Background and Objective: The right atrioventricular valve is the largest of all the heart valve. From a functional standpoint the term ‘atrioventricular valve apparatus/complex’ is more appropriate. The tricuspid valve is often called the “forgotten valve” or “lost valve” because it is relatively understudied compared to the other cardiac valves. The normal data of the tricuspid valve complex is of great clinical importance in the light of progress in cardiosurgery. The right atrium communicates with the right ventricle through right atrioventricular orifice, which is guarded by right atrioventricular valve. The objectives of the present study are to measure frontal, sagittal dimensions, circumference, right atrioventricular orifice area, height of anterior, posterior & septal leaflet, average number of chordae tendinae attached to anterior leaflet and average length of chordae tendinae attached to anterior leaflet of the Tricuspid valve. Methods: The study sample consists of 50 formalin fixed adult human heart available in the Department of Anatomy & Forensic department of NMCH Patna. The parameters were noted meticulously and the data processed. Conclusion: The results of the present study show that the morphometric measurement of Tricuspid Valve will serve as reference data for further studies, clinical use in patients with various cardiac abnormalities and construction of bioprosthetic valves for tricuspid repair.

DOI: 10.5281/zenodo.

Background:  Acquired immune deficiency (AIDS) is retroviral disease caused by human immunodeficiency virus (HIV). AIDS is seen in all continents of the word. There were approximately 39 million people across the globe with HIV in 2022.Of these 37.5 million were adults, and 1.5 million were children(<15years) . Antiretroviral drugs also have side effects like dyslipidemia of order of severity. Between 33 to 75% of patients with HIV infection  receiving highly active antiretroviral therapy(HAART) develop a syndrome  often referred to as lipodystrophy, consisting of elevations in plasma triglycerides(TGs), Total cholesterol(TC)  and  apoipoprote in B. HAART causes increase in low density lipoprotein(LDL). However, with protease inhibitors(PIs)-based therapies, HDL levels remain low and hypertriglyceridemia may be seen, giving rise to a distinctly atherogenic lipid profile. Aim: The aim of our study is to see the Dyslipidemia in HIV patients with and without HAART therapy. Material and Methods: A total of 150 subjects taken for study. The study was divided in to 3groups.Group-1: Healthy controls, Group-2: 50 newly diagnosed HIV patients and Group-3: HIV patients  on ART. The age group of the subjects varied from 25-50 years. Sample Collection: Blood samples were collected in ART centre at Government General Hospital, GGH, Kadapa, Andhra Pradesh.5ml of venous  blood sample was collected in plane tube in the morning after an overnight fast. After collection, the sample was centrifuged and serum was analyzed for estimation of  Total cholesterol, Triglycerides, High density lipoprotein(HDL) by  using Semi-auto analyzer (Erba). Serum  LDL cholesterol was estimated by using Friedewalds  formula. Stastical Analysis: Data was entered in MS excel .The data  was analyzed and consolidated  as mean and standard deviation(SD).To analyze the statistical significance, we are using SPSS 23 software. The test probability of less than 0.05(P<0.05) was considered as statistically significant. Results: In the present study the mean serum value of Total cholesterol, LDL-cholesterol, Triglycerides  are high in Group-2  compared to Group-1(P<0.0001) and mean serum value of HDL-cholesterol is low in Group-2 compared to  Group-1(P<0.0001). The mean serum total cholesterol, LDL-cholesterol, Triglyceride value is high in Group-3  compared to Group-1 and  the mean value of serum HDL-cholesterol  is  low in group-3 compared to Group-1 (P<0.0001).The mean value of serum Total cholesterol, LDL-cholesterol, Triglycerides significantly high in Group-3 compared to Group-2(p<0.0001).The mean value of serum HDL-cholesterol  is significantly low in Group-3 compared to Group-2. Conclusion: We  concluded that lipid profile  can be a  good index of disease  progression in HIV infection.  Significant dyslipidemia is present in HIV patients on antiretroviral therapy.

DOI: 10.5281/zenodo.

It is a strong band made of connective tissue and collagenous fibres that originate from the anteromedial aspect of the intercondylar region of the tibial plateau and extends posteromedially to attach to the lateral femoral condyle. Study Design: Prospective cohort study. Study Area: This study was done at Hospital for Orthopedics, Sports Medicine, Arthritis and Accident -Trauma (HOSMAT), Bangalore, which is a tertiary care referral Centre for Orthopaedics and Sports medicine. Results: The mean age of the study population was 32.91 ± 8.36 years. Based on distribution, 40% belong to 17-30 years, 42% belong to 31-40 years, 14% belong to 41-50 years, 4% belong to 51-60 years. Conclusion: In conclusion, the findings of this study were able to demonstrate that females not only exhibited greater instrumented laxity after arthroscopic ACL reconstruction but also showed inferior functional scores in IKDC and Lysholm scoring systems as compared to men.

DOI: 10.5281/zenodo.

Background: Silicosis has been known in industrial workers for millennia. Until recently, clinical evaluation of the respiratory system, pulmonary function tests, and chest radiography were the mainstays of its diagnosis and progression. Several indicators, such as serum angiotensin II, have been identified. The activity of converting enzyme (ACE) has been studied to identify the degree of silicosis. Objectives: The purpose of this study was to determine the effect of age, gender, duration of silica dust exposure, smoking habit, and pulmonary function status on serum ACE activity in healthy quartz stone miners. Methods: A cross-sectional study was conducted on 60 stone mine workers and 60 non- mine workers as a control. All the personnel who were being researched had their chests examined. They also measured the pulmonary functions. Blood samples were taken from exposed workers and the controls, centrifuged to separate the serum, and then refrigerated until serum ACE levels could be determined. Results: The participants’ mean age was 35.28 years in mine workers and 38.45 years in non- mine workers.  The ACE levels were directly associated with increase in exposure of silica and ACE level (76.45IU/L) was maximum in participants who were exposed to silica for more than 5 years. Males (68.32 IU/L) had higher ACE values compared to females (64.23 IU/L). Participants with smoking habits had values greater than non- smokers. Conclusion: We found no correlation between serum ACE activity and age, gender but was significant with duration of exposure, smoking behaviours, or pulmonary function status. Increased levels of serum ACE were discovered in cases of silicosis.

DOI: 10.5281/zenodo.

Rationale: TheHepatitis B virus is one of the most contagious blood-borne pathogens that can cause both acute and chronic liver disease. Use of contaminated needles for injections, blood transfusion, sexual contact, and vertical transmission from mother to fetus are the most common routes of transmission. About 10% of the patients develop chronic hepatitis and about 15% to 25% develop cirrhosis or liver cancer. Vaccination is the mainstay of prevention against hepatitis B infection with 90% to 100% protection conferred following complete vaccination. The present study was carried out to assess Knowledge, Attitude and Practice towards Hepatitis B infection and vaccination among medical students. Methods: The present cross-sectional descriptive was conducted amongst 399 medical students, interns, and residents from July 2022 to August 2022.  Result: In the study, students showed sound knowledge regarding Hepatitis B, safe practices & attitude. More awareness is required about Hepatitis B vaccination in pregnancy & newborn care. In the present study, only 56.5 % of students were vaccinated and all the 3 doses were taken by only 23 % of students. 14.8 % cited that they do not know where to go & receive it. 10.8 % were not aware of the vaccination. Whereas, 36.6 % were incompletely vaccinated. Conclusion: Participants had an overall sound knowledge regarding the structure of the virus, transmission, knowledge of complications and management. The majority of students were aware of safe practices and were following them. Initiating Hepatitis B campaigns to increase awareness of practice methods & vaccination drives would help increase practice levels and significantly reduce the incidence of Hepatitis B viral infections in the student community.

DOI: 10.5281/zenodo.

Background and Objectives: Diabetes Mellitus is common endocrine disorder. Its knowledge is important because of high prevalence. The diabetic foot can be divided into the neuropathic foot in which the neuropathy predominates and the ischemic foot where occlusive vascular disease is the main factor. The clinical study on diabetic foot is undertaken to assess the various presentations of diabetic foot like ulceration, resistant deep infections, Cellulitis and severe ischemia leading onto gangrene and to study percentage of surgical intervention like debridement, minor/major amputations. Methods: 1536 patients admitted in surgical wards as above will be considered as data source using clinical proforma in 318 patients over a period of 2 years. It is a simple case study where the mode of presentation and the percentage of patients going for surgical intervention are studied. Results: Most of the diabetic patients were in the age group of 46 – 65 years (65%). Out of 318 cases studied, there was a male predominance in occurrence of diabetic lesions. 72% were male patients and 28% were female patients. The most common presentation of a diabetic patient with a foot lesion was Toes lesion which was about 30%. Non healing ulcer was the commonest mode of presentation in about 44% of patients followed by Cellulitis in 34% of patients; gangrene in 17% and abscess in 5% of patients. Out of 318 cases studied 188 cases that is 59% of patients were treated with minor procedures and 130 cases that is 41% were treated with major surgical procedures. Conclusion: Diabetic foot is more common in the elderly but younger age groups are not spared. Incidence of diabetic foot is more common in males when compared to females. Non healing ulcer is the most common mode of presentation. Neuropathy and vasculopathy are the most common pathology and the patients with neuropathy are more prone for the development of diabetic foot. Early detection and prompt treatment will decrease the incidence of complications of diabetic foot.

DOI: 10.5281/zenodo.

Background: Of the various surgical modalities for treating spondylolysis and spondylolisthesis, transforaminal lumbar inter body fusion (TLIF) is considered the best. Objective: To assess the functional outcome in symptomatic lumbar spondylolisthesis and spondylolysis patients treated by TLIF using transpedicle screws and rods interms of complications, changes in Visual Analog Score (VAS) and Oswestry disability index (ODI) among them. Methods: 20 patients (09 male, 11 female) admitted with isolated symptomatic lumbar spondylolisthesis of any grade with or without spinal canal stenosis, treated with Transforaminal Lumbar interbody fusion were included in the study. Results: Most commonly affected age group was 40-50 years; degenerative type of spondylolisthesis was more common than isthmic and traumatic types of spondylolisthesis. The mean of disc height was 8.96 mm pre-operatively and 10.69 mm postoperatively. Mean Visual analog score (VAS) for Leg pain pre-operatively was 7.50 ± 1.05, with the post-operative VAS being 2.20 ± 1.19. Pre-operative ODI score was 59.11 ± 8.65, and post-operative ODI score was 39.10 ± 9.69. Insitu Transforaminal lumbar interbody fusion and posterior decompression significantly reduced the pain and functional disability in patients. Conclusion: Transforaminal lumbar interbody fusion with transpedicle screws along with posterior decompression was safe and effective in achieving good functional outcome. It provides better functional outcome by providing pain relief and improving quality of life in the patients.

DOI: 10.5281/zenodo.

Introduction: The study aimed to assess the efficacy of bupivacaine combined with clonidine, administered via ultrasonography-guided transversus abdominis plane (TAP) block, in providing postoperative analgesia following laparoscopic appendicectomy, aiming to improve pain management and patient outcomes. Methods: The study employed computer-generated randomization to assign patients to treatment groups. Patients received detailed preoperative explanations. Standard assessments were conducted, including baseline VAS scores. Premedication was administered before induction. General anesthesia followed a consistent protocol. Bilateral ultrasound-guided TAP blocks were administered before surgery. Pain severity was assessed postoperatively using VAS scores. Results:  Total 60 members were included, 30 (100%) in each group. The mean ages were 30.87 ± 9.94 and 29.80 ± 8.63. Male female ratio was 0.9 and 0.7. Statistically there was no significant difference in age, gender, BMI, ASA status, mean surgery duration, VAS scores, respectively between groups. There was significant difference between the groups in mean time of analgesia. Conclusion: Ultrasound-guided TAP block with bupivacaine plus clonidine provided superior and sustained analgesia compared to bupivacaine alone. Clonidine administration postoperatively significantly reduced hemodynamic parameters. Real-time imaging during the procedure prevented complications. Patients receiving bupivacaine plus clonidine required fewer analgesics over 24 hours, indicating its efficacy and safety in laparoscopic appendicectomy.

DOI: 10.5281/zenodo.

Introduction: Umbilical hernias are commonly managed through mesh repair via open or laparoscopic surgery. Open surgery involves a larger incision, while laparoscopic surgery offers smaller incisions and quicker recovery. This study compares outcomes like complications and recurrence rates to inform clinical decisions and enhance patient care. Methods: The methodology involved detailed history-taking, physical examinations, and various investigations to assess umbilical hernia repair outcomes. Patients were randomly assigned to open or laparoscopic mesh repair groups. Variables like age, sex, BMI, and postoperative complications were meticulously documented to analyze factors affecting surgical outcomes and inform patient management strategies. Results: Sixty participants were evenly divided into meshplasty and laparoscopic repair groups. Meshplasty group had 50% aged 40-60, male-female ratio 1.5; laparoscopic repair group had 50% aged 20-40, male-female ratio 2. Postoperative stays and return to activities significantly favored laparoscopic repair (P < 0.01). Conclusion: Age and gender distribution were similar between meshplasty and laparoscopic repair groups, postoperative outcomes favored laparoscopic techniques due to shorter stays and faster recovery. Comparable rates of seroma formation and recurrence highlight the effectiveness of both approaches, with laparoscopy offering superior patient satisfaction.

DOI: 10.5281/zenodo.

Introduction: This study compares the efficacy and safety of dexmedetomidine and clonidine as adjuvants to levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries. Dexmedetomidine’s higher selectivity for α2-adrenergic receptors potentially enhances its analgesic effects compared to clonidine. Methods: A prospective study conducted at Rangaraya Medical College, Kakinada, evaluated ASA grade I and II patients, aged 18-50, undergoing upper limb surgeries. groups C and D received clonidine and dexmedetomidine, respectively, with levobupivacaine in supraclavicular blocks. Sensory and motor block characteristics were assessed post-operatively for 24 hours. Results: Group D exhibited faster onset of sensory and motor blocks (4.86 ± 0.91 mins and 7.08 ± 1.006 mins) compared to group C (7.2 ± 1.1 mins and 9.94 ± 1.67 mins). Motor block duration was longer in group D (12.7 ± 0.7 hrs) than group C (10.8 ± 0.6 hrs). Rescue analgesic requirement and sedation scores significantly varied between groups. Conclusions:  Dexmedetomidine as an adjuvant to levobupivacaine in brachial plexus block demonstrated faster onset of sensory and motor blocks, prolonged motor block duration, and reduced rescue analgesic requirement compared to clonidine. These findings suggest dexmedetomidine’s potential superiority in enhancing regional anesthesia outcomes for upper limb surgeries.

DOI: 10.5281/zenodo.

Background: Persea americana also known as avocado, belong to family Lauraceae. The leaves and fruits are used as traditional folk medicine to treat inflammation and algesia. The purpose of this research is to evaluate the anti-inflammatory and analgesic activity of hydro-alcoholic extract from persea americana seeds. Methods: Phytochemically, hydro-alcoholic extract of persea americana seeds gave positive reactions for Proteins, amino acids, Fatty acids, alkaloids, glycosides, flavonoids, tannins, saponins, phenolic, Terpenoids and steroids. The invitro anti-inflammatory potential was accessed by using Protein denaturation method. In vivo anti- inflammatory activity was evaluated by using the carrageenan-induced paw edema method and analgesic activity was evaluated by using eddy’s hot plate method. Result: The present finding exhibited a concentration dependent inhibition of protein denaturation by Persea americana and IC 50 Value found at 305 µg/ml. The hydroalcoholic extract showed significant inhibition on the rat paw volume at 52.40% as compared to standard (diclofenac sodium). The analgesic activity of hydroalcoholic extract was shown significant activity after 60 minutes. Conclusion: The extract possesses analgesic and anti-inflammatory activity which may be mediate through the phytochemical constituents of the plant which supports its traditional use. Further isolation of active constituent responsible for activity will be isolated.

DOI: 10.5281/zenodo.

Background: Glaucoma is the leading cause of irreversible blindness worldwide. It is estimated that around 80 million people have glaucoma worldwide. Primary open-angle glaucoma (POAG) is a bilateral, symmetrical disease, has adult onset. Ocular examination shows an open anterior chamber angle, glaucomatous optic disc changes, visual field defect and an intraocular pressure of >21 mmHg. Reduction of raised IOP is important to protect against visual field loss in patients with open-angle glaucoma. Topical antiglaucoma drugs which reduced elevated IOP are miotics, adrenergic agonists, b-blockers, carbonic anhydrase inhibitors and prostaglandins. Aims and Objectives: This study was conducted to compare and evaluate effectiveness, safety and compliance of monotherapy 0.5% Timolol with fixed dose combination of 0.15% Brimonidine and 0.5% Timolol in newly diagnosed patients of POAG. Methods: This was a prospective, observational study conducted in Ophthalmology department of PDU medical college and hospital, Rajkot. 60 patients enrolled into study. 30 patients (54 eyes) were in Timolol group and other 30 patients (50 eyes) were in Brimonidine-Timolol fixed dose combination (BT FDC) group. Data was collected at baseline, 2 weeks, 6 weeks and 10 weeks. Result: There was significant lowering (p<0.0001) in mean IOP at 2, 6 and 10 weeks compare to baseline in both treatment groups. But there was more significant reduction (p<0.0001) in IOP in BT FDC group compared to Timolol group. Like, at 10th weeks, mean IOP reduction in Timolol group was 13.5 mmHg (48.15%) and in BT FDC group was 17.82 mmHg (54%) which was significantly more (p<0.0001). Conclusion: There is faster and greater reduction of IOP with FDC Brimonidine-Timolol than monotherapy Timolol in POAG.

DOI: 10.5281/zenodo.

Background and Aim: The combined use of Peripheral nerve stimulator (PNS) and Ultrasound (USG) has added advantage of real time visualization and reduced number of needle passes to reach the target nerve group which in turn shortens the time required to perform the block and thus increasing the success rate. The aim was to compare the efficacy of infraclavicular block and axillary block using ultrasound and peripheral nerve stimulator in upper limb surgeries in a tertiary care centre. Material and Methods: 60, ASA grade I-II patients, age 18 to 50 years, weighing between undergoing upper limb surgery under regional anaesthesia were equally allocated in two groups. GROUP I- USG and PNS guided Vertical Infraclavicular block (n=30) GROUP A- USG and PNS guided Axillary block (n=30). Hemodynamic parameters, onset of sensory and motor blockade, total duration of blockade and VAS score were compared. Results: Onset of sensory block, in group I was 794.9 ± 54.91 seconds and in group A was 802.4 ± 57.87 seconds. Onset of motor blockade, in group I was 943.1 ± 54 seconds and in group A was 949.4 ± 56.46 seconds. Total duration of block, in group I was 721.6 ± 56.27 minutes and in group A was 701.5 ± 77.98 minutes. Hemodynamic stability in terms of heart rate, systolic, diastolic and mean arterial blood pressure was observed and noted that all the patients in both the groups were haemodynamically stable. Conclusion: Peripheral nerve blocks (PNB) have an increasingly important role in ambulatory anaesthesia and have many characteristics of the ideal outpatient surgical anaesthesia with prolonged postoperative analgesia, early ambulation and facilitated discharge with less hospital stay.

DOI: 10.5281/zenodo.

Background: Wrist fractures are one among the common injuries of the elderly leading to reduced quality of life and impaired functionality, if not treated and restored adequately. Factors like asymmetry of vestibular function, decreased plantar sensation, unstable posture and functional disability have been more commonly associated with fall related wrist fractures among the geriatric population. Objective: To determine effect of multi-sensory training (MST) on posture (muscle strength), vestibular function, vibration perception, tactile sensation and functional ability compared to wrist stabilization training (WT) among elderly with fall related wrist fractures. Materials and Methods: Experimental research design was adopted for the study among the 130 follow up cases of wrist fracture where 88 participants were randomized to Multi-Sensory Training and 42 received Wrist stabilization Training. The training period was 12 weeks, with 4 supervised sessions by a physiotherapist and home exercises for both groups. Pre and post training measurements included Head Shake Test (HST), Semmes–Weinstein Monofilaments (SWM), Vibration perception Test, 10m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). Results: FTSTS, ABC, DHI were found to be statistically significant between the 2 groups. In contrast to wrist stabilization training, MST was more helpful in improving HST (p=0.001). Conclusions: Vestibular function among the cases of wrist fracture was better with Multi-Sensory Training. It may be applied as a routine training intervention post fracture treatment. A robust sample size can be taken up to generalize its effectiveness.

DOI: 10.5281/zenodo.

Background: As Coronary artery disease is one of the most common heart diseases and also the major cause of death in developing countries. The aim of the present study is to evaluate the coronary dominance pattern which will help the cardiac physicians and surgeons for better diagnosis and management of coronary artery diseases. Material and Methods: The study was planned on 30 heart subjects. These selected hearts are without any obvious pathology referred with cardiac conditions was enrolled into the study in NMC Patna. The coronary arteries were dissected and analysed for the origin of sinoatrial Nodal artery and Observations were noted. The approval of the Institutional ethical committee was taken for the present study. The hearts identified with the congenital anomalies were excluded from study. From the above study it can be concluded that the most common is the right coronary dominance compared to left and balanced dominance as seen in this study. The present study is in comparison with the data generated by previous authors. Conclusion: This knowledge of normal anatomy and variations of coronary dominance will help interventional cardiologist, cardio-thoracic surgeons and radiologist to plan and provide proper management to patients.

DOI: 10.5281/zenodo.

Background: Variations in renal hilar arrangement patterns and morphometric dimensions are clinically relevant in this age of advancing modern medicine and minimally invasive surgery. The purpose of the present study is to record variations in renal hilar arrangement patterns and assess renal dimensions of length, width and thickness respectively. Methods: Hilar regions of fifty isolated embalmed kidneys were carefully dissected and variations observed were photographed and documented. Renal dimensions were measured with digital calipers and values obtained were tabulated and analysed. Normal anteroposterior hilar arrangement pattern was observed in 72% cases. Anterior and posterior divisions of renal artery were observed in 24% cases with anterior division being the most anteriorly placed structure in 14% cases. The renal pelvis was situated between the divisions of the renal artery in 8% cases. Prehilar segmental branches anterior to renal vein were observed in 4% cases. Other variations seen included extrahilar branches (4%), superior polar artery arising from anterior division of renal artery, prehilar tributaries of renal vein and an additional renal artery in 1 case each. The mean renal length was 9.35+/- 0.98 cm for right and 9.25 +/- 1.25 cm for left kidneys, mean renal width 4.93 +/- 0.65 cm for right and 4.95 +/- 0.5 cm for left kidneys and mean renal thickness 3.77 +/- 0.7 cm for right and 3.86 +/- 0.53 cm for left kidneys respectively. No statistically significant difference was observed in the mean values between right and left sides. The clinical implications of these findings have been discussed. The findings of this study may enhance the existing literature and contribute additional information for improving treatment outcomes during clinical and surgical interventions.

DOI: 10.5281/zenodo.

Introduction: Recent research highlights the global challenge of Candida infections among adults, necessitating comprehensive understanding. Investigating prevalence and risk factors of vaginal candidiasis (VC) in pregnancy versus non-pregnancy aims to contribute insights into this common fungal infection’s epidemiology and its implications for maternal health. Methods: It was a prospective research conducted in GSL Medical College. Pregnant women aged > 18 years were considered in the test and non pregnant women in control group. Collection of vaginal swab, microscopic examination, culture were practised as per the guidelines. For analysis, Chi square test was used, P<0.005 was considered to be significant. Results: In this study 174 participants, evenly divided into test and control groups, the mean ages were similar. VC incidence was 31.6%, with 19.5% in the test and 12% in the control group, showing no significant difference. Candida albicans predominated, with a 10:1 ratio of non-albicans species. Conclusion: This study found a comparable incidence of VC between pregnant and non-pregnant groups, suggesting pregnancy status may not significantly influence VC risk. Candida albicans predominated among isolated species. Further research is warranted to elucidate VC’s multifactorial etiology and optimize preventive strategies.

DOI: 10.5281/zenodo.

Introduction: Sepsis, a dysregulated host response to infection, carries a mortality rate of 20%. Prognostic markers like neutrophil lymphocyte ratio (NLR) and shock index (SI) offer insights into inflammation and cardiovascular status, aiding in risk assessment. This study aims to evaluate NLR and SI as predictors of clinical outcomes in sepsis and septic shock.  Methods: A hospital-based cross-sectional study conducted at GSL Medical College, Rajahmundry, between January 2021 to June 2022, assessed NLR and SI as prognostic indicators in sepsis. Inclusion criteria involved hospitalized adults meeting sepsis criteria, with exclusion of pregnant patients. Comprehensive evaluations and statistical analyses were conducted using SPSS and Excel. Results: Out of 79 patients, mean age was 54.82 ± 13.42 years, with 55 survivors (mean age 55.42 ± 13.12) and 24 non-survivors (mean age 53.46 ± 14.28). Diabetes (60.8%) and hypertension (44.3%) were prevalent. No significant gender difference (63.3% male). Significant differences were observed in SOFA scores, NLR, and SI between survivor and non-survivor groups. Conclusion: Sepsis and septic shock present critical challenges in patient management. Despite no significant gender disparity, females tend to have a lower likelihood of sepsis. Comorbidities like diabetes and hypertension did not significantly affect disease severity or mortality. NLR and SI emerged as valuable prognostic markers, reflecting disease severity and aiding in risk stratification.

DOI: 10.5281/zenodo.

Introduction:  This study aims to investigate the unique aspects of acute coronary syndrome (ACS) in post-menopausal women (PMW) compared to age-matched men, focusing on ethnic representation. By isolating the impact of estrogen, we aim to provide insights into ACS presentation and outcomes in this demographic. Methods: A cross-sectional study conducted at GSL Medical College, Rajahmundry from January 2021 to June 2022. Approved by the Institutional Ethics Committee, it included post-menopausal women with STEMI. Comprehensive assessments, including clinical exams and investigations, were conducted. Statistical analysis was performed using SPSS and Excel, with significance set at p<0.05. Results: Among 76 participants, mean age was 59.91±11.25 years, with 28.9% aged 51-60. Smoking (54%) was prevalent, followed by alcohol (45%) and tobacco (8%) use. Most (40%) were obese. 34.2% showed no regional wall abnormality, 17.1% had global hypokinesia. Coronary angiogram results varied, with no significant CA-BMI correlation. Conclusion: The study underscores the multifactorial nature of ACS in PMW, implicating age, lifestyle factors like smoking and alcohol consumption, and obesity as significant contributors to ACS risk. Moreover, cardiac pathology diversity revealed by coronary angiograms highlights the importance of tailored management approaches for optimal ACS outcome.

DOI: 10.5281/zenodo.

Diabetes mellitus (DM) presents a global health challenge, often accompanied by dyslipidemia. Understanding the link between lipid profile and DM is crucial. Recent studies have explored this correlation. A study was conducted to find the relation between DM and blood lipids. Methods: Individuals of both gender, aged > 18 years those come to this hospital for routine check-up were included. Fasting blood specimen was collected, transported to the hospital lab. Serum was used to estimate fasting blood glucose (FBG) and lipid parameters such as CL, TG and high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) were estimated by automated blood analyser. Based on the FBG levels, the members were classified to be DM and non DM. Results: DM patients displayed markedly higher FBG levels (209 ± 63.1 mg/dL) compared to non-DM counterparts (88.4 ± 11.6 mg/dL) with a p-value of 0.0012. Additionally, DM individuals exhibited elevated TC, TG, LDL, and VLDL levels, and decreased HDL levels (P < 0.01), emphasizing dyslipidemia’s association with DM. Conclusion: This study found significant increases in FBG and lipid parameters, particularly TC, TG, and LDL, with notable decreases in HDL among DM patients compared to non-diabetic individuals. VLDL and TG exhibited the highest increases, correlating with TC and TG elevation. With this, managing DM’s cardiovascular risks remains challenging despite available therapies.

DOI: 10.5281/zenodo.

Introduction: Retinopathy of prematurity (ROP) manifests with abnormal blood vessel growth in premature infants, affecting up to 80% of those weighing under 1000 grams. Historical ROP epidemics underscore the need for meticulous oxygen monitoring. Developing countries face a current ROP epidemic due to rising preterm births and limited healthcare resources. Vision 2020 targets ROP to mitigate childhood blindness, emphasizing the study’s focus on ROP incidence and its correlation with gestational age (GA). Methods: This hospital-based cross-sectional observational study utilized indirect ophthalmoscopy with a 20D lens for ROP screening. A wire speculum and scleral indenter maintained eye position, with aseptic measures followed. Examination included posterior pole assessment for plus disease, peripheral screening with enhanced temporal visualization. Neonatal complications were managed, ROP classified per ICROP, and risk factors documented. Results: In the study of 60 preterm infants, 40% developed ROP, predominantly stage 2 (14 cases), followed by stage 1 (8) and stage 3 (2). Gender distribution showed no statistical significance (P = 0.672). ROP babies had a mean GA of 30.71±2.34 weeks by dates and 30.67±2.30 weeks by Ballard score (P<0.001). Birth weight decreased with higher ROP stages (P = 0.001). Oxygen therapy type significantly influenced ROP risk (p < 0.001), with 66.7% using hood oxygen, 16.7% C-PAP, and 16.7% ventilation. Conclusion: Lower birth weight and type of oxygen therapy significantly influence ROP severity. Meticulous monitoring and management of these factors are crucial to reducing ROP risk in preterm infants, highlighting the need for targeted screening and intervention strategies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the association between the serum uric acid and the severity of COVID-19. Methods: A retrospective observational study on patients admitted to Government Institute of Medical Sciences (GIMS), Greater Noida with diagnosis of SARS-CoV-2 between March 2020 and March 2021. The data from a total of 1220 patients admitted between March 2020 and March 2021 with COVID-19 were initially screened. The electronic medical records were reviewed and COVID-19 patients who underwent uric acid analysis at the time of admission were included. The study was approved by Institutional ethics committee. Results: Out of 1220 patients, 550 (45.08%) women were included, and the median age was 63 (18-98) years. Out of 1220 patients, 40.98% had hypertension, 23.77% had diabetes mellitus, and 20.49% had chronic kidney disease. Pneumonia was detected in 86.06% of the patients at admission. Median UA level was 5.1 mg/dl. The uric acid levels were measured after the progression of COVID-19. The most severe period  of  COVID-19  was  considered when maximum oxygen support  was  required and predictors associated with poor prognosis, namely CRP, procalcitonin, ferritin, and D-dimer were at the highest values. The mean uric acid levels were found to be significantly decreased in patients with a negative prognosis. Conclusion: The study concluded that UA, a purine base metabolite, can be used as a prognostic indicator in severe patients with COVID-19. Risk assessment for the prognosis of patients can be made according to the UA levels at admission. It is important to emphasize that low baseline uric acid levels, as well as a decline in uric acid levels during the hospitalization period, constitute a higher risk for poor prognosis.

DOI: 10.5281/zenodo.

Background: Children with wasting need to be screened promptly and accurately in countries with a high prevalence of undernutrition. The World Health Organization recommends using WHZ and MUAC to identify children with acute malnutrition for treatment. Aim: To compare WHZ and MUAC cut-offs to identify wasting among children aged 6–59 months. Setting and design: A hospital based cross-sectional study among under-five children visiting Paediatric OPD at RIMS, Raipur Chhattisgarh from January 2022 to June 2022 was conducted. Methods and Material: Children in the age group 6-59 months with consent of guardians collected sociodemographic data and anthropometric measurements. Anthropometric measurements were transformed into z-scores with the aid of WHO Anthropometric calculator software version 3.2. Statistical Analysis: To compare the use of MUAC and WHZ to identify wasting, we used descriptive statistics and Kappa statistics to compare the use of MUAC and WHZ to identify wasting. SPSS was used for data analysis. Results: The prevalence of severe wasting was 3.4% and 10.5% using MUAC and WHZ, respectively, while moderate wasting as 8.1% and 13.4%. We found 5.88% sensitivity for SAM and 6.97% sensitivity for MAM, with specificity of 96.87% and 91.75%, respectively. The kappa values for SAM and MAM are 0.037 and -0.015 respectively. Conclusions: Although MUAC can be used as a rapid screening tool to detect wasting in children aged 6–59 months, using the recommended MUAC cut-offs captures only a small proportion of the total number of wasted children. The poor sensitivity of MUAC compared to WHZ as well as kappa values suggests no agreement between MUAC and WHZ need to refine admission and discharge criteria for malnutrition management programs.

DOI: 10.5281/zenodo.

Aim: To study the various causes of encephalopathy and their outcome in newborns admitted in NMCH and to evaluate the myocardial dysfunction in neonates having birth asphyxia from the study of electrocardiography (ECG) and creatine phosphokinase muscle brain fraction (CK-MB) assay. Methodology: All term neonates with features of encephalopathy admitted in the neonatal ICU of Nalanda Medical College & Hospital for a period of 9 months between August 2023 to May 2024 were included. Babies were admitted in the hospital with the evidence of asphyxia indicated by any three of the following: (i) APGAR <3 at 5 minutes. (ii) Meconium stained amniotic fluid (MSAF) (iii) need for PPV for >1 min at birth. Preterm babies, neonates with sepsis or congenital malformation, neonates whose mothers received opioids or any other form of sedation were excluded. After written consent from parents, the demographic details were taken, maternal history, birth events, APGAR score were recorded. Detailed clinical examination and serum CK-MB assay were done at birth, 24 hours and at 72 hours. Chest X-ray to assess cardiomegaly, and electrocardiography and echocardiographic evaluation were done. Results: During the study period 90 babies were found to be of neonatal encephalopathy. Out of which 82 babies had hypoxic encephalopathy. Of 82 cases, 35(42.7%) were in mild, 27(32.9%) in moderate and 20(24.4%) belonged to severe HIE. Further 82 babies with HIE were evaluated for transient myocardial ischemia. MSAF was commonly associated with HIE. Common complications were shock and respiratory failure. Mortality was observed to be 31.7 % in cases of HIE. Cardiomegaly in CXR, ST depression in ECG, Tricuspid Regurgitation (TR) in ECHO, and elevated CK- MB were commonly detected in babies with transient myocardial ischemia. Conclusion: Hypoxic ischemic encephalopathy is the most common cause of neonatal encephalopathy. Routine ECG monitoring of asphyxiated babies helps to detect myocardial dysfunction and hence the identification of shock. Assay of cardiac enzyme markers CPK-MB helps to complement clinical evaluation for early identification of shock.

DOI: 10.5281/zenodo.

Bronchial asthma is a respiratory disease with complex etiology involving airway inflammation, airway hyper responsiveness, and airflow restriction and clinically manifesting as wheezing and respiratory distress. Medical management comprises of supportive therapy and aggressive pharmacotherapy with anti-inflammatory agents and bronchodilators given by both inhalation and systemic routes. Such treatment is commonly associated with safety concerns, loss of efficacy and cost issues over a long term – all of which influence treatment compliance. There is thus an unmet need to device effective alternative/complimentary forms of therapy for ensure better quality of life for asthma patients. Herbal drugs primarily derived from botanical sources. Can form a viable alternative for asthma by virtue of their multi-targeted approach to therapy. Many such medicinal plants have been documented in Indian traditional systems of medicine with well proven beneficial effects on different components of the asthma disease biology. Validation of these traditionally known effects by modern scientific methodology is one of the national initiatives for promoting interactions between traditional and modern medicine and developing and integrated approach for rational treatment of intractable disease states. The present review summarizes some of the commonly used medicinal plants for bronchial asthma and presents a comprehensive compilation of the existing research data.

DOI: 10.5281/zenodo.

Background and Aim: The transversus abdominis plane (TAP) block is a modern and highly effective technique used to provide postoperative pain relief for individuals who have undergone lower abdominal surgeries. In this study, we will be comparing two techniques of TAP block for postoperative analgesia in abdominal surgeries. Material and Methods:  A total of 100 patients, ranging in age from 18 to 60 years old, and classified as ASA grade I-II, are scheduled for various abdominal surgeries including appendicectomy, appendicular perforation, umbilical, paraumbilical, incisional and ventral hernia repair, hysterectomy, and exploratory laparotomy under general anesthesia. The participants were split into two groups, with each group receiving either a blind or USG-guided TAP block. After the procedure was completed, just before the reversal, both groups were given a TAP block with Inj. Bupivacaine 0.25% 20cc on each side while lying on their backs. Patients were monitored for duration of 24 hours; with pain levels assessed using a visual analogue scale. We recorded the total amount of pain medication needed over a 24-hour period and documented any complications that arose. Results: The results showed a significant prolongation in the time to first rescue analgesic in the group that used USG guidance, compared to the blind technique. This suggests that the use of USG allows for a more precise TAP block. The USG-guided group demonstrated a significantly better efficacy score (p<0.05) compared to the other group. This indicates improved analgesia and reduced need for additional pain medications. Conclusion: Utilizing ultrasound technology allows for more accurate administration of local anesthesia in the correct location, although it does require a steeper learning curve. Considering the TAP block as part of multimodal analgesia and enhanced recovery in patients undergoing abdominal surgery is highly recommended. This technique offers a simple, safe, and easy way to achieve improved analgesia.

DOI: 10.5281/zenodo.

Although though high-flow nasal cannula treatment has been available for some time, there are still a lot of individuals who aren’t familiar with how to use the equipment correctly. Before the new treatment is implemented, there should be seminars organized for the professionals working in the hospital, including respiratory therapists, nurses, and others. The patient will have an easier time breathing if the flow is high because it will flush out excess CO2 and wash away any stale air that may be in the lungs, which will allow for improved oxygenation. Because of the influence of positive end-expiratory pressure and the clearance of mucus through vapours created by hot water, the alveoli are able to expand to their full size. This is possible because to both of these factors. A specialized nasal cannula is used in order to provide high flow nasal oxygen, also known as HFNO. This method is capable of delivering a flow rate of up to 70 l/min while maintaining a FiO2 value that is very close to 100%. While its usage is well-established in critical care for patients who can breathe on their own, new applications in anesthesia are now being researched as a part of this field. THRIVE (Transnasal Humidified Rapid Insufflation Ventilatory Exchange) and STRIVE Hi (SponTaneous Respiration utilizing IntraVEnous anaesthesia and High-flow nasal oxygen) research suggest its usage in this sector. When a patient is receiving high-flow nasal cannula treatment, the best possible outcome may be achieved via the collaboration of a multidisciplinary team that includes a respiratory therapist, a clinical or critical care nurse, and a medical physician. The potential for patients to have beneficial impacts on their health would be significantly enhanced. We investigated intubation rates, long-term outcomes after HFNC, as well as the variables that are connected to long-term functional impairment in this prospective study that was conducted at a single center. We hypothesised that HFNC would provide the patient adequate time to recover from AHRF and avoid intubation as it delivers a high oxygen concentration and minimises the amount of dead space. Antiviral medication in combination with steroid treatment has the potential to provide the best results in this particular scenario.

DOI: 10.5281/zenodo.