dyslipidemia and increased cardiovascular risk. This study aims to explore the association between serum lipid levels and diabetes in CKD patients, informing tailored management strategies for mitigating cardiovascular complications in this challenging patient population. Methods: A prospective study conducted at NRI Medical College, Andhra Pradesh, spanning 18 months, aimed to investigate the association between serum lipid levels and diabetes in CKD patients. Ethical approval was obtained, and informed consent was obtained from participants. Physical examinations and detailed clinical histories were conducted. Blood samples were collected after an overnight fast, processed for lipid estimation, and analyzed using SPSS version 17.0. Statistical analysis included the student t-test, with significance set at p < 0.05. Results: Statistical analysis revealed higher total cholesterol (TC), triglyceride (TG), very low density lipoprotein levels, and lower low density lipoprotein levels in DM individuals compared to non-DM counterparts. HDL levels were slightly lower in DM patients. These findings indicate an association between DM and altered lipid profiles, with dyslipidemia more pronounced in diabetic individuals, suggesting potential cardiovascular risk. Conclusion: This study highlights the complex interaction between dyslipidemia, DM, and CKD. Elevated TG levels were observed in both DM and CKD, while DM individuals displayed higher TC and TG levels. Comprehensive lipid management strategies are crucial in mitigating cardiovascular complications in these populations.

DOI: 10.5281/zenodo.

Introduction: Severe acute pancreatitis (SAP) requires accurate severity prediction. Studies show mixed results on BISAP and Ranson’s scores. While some favor BISAP’s early prediction, others find comparable accuracy. The debate continues, balancing BISAP’s simplicity with Ranson’s comprehensiveness. Future research aims to refine scoring systems and incorporate advanced diagnostic tools. Methods: Demographic, clinical, and biochemical data were collected at baseline and 48 hours post-admission. Ranson’s and BISAP scores were assigned to each patient and compared with the revised Atlanta classification for acute pancreatitis (AP). Parameters evaluated included age, gender, etiology, and various biochemical markers, among others, with data tabulated and graphically presented. Results: Among 101 patients, BISAP scores distribution was: 5.94% scored 0, 24.75% scored 1, 34.65% scored 2, 18.81% scored 3, 10.89% scored 4, and 4.95% scored 5; mean score was 2.18±1.23. SAP was observed in 27.72% of patients, with 6.93% mortality. Ranson’s score ≥3 was in 36% of patients. BISAP score demonstrated higher predictive ability for SAP (OR=2.67, P=0.0003) than Ranson’s (OR=1.47). Conclusion: Our study provides evidence supporting the superior predictive capability of the BISAP score compared to Ranson’s criteria in identifying SAP cases. Early risk stratification using the BISAP score can aid clinicians in optimizing patient management and improving outcomes in AP.

DOI: 10.5281/zenodo.

Introduction: Pancreatitis is a significant medical concern, characterized by inflammation of the pancreas and presenting as acute or chronic forms. Understanding its severity and classifying complications is crucial for effective management. Diagnostic modalities such as ultrasound (USG) and computed tomography (CT) play vital roles in assessing pancreatitis. While USG offers non-invasive imaging, CT provides precise lesion definition. This study aims to evaluate the efficacy of USG in diagnosing pancreatitis and compare findings with CT. Materials and Methods: Study was conducted at Agartala Government Medical College, this observational study included 50 patients over two years. Ethical clearance was obtained, and written consent was acquired. Patients underwent both USG and CT examinations using appropriate equipment. Data analysis employed statistical tools for comparison and presentation. Results: Among the 50 patients, the majority fell within the 30-to-50-year age group, with a higher prevalence in males. USG visualized the pancreas in 88% of cases, predominantly showing hypoechoic patterns and duct dilatation. CT successfully visualized the pancreas in all cases, detecting hypodensity in 98% and duct dilatation in 12%. Extra-pancreatic findings were observed in 26% of cases, including fluid collections, ascites, and pleural effusions. Conclusion: In diagnosing pancreatitis, both USG and CT are valuable tools, with CT offering superior visualization and assessment of pancreatic pathologies. While USG remains non-invasive and widely available, CT provides more detailed information, particularly in detecting extra-pancreatic complications. A combination of both modalities enhances diagnostic accuracy and patient care.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the usefulness of patient education and if AR control was affected by different methods of teaching of nasal spray usage. Methods: The Present study was conducted in the Department of ENT-HNS, Hamdard Institute of medical sciences, New Delhi, India and patients were recruited aged 18 and above with clinical symptoms suggestive of mild persistent or moderate-severe persistent AR (ARIA guidelines 2008). Total 100 patients were included in the study. Results: Patients were between 20 to 60 years old (mean=32.4 years) and among them 40 (40%) were male patients and 60 (60%) were female patients. Based on the 2008 ARIA guidelines, 88 (88%) patients were diagnosed with moderate-severe persistent (MSP) AR, 4 (4%) had moderate- severe intermittent (MSI) AR while 8 (8%) had mild persistent (MP) AR. Assessment on the techniques during the 2nd (visit 2) showed that none of the participants were able to show a correct technique on the usage of INCS. During the 3rd visit despite re-education, only 26% of participants were able to show the correct techniques. There was statistically significant association between ARIA classification and severity of TNSS during V1-V3. Majority of patients with MSP AR had severe TNSS during V1 and subsequently improved to moderate symptoms during V2 and mild/very mild during V3. Conclusion: Our study showed the importance of educating patient regarding the use of INCS. Both objective and subjective assessment of improvement after each method of patient education showed statistically significant outcome.

DOI: 10.5281/zenodo.

Introduction: Thalassemia is a group of hereditary single gene disorders of haemoglobin chains. Excess iron in vital organs is known to cause impaired organ function and increased rates of morbidity and mortality. The regulation of iron by hepcidin is of clinical importance in thalassemia patients, as anemia often occurs along with iron overload. Our aim was to determine serum hepcidin level in beta thalassemia patients and healthy controls and to compare serum hepcidin level in beta thalassemia major patients and healthy controls. Material & Methods: This was a case–control study. Total 35 diagnosed patients of β-thalassemia major were taken as cases, and 35 healthy, age and sex matched individuals were included as controls after taking informed consent. Samples were taken for determination of serum Hepcidin levels along with serum iron, serum ferritin and total iron binding capacity. Observation and Results: 35 beta thalassemia major patients and 35 age and sex matched healthy controls were included in the study. Both groups comprised of 21 boys and 14 girls. Serum hepcidin level was found significantly low in Thalassemia patients as compared to the controls. Discussion: Iron overload in β‑thalassemia patients is a major cause of mortality and morbidity leading to a marked cellular damage and organ dysfunction. The increase in serum ferritin in β‑thalassemia patients is mainly due to the suppression of hepcidin caused by ineffective erythropoiesis which then increases iron absorption. Conclusion: Determination of hepcidin concentration is a useful indicator for high risk of iron toxicity in patients of beta thalassemia.

DOI: 10.5281/zenodo.

Objective: To compare oral nifedipine with topical nifedipine in the management of anal fissure. Patients and Methods: In this prospective randomized controlled study, a total of 120 patients ~ anal fissure were selected through surgical outpatient department and divided randomly into 2 equal groups. Group A received oral nifedipine 10 mg TDS and group B were given 0.2% nifedipine ointment for local application TDS. Both groups were compared in terms of pain relief and wound healing at 1^st week, 3^rd week and 2^nd month after starting the treatment. Results: Mean age of the patients was 39.11±10.85 years. In the follow-up visits, there was significant improvement in VAS scores in both the groups. Oral and topical applications of nifedipine were comparable in terms of pain relief. On comparing oral nifedipine with topical nifedipine, improved healing rates were observed in patients who received the topical application, but the results were statistically insignificant. Conclusion : Both oral and topical nifedipine significantly improve pain relief and healing rate in patients with anal fissure and are comparable in terms of efficacy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the role of maternal serum ferritin as a predictive marker in intrauterine growth restriction. Methods: This was a prospective study conducted in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College, Bihta, Patna, India. Total 250 antenatal women visiting the antenatal clinic were enrolled in the study at 25th week. Results: The difference between mean ages of both groups was not significant statistically. The difference in mean birth weight between two group was statistically significant (P<0.05). There was statistically significant difference between mean ferritin value of two group (P=0.03). The mean hemoglobin in group A was 10.46 gm% and in group B was 11.91%, the difference between two was statistically significant (P<0.05). The analysis was statistically significant P<0.0001 for asymmetrical growth restriction as an outcome and P<0.05 for symmetrical growth restriction as an outcome). The serum ferritin value at 20.2 ng/ml was associated with highest Yuden’s index which means that it can be taken as a cut off for screening antenatal patients for development of fetal growth restriction with 61.5% sensitivity and 80.1% specificity. Conclusion: In our study negative correlation was found between the value of serum ferritin and neonatal birth weight. In future large randomized control trial is needed to found association between maternal serum ferritin and IUGR.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the prevalence of febrile seizures in children in DMCH. Methods: The present study was conducted at Pediatric Department of Nalanda Medical College and Hospital, Patna, Bihar, India. Total 200 children were studied for various demographic characteristics like age and sex, type of febrile seizure, risk factors of febrile seizures like family history of febrile seizure, associated infection and length of hospital stay. Results: Of the 200 children 110 (55%) were boys and 90 (45%) were girls. 36 (18%) were in below 1 years of age, 60 (30%) were in 1-2 years of age, 70 (35%) were in 2- 3 years of age and 34 (17%) were in 3-5 years of age. Mean age of occurrence was 2.2 years (±1.5 years). In this study, 80% (160) of the patients had simple and 20% (40) had the complex form of febrile seizure. In our study, 60% (120) of affected children had positive family history of febrile seizure. Acute gastroenteritis (AGE) (24%) followed by upper respiratory tract infection (URTI) (20%) was the most common co- morbidity. 48% children were hospitalized for 1-3 days, 32% for 4-7 days and 20% for more than 7 days. Conclusion: Most of the children had a positive family history and the most common causative factor was acute gastroenteritis – morbidities/risk factors in the form of URTI, LRTI, AGE etc. are associated with febrile convulsion and these diseases can be managed effectively thereby reducing the occurrence of febrile convulsion.

DOI: 10.5281/zenodo.